Robin sequence: what the multidisciplinary approach can do

Stephanie M Cohen,1 S Travis Greathouse,2 Cyrus C Rabbani,3 Joseph O’Neil,4 Matthew A Kardatzke,5 Tasha E Hall,6 William E Bennett Jr,7 Ameet S Daftary,8 Bruce H Matt,3 Sunil S Tholpady1 1Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, 2Reid Health, Richmond, 3Department of Otolaryngology – Head and Neck Surgery, 4Section of Developmental Pediatrics, 5Section of Neonatal-Perinatal Medicine, Department of Pediatrics, 6Department of Orthodontics, 7Section of Children’s Health Services Research, Section of Pediatric and Adolescent Comparative Effectiveness Research, 8Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA Abstract: Robin sequence (RS) is a commonly encountered triad of micrognathia, glossoptosis, and airway obstruction, with or without a cleft palate. The management of airway obstruction is of paramount importance, and multiple reviews and retrospective series outline the diagnosis and treatment of RS. This article focuses on the multidisciplinary nature of RS and the specialists’ contributions and thought processes regarding the management of the RS child from birth to skeletal maturity. This review demonstrates that the care of these children extends far beyond the acute airway obstruction and that thorough monitoring and appropriate intervention are required to help them achieve optimal outcomes. Keywords: cleft palate, micrognathia, mandibular distraction, retrognathia, laryngomalaci

Jupiter's Equatorial Plumes and Hot Spots: Spectral Mapping from Gemini/TEXES and Juno/MWR

We present multi-wavelength measurements of the thermal, chemical, and cloud contrasts associated with the visibly dark formations (also known as 5-μm hot spots)and intervening bright plumes on the boundary between Jupiter’s Equatorial Zone (EZ)and North Equatorial Belt (NEB). Observations made by the TEXES 5-20μm spectrometer at the Gemini North Telescope in March 2017 reveal the upper-tropospheric properties of 12 hot spots, which are directly compared to measurements by Juno using the Microwave Radiometer (MWR), JIRAM at 5μm, and Juno Cam visible images. MWR and thermal-infrared spectroscopic results are consistent near 0.7 bar. Mid-infrared-derived aerosol opacity is consistent with that inferred from visible-albedo and 5-μm opacity maps. Aerosol contrasts, the defining characteristics of the cloudy plumes and aerosol-depleted hot spots, are not a good proxy for microwave brightness. The hot spots are neither uniformly warmer nor ammonia-depleted compared to their surroundings at p 10 bars, suggesting that the hot-spot/plume wave is a relatively shallow feature.Plain Language Summary To date, our only direct measurement of Jupiter’s gaseous composition came from the descent of the Galileo probe in 1995. However, the results from Galileo appeared to be biased due to the unusual meteorological conditions of its entry location: a dark,cloud-free region just north of the equator, known as a hot spot. One of the aims of NASA’s Juno mission was to place the findings of the Galileo probe into broader con-text, which requires a detailed characterisation of these equatorial hot spots and their neighbouring plumes. We combine (a) data from Juno (microwave observations sounding conditions below the clouds, and visible/infrared observations revealing variations in cloud opacity) with (b) observations from amateur observers (to track the hot spots over time) and (c) observations from the TEXES infrared spectrometer mounted on the Gemini-North telescope. The latter provides the highest-resolution thermal maps of Jupiter’s tropics ever obtained, and reveals contrasts within and between the individual hot spots and plumes. We find that the hot spots are distinguishable from their surroundings for relatively shallow pressures, but that the deep measurements from Juno and Galileo are probably more representative of Jupiter’s North Equatorial Belt than previously thought.</div