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Lessons drawn from observing young peers together.

Based on studies during the past 13 years of what transpires between young peers, lessons are drawn about the nature of human sociability and the development of social skill during the first three years of life. Peer encounters have proven especially helpful for discovering the forms of sociability and social skill the infant is capable of without the aid of a more skillful social partner. From early in infancy, children are quite sociable with peers (age-mates), both in novel play settings and in their own home or customary group care settings, both with an unfamiliar peer and with those quite familiar, both at the start of acquaintanceship with a particular peer and after many encounters with that peer. Their sociability is seen in their attraction to peers, their directing to peers of such distinctively social behaviors as vocalizations, smiles, and gestures, and the predominantly friendly nature of their behavior. Peer encounters in the absence of customary play materials refute claims that attraction to peers is a by-product of interest in toys and the inanimate spectacles peers create through their actions on toys. Distinctions should be drawn between sociability and social skills, especially interactive skills. Interactive skills are systematic ways the young child relates his/her own behavior to the details of a partner's behavior that function to facilitate such valued social outcomes as the generation of a cooperative game or a conversation or the resolution of a dispute. Observations of young peers highlight the distinctive nature of the infant's interactive skills. Social influence between peers is present from 6 months, but rarely takes the form customary for older children. Joining a peer and manipulating the same play material as the peer are rudimentary interactive skills that emerge by 12 months. Interactive skills enabling the generation of extended sequences of social interaction on a common cooperative theme progress rapidly during the third year of life. The distinctive form of the young child's interactive skills produces distinctive patterns of interaction among young peers. Their interactions are managed largely nonverbally well into the third year of life, and extended cooperative interactions most often take the form of games in which one or both children imitate each other's actions. Despite the predominance of imitation, their encounters are also marked by complementary role relationships. The distinctive features of peer encounters prompt speculations about the role peer encounters can play in early development.

Child, Preschool↗

Issues in esthetic dentistry for older adults.

Esthetic dentistry offers a myriad of opportunities for older adults wishing to improve their smile, oral function, and self-esteem. The challenge for dental professionals is to maintain oral health throughout the patient's lifetime, even through periods of dependence that may include residence in a nursing home. Dental professionals will have increasing opportunities to share their knowledge and expertise about the relation between oral health and overall health, with a variety of health professionals who care for the aging population.

Aged↗

Esthetic orthodontic considerations for the adult patient: a general dentist's perspective.

Esthetic orthodontics is a viable treatment option for patients seeking cosmetic enhancement. Today, the use of preadjusted orthodontic brackets and straight wire allow general dentists to create optimum esthetic results in a short period of time. Two cases are presented to demonstrate a clinical technique to enhance a patient's smile through adjunctive orthodontic therapy.

Adult↗

Esthetic rehabilitation of anterior teeth affected by enamel hypoplasia: a case report.

UNLABELLED: Alterations during tooth structure formation, mainly on anterior teeth, are known to severely compromise esthetics. This article presents a case report in which the etiology and clinical characteristics of anterior teeth affected by enamel hypoplasia are analyzed. The restoration treatment sequence is also discussed, demonstrating that the use of a hybrid and a microfilled composite associated with tooth hybridization (interdiffusing zone) can be used to conservatively rehabilitate a smile. CLINICAL SIGNIFICANCE: This article presents a simple and conservative technique for restoring disfiguring areas of enamel hypoplasia to achieve an optimally esthetic result.

Acid Etching, Dental↗

Integration of composite and ceramic restorations in tetracycline-bleached teeth: a case report.

UNLABELLED: The success of an esthetic rehabilitation depends on the understanding of the patient's need and expectation. The management of patients with moderate to severe tetracycline-stained teeth is very challenging. Tooth whitening may be a valid alternative to more aggressive treatments; however, patients should be aware of the limitations of tooth whitening therapy. Clinicians may select differing treatment plans; tooth whitening can improve intrinsic discoloration in a way so that no further treatment is required. Once tooth whitening is completed, direct or indirect restorative procedures may be afforded to match the existing restoration with the bleached tooth structure. This article describes a conservative clinical approach to rehabilitate the smile of a patient with moderate to severe tetracycline-stained teeth using a combination of tooth whitening and direct composite and indirect porcelain restorations in the maxillary anterior segment. CLINICAL SIGNIFICANCE: The combination of tooth whitening and adhesive restorations allows clinicians a significantly more conservative approach to intrinsically stained teeth; tooth preparation for porcelain veneers and porcelain-fused-to-metal and full-ceramic crowns can be restricted to conditions in which persistent tooth discoloration or significant loss of both dentin and enamel exists.

Adult↗

Chlorhexidine swabbing applications under various conditions of use in preventive oral care for persons with disabilities.

A sample of 44 adults with severe disabilities completed a randomized single-blind cross-over study testing chlorhexidine swabbing under various conditions: with/without prior dental prophylaxis, reduced frequency of application (2 vs. 5 times per week), and prolonged use (42 weeks). All subjects received therapeutic doses of 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) and 10 mL 0.05% NaF applied with a Toothette (Sage Products). Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported. In the present study, while initial benefits were observed to be independent of dental prophylaxis, significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol, at reduced frequency of application and over prolonged time. High levels of acceptance and compliance by subjects/caregivers were maintained. Subjects/caregivers reported improvements in dental health as well as in attitude, quality of life, and smile. Chlorhexidine swabbing at maintenance frequency, combined with periodic dental prophylaxis, may offer an effective and pragmatic long-term preventive regimen for persons with disabilities.

Adult↗

Special Olympics: the oral health status of U.S. athletes compared with international athletes.

The Healthy Athletes Special Smiles Program provides oral health screening and data collection for athletes with mental retardation who are participating in Special Olympic events. Recently, data regarding international athletes have become available for the first time, allowing a comparison against data collected in the United States. The international athletes from the countries of China, Lebanon, Poland, South Africa, and Turkey were generally younger than those of the United States (mean age 17.4 versus 24.0 years) and were more likely to be males (64.3 versus 54.6%). The international athletes were more likely to have untreated caries (50.1 versus 28.2%), and less likely to have restorations (19.6 versus 62.9%), sealants (1.8 versus 13.5%), fluorosis (3.5 versus 8.8%), signs of gingival disease (27.8 versus 40.1%), or to be edentulous (0.1 versus 3.7%). These relationships persisted after adjustment for sex and age differences between the populations.

Adolescent↗

Anterior dental extractions among Dinka and Nuer refugees in the United States: a case series.

Few U.S. adults today experience life without permanent anterior teeth and know little about how an incomplete anterior dentition affects adult well-being. Sudanese refugees, who had resettled in the U.S. and who had six mandibular anterior teeth ritually extracted during youth, provided an opportunity to examine the significance of the effect of this partial edentulism. The authors interviewed five adult refugees whose anterior dentition was restored using dental implants. Factors considered before and after restoration included incisal ability, food item recognition, food consumption patterns and related social factors. Before restoration of the anterior dentition, participants could not incise typical foods eaten in the U.S. and expressed embarrassment about their dental status, which limited smiling, speaking and social interaction. This case series offers insight into the bio-cultural importance of the anterior dentition for all populations living with a visible gap in the lower jaw.

Adult↗

Bodily communication and personality.

Fifteen measures of non-verbal communication were coded from videotaped interactions between a female confederate and 18-21 year old female subjects (n = 46). Three measures of extraversion and neuroticism had previously been taken from the subjects, as was a measure of IQ. Correlation and factor analysis revealed significant relationships between certain of the variables. Extraversion was strongly associated with speaking more; a teacher's rating of neuroticism was associated with touching the self, pausing during conversation, and an absence of expressive gesture; lower IQ was associated with smiling while listening; and self-report personality questionnaire neuroticism was associated with gaze aversion.

Adolescent↗

Changing faces: visual and non-visual coding processes in face recognition.

Two experiments examined the effect of recognition accuracy and latency of changing the view of faces between presentation and test. In Expt 1, all the faces were unfamiliar to the subjects. Faces at test were either unchanged, or changed in angle (e.g. full face to 3/4), expression (e.g. smiling to unsmiling) or both. Unchanged faces were recognized more quickly and accurately than faces with a change in angle or expression which were in turn better than faces with both changed. In Expt 2, half the faces were highly familiar to the subjects, and at test unfamiliar and familiar faces were either unchanged or changed in both angle and expression. Unfamiliar faces were recognized more slowly and less accurately if changed at test, while familiar faces were recognized more slowly though no less accurately if change (though performance was effectively at ceiling). Familiar faces were recognized more quickly and accurately than unfamiliar, though false positive rates and rejection latencies were similar for familiars and unfamiliars. The results are discussed in terms of the combination of information from "pictorial', "structural', and "semantic' and "name' codes.

Discrimination Learning↗

Science for the common good.

A smile comes easily to the face of Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, as he encounters visitors to his offices at the Institute. He does not, however, allow himself to be distracted from his duties for longer than it takes to nod warmly. The sense of discipline and the determination and preparedness that were instilled in him through a Jesuit course of education are apparent. He is as direct and as clear spoken in person as you've seen him on television, speaking on innumerable occasions over the past two decades about the pathology and treatment of AIDS, and more recently, delineating the public health from the national security issues precipitated by the bioterrorist events of the past year. The three office assistants who occupy his reception area have been particularly taxed in the management of Fauci's schedule since 9/11; as they pause briefly from their work to share photographs of a friend's recent wedding, Fauci is there to admonish them, semi-good-naturally, as government employees, to return to their official duties. He has been meeting with high government officials and has been courted by the media for interviews regularly since the tragedies began. Given his high profile, it is easy to forget that Fauci is, foremost, a clinical immunobiologist and physician. His dedication to science is part of his commitment to public service, also a value instilled in him by the Jesuits. Fortunately for all of us, Fauci was pursuing this combination of interests--within the venue of bioterrorism--in his official capacity at the NIAID well before the general public had awaken to the threat.

Biomedical Research↗

Dental disease in children with chronic illness.

This article aims to raise awareness among paediatricians and specialist paediatric services that poor oral health, in particular children with chronic illness, is a major cause of morbidity and can be a risk factor for severe, even life threatening complications. Good oral health and dentition is important for efficient mastication, speaking and of course, cosmetically for smiling. If left untreated, dental caries can lead to pain and infection. Chronic infection around one or more teeth can result in damage to localised structures, such as the developing permanent teeth. Children who are medically compromised (such as being immunocompromised from disease and/or therapy) however are at increased risk of developing systemic complications from dental infections, which may prove fatal. We focus on the role of the general paediatrician in promoting the importance of good dental health for all children and in particular those children "at risk". We present preventive measures, evidence based where available, that may improve dental care and promote the role of paediatric dental services in the multidisciplinary management of chronic disease.

Child↗

What do parents expect antenatally and do babies teach them?

Antenatal inquiry of 658 parents in the North Staffordshire District Health Authority showed at least 13% to lack knowledge about a baby's potential for personal interaction when under 1 week old. Mothers and fathers varied significantly, independent of parity. Experienced parents expected later smiles. Two hundred and seventy eight of the same families were questioned three to four months after birth. Most parents had observed their baby's early responsiveness. Specific responses (Looking, listening) were noted earlier when anticipated and looked for. Significant among postnatal non-responders was their antenatal selection of predominantly impersonal stimulation for a baby. The greatest degree of warmth noted in postnatal observations correlated notably with a father's antenatal interest and postnatal support from him and their friends, a mother's commitment to breast feeding and her knowledge that a very young baby can see, like faces, and cries for emotional reasons. This highlights areas for antenatal tuition and postnatal encouragement, aiming to enhance warm early mutual regard between parents and child.

Adolescent↗

Engagement of patients with psychosis in the consultation: conversation analytic study.

OBJECTIVE: To investigate how doctors engage with patients with psychotic illness in routine consultations. DESIGN: Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder. SETTING: Two psychiatric outpatient clinics in east London and south west London. PARTICIPANTS: 7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder. MAIN OUTCOME MEASURE: Mutual engagement in communication during the consultation. RESULTS: Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms. CONCLUSIONS: Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.

Adult↗

The case of Medea--a view of fetal-maternal conflict.

Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation.

Abortion, Eugenic↗

Angelman syndrome: a review of the clinical and genetic aspects.

Angelman syndrome (AS) is a neurodevelopmental disorder characterised by severe learning difficulties, ataxia, a seizure disorder with a characteristic EEG, subtle dysmorphic facial features, and a happy, sociable disposition. Most children present with delay in developmental milestones and slowing of head growth during the first year of life. In the majority of cases speech does not develop. Patients with AS have a characteristic behavioural phenotype with jerky movements, frequent and sometimes inappropriate laughter, a love of water, and sleep disorder. The facial features are subtle and include a wide, smiling mouth, prominent chin, and deep set eyes. It is caused by a variety of genetic abnormalities involving the chromosome 15q11-13 region, which is subject to genomic imprinting. These include maternal deletion, paternal uniparental disomy, imprinting defects, and point mutations or small deletions within the UBE3A gene, which lies within this region. UBE3A shows tissue specific imprinting, being expressed exclusively from the maternal allele in brain. The genetic mechanisms identified so far in AS are found in 85-90% of those with the clinical phenotype and all interfere with UBE3A expression.

Angelman Syndrome↗

Deep brain stimulation in the internal capsule and nucleus accumbens region: responses observed during active and sham programming.

BACKGROUND: Recently, anterior limb of the internal capsule and nucleus accumbens deep brain stimulation (DBS) has been used in the treatment of medication-refractory obsessive-compulsive disorder (OCD). This region has been previously explored with lesion therapy, but with the advent of DBS there exists the possibility of monitoring the acute and chronic effects of electrical stimulation. The stimulation-induced benefits and side effects can be reversibly and blindly applied to a variety of locations in this region. OBJECTIVE: To explore the acute effects of DBS in the anterior limb of the internal capsule and nucleus accumbens region. METHODS: Ten total DBS leads in five patients with chronic and severe treatment-refractory OCD were tested. Patients were examined 30 days after DBS placement and received either "sham" testing or actual testing of the acute effects of DBS (the alternative condition tested 30 days later). RESULTS: Pooled responses were reviewed for comparability of distribution using standard descriptive methods, and relationships between the variables of interest were sought using chi2 analysis. A total of 845 stimulation trials across the five patients were recorded and pooled. Of these 16% were elicited from sham stimulation and 17% from placebo (0 V stimulation). A comparison of active to sham trials showed that sham stimulation was not associated with significant side effects or responses from patients. Non-mood-related responses were found to be significantly associated with the ventral lead contacts (0 and 1) (p = 0.001). Responses such as taste, smell and smile were strongly associated with the most ventral lead positions. Similarly, physiological responses--for example, autonomic changes, increased breathing rate, sweating, nausea, cold sensation, heat sensation, fear, panic and panic episodes--were significantly associated with ventral stimulation (p = 0.001). Fear and panic responses appeared clustered around the most ventral electrode (0). Acute stimulation resulted in either improved or worsened mood responses in both the dorsal and ventral regions of the anterior limb of the internal capsule. CONCLUSION: The acute effects of DBS in the region of the anterior limb of the internal capsule and nucleus accumbens, particularly when obtained in a blinded fashion, provide a unique opportunity to localise brain regions and explore circuitry.

Adult↗

Renal endothelial and macula densa NOS: integrated response to changes in extracellular fluid volume.

If, only 20 years ago, anyone had postulated that the absence of nitric oxide gas (NO) would lead to severe hypertension and destruction of the vascular bed of the kidney within weeks, it is not unlikely that smiles of pity would have appeared on the faces of fellow researchers. By now, this has become common knowledge, and hundreds of reports have appeared on the regulation of vascular and renal function by nitric oxide. The amount of information complicates the design of a concept on how NO participates in control of extracellular fluid volume (ECFV) by the kidney. This review analyzes the function of endothelial and macula densa NO synthase (NOS) in the regulation of renal function. From this analysis, endothelial NOS (eNOS)-derived NO is considered a modulator of vascular responses and of renal autoregulation in particular. Increases in renal perfusion pressure and sodium loading will increase eNOS activity, resulting in vasodilatation and depression of tubuloglomerular feedback system responsiveness. Endothelium-derived NO seems important to buffer minute-to-minute variations in perfusion pressure and rapid changes in ANG II activity. In contrast, macula densa NOS is proposed to drive adaptations to long-term changes in distal delivery and is considered a mediator of renin formation. Increases in perfusion pressure and distal delivery will depress the activity and expression of the enzyme that coincides with, and possibly mediates, diminished renin activity. Together, the opposite responses of eNOS and macula densa NOS-derived NO to changes in ECFV lead to an appropriate response to restore sodium balance. The concept that the two enzymes with different localizations in the kidney and in the cell are producing the same product, displaying contrasting responses to the same stimulus but nevertheless exhibiting an integrated response to perturbation of the most important regulated variable by the kidney, i.e., the ECFV, may be applicable to other tissues.

Animals↗