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Biomedical subjects

Stephen Richmond

Publications and source records attributed to Stephen Richmond.

13 recordsLinked to original sources

Optimized phenotyping of complex morphological traits: enhancing discovery of common and rare genetic variants.

Genotype-phenotype (G-P) analyses for complex morphological traits typically utilize simple, predetermined anatomical measures or features derived via unsupervised dimension reduction techniques (e.g. principal component analysis (PCA) or eigen-shapes). Despite the popularity of these approaches, they do not necessarily reveal axes of phenotypic variation that are genetically relevant. Therefore, we introduce a framework to optimize phenotyping for G-P analyses, such as genome-wide association studies (GWAS) of common variants or rare variant association studies (RVAS) of rare variants. Our strategy is two-fold: (i) we construct a multidimensional feature space spanning a wide range of phenotypic variation, and (ii) within this feature space, we use an optimization algorithm to search for directions or feature combinations that are genetically enriched. To test our approach, we examine human facial shape in the context of GWAS and RVAS. In GWAS, we optimize for phenotypes exhibiting high heritability, estimated from either family data or genomic relatedness measured in unrelated individuals. In RVAS, we optimize for the skewness of phenotype distributions, aiming to detect commingled distributions that suggest single or few genomic loci with major effects. We compare our approach with eigen-shapes as baseline in GWAS involving 8246 individuals of European ancestry and in gene-based tests of rare variants with a subset of 1906 individuals. After applying linkage disequilibrium score regression to our GWAS results, heritability-enriched phenotypes yielded the highest SNP heritability, followed by eigen-shapes, while commingling-based traits displayed the lowest SNP heritability. Heritability-enriched phenotypes also exhibited higher discovery rates, identifying the same number of independent genomic loci as eigen-shapes with a smaller effective number of traits. For RVAS, commingling-based traits resulted in more genes passing the exome-wide significance threshold than eigen-shapes, while heritability-enriched phenotypes lead to only a few associations. Overall, our results demonstrate that optimized phenotyping allows for the extraction of genetically relevant traits that can specifically enhance discovery efforts of common and rare variants, as evidenced by their increased power in facial GWAS and RVAS.

Humans↗

Peer assessment of dental attractiveness.

INTRODUCTION: The objectives of the study were to determine the relative importance of various dental features that contribute to overall dental attractiveness and to test the validity of the concepts of golden proportion and golden percentage as applied to the human dentition. METHODS: Sixty 30-year-old subjects (29 men, 31 women) were selected from the 20-year longitudinal Cardiff Survey. Color photographs of the subjects' dentitions were taken with the lips retracted so that their teeth and gums were clearly exposed. Twelve nondentists, aged 32 to 33 years, equally divided according to sex, rated the subjects' dental appearances on a 5-point Likert attractiveness scale. The maxillary anterior teeth were measured, and relevant ratios were calculated and compared with the golden proportion. Factor analyses and linear regression were used to investigate the hierarchy of dental features, and variance components analysis was used to estimate interrater agreement. RESULTS AND CONCLUSIONS: Overall dental attractiveness did not depend on any particular feature of the dentition. A hierarchy of various features was established, with crown shape ranked highest, and tooth and gum color ranked lowest. The golden proportion and the golden percentage were not decisive factors in determining dental attractiveness.

Adult↗

The 3-dimensional construction of the average 11-year-old child face: a clinical evaluation and application.

PURPOSE: This article describes construction of the average face and its application in the clinical environment. SUBJECTS AND METHODS: A total of 72 children, mean age 11.8 years, were selected for the study. Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with 2 Minolta Vivid 900 (Minolta, Osaka, Japan) optical laser-scanning devices assembled as a stereo pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 seconds. These scanned images were processed and merged to form a composite 3-dimensional soft tissue reproduction of the subjects using commercially-available reverse modeling software. The differences in facial morphology were measured using shell deviation color maps. The average face was used to compare differences between male and female groups and 3 subjects with craniofacial anomalies. RESULTS: The difference between the average male and female face was 0.460 +/- 0.353 mm. The areas of greatest deviation were at the zygomatic area and lower jaw line, with the males being more prominent. The results of the surface deviation between the subjects with craniofacial anomalies were significant. CONCLUSIONS: The construction of the average face provides an interesting perspective into measuring changes in groups of patients and also acts as a useful template for the comparison of craniofacial anomalies.

Cephalometry↗

Changes in arch width. A 20-year longitudinal study of orthodontic treatment.

The changes in the dental arch dimensions that occur as a result of growth and treatment are of interest to the orthodontist and require careful consideration during treatment planning. A greater understanding of these changes could influence the patient's expectations from treatment as well as the formulation of the treatment and retention plans by the clinician. A retrospective study of the maxillary and mandibular canine and molar arch width changes in 60 patients over 20 years was carried out. Approximately half were treated orthodontically, and measurements were made on dental casts taken at four time points during the study: 1981, 1985, 1989, and 2001. Between baseline and final follow-up, the treated group demonstrated a statistically significant increase in maxillary intercanine arch width and statistically significant decreases in maxillary intermolar and mandibular intercanine and intermolar widths. No significant changes were observed for the untreated group. When comparing the orthodontically treated group with the untreated group, there was a significantly greater increase in maxillary intercanine width and a significantly greater reduction in mandibular intercanine width in the treated group over the duration of the study. No significant difference was observed between treated and untreated groups for maxillary and mandibular intermolar width changes. Sex had no statistically significant effect on these treatment differences. Type of orthodontic treatment had no effect on arch width changes within the treated group; however, the effect of tooth extraction needs further investigation.

Adolescent↗

Measuring adult facial morphology in three dimensions.

OBJECTIVES: The aim of this study is to evaluate the reliability of measuring three-dimensional soft tissue morphology using a laser imaging system. DESIGN: Prospective clinical trial. MATERIALS AND METHODS: Thirty-eight adult subjects, mean age 24.5 years, were analyzed for soft tissue changes at baseline (T1) and at 1 week (T2) using two commercially available Minolta Vivid 900 (Osaka, Japan) laser scanning devices assembled as a stereopair. Left and right images were merged to form the whole face, and these images were superimposed to assess the errors between the two faces at T1 and at T2. RESULTS: The results showed that the mean shell deviations for left and right scans at T1 were 0.32 +/- 0.08 mm and 0.30 +/- 0.09 mm for males and females, respectively. The mean shell deviations for left and right scans at T2 were 0.34 +/- 0.08 mm and 0.32 +/- 0.09 mm for males and females, respectively. The mean difference of the merged composite faces superimposed at T1 and T2 was 0.37 +/- 0.07 mm and 0.35 +/- 0.09 mm for males and females, respectively. Paired t-tests revealed that the mean difference of 0.02 mm was statistically insignificant (P > .05). The reproducibility error was 0.7 and 0.8 mm for females and males, respectively, when a tolerance of 90% was imposed on the aligned faces. CONCLUSIONS: Capturing soft tissue morphology of the face, using the technique described, is clinically reproducible within 1 week of the initial records.

Adult↗

A cultural comparison of treatment need.

The aims of this study were two-fold. First to compare the perceptions of African dental aesthetics as determined by a panel of black African Senegalese and French Caucasian judges, and second to compare the sensitivity and specificity of both components of the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome and Need (ICON) in relation to the opinions of African and Caucasian judges. Ninety-eight colour digital dental images of black adolescents and adults were scored for attractiveness on a 100 mm visual analogue scale (VAS) by 45 Caucasian and 41 black African judges. In addition the judges were asked to classify the level of treatment need. Both components of the IOTN and ICON were recorded for the 98 cases. The results indicated that Caucasian judges perceived the majority of images to be less attractive than African judges. African and Caucasian judges showed similar levels in the estimation of treatment need. The aesthetic component (AC) of the IOTN and ICON showed similar levels of sensitivity. Taking all factors into account, it would appear that the ICON is marginally better at identifying those individuals who are perceived to need orthodontic treatment.

Adolescent↗

Facial attractiveness: a longitudinal study.

BACKGROUND: The aim of the study was to investigate various factors that might affect facial attractiveness from ages 11 to 31 years. METHODS: Sixty subjects were selected from a sample participating in the longitudinal Cardiff Survey. Three-quarter-view facial photographs were taken of the subjects smiling and not smiling. Photos were taken in 1981, when the subjects were aged 11 years, and in 2001, when they were aged 31. Twelve judges used a 9-point Likert scale to evaluate overall facial attractiveness and the attractiveness of various facial features. The judges were also asked to estimate the adults' ages. Univariate and multivariate statistical tests and the generalizability theory were used. RESULTS AND CONCLUSIONS: Overall facial attractiveness does not depend on any single feature; smiling and youthful facial appearance make women look more attractive; facial attractiveness tends to decrease over time from ages 11 to 31; people tend to retain their relative levels of attractiveness throughout their life spans; orthodontic treatment improves dental appearance, but it does not necessarily make a person more attractive in the long term. Nevertheless, the positive effect of orthodontic treatment could still be observed, especially in men with lower levels of facial attractiveness in childhood.

Adult↗

Reliability of measuring facial morphology with a 3-dimensional laser scanning system.

INTRODUCTION: The purpose of this prospective clinical trial was to evaluate the reliability of a 3-dimensional facial scanning technique for the measurement of facial morphology. METHODS: A field study was conducted in 2 comprehensive schools in the South Wales region of the United Kingdom. Forty subjects, mean age 11 years 3 months, were analyzed for soft tissue changes at baseline (T1), within 3 minutes (T2), and 3 days later (T3) by using 2 commercially available Minolta Vivid 900 (Osaka, Japan) laser-scanning devices assembled as a stereo pair. Left and right images were merged to form the whole face, and these images were superimposed to assess the errors at T1 and T2, and T1 and T3. RESULTS: The results showed that premerged left and right mean shell deviations were 0.38 +/- 0.14 mm for scans at T1, 0.31 +/- 0.09 mm at T2, and 0.34 +/- 0.12 mm at T3. The mean differences of the merged composite face were 0.31 +/- 0.08 mm between T1 and T2, and 0.40 +/- 0.11 mm between T1 and T3. Paired t tests showed no significant difference between these groups (P > .05). Shell deviation facial maps of the merged scans showed that 90% of the created composite facial scans were within an error of 0.85 mm. CONCLUSIONS: Capturing the soft tissue morphology of the face with this technique is clinically reproducible within 3 minutes and 3 days of the initial records.

Cephalometry↗

An update on the analysis of agreement for orthodontic indices.

The training of clinicians in the correct use of commonly used orthodontic indices involves calibration. The level of agreement between the trainee and a standard is assessed both as a measure of reproducibility and the success of training programmes. For the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON), the recommended level of acceptable inter-rater agreement is no more than +/-12 and +/-18, respectively. Many commonly used methods of analysing this type of agreement are inappropriate. The method used in this investigation allows the calculation of limits of agreement, which easily demonstrate any major departures in agreement between trainee scores and standard scores. The basic method assumes that the differences between trainee and standard scores are normally distributed and that there is no relationship between these differences and the magnitude of the index. An extension to this approach is required when the assumptions of the basic method are not upheld. This extension provides a regression-based approach to calculating limits of agreement. The results of this study demonstrate that the assumptions of the basic approach need to be checked for each comparison of trainee versus standard. In addition, regression-based methods are a more accurate means of calculating limits of agreement when these assumptions are not upheld. They also provide more information about bias and the range of disagreement between raters.

Algorithms↗

Measuring the cost, effectiveness, and cost-effectiveness of orthodontic care.

AIM: To determine the relative effectiveness and cost-effectiveness of orthodontic treatment per case in one "fee for item" and two different types of salaried orthodontic clinics. SUBJECTS AND METHODS: This prospective study recruited a random sample of six self-employed orthodontists (fee-for-item) and six orthodontists from both hospital and community clinics (salaried services). One hundred patients were followed to completion of orthodontic care. Questionnaires were employed to determine cost of treatment from the clinicians' and patients' points of views. Four cost-effectiveness models were developed. RESULTS: Complete records of outcome were available for 1,087 patients, but only 789 had complete data on costing. Three of the four cost-effectiveness models indicated similar rankings for the 18 clinicians. The most cost-effective service was provided by clinicians working in community clinics, followed by clinicians working in hospitals, then self-employed clinicians. The preferred cost-effective model takes into consideration the initial need and successful outcome of orthodontic treatment. CONCLUSION: Cost-effectiveness models have been developed to quantify the performance of individual clinicians working in self-employed and salaried clinics. Costs and effectiveness of the clinicians in each clinical setting show considerable variation.

Cost-Benefit Analysis↗

Social inequality and discontinuation of orthodontic treatment: is there a link?

The aims of this study were to investigate the effects of social inequality on the likelihood of patients discontinuing orthodontic treatment, and to determine which, if any, indicators of social inequality are of greater relevance. In this retrospective study of English and Welsh General Dental Services (GDS) cases, consecutive 'discontinued' cases collected at the Dental Practice Board (DPB) during 1990-91, were compared for age, treatment modality, and measures of social inequality, with a 2 per cent sample of cases contemporaneously submitted as 'complete'. Three deprivation indices, and occupation-based social class spectra of neighbourhoods, were compared between the groups. A model was sought to predict discontinuation/completion using logistic regression analysis. The discontinued sample represented lower social stratum spectra for home and practice areas under all indicators tested, and the subjects were a little older at the start of treatment. Fewer were treated by orthodontically qualified practitioners or with fixed appliances, but more with extra-oral traction. Occupation-based classification (patient's home) and the Carstairs Index (practice area) were selected by the analysis as explaining more of the variation than other measures of social inequality, but the model failed to predict the discontinued cases. Lower social class may be a risk factor for discontinuation of orthodontic treament, but is not a predictor for it. Patients should be considered for, and counselled about, orthodontic treatment on an individual basis. Occupation-based social classifications and the Carstairs Index may be a little more sensitive to orthodontic applications than other indicators of social inequality.

Age Factors↗

Orthodontic treatment need in Latvia.

Measuring the prevalence of malocclusion and treatment need in a population is useful for the planning of orthodontic services. In addition, knowledge concerning the attitudes of patients to malocclusion is becoming increasingly important in orthodontics. Without a satisfactory estimate of the need and demand for treatment it is difficult to develop and organize a meaningful service. The aims of this investigation were to estimate the need for orthodontic treatment in 12-13-year-old school children in urban and rural schools in Latvia. Five hundred and four school children aged 12-13 years were examined using the Index of Complexity, Outcome and Need (ICON). The children were invited to complete a questionnaire about treatment need and their appearance. The survey was carried out in four urban and five rural school settings. There were no statistically significant differences in treatment need between rural and urban settings or between boys and girls. However, there was a difference in ICON scores between Riga and Daugavpils, with a greater need for treatment in Daugavpils. Individual responses to questionnaires illustrated a correlation between individuals who expressed dissatisfaction with the arrangement of their teeth and treatment need according to the ICON score. The overall prevalence of individuals needing orthodontic treatment in Latvia was 35.3 per cent, but this figure masked considerable variation between schools. For example, a greater need was found in Daugavpils than in Riga. This difference is not fully explained but could be due to genetics, the individuals in Daugavpils being mainly of Russian origin. The individuals' perception of the arrangement of teeth and the need for treatment correlated significantly with the ICON score.

Adolescent↗

Critical assessment of a device to measure incisor crown inclination.

The aims of this study were to critically assess the use of a disposable device--the tooth inclination protractor (TIP)--to record incisor crown inclination and to compare its reliability and validity with that of traditional cephalometric radiographic analysis. The sample comprised 30 dental students with lateral cephalometric radiographs and dental casts. Four examiners were trained and calibrated to digitize radiographs and to use intraoral (on patients and dental casts) and extraoral (on dental casts) TIPs. The following angles were measured on the radiographs: maxillary incisor to maxillary plane, mandibular incisor to mandibular plane, maxillary incisor to occlusal plane, and mandibular incisor to occlusal plane. Measurements were also made with the TIP: maxillary incisor to occlusal plane and mandibular incisor to occlusal plane. All techniques were reliable between examiners. There were statistically significant systematic differences between the TIP and the radiographic assessments. The following differences were found. The TIP tended to record maxillary incisor crown inclination an average of 14 degrees less than maxillary incisor to maxillary plane. The TIP tended to record mandibular incisor crown inclination as similar to mandibular incisor to mandibular plane. The TIP recorded mandibular crown inclination 19 degrees less than mandibular incisor to occlusal plane. The disposable TIP was shown to be a simple, inexpensive, reliable, and valid method of assessing incisor inclination.

Cephalometry↗