Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics.

BACKGROUND: In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. METHODS: All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. RESULTS: We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. CONCLUSIONS: Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients' parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current recommendations. However, key outcomes, including facial appearance and speech, can only be assessed many years after the initial surgical treatment

The JCSG high-throughput structural biology pipeline

The Joint Center for Structural Genomics high-throughput structural biology pipeline has delivered more than 1000 structures to the community over the past ten years and has made a significant contribution to the overall goal of the NIH Protein Structure Initiative (PSI) of expanding structural coverage of the protein universe

Grommet Surgery in Children With Orofacial Clefts in England.

OBJECTIVE: To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. DESIGN: Analysis of national administrative data of hospital admissions. SETTING: National Health Service hospitals, England. PATIENTS: Patients born between 1997 and 2005 who underwent surgical cleft repair. INTERVENTION: Children receiving grommets before the age of 5 years. OUTCOME MEASURES: The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. RESULTS: The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. CONCLUSION: Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored

Manual versus powered toothbrushes for oral health; an update

Background: Plaque removal is a cornerstone in the prevention and treatment of periodontal diseases. Powered toothbrushes have been devised to assist in plaque removal. An earlier Cochrane systematic review found that only powered toothbrushes with a rotation-oscillation action were more effective at removing plaque and reducing gingivitis. That review requires updating to include recent trials. Objective: To compare the effects of manual and powered toothbrushes on plaque removal and gingival health. Method: We searched the Cochrane Oral Health Group Trials Register, CENTRAL; MEDLINE, EMBASE and CINAHL to 9 March 2011. Manufacturers and authors were contacted for additional data. Trials were selected for random allocation of participants to use a manual or powered toothbrush. Participants were members of the public with uncompromised manual dexterity who brushed unsupervised for at least 4 weeks. There was no language restriction. Primary outcomes were plaque and gingivitis scores at the end of the trial. Assessment of methodological quality and data extraction were conducted in duplicate. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. Results: Fifty trials, involving 4326 participants, provided data. Effect sizes, calculated as standardized mean difference (95% confidence intervals) for brushes with a rotation oscillation action were: 1 to 3 months >3 months Plaque -0.53 (-0.74 to -0.31) -0.66 (-1.28 to -0.03) Gingivitis -0.49 (-0.73 to -0.26) -0.34 (-0.56 to -0.11) This represents approximately 27% fewer sites with bleeding on probing in the long term. No other powered designs were consistently superior to manual toothbrushes. There was considerable heterogeneity between trials. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. Conclusion: Rotation-oscillation powered toothbrushes remove plaque and reduce gingivitis more than manual brushes in the short and long term

Early academic achievement in children with isolated clefts: a population-based study in England.

OBJECTIVES: We used national data to study differences in academic achievement between 5-year-old children with an isolated oral cleft and the general population. We also assessed differences by cleft type. METHODS: Children born in England with an oral cleft were identified in a national cleft registry. Their records were linked to databases of hospital admissions (to identify additional anomalies) and educational outcomes. Z-scores (signed number of SD actual score is above national average) were calculated to make outcome scores comparable across school years and across six assessed areas (personal development, communication and language, maths, knowledge of world, physical development andcreative development). RESULTS: 2802 children without additional anomalies, 5 years old between 2006 and 2012, were included. Academic achievement was significantly below national average for all six assessed areas with z-scores ranging from -0.24 (95% CI -0.32 to -0.16) for knowledge of world to -0.31 (-0.38 to -0.23) for personal development. Differences were small with only a cleft lip but considerably larger with clefts involving the palate. 29.4% of children were documented as having special education needs (national rate 9.7%), which varied according to cleft type from 13.2% with cleft lip to 47.6% with bilateral cleft lip and palate. CONCLUSIONS: Compared with national average, 5-year-old children with an isolated oral cleft, especially those involving the palate, have significantly poorer academic achievement across all areas of learning. These outcomes reflect results of modern surgical techniques and multidisciplinary approach. Children with a cleft may benefit from extra academic support when starting school

Analysis of the role of 13 major fimbrial subunits in colonisation of the chicken intestines by Salmonella enterica serovar Enteritidis reveals a role for a novel locus

<p>Abstract</p> <p>Background</p> <p><it>Salmonella enterica </it>is a facultative intracellular pathogen of worldwide importance. Over 2,500 serovars exist and infections in humans and animals may produce a spectrum of symptoms from enteritis to typhoid depending on serovar- and host-specific factors. <it>S</it>. Enteritidis is the most prevalent non-typhoidal serovar isolated from humans with acute diarrhoeal illness in many countries. Human infections are frequently associated with direct or indirect contact with contaminated poultry meat or eggs owing to the ability of the organism to persist in the avian intestinal and reproductive tract. The molecular mechanisms underlying colonisation of poultry by <it>S</it>. Enteritidis are ill-defined. Targeted and genome-wide mutagenesis of <it>S</it>. Typhimurium has revealed conserved and host-specific roles for selected fimbriae in intestinal colonisation of different hosts. Here we report the first systematic analysis of each chromosomally-encoded major fimbrial subunit of <it>S</it>. Enteritidis in intestinal colonisation of chickens.</p> <p>Results</p> <p>The repertoire, organisation and sequence of the fimbrial operons within members of <it>S. enterica </it>were compared. No single fimbrial locus could be correlated with the differential virulence and host range of serovars by comparison of available genome sequences. Fimbrial operons were highly conserved among serovars in respect of gene number, order and sequence, with the exception of <it>safA</it>. Thirteen predicted major fimbrial subunit genes were separately inactivated by lambda Red recombinase-mediated linear recombination followed by P22/int transduction. The magnitude and duration of intestinal colonisation by mutant and parent strains was measured after oral inoculation of out-bred chickens. Whilst the majority of <it>S</it>. Enteritidis major fimbrial subunit genes played no significant role in colonisation of the avian intestines, mutations affecting <it>pegA </it>in two different <it>S</it>. Enteritidis strains produced statistically significant attenuation. Plasmid-mediated <it>trans</it>-complementation partially restored the colonisation phenotype.</p> <p>Conclusion</p> <p>We describe the fimbrial gene repertoire of the predominant non-typhoidal <it>S. enterica </it>serovar affecting humans and the role played by each predicted major fimbrial subunit in intestinal colonisation of the primary reservoir. Our data support a role for PegA in the colonisation of poultry by <it>S</it>. Enteritidis and aid the design of improved vaccines.</p

School absence and achievement in children with isolated orofacial clefts.

OBJECTIVES: To examine school absence and academic achievement among 7-year-old children with isolated orofacial clefts in England. DESIGN: Analysis of educational data linked to national cleft registry and administrative hospital data. SETTING: English state schools. PATIENTS: 3523 children with isolated clefts aged 7 years between 2006 and 2014. MAIN OUTCOME MEASURES: Annual school absence and reaching the national 'expected level' according to teacher-assessed academic achievement. RESULTS: Children with isolated clefts had higher mean annual school absence (10.5 days) than their peers in the national population (8.9 days). Total absence was higher in children with a cleft lip and palate (CLP; 11.3 days) or with a cleft palate only (CPO; 10.5 days) than in children with a cleft lip only (CLO; 9.5 days). The percentage reaching the expected academic level decreased with increasing school absence (from 77.4% (923/1192) with annual school absence ≤5 days to 43.4% (193/445) with annual school absence >20 days). However, differences in school absence did not explain that children with CPO (65.9% reaching expected level) or CLP (66.1% reaching expected level) had poorer levels of academic achievement than children with CLO (73.5% reaching expected level). Children with a cleft were twice as often recognised as having special education needs (40.5%) than their peers (21.6%). CONCLUSIONS: School absence and cleft type are both independently associated with school attainment at 7 years. Children with an isolated cleft, especially when the palate is involved, and those with high levels of school absence may benefit from increased support addressing their educational needs

Structure of the first representative of Pfam family PF04016 (DUF364) reveals enolase and Rossmann-like folds that combine to form a unique active site with a possible role in heavy-metal chelation.

The crystal structure of Dhaf4260 from Desulfitobacterium hafniense DCB-2 was determined by single-wavelength anomalous diffraction (SAD) to a resolution of 2.01 Å using the semi-automated high-throughput pipeline of the Joint Center for Structural Genomics (JCSG) as part of the NIGMS Protein Structure Initiative (PSI). This protein structure is the first representative of the PF04016 (DUF364) Pfam family and reveals a novel combination of two well known domains (an enolase N-terminal-like fold followed by a Rossmann-like domain). Structural and bioinformatic analyses reveal partial similarities to Rossmann-like methyltransferases, with residues from the enolase-like fold combining to form a unique active site that is likely to be involved in the condensation or hydrolysis of molecules implicated in the synthesis of flavins, pterins or other siderophores. The genome context of Dhaf4260 and homologs additionally supports a role in heavy-metal chelation

The Political Economy of Natural Resource Use: Lessons for Fisheries Reform

This report discusses key lessons drawn from reform experience in the wider natural resource sector that might inform successful reform in fisheries. This report is a compilation of 12 papers prepared by acknowledged international experts in the fields of fisheries and wider natural resource reform which were reviewed at a workshop convened by the Property and Environment Research Center (PERC) in May 2009.The report forms an important initial input into an ongoing enquiry into the political economy of fisheries reform initiated by the World Bank in partnership with the Partnership for African Fisheries (a United Kingdom Department for International Development funded program of the New Partnership for African Development (NEPAD))