Evaluation of 4 Outcomes Measures in Microtia Treatment: Exposures, Infections, Aesthetics, and Psychosocial Ramifications.

BackgroundIn craniofacial microsomia, microtia and canal atresia pose formidable reconstructive challenges. We review our institutional experience in treating microtia and atresia to identify variables associated with 4 outcomes measures: complications, surgical revisions, aesthetic outcomes, and psychosocial function.MethodsCraniofacial microsomia patients treated at the University of California Los Angeles Craniofacial Clinic between 2008 and 2014 greater than 13 years of age (n = 68) were reviewed for microtia and atresia treatment and outcomes.ResultsIn total, 91.2% of patients diagnosed with craniofacial microsomia presented with microtia, affecting 75 ears. Both a male and right-sided predominance were observed. Fifty-six patients (90.3%) underwent autologous external ear reconstruction at an average age of 8.5 years. Age, type of incision, and size of cartilage framework did not predict total number of surgeries or complications. Severity of ear anomalies correlated with increased number of surgeries (P < 0.001) and decreased aesthetic outcomes (P < 0.001) but not complications. In total, 87.1% of patients with microtia had documented hearing loss, of which the majority were conductive and 18.5% were mixed sensorineural and conductive. Hearing deficits were addressed in 70.4% of patients with external hearing aids, bone anchored hearing aids, or canaloplasty. Of all variables, improvement of psychosocial function was correlated only to hearing loss treatment of any type (P = 0.01).ConclusionsOn evaluation of surgical and patient characteristics, severity of microtia predicted the total number of surgical revisions performed and aesthetic ratings. In addition, we found that the only factor that correlated with improved patient and parent-reported psychosocial outcomes was treatment of hearing loss

Quantifying Implications of Deposit Aging from Crude Refinery Preheat Train Data

Heat exchanger fouling has been studied for some time in the petroleum industry. As understanding of fouling dynamics and mitigation methods improves, refinery fouling mitigation strategies are changing. The implications of deposit aging in refinery units have not been addressed in detail: aging refers to where the deposit undergoes physical and chemical conversion over time. In the 2009 Heat Exchanger Fouling and Cleaning conference, Wilson et al. [Ageing: Looking back and looking forward] presented a simple framework illustrating how deposit aging impacts heat exchanger thermal and hydraulic performance. This paper presents insights into deposit aging gained from analysis of refinery monitoring data. Two case studies are presented: (i) one from the Preem refinery in Sweden where stream temperature, flow and gauge pressure measurements indicated a higher deposit thermal conductivity in exchangers located in the hotter section of the preheat train. (ii) US refinery stream temperature, flow and plant cleaning log data, showing an increased resistance to cleaning when deposits are exposed to high temperature for a prolonged period. The use of deposit aging analysis to improve exchanger operation is discussed.I am a co-author on this paper. The work reported was undertaken for a Swedish company by another company, HTRI.I advised on the results