Speech outcome in children born with cleft lip and palate treated with one-stage palate repair : aspects of function and environment

Introduction and aims: This project focused on speech outcomes at 5 and 10 years of age after two different surgical protocols and on peer perceptions of speech in children born with cleft palate. The aim was to gain knowledge about speech outcome in children born with unilateral cleft lip and palate (UCLP) or cleft palate only (CPO), treated with one-stage palatoplasty at approximately 12 months of age, according to two different surgical protocols: minimal incision technique (MIT) and minimal incision technique with muscle reconstruction (MITmr). In addition, the aims included to study how peers not familiar with the speaker describe cleft related speech impairment in their own words and the possible consequences that it might have in a social context. Materials and methods: A total of 217 children born with a cleft palate were included in this project: 69 children with UCLP and 148 children with CPO. In the CPO group, 98 had a cleft in both the hard and soft palate (CPH) and 50 in the soft palate only (CPS). The children were born in the Stockholm region in 1987–2004. In addition, 37 children born without a cleft participated: 18 children as a reference group at 5 years of age and 19 children in focus groups at 10 years of age. Speech outcomes were assessed from audio recordings by external expert speech and language pathologists. Intra- and inter-rater reliability were determined. Three focus groups of peers listened to and described speech samples with different types of cleft speech characteristics as well as normal speech. Results: The children with different cleft types presented a high degree of hypernasality and audible nasal air leakage at 5 years of age, especially in the group operated on according to the MIT protocol. A significant decrease at age 10 was found, except for audible nasal air leakage in children with CPO. With the MIT protocol 43% of the children with UCLP, 42 % with CPH and 4% with CPS had received a velopharyngeal flap. The prevalence of articulation errors, such as retracted oral articulation and glottal articulation, decreased with age. The CPO group showed fewer articulatory errors than the UCLP group. Peers identified normal speech and more pronounced signs of nasality and easily detected and reacted upon even single occurrences of articulatory difficulties and commented on possible reasons why and how these errors could influence communication. Conclusions: The prevalences of nasality and articulation errors were similar to what is commonly reported at 5 and 10 years of age in children born with cleft lip and palate. Nasality and articulation improved with age, except for nasal air leakage in the CPO group, indicating that more velopharyngeal flaps might be required at a later age. In the CPO group, were velopharyngeal flaps common in children with CPH treated with MIT. Velopharyngeal flaps were also common in the UCLP group treated with MIT. Peers detected and commented on moderate to severe nasality and articulatory difficulties including minor errors. This should be considered when planning intervention

Scandcleft randomised trials of primary surgery for unilateral cleft lip and Palate: 9. Parental report of social and emotional experiences related to their 5-year-old child’s cleft diagnosis

© 2017 Acta Chirurgica Scandinavica Society. Background and aim: Parents of children with a cleft lip and palate may be emotionally affected by the child’s diagnosis. Their experiences and perceptions are important when evaluating the complexity of satisfactory treatment outcomes. The objective was to examine parents’ social and emotional experiences related to their child’s cleft diagnosis, and their perceptions of the child’s adjustment to living with a visible difference. Design: International multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: A cohort of 448 children born with a non-syndromic UCLP were included. A total of 356 parents completed the Scandcleft Parent Questionnaire. Results: The majority of parents experienced practical and emotional support from family, friends, and health professionals. Nevertheless, parents had to cope with other people’s reactions to the cleft, experiences that were described as ranging from hurtful to neutral and/or positive. According to parents, 39% of the children had experienced cleft-related comments and/or teasing. More than half of the parents reported specific worries related to their child’s future. Conclusion: While the majority of the parents experienced positive support and coped well with the child’s diagnosis, some parents were at risk for psychological and emotional challenges that should be identified by the cleft team. To optimise outcomes and the child’s adjustment, these parents should be offered psychological support when necessary. Trial registration: ISRCTN29932826

Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child

© 2017 Acta Chirurgica Scandinavica Society. Background and aim: Few studies have explored children’s emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents’ evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications. Design: Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile. Results: The results indicated that the majority of parents were satisfied with cleft-related features of their child’s appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications. Conclusions: Most parents reported satisfaction with their child’s appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety. Trial registration: ISRCTN29932826

A Global Ecological Classification of Coastal Segment Units to Complement Marine Biodiversity Observation Network Assessments

A new data layer provides Coastal and Marine Ecological Classification Standard (CMECS) labels for global coastal segments at 1 km or shorter resolution. These characteristics are summarized for six US Marine Biodiversity Observation Network (MBON) sites and one MBON Pole to Pole of the Americas site in Argentina. The global coastlines CMECS classifications were produced from a partitioning of a 30 m Landsat-derived shoreline vector that was segmented into 4 million 1 km or shorter segments. Each segment was attributed with values from 10 variables that represent the ecological settings in which the coastline occurs, including properties of the adjacent water, adjacent land, and coastline itself. The 4 million segments were classified into 81,000 coastal segment units (CSUs) as unique combinations of variable classes. We summarize the process to develop the CSUs and derive summary descriptions for the seven MBON case study sites. We discuss the intended application of the new CSU data for research and management in coastal areas

Risk of depression, suicide and psychosis with hydroxychloroquine treatment for rheumatoid arthritis:a multinational network cohort study

Objectives: Concern has been raised in the rheumatology community regarding recent regulatory warnings that HCQ used in the coronavirus disease 2019 pandemic could cause acute psychiatric events. We aimed to study whether there is risk of incident depression, suicidal ideation or psychosis associated with HCQ as used for RA.Methods: We performed a new-user cohort study using claims and electronic medical records from 10 sources and 3 countries (Germany, UK and USA). RA patients ≥18 years of age and initiating HCQ were compared with those initiating SSZ (active comparator) and followed up in the short (30 days) and long term (on treatment). Study outcomes included depression, suicide/suicidal ideation and hospitalization for psychosis. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate database-specific calibrated hazard ratios (HRs), with estimates pooled where I2 &lt;40%.Results: A total of 918 144 and 290 383 users of HCQ and SSZ, respectively, were included. No consistent risk of psychiatric events was observed with short-term HCQ (compared with SSZ) use, with meta-analytic HRs of 0.96 (95% CI 0.79, 1.16) for depression, 0.94 (95% CI 0.49, 1.77) for suicide/suicidal ideation and 1.03 (95% CI 0.66, 1.60) for psychosis. No consistent long-term risk was seen, with meta-analytic HRs of 0.94 (95% CI 0.71, 1.26) for depression, 0.77 (95% CI 0.56, 1.07) for suicide/suicidal ideation and 0.99 (95% CI 0.72, 1.35) for psychosis.Conclusion: HCQ as used to treat RA does not appear to increase the risk of depression, suicide/suicidal ideation or psychosis compared with SSZ. No effects were seen in the short or long term. Use at a higher dose or for different indications needs further investigation.Trial registration: Registered with EU PAS (reference no. EUPAS34497; http://www.encepp.eu/encepp/viewResource.htm? id=34498). The full study protocol and analysis source code can be found at https://github.com/ohdsi-studies/Covid19EstimationHydroxychloroquine2.</p

Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study

Background: Hydroxychloroquine, a drug commonly used in the treatment of rheumatoid arthritis, has received much negative publicity for adverse events associated with its authorisation for emergency use to treat patients with COVID-19 pneumonia. We studied the safety of hydroxychloroquine, alone and in combination with azithromycin, to determine the risk associated with its use in routine care in patients with rheumatoid arthritis. Methods: In this multinational, retrospective study, new user cohort studies in patients with rheumatoid arthritis aged 18 years or older and initiating hydroxychloroquine were compared with those initiating sulfasalazine and followed up over 30 days, with 16 severe adverse events studied. Self-controlled case series were done to further establish safety in wider populations, and included all users of hydroxychloroquine regardless of rheumatoid arthritis status or indication. Separately, severe adverse events associated with hydroxychloroquine plus azithromycin (compared with hydroxychloroquine plus amoxicillin) were studied. Data comprised 14 sources of claims data or electronic medical records from Germany, Japan, the Netherlands, Spain, the UK, and the USA. Propensity score stratification and calibration using negative control outcomes were used to address confounding. Cox models were fitted to estimate calibrated hazard ratios (HRs) according to drug use. Estimates were pooled where the I2 value was less than 0·4. Findings: The study included 956 374 users of hydroxychloroquine, 310 350 users of sulfasalazine, 323 122 users of hydroxychloroquine plus azithromycin, and 351 956 users of hydroxychloroquine plus amoxicillin. No excess risk of severe adverse events was identified when 30-day hydroxychloroquine and sulfasalazine use were compared. Self-controlled case series confirmed these findings. However, long-term use of hydroxychloroquine appeared to be associated with increased cardiovascular mortality (calibrated HR 1·65 [95% CI 1·12–2·44]). Addition of azithromycin appeared to be associated with an increased risk of 30-day cardiovascular mortality (calibrated HR 2·19 [95% CI 1·22–3·95]), chest pain or angina (1·15 [1·05–1·26]), and hear

Varför leker du inte med de andra barnen? : En essä om de inåtvända barnen på fritidshemmet

This essay begins with an anecdote about a child in school who in my opinion displayed introverted behavior. This child seemed to prefer playing on its own rather than with friends. These children often become less visible due to their extrovert peers who have a greater tendency to actively seek attention from adults. The purpose of this essay is to get a wider understanding about these introvert children. What are their needs and how can we best support them in school?  In this essay I have tried to see my own actions in relation to the school’s rules and regulations concerning introvert children. I have also studied literature, how playing can support extrovert children, what a teacher can do to help and support and what the norm in today’s society is. To reflect and learn I have read books on this topic and my aim is to gain a better understanding and deeper knowledge. Den här essän börjar med en berättelse som handlar om ett av de barn i skolan och fritidshemmet som av mig som pedagog upplevs som tyst och inåtvänt. Ett barn som verkar föredra ensamlek framför lek med klasskamrater. Ofta hamnar dessa barn i skymundan i förmån till de mer extroverta och utåtagerande barnen som aktivt söker kontakt med oss vuxna. Syftet med denna essä är att få en större förståelse för varför de tysta barnen är tysta och inåtvända. Vilka behov har de och vilket förhållningssätt bör jag som pedagog ha gentemot dem? Jag har granskat mitt agerande i berättelsen utifrån skolans och fritidshemmets styrdokument samt litteratur som tar upp blyghet, lekens betydelse, pedagogens betydelse för de tysta barnen, dagens samhällsideal och ämnet praktisk kunskap. Jag har även använt skönlitteratur för att reflektera över mitt agerande för att på så sätt få en djupare förståelse för vad jag kunde gjort annorlunda

Influence of composition, structure and testing atmosphere on the tribological performance of W-S-N coatings

W-S-N coatings deposited by reactive magnetron sputtering offer the possibility of ultra-low friction in unlubricated sliding. In this work, W-S-N coatings of different composition and structure have been deposited, characterised and evaluated with respect to the tribological performance and tribofilm formation. The composition was varied by changing the flow of N-2 into the deposition chamber, leading to N contents ranging from 0 to 47 at.%. W-S-N coatings deposited without substrate heating are amorphous, while substrate heating results in coatings containing nanocystalline tungsten sulphide (WSx) for low N contents, and nanocrystalline tungsten nitride (WyN) at a high N content. The coatings were tribologically tested against steel balls in four different atmospheres dry N-2, dry air, humid N-2 and humid air to study the effects of atmospheric O-2 and H2O both separately and simultaneously. In dry N-2, all coatings exhibited an excellent performance with very low friction (mu approximate to 0.02) and wear. Notably, this included the N-richest and hardest coating, containing nanocrystalline WyN and only 13 at.% of S. The friction and wear increased on changing the atmosphere, in the order of dry air-humid N-2-humid air. In these three non-inert atmospheres, the friction and wear also increased with increasing N content of the coating. It is thus concluded that the presence of O-2, the presence of H2O, and a high N content (i.e., low Wand S contents) are three factors increasing the risk of high friction and wear, especially when occurring together. Raman spectroscopy mapping of the contact surfaces on the coatings and the balls showed that low friction and wear is connected to the presence of WS2 tribofilms in the contact, and that the three previously mentioned factors affect the formation and function of this tribofilm

Tribochemically Active Ti–C–S Nanocomposite Coatings

We demonstrate a new concept of self-adaptive materials, where sulphur is incorporated into TiC/a-C coatings and may be released in, for example, a tribological contact. By reactive sputtering with H2S, sulphur goes into the carbide to form a TiC x S y phase in an amorphous carbon matrix. The addition of sulphur lowers the friction against steel. Significantly lower friction is obtained against a tungsten counter-surface, as WS2 is generated in the contact. Annealing experiments and formation energy calculations confirm that sulphur can be released from TiC x S y . Ti–C–S coatings are thus chemically active in tribological contacts, creating possibilities of new low-friction systems