Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 2: The palate of the preterm/low birthweight infant

BACKGROUND: Well-designed clinical studies on the palatal development in preterm and low birthweight infants are desirable because the literature is characterized by contradictory results. It could be shown that knowledge about 'normal' palatal development is still weak as well (Part 1). The objective of this review is therefore to contribute a fundamental analysis of methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants. METHODS: An electronic literature search as well as hand searches were performed based on Cochrane search strategies including sources of more than a century in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered for comparison. RESULTS: Seventy-eight out of 155 included articles were analyzed for palatal morphology of preterm infants. Intubation, feeding tubes, feeding mode, tube characteristics, restriction of oral functions, kind of diet, cranial form and birthweight were seen as causes contributing to altered palatal morphology. Changes associated with intubation concern length, depth, width, asymmetry, crossbite, and contour of the palate. The phenomenon 'grooving' has also been described as a complication associated with oral intubation. However, this phenomenon suffers from lack of a clear-cut definition. Head flattening, pressure from the oral tube, pathologic or impaired tongue function, and broadening of the alveolar ridges adjacent to the tube have been raised as causes of 'grooving'. Metrically, the palates of intubated preterm infants remain narrower, which has been examined up to the age of the late mixed dentition. CONCLUSION: There is no evidence that would justify the exclusion of any of the raised causes contributing to palatal alteration. Thus, early orthodontic and logopedic control of formerly orally intubated preterm infants is recommended, as opposed to non-intubated infants. From the orthodontic point of view, nasal intubation should be favored. The role that palatal protection plates and pressure-dispersing pads for the head have in palatal development remains unclear

Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 1: The palate of the term newborn

BACKGROUND: The evidence on prematurity as 'a priori' a risk for palatal disturbances that increase the need for orthodontic or orthognathic treatment is still weak. Further well-designed clinical studies are needed. The objective of this review is to provide a fundamental analysis of methodologies, confounding factors, and outcomes of studies on palatal development. One focus of this review is the analysis of studies on the palate of the term newborn, since knowing what is 'normal' is a precondition of being able to assess abnormalities. METHODS: A search profile based on Cochrane search strategies applied to 10 medical databases was used to identify existing studies. Articles, mainly those published before 1960, were identified from hand searches in textbooks, encyclopedias, reference lists and bibliographies. Sources in English, German, and French of more than a century were included. Data for term infants were recalculated if particular information about weight, length, or maturity was given. The extracted values, especially those from non-English paper sources, were provided unfiltered for comparison. RESULTS: The search strategy yielded 182 articles, of which 155 articles remained for final analysis. Morphology of the term newborn's palate was of great interest in the first half of the last century. Two general methodologies were used to assess palatal morphology: visual and metrical descriptions. Most of the studies on term infants suffer from lack of reliability tests. The groove system was recognized as the distinctive feature of the infant palate. The shape of the palate of the term infant may vary considerably, both visually and metrically. Gender, race, mode of delivery, and nasal deformities were identified as causes contributing to altered palatal morphology. Until today, anatomical features of the newborn's palate are subject to a non-uniform nomenclature. CONCLUSION: Today's knowledge of a newborn's 'normal' palatal morphology is based on non-standardized and limited methodologies for measuring a three-dimensional shape. This shortcoming increases bias and is the reason for contradictory research results, especially if pathologic conditions like syndromes or prematurity are involved. Adequate measurement techniques are needed and the 'normal palatal morphology' should be defined prior to new clinical studies on palatal development

Publicity waves based on manipulated geoscientific data suggesting climatic trigger for majority of tsunami findings in the mediterranean – response to ‘tsunamis in the geological record: Making waves with a cautionary tale from the mediterranean’ by marriner et al. (2017)

This article is a response to the publication by Nick Marriner, David Kaniewski, Christophe Morhange, Clément Flaux, Matthieu Giaime, Matteo Vacchi and James Goff entitled “Tsunamis in the geological record: Making waves with a cautionary tale from the Mediterranean”, published in October 2017 in Science Advances. Making use of radiometric data sets published in the context of selected palaeotsunami studies by independent research groups from different countries, Marriner et al. (2017) carried out statistical and time series analyses. They compared their results with an assessment of Mediterranean storminess since the mid-Holocene that was previously published by Kaniewski et al. (2016) based on a single-core study from coastal Croatia. Marriner et al. (2017) now present “previously unrecognized” 1500-year “tsunami megacycles” which they suggest correlating with Mediterranean climate deterioration. They conclude that up to 90 % of all the ‘tsunamis’ identified in original tsunami papers used for their study are “better ascribed to periods of heightened storminess”. In this response, we show that (i) the comparison of statistical data describing storm and tsunami events presented by Marriner et al. (2017) is incorrect both from a geographical and a statistical point of view, (ii) the assumed periods of central Mediterranean storminess published by Kaniewski et al. (2016) are missing convincing geological and geochronological evidence and are statistically incorrect, (iii) the palaeotsunami data that was originally collected by different groups of authors were manipulated by Marriner et al. (2017) in a way that the resulting data set – used as a benchmark for the entire study of these authors – is wrong and inaccurate, and that (iv) Marriner et al. (2017) did not address or even negate the original sedimentological studies’ presentation of comparative tsunami versus storm deposits for the selected individual localities. Based on a thorough and detailed evaluation of the geoscientific background and the methodological approach of the studies by Kaniewski et al. (2016) and Marriner et al. (2017), we conclude that there is no serious and reliable geoscientific evidence for increased storminess in the (central) Mediterranean Sea between 3400–2550, 2000–1800, 1650–1450, 1300–900 and 400–100 cal BP. The impact of those storms in the Mediterranean, producing geological traces somewhat comparable to those caused by tsunamis, is insignificantly small. For the period 1902–2017, Mediterranean tsunamis make up 73–98 % of all combined extreme wave events (EWE) leading to coastal flooding and appeared up to 181 times deadlier than comparable storm effects. This is the reason why coastal Mediterranean research has focused on Holocene records of the tsunami hazard, while research on comparable storm effects is of lower signifi-cance. The validity of geological evidence for Mediterranean EWE and their interpretation as caused by palaeotsunami impacts thus remains untouched. Tsunamis, in most cases directly and indirectly induced by seismo-tectonics, have always been a much greater threat to Mediterranean coastal regions than comparable storm effects. ‘Tsunami megacycles’ as expressions of a 1500-year periodicity centered on the Little Ice Age, 1600 and 3100 cal BP that were correlated with questionable storm data do not exist. Cause and effect relationships work the other way round: Major tsunami events, testified by historical accounts, such as those that occurred in 1908 AD, 1755 AD, 1693 AD and 365 AD, induced numerous studies along Mediterranean coasts. These investigations resulted in a large number of publications that specifically focus on those time periods, suspected by Marriner et al. (2017) to bear signs of increased storminess, namely 200–300 BP and 1600 BP. The Mediterranean tsunami record cannot be ascribed to periods of increased storminess. On the contrary, the tsunami record as interpreted by the authors of the original papers cited by Marriner et al. (2017), is due to the outstandingly high seismo-tectonic activity of the region. Mediterranean tsunamis are mostly triggered by earthquakes or by earthquake-related secondary effects such as underwater mass movements. The study by Marriner et al. (2017) is also problematic because it includes simple basic statistical mistakes and major methodological inconsistencies. The geomorphological and sedimentary background of EWE deposits was not taken into account. The ‘broad brush’ approach used by Marriner et al. (2017) to sweep sedimentary deposits from tsunami origin into the storm bag origin, just on the basis of (false) statistics coupled with very broad and unreliable palaeoclimatic indicators and time frames, is misleading. The distortion of original data collected and interpreted by other research groups by Marriner et al. (2017) is particularly disturbing. Their publication is also bound to question in this case the effectiveness of scientific quality assurance in modern publishing commerce. Marriner et al. (2017: 7) talk down the considerable risk to human settlements and infrastructure along Mediterranean coasts in relation to tsunami and earthquake hazards. Their conclusion is not only wrong as a result of their incorrect data mining and analyses, it is also irresponsible with regard to national and international efforts of tsunami and earthquake risk mitigation