Variability of study cast assessment among orthodontists

This study examined the accuracy and reliability with standardized definitions among 30 orthodontists in assessing different aspects of malocclusion from the study casts of 10 patients. Previous studies have indicated a lack of consistency among orthodontists in describing malocclusions. The diagnostic subcategories measured in this study included maxillary and mandibular crowding, overbite, overjet, and a modified molar, premolar, and canine Angle classification. Intraclass correlations indicated that the reliability of all parameters was good (intraclass correlation > 0.80), with overbite being the most reliable (0.98) and maxillary crowding and canine classification somewhat less reliable (0.89 and 0.87, respectively). Among Angle classifications, molar classification was the highest (0.95), followed by premolar (0.92) and canine (0.87). This study also measured the accuracy of the orthodontists' measurements compared with established true values (validity). T tests indicated that mandibular arch crowding and overbite were not statistically different from the true values. Overjet and molar classification were assessed very close to the true values. Although premolar and canine classifications were statistically different from the true values, they were within a one-eighth cusp of the true value (a clinically insignificant difference). The orthodontists consistently overestimated the amount of maxillary arch crowding or spacing. The results suggest that high reliability and reasonable accuracy can be expected for assessing study casts when using standardized definitions for the diagnostic subcategories.     

Transforming Dementia Care Through Pragmatic Clinical Trials Embedded in Learning Healthcare Systems

The current evidence base for testing nonpharmacological interventions for people living with dementia (PLWD) and their caregivers is limited, especially within care settings such as ambulatory care, assisted living communities, nursing homes, hospitals, and hospices. There has been even less attention to translation of effective interventions for PLWD into delivery of care. Thus, there is an urgent need for researchers to partner with these care settings, especially those that follow a learning healthcare systems (LHSs) model, and vice versa to conduct embedded pragmatic clinical trials (ePCTs). These trials are conducted within sites that offer routine care and are designed to answer important, relevant clinical questions and leverage existing electronic health and administrative data. ePCTs set in LHSs create a unique opportunity for researchers, healthcare providers, and PLWD and their families to work and learn together as potentially effective interventions are studied and stress tested in real-world situations. Healthcare settings that embrace research or quality improvement as part of a culture of continuous learning are ideal settings for ePCTs. In this article, we summarize what we have learned from the National Institutes of Health's Health Care Systems Research Collaboratory–funded ePCTs, discuss challenges of ePCTs within settings that serve PLWD, and describe the work of the Health Care Systems Core within the National Institute on Aging's IMbedded Alzheimer's Disease and Related Dementias Clinical Trials Collaboratory that will occur over the next 5 years. J Am Geriatr Soc 68:S43–S48, 2020 .     

Cross-correlation of fetal cardiac and somatic activity as an indicator of antenatal neural development

OBJECTIVE: In this study, we wanted to model the emergence of coupling between fetal cardiac and somatic activity in normal and at-risk fetuses. STUDY DESIGN: One hundred six fetuses of uncomplicated pregnancies were longitudinally monitored at 20, 24, 28, 32, 36, and 38 weeks of gestation by using a fetal actocardiograph and computerized data collection. Twenty-six fetuses of complicated pregnancies were also included. Statistical time series analysis techniques were used to examine the relation between fetal movement and fetal heart rate. RESULTS: A linear increase was found in the magnitude of the cross-correlation function between fetal movement and fetal heart rate as gestation advanced, with coalescence around a peak lag of 5 seconds by 32 weeks. Fetuses that delivered before term evidenced accelerated fetal movement and fetal heart rate coupling, whereas fetuses affected by deleterious conditions showed a decline in developmental trajectory. CONCLUSIONS: The cross-correlation between fetal cardiac and somatic activity is an indicator of neuroregulation in human fetuses.