Treatment Phase Research Articles

Comparison of the Cost Effectiveness of Orthognathic Surgery Treatment Between Orthodontic-first and Surgery-first Approaches in the Surgical Phase in Thammasat University Hospital

Objectives: This retrospective cohort study aims to evaluate the costs and advantages of the surgical phase of the surgery-first approach (SFA) versus the orthodontic-first approach (OFA). Methods: Orthognathic surgery has been described as having two concepts: an orthodontic-first approach and a surgery-first approach. However, there was no consensus on which group has the best cost effectiveness in the surgical treatment phase. In total, 70 patients were treated; half of the patients were treated via the SFA, and another half were treated via the OFA. The information collected included operation cost, operation time, total hospital cost, and length of hospitalization. Effectiveness was determined by quality of life, which was measured with the Orthognathic Quality of Life Questionnaire Thai Version (OQLQ) before and then 6 months after treatment. The cost effectiveness was assessed with an incremental cost effectiveness ratio (ICER) and an incremental time effectiveness ratio (ITER). Results: The results indicated the intervention cost and time of SFA were slightly higher but more effective than those of OFA. However, the operation cost (p=0.375), operation time (p=0.556), total hospital cost (p=0.363), and length of hospitalization (p=0.643) and OQLQ scores (p=0.344) of both groups were not significantly different. Conclusions: The intervention cost and time of SFA were slightly higher but more effective than those of OFA. Depending on the result of this study, SFA treatment planning was a good choice for orthognathic treatment.

Diagnostic and Therapeutic Indications of Different Types of Mandibular Advancement Design for Patients with Obstructive Sleep Apnea Syndrome: Indications from Literature Review and Case Descriptions.

Mandibular advancement devices (MADs) are considered a primary alternative treatment for adults with moderate to severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, supported by substantial scientific evidence. While a range of designs and materials for MADs are commercially available, there is a lack of clear diagnostic guidelines to assist clinicians in selecting the most appropriate device based on a multidisciplinary evaluation of OSA patients. This narrative review seeks to outline the key characteristics of MADs that clinicians should evaluate during both the diagnostic and treatment phases for patients with OSA. An extensive search of academic databases was conducted to gather relevant studies that address therapeutic and diagnostic recommendations for the design and titration of MADs. The search was carried out across EMBASE, Scopus, PubMed, and Web of Science up to May 2024. From a total of 1445 identified citations, 1103 remained after duplicate removal. Based on the inclusion criteria, the full text of 202 articles was retrieved, and 70 studies were ultimately included in this review. The extracted data were organized to generate clinical insights, aimed at guiding orthodontists in optimizing diagnostic and decision-making processes for treating OSA patients with MADs. The analysis led to the identification of key clinical questions that can assist orthodontists in enhancing their approach and choosing the appropriate appliance basing on the diagnosis and clinical dento-orofacial characteristics. Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient's clinical condition and orofacial symptoms. Provisional devices could be used as screening tools to verify the patient's adherence to the therapy. Regardless of the MAD design, type and programmed advancement, it must be under-lined that the rule of the orthodontist/dental specialist is secondary to the other sleep-medicine specialists (ORL, pulmonologist) and must be related to (1) a preliminary assessment of MAD usage (dental anatomical conditions), (2) testing a diagnostic MAD usable during a sleep examination (PSG or DISE), (3) final treatment with a definitive MAD.

Mental health related adverse events of cytisine and varenicline in smokers with and without mental health disorders: Secondary analysis of a randomized controlled trial

IntroductionLittle is known about the adverse events (AEs) of cytisine versus varenicline among individuals with mental health disorders (MHDs), highlighting the necessity for further exploration to inform clinical practice. This secondary analysis of clinical trial data aimed to investigate the effect of varenicline vs. cytisine regarding mental-health-related AEs (MH-related AEs) on smokers with and without MHDs. MethodsAustralian daily smokers interested in quitting were randomised to varenicline (84 days) or cytisine (25 days) and categorised by self-reported MHD diagnosis or treatment in the past year (MHD or non-MHD groups). Treatment adherence was assessed by self-reported number of doses taken during the active treatment phase via two check-in calls (at one month), while AEs were evaluated through four phone interviews: two check-in calls (one month) and follow-up calls at four and seven months. Logistic regression analysis compared MH-related AEs between groups, including only participants taking at least one dose. ResultsOf 1452 smokers 246 reported MHDs, 725 received cytisine and 727 received varenicline. Median number of doses taken was comparable between MHD (34 cytisine and 12 varenicline) and non-MHD (33 cytisine and 13 varenicline) groups. MH-related AEs were: 14.1 % (n = 30) in MHD (12.5 % in cytisine and 15.4 % in varenicline), and 11.8 % (n = 126) in non-MHD group (10.9 % in cytisine and 13.7 % in varenicline). No significant difference in MH-related AE occurrence was identified between medication groups (aOR=0.96, 95 % CI 0.4 to 2.2, p-value = 0.94). ConclusionComparable MH-related AEs were observed between smokers with and without MHDs, suggesting that cytisine, like varenicline, may be well-tolerated by those with MHDs. However, larger clinical trials focused on MH-related AEs are needed for more conclusive evidence.

The PATCH trial: 5% lidocaine-medicated plaster for trigeminal neuralgia-Results of a multicentric, enriched enrollment, randomized withdrawal, double-blind, vehicle-controlled, parallel-group study.

To explore the efficacy and safety of 5% lidocaine-medicated plaster (LMP) in patients with trigeminal neuralgia (TN). TN is an excruciatingly painful type of neuropathic facial pain. Anti-epileptics are the first-line treatment for TN; however, these oral drugs alone sometimes fail to achieve satisfactory analgesic effects. Two retrospective studies have shown that LMP can be an effective and safe treatment option for some patients with TN. No other high-quality clinical studies have explored the effect and safety of LMP in patients with TN. The PATCH trial is an enriched enrollment with randomized withdrawal, double-blind, vehicle-controlled, parallel-group trial performed at five study centers. Eligible patients with TN received LMP during a 3-week initial open-label phase. Patients who met the response criteria entered the double-blind treatment phase and were randomly assigned for treatment with either LMP (LMP group) or vehicle patches (control group) at a 1:1 ratio. Patients who met the criteria for treatment failure were withdrawn from the double-blind treatment phase, and treatment was continued in the remaining patients for up to 28 days. The primary outcome was the number of treatment failures. The secondary endpoints were the time to loss of therapeutic response (LTR) in the double-blind phase and the weekly mean pain severity in both the open-label phase and the double-blind phase of the study. The first patient was enrolled in this study on May 1, 2021, and the enrollment of the last patient was completed on August 26, 2022. A total of 307 patients were initially screened, 226 (74.0%) of whom entered the open-label phase. Of the 226 respondents, 124 (55.0%) were randomized to the double-blind phase. In the double-blind phase, 62 patients were assigned to the LMP group, and 62 were assigned to the control group. For the primary endpoint, 16 (26.0%) patients with LMP and 36 (58.0%) patients with vehicle patches met the treatment failure criteria during the double-blind phase (relative risk, 0.48; 95% confidence interval [CI], 0.31 to 0.75; p < 0.001). The survival curve of the LTR showed that the LTR of LMP was significantly longer than that of the vehicle patches (hazard ratio, 0.275; 95% CI, 0.15 to 0.50; log-rank p < 0.001). LMP also significantly reduced the weekly mean pain severity in the double-blind phase of the study (p = 0.007). LMP produced partial relief of pain symptoms in some patients with TN. For responders, LMP may be used as an add-on therapy in a multidrug treatment protocol.

Personalized Sound Therapy Combined with Low and High-Frequency Electromagnetic Stimulation for Chronic Tinnitus.

This study investigates a novel multimodal treatment for chronic tinnitus, a condition that significantly affects quality of life, by combining personalized sound therapy with both low- and high-frequency electromagnetic wave stimulation. Conducted at Tor Vergata University Hospital in Rome, the research involved 55 patients and employed a portable medical device for therapy delivery. Treatment effectiveness was measured through the Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Hyperacusis Questionnaire (HQ), and Short Form-36 Health Survey (SF-36), encompassing initial sound therapy and subsequent multimodal treatment phases. Remarkably, 73% of participants experienced notable improvements in TFI scores, with 39% reporting a significant enhancement of 13 points or more. This improvement was mirrored in secondary outcomes like THI, VAS, and HQ scores, along with certain SF-36 domains, indicating enhanced life quality and reduced tinnitus distress. The study underscored high compliance and no adverse effects, suggesting the combined therapy's promising potential in chronic tinnitus management. The findings advocate for further research to discern the distinct contributions of each treatment modality, positing that this innovative approach could ameliorate tinnitus symptoms and improve patient well-being, confirming its safety and efficacy.

Assessment of the efficacy and safety of Indulekha svetakutaja hair oil in management of dandruff: a randomized, double-blind, and placebo-controlled study

Background: This study aimed to evaluate the efficacy and safety of Indulekha Svetakutaja Hair Oil in comparison with coconut oil in the management of dandruff through a randomized, double-blind, placebo controlled study. Methods: A total of 110 subjects with clinically diagnosed moderate dandruff were randomly assigned into two groups: Group A (The Indulekha Svetakutaja Hair Oil group, n=55) and Group B (Placebo coconut hair oil group, n=55), where 50 subjects in each group completed the study. The treatment phase was for 4 weeks, followed by a regression phase of 2 weeks. Subjects applied the allotted oil on their scalp, massaged and kept it for a minimum of 30 mins or overnight thrice a week, then washed it with the provided neutral shampoo for a duration of 4 weeks. Dermatological assessments, instrumental measurements and subject self-assessment questionnaire were evaluated in comparison to baseline at weekly intervals throughout the study period. Results: After 4 weeks of treatment, group A demonstrated a significantly greater reduction (p&lt;0.05) in dandruff severity compared to group B. The Total Dandruff scores in Group A showed a significant reduction of 70.62 units while in Group B, it was noted to be 48.79 units. Nearly all participants (98%) in Group A reported a subjective perception improvement in dandruff symptoms compared to Group B. Conclusions: Indulekha Svetakutaja Hair Oil is safe and effective in controlling dandruff and improving scalp and hair health, making it a promising therapeutic option for individuals with dandruff.

Supervised classification and circuit parameter analysis of electrical bioimpedance spectroscopy data of water stress in tomato plants

Drought poses a significant challenge by inducing water stress in crops, urgently calling for effective monitoring and early intervention. In this work, we conducted a comprehensive 38-day investigation of the bioimpedance of water stressed tomato stems under controlled environmental conditions. A total of 8000 measurements were meticulously collected across a frequency spectrum spanning from 100 Hz to 10 MHz. The collected data was categorized into control, early stress, and late stress groups, corresponding to distinct phases of water stress treatment. To analyze the data, we employed established equivalent circuit models, including Cole, Randles, and double Cole. Subsequently, we evaluated the performance of eight machine learning algorithms widely-used in predicting the water stress stages of the plants. Remarkably, the Cole model, in conjunction with a multi-layer perceptron (MLP) algorithm, demonstrated robust performance, achieving an impressive F1 score of 0.89. In fact, in the control group, 378 out of 388 instances were accurately identified. However, misclassifications were observed in the early and late stress groups, with 31 out of 179 and 14 out of 208 instances mislabeled, respectively. Furthermore, we scrutinized the Cole model’s circuit parameters over time, providing insights aligned with the plant physiological behavior documented in the literature. Our findings suggest that MLP models trained on stem bioimpedance data hold promise as a valuable technique for estimating water stress in tomato plants, offering an essential tool for proactive management by farmers.

Three-dimensional analysis of posttreatment tooth movements despite bonded retainers: partI-upper jaw.

Adverse side effects of fixed retainers in terms of unwanted tooth movements have been described for both the upper and lower jaw, but data about the extent and movement patterns for the maxilla are scarce. The purpose of the present retrospective case-control study was to analyze the amount and direction of unwanted tooth movements despite upper bonded retainers as well as to analyze possible predisposing pretreatment- and treatment-related factors. Plaster casts of 1026 patients who completed orthodontic treatment and asubsequent retention phase of 2years were screened for unintentional tooth movements. The study group comprised 57patients with visually obvious tooth movements in the upper jaw, while 57randomly selected patients without visible tooth movements served as control group. For all patients, plaster casts after debonding of multibracket appliance (T1) and after supervised retention (T2) were digitized, and superimposed digitally using astable palatal reference area. Thereafter, translational and rotational movements were measured in all three planes of space. Pretreatment- and treatment-related factors of the study and control groups were compared by χ2 test, exact Fisher test, Mann-Whitney U test, and the T‑test for independent samples. The mean translational movements ranged between 0 and 0.6 mm and the average rotational movements between 0 and 1.3°. Large individual movements up to 2.7 mm translation and 15.9° rotation were seen. Amovement pattern around the Y‑ and Z‑axis with an opposite rotational peak at the canines ("upper twist effect") was identified. Compared to the control group, patients of the study group showed asignificantly smaller intercanine width pretreatment. Also, study group patients presented alarger intercanine expansion and aslightly larger overjet reduction during treatment, and were more often affected by retainer bonding site detachments and wire fractures, but without reaching statistically significance. Upper bonded retainers show asimilar unwanted movement pattern ("twist effect") like the one described for mandibular retainers.

Decarburization and Gas Formation During Sintering of Alloyed PM Steel Components

AbstractThis study investigates the delubrication, reduction, and decarburization processes of powder metallurgical steel alloys (CrM, CrL, AHC, Mo85, SintD 35) and an unalloyed steel during sintering in a pure hydrogen atmosphere. Utilizing in-situ FTIR gas phase analysis, components with ethylenebisstearamide (EBS) as a lubricant are analyzed. EBS decomposition in steel components yields CO, CO2, H2O, and CH4, with dominant CH groups observed in the 230 °C to 480 °C range. In the temperature range between 750 °C and 850 °C, where CO formation is expected due to the reduction of surface iron oxides, CH4 is present instead, indicating that an “internal getter effect” also occurs in pre-alloyed powders. In addition, with high carbon activity, the reduction of internal iron oxides and the reduction of chromium oxides also trigger an internal getter effect. Depending on the carbon potential, these processes cause a considerable reduction in the carbon content of the powder metallurgical components. The study therefore shows that the decarburization of powder metallurgical components during the heat treatment phases prior to sintering in a 100 pct hydrogen atmosphere is less due to the mechanism of delubrication, but rather to mechanisms of carbothermal reduction.

Exploring the Effectiveness of Digital Reading Platforms in Developing Reading Comprehension Skills

This study investigates the effectiveness of the digital reading platform ReadWorks in improving the reading comprehension skills of high school students. A within-subject design was employed, wherein students experienced two phases of treatment: the use of conventional teaching methods and the application of the ReadWorks platform, with a washout period in between to minimize carryover effects. The research was conducted with second-grade students at SMA Negeri 16 Samarinda, using a standardized reading comprehension test to assess performance. Paired samples t-tests were utilized to analyze the data. The findings revealed a significant improvement in students' reading comprehension scores when using the ReadWorks platform compared to conventional methods. The statistical analysis shows that the p-values for both the experimental group (p = 0.000) and the control group (p = 0.000) are less than the significance level of 0.05, leading to the rejection of the Null Hypothesis (H0) and acceptance of the Alternative Hypothesis (Ha). These results indicates that the ReadWorks platform is effective in enhancing reading comprehension skills among high school students. The study contributes to the growing body of literature advocating for the integration of digital tools in education to improve student learning outcomes.

Infections in Children with Acute Lymphoblastic Leukemia.

Background and Objectives: Infections are the most common and potentially life-threatening complications of the treatment of children with acute lymphoblastic leukemia (ALL). The aim of this study was to determine epidemiological, clinical, and microbiological characteristics of infections in pediatric patients with ALL. Materials and Methods: Twenty-three children (16 males and 7 females, with a mean age of 5.9 years (range of 1.3 to 12.2 years)) with ALL, treated at the Division of Hematology, Oncology, and Clinical Genetics, Department of Pediatrics, Clinical Hospital Center Rijeka, Croatia, from 1 January 2015 to 31 December 2020, were included in the study. Results: One hundred and four infectious episodes (IEs) were reported (an average of 4.5 IE per patient). IEs were more frequent in the intensive phases of antileukemic treatment. Neutropenia was present in 48 IEs (46.2%) with a duration greater than 7 days in 28 IEs (58.3%). The respiratory tract was the most common infection site (48.1%). We documented 49 bacterial (47.1%), 4 viral (3.9%), 4 fungal (3.9%), and 10 mixed isolates (9.6%), while in 37 IEs (35.6%), a pathogen was not isolated. The most common causes of bacteremia were coagulase-positive staphylococci. The most frequent empirical therapy was third- and fourth-generation cephalosporins, followed by piperacillin/tazobactam. The modification of first-line antimicrobial therapy was performed in 56.9% of IEs. Granulocyte-colony stimulating factor was administered in 53.8% of IEs, and intravenous immunoglobulins were administered in 62.5% of IEs. One patient required admission to the intensive care unit. No infection-related mortality was reported. Conclusions: ALL patients have frequent IEs. Close monitoring, the identification of risk factors, the rapid empirical use of antibiotics in febrile neutropenia, and the timely modification of antimicrobial therapy play key roles in reducing infection-related morbidity and mortality in children with ALL.

Mental health problems among children with lupus nephritis

Aim of the workTo assess and compare depression, anxiety, and cognitive impairments in juvenile systemic erythematous lupus (JSLE) children with lupus nephritis (LN) during the induction and maintenance phases of treatment and to investigate the association with disease activity, damage and immunosuppressive medications. Patients and methodsThis study included 33 patients diagnosed as JSLE with LN. Attention and working memory were assessed by the working memory index Wechsler Intelligence Scale (WISC). Depression and anxiety were assessed by the Children Depression Inventory (CDI) and the Spence Children Anxiety Scale respectively. The SLE disease activity index 2000 (SLEDAI-2 K) was recorded. ResultsThe mean age of the children was 11.6 ± 2.2 years, 88 % were females and 12 % males with disease duration of 16.9 ± 9.2 months and age at onset of 10.2 ± 2.3 years. Mean anxiety scores were higher among patients during the induction phase than those during maintenance phase (62.1 ± 7.2 and 40.2 ± 8.8 respectively; p < 0.001). The depression score was higher in the induction (19 ± 5.5) than in the maintenance group (12.4 ± 5.6) (p = 0.002). Mean anxiety scores significantly correlated with SLEDAI-2 K and corticosteroids dose (r = 0.58 and r = 0.43, p = 0.0004 and p = 0.013 respectively) and a significant negative correlation with duration of corticosteroids and number of cyclophosphamide doses (r = 0.46 and r = 0.69, p = 0.008 and p = 0.0001 respectively). ConclusionDepression and anxiety levels were higher in children with LN during the induction phase of treatment than those in the maintenance phase. Mental health problems must be screened among children with LN and treating these problems can improve the medical and psychosocial outcomes.

The Effect of Bruxism on the Severity of Temporomandibular Dysfunction and Chewing Functionality: A Cross-Sectional Study

Objective: The study was conducted to investigate the effect of bruxism on Temporomandibular Dysfunction (TMD) severity and chewing functionality in individuals with TMD. Methods: This cross-sectional study was conducted with 91 individuals diagnosed with TMD. TMJ pain was assessed with the Numeric Pain Scale (NPS), maximum mouth opening (MMO) was evaluated with a ruler, TMD severity was assessed with the Fonseca Anamnestic Questionnaire (FAQ), and chewing functionality was considered with the Jaw Functional Limitation Scale-20 (JFLS-20). Results: 65 (71.4%) of the individuals were female, and the median age was 29.0 (20-55) years. Individuals were divided into two groups: self-reported bruxism (Group 1: 63) and non-reported bruxism (Group 2: 28). When the groups with and without bruxism were compared, NPS (p=0.002), MMO (p=0.007) FAQ (p=0.000) and JFLS-20 (p=0.000) results were significantly worse in the group with bruxism. TMD severity was significantly higher in the group with bruxism (p=0.000). The probability of having moderate-severe TMD increased statistically significantly 16.236 times (95% CI: 3.485-75.651) with bruxism (p=0.000). Limitation in chewing functionality was significantly increased 4.364 times (95% CI: 1.127- 16.906) in the presence of bruxism (p=0.033). Conclusion: The study results showed that pain, TMD severity, and chewing functionality limitation were higher in individuals with TMD accompanied by bruxism. It should be considered that knowing the bruxism and its effects that may accompany TMD, which is very common and increasing in number and severity daily, in the evaluation or treatment phase is essential in improving rehabilitation success.

Therapists' defense use impacts their patients' defensive functioning: a systematic case study.

Research into defensive functioning in psychotherapy has thus far focused on patients' defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient's overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist's defense mechanisms and their relationship to changes in the patient's defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist's and patient's defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient's defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists' overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient's use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst's role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient's defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Long-term efficacy and safety of PEGylated recombinant human growth hormone in treating Chinese children with growth hormone deficiency: a 5-year retrospective study.

The study endeavored to evaluate the prolonged efficacy and safety of PEGylated rhGH (PEG-rhGH) administration in Chinese children diagnosed with growth hormone deficiency (GHD) over a 5-year period. A retrospective analysis was conducted on children with GHD, who received a 0.2 mg/kg/week dose of PEG-rhGH between 2016 and 2023 in our department. The height standard deviation score (Ht SDS) exhibited a marked elevation post-PEG-rhGH administration (p<0.001), sustaining this enhancement beyond year 3, with increments recorded at 0.94±0.37, 1.49±0.48, 1.77±0.51, 2.12±0.65, and 2.15±0.58 across 5 years. Similarly, the height velocity (HV), insulin-like growth factor-1 standard deviation score (IGF-1 SDS), and bone age to chronological age ratio (BA/CA ratio) underwent significant augmentations (p<0.01). Remarkably, no signs of rapid bone maturation were detected during the 5-year observation. Among the participants, 31 patients (59.62 %) experienced adverse events, of which eight instances (15.38 %) were classified as treatment-related adverse events, but none were severe or unexpected. Additionally, high-density lipoprotein (HDL) levels rose while low-density lipoprotein (LDL) levels fell, both remaining within the standard range throughout the treatment phase. Administering PEG-rhGH at a dosage of 0.2 mg/kg/week proved both effective and well-tolerated in treating prepubertal children with GHD. This regimen also demonstrated positive impacts on lipid metabolism over an extended treatment period.

Three-dimensional analysis of posttreatment tooth movements despite bonded retainers: partII-lower jaw.

Complications of bonded lingual retainers in terms of unexpected tooth movements have been reported with increasing frequency during the last decade, but the vast majority of the literature comprises case reports. The purpose of the present retrospective case-control study was to analyze the amount and direction of unwanted tooth movements despite lower bonded retainers, to analyze possible predisposing pretreatment- and treatment-related factors, and to seek for movement thresholds which could enhance the rapid and objective identification of critical cases. Plaster casts of 1026 patients who completed orthodontic treatment and asubsequent retention phase of 2years were screened for unintentional tooth movements. The study group comprised 39patients with tooth movements in the lower jaw, while 39randomly selected patients without visible tooth movements served as the control group. For all patients, plaster casts after debonding of multibracket appliances (T1) and after supervised retention (T2) were digitized, and athree-dimensional (3D) digital superimposition based on the best fit of premolars and molars was undertaken. Thereafter, translational as well as rotational movements were measured in all three planes of space. Pretreatment- and treatment-related factors of the study and control groups were compared. Aseverity classification based on rotational movement thresholds was applied to seek acritical amount of translational movements. The mean translational movements ranged between 0 and 0.4 mm and the average rotational movements between 0 and 1.6°. Large individual movements up to 1.9 mm translation and 16° rotation were seen. Atwist-effect with opposite movements of the canines along the Y‑axis could be confirmed. Compared to the control group, patients of the study group had asmaller intercanine distance at all timepoints. In addition, study group patients presented aslightly larger intercanine expansion during treatment and were more often affected by retainer bonding site detachments. Applying the severity classification based on rotational thresholds, translational movements of 0.5-1.0 mm along the X‑ and Y‑axis could serve as acritical threshold. It can be assumed that extrusive translational movements along the Z‑axis seem to be of specific nature and perhaps do not reflect aretainer complication in terms of unwanted tooth movements. Patients with alarger intercanine distance after active treatment and those with more frequent retainer bonding site detachments could be at higher risk for unwanted tooth movements during fixed retention. Sagittal and transverse movements of 0.5-1.0 mm should sensitize the practitioner for further measures.

Intravaginal artesunate pessaries for treatment of cervical intraepithelial neoplasia 2/3 among HIV-positive and HIV-negative women in Kenya: Study protocol for a pilot trial.

Cervical cancer disproportionately affects women in low- and middle-income countries (LMICs), which bear 90% of deaths. Current precancer treatments rely on healthcare workers who may be out of reach for many women. Development of a patient-controlled cervical precancer treatment can significantly improve access in remote areas and promote secondary prevention of cervical cancer. This is a phase I trial among 18 HIV-positive and HIV-negative women in Kenya, investigating use of artesunate vaginal pessaries as treatment for cervical precancer among women screening positive for cervical precancer who need excisional treatment. The primary objective will be the safety of self-administered artesunate pessaries. Participants will self-administer 200mg of artesunate vaginally daily for 5 days, followed by a drug-free week, repeated for a total of 4 cycles (artesunate self-administration on weeks 1, 3, 5, 7). The total study duration, including participant follow-up is 48 weeks. Safety and adherence will be assessed through review of symptom diaries and biweekly follow-ups during the treatment phase. Data analysis will include quantitative and qualitative methods. Figure 1 illustrates the study schema. Considering the challenges associated with excisional treatments for cervical precancer in LMICs where access to care is limited, this study proposes an alternative approach using intravaginal Artesunate. This clinical trial will provide important safety and efficacy data on using artesunate as a topical therapy for both HIV-positive and HIV-negative women. ClinicalTrials.gov identifier: NCT06165614.

Independent and interdependent group contingencies to increase on‐task work behavior among adults with intellectual disabilities

AbstractWe applied independent and interdependent group contingencies in a counterbalanced reversal experimental design to the vocational on‐task behavior for two groups of adults with intellectual disabilities. On‐task behavior increased for all participants in both groups above a criterion of 80% of time on‐task during both treatment phases. Independent and interdependent group contingencies were equally effective in increasing on‐task behavior. Responding was maintained at the criterion level for all members of one group at a 4‐week follow‐up. No increases in negative social interactions were observed when the interdependent group contingency was in effect and participants reported both contingencies to be socially valid. We suggest that group contingencies can be an effective intervention in increasing on‐task behavior of individuals with intellectual disabilities in vocational settings.

Accuracy of clear aligners in the orthodontic rotational movement using different attachment configurations.

To evaluate the accuracy of dental rotational movements using clear aligners with different attachment configurations. This retrospective study analysed 212 teeth from 89 patients undergoing Invisalign treatment. Digital models were analysed after the virtual treatment plan (ST1) and after the first treatment phase (ET1) to evaluate the effective clinical rotational movement. The rotational movements of incisors, canines, and bicuspids were measured using data from the Clincheck Movements Table. ST1 and ET1 were compared to determine the actual rotational movement achieved (ST1-ET1). The presence or absence of attachments (rectangular or optimized) on teeth was analysed. The accuracy of rotational movements among attachment types was compared using the Kruskal-Wallis test. Multiple linear regressions were conducted with accuracy as the dependent variable and tooth type, gender, and age as predictors. Optimized attachments had the highest median accuracy (70%), followed by rectangular (65%), and without attachment (63%), with no significant differences (p = .5). There were no significant differences across age groups, genders, or tooth types. Baseline accuracy was 68.62% (95% CI: 56.03-81.20, p < .001). Age was a significant predictor (estimate = -0.30, 95% CI: -0.58 - -0.03, p = .032), indicating decreased accuracy with increasing age. The model's R2 was 0.046, with an adjusted R2 of 0.003, indicating minimal variance explained. The addition of attachment configurations to clear aligners improves rotational accuracy, but not significantly. Further advancements in these configurations are needed to enhance the performance of the aligners.

Paper assessment or online assessment: exploring the impact of assessment modes on EFL students’ language learning outcomes and personal development

This research explores how paper and online assessments (OA) can affect EFL learners’ personal development variables such as self-esteem, mindfulness, demotivation, and language learning development. Sixty intermediate English as a foreign language (EFL) students participated in the current research and were randomly grouped into the experimental group (EG) and the control group (CG). Before the intervention, the data collection tools assessing language learners’ self-esteem, mindfulness, demotivation, and language learning development were administered as pre-tests to all the participants. Subsequently, the EG was taught all lessons of the coursebook, Top Notch 2, by utilizing OA while the CG was taught the identical lessons using a conventional (pen and paper) assessment. In the post-treatment phase, the two groups completed the post-tests on self-esteem mindfulness, demotivation, and language learning progress. The study demonstrated that the EG group outperformed the CG group on the four post-tests. The findings indicate that the intervention of OA significantly enhanced language learning outcomes and psychological well-being regarding the measured personal development variables. The enhanced efficacy in the EG group can be ascribed to the utilization of OA during the treatment phase, which has a beneficial effect on academic and personal development. This study also posits that integrating OA augments psychological engagement and language development among EFL learners. It highlights the implications of the results associating teaching EFL via OA with the observed personal development aspects and attributes them to effects of positive psychology.