The Cleft Care UK study. Part 4:perceptual speech outcomes

OBJECTIVES: To describe the perceptual speech outcomes from the Cleft Care UK (CCUK) study and compare them to the 1998 Clinical Standards Advisory Group (CSAG) audit. SETTING AND SAMPLE POPULATION: A cross-sectional study of 248 children born with complete unilateral cleft lip and palate, between 1 April 2005 and 31 March 2007 who underwent speech assessment. MATERIALS AND METHODS: Centre-based specialist speech and language therapists (SLT) took speech audio–video recordings according to nationally agreed guidelines. Two independent listeners undertook the perceptual analysis using the CAPS-A Audit tool. Intra- and inter-rater reliability were tested. RESULTS: For each speech parameter of intelligibility/distinctiveness, hypernasality, palatal/palatalization, backed to velar/uvular, glottal, weak and nasalized consonants, and nasal realizations, there was strong evidence that speech outcomes were better in the CCUK children compared to CSAG children. The parameters which did not show improvement were nasal emission, nasal turbulence, hyponasality and lateral/lateralization. CONCLUSION: These results suggest that centralization of cleft care into high volume centres has resulted in improvements in UK speech outcomes in five-year-olds with unilateral cleft lip and palate. This may be associated with the development of a specialized workforce. Nevertheless, there still remains a group of children with significant difficulties at school entry

Kick stability in groups and dynamical systems

We consider a general construction of ``kicked systems''. Let G be a group of measure preserving transformations of a probability space. Given its one-parameter/cyclic subgroup (the flow), and any sequence of elements (the kicks) we define the kicked dynamics on the space by alternately flowing with given period, then applying a kick. Our main finding is the following stability phenomenon: the kicked system often inherits recurrence properties of the original flow. We present three main examples. 1) G is the torus. We show that for generic linear flows, and any sequence of kicks, the trajectories of the kicked system are uniformly distributed for almost all periods. 2) G is a discrete subgroup of PSL(2,R) acting on the unit tangent bundle of a Riemann surface. The flow is generated by a single element of G, and we take any bounded sequence of elements of G as our kicks. We prove that the kicked system is mixing for all sufficiently large periods if and only if the generator is of infinite order and is not conjugate to its inverse in G. 3) G is the group of Hamiltonian diffeomorphisms of a closed symplectic manifold. We assume that the flow is rapidly growing in the sense of Hofer's norm, and the kicks are bounded. We prove that for a positive proportion of the periods the kicked system inherits a kind of energy conservation law and is thus superrecurrent. We use tools of geometric group theory and symplectic topology.Comment: Latex, 40 pages, revised versio

Ion-lithium collision dynamics studied with an in-ring MOTReMi

We present a novel experimental tool allowing for kinematically complete studies of break-up processes of laser-cooled atoms. This apparatus, the 'MOTReMi', is a combination of a magneto-optical trap (MOT) and a Reaction Microscope (ReMi). Operated in an ion-storage ring, the new setup enables to study the dynamics in swift ion-atom collisions on an unprecedented level of precision and detail. In first experiments on collisions with 1.5 MeV/amu O$^{8+}$-Li the pure ionization of the valence electron as well as ionization-excitation of the lithium target has been investigated

Epilepsy Surgery for Pharmacoresistant Temporal Lobe Epilepsy: A Decision Analysis

Context Patients with pharmacoresistant epilepsy have increased mortality compared with the general population, but patients with pharmacoresistant temporal lobe epilepsy who meet criteria for surgery and who become seizure-free after anterior temporal lobe resection have reduced excess mortality vs those with persistent seizures. Objective To quantify the potential survival benefit of anterior temporal lobe resection for patients with pharmacoresistant temporal lobe epilepsy vs continued medical management. Design Monte Carlo simulation model that incorporates possible surgical complications and seizure status, with 10 000 runs. The model was populated with health-related quality-of-life data obtained directly from patients and data from the medical literature. Insufficient data were available to assess gamma-knife radiosurgery or vagal nerve stimulation. Main Outcome Measures Life expectancy and quality-adjusted life expectancy. Results Compared with medical management, anterior temporal lobe resection for a 35-year-old patient with an epileptogenic zone identified in the anterior temporal lobe would increase survival by 5.0 years (95% CI, 2.1-9.2) with surgery preferred in 100% of the simulations. Anterior temporal lobe resection would increase quality-adjusted life expectancy by 7.5 quality-adjusted life-years (95%, CI, −0.8 to 17.4) with surgery preferred in 96.5% of the simulations, primarily due to increased years spent without disabling seizures, thereby reducing seizure-related excess mortality and improving quality of life. The results were robust to sensitivity analyses. Conclusion The decision analysis model suggests that on average anterior temporal lobe resection should provide substantial gains in life expectancy and quality-adjusted life expectancy for surgically eligible patients with pharmacoresistant temporal lobe epilepsy compared with medical management

Electrospun Collagen: A Tissue Engineering Scaffold with Unique Functional Properties in a Wide Variety of Applications

Type I collagen and gelatin, a derivative of Type I collagen that has been denatured, can each be electrospun into tissue engineering scaffolds composed of nano- to micron-scale diameter fibers. We characterize the biological activity of these materials in a variety of tissue engineering applications, including endothelial cell-scaffold interactions, the onset of bone mineralization, dermal reconstruction, and the fabrication of skeletal muscle prosthetics. Electrospun collgen (esC) consistently exhibited unique biological properties in these functional assays. Even though gelatin can be spun into fibrillar scaffolds that resemble scaffolds of esC, our assays reveal that electrospun gelatin (esG) lacks intact α chains and is composed of proinflammatory peptide fragments. In contrast, esC retains intact α chains and is enriched in the α 2(I) subunit. The distinct fundamental properties of the constituent subunits that make up esC and esG appear to define their biological and functional properties

Stellar feedback as the origin of an extended molecular outflow in a starburst galaxy

Recent observations have revealed that starburst galaxies can drive molecular gas outflows through stellar radiation pressure. Molecular gas is the phase of the interstellar medium from which stars form, so these outflows curtail stellar mass growth in galaxies. Previously known outflows, however, involve small fractions of the total molecular gas content and have typical scales of less than a kiloparsec. In at least some cases, input from active galactic nuclei is dynamically important, so pure stellar feedback (the momentum return into the interstellar medium) has been considered incapable of rapidly terminating star formation on galactic scales. Molecular gas has been detected outside the galactic plane of the archetypal starburst galaxy M82 (refs 4 and 5), but so far there has been no evidence that starbursts can propel substantial quantities of cold molecular gas to the same galactocentric radius (about 10 kiloparsecs) as the warmer gas that has been traced by metal ion absorbers in the circumgalactic medium. Here we report observations of molecular gas in a compact (effective radius 100 parsecs) massive starburst galaxy at redshift 0.7, which is known to drive a fast outflow of ionized gas. We find that 35 per cent of the total molecular gas extends approximately 10 kiloparsecs, and one-third of this extended gas has a velocity of up to 1,000 kilometres per second. The kinetic energy associated with this high-velocity component is consistent with the momentum flux available from stellar radiation pressure. This demonstrates that nuclear bursts of star formation are capable of ejecting large amounts of cold gas from the central regions of galaxies, thereby strongly affecting their evolution by truncating star formation and redistributing matter.Peer reviewedFinal Accepted Versio