Cleft Care UK study. Part 5: Child psychosocial outcomes and satisfaction with cleft services

© 2015 John Wiley & Sons A/S. Objectives: To describe the impact of cleft service centralization on parental perceptions of child outcomes and satisfaction with care from the Cleft Care UK (CCUK) study and compare them to the Clinical Standards Advisory Group (CSAG) study that took place 15 years earlier. Setting and Sample Population: A subgroup of respondents from a UK multicentre cross-sectional study (CCUK) of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Materials and Methods: Data on parents' perceptions of child self-confidence and their satisfaction with treatment outcomes and service provision were collected via self-report questionnaires. Data were compared with findings from the 1998 CSAG study. Results: Fewer parents in the CCUK study perceived their children as having poor self-confidence than in the 1998 CSAG study (8 and 19%, respectively). At least 81% of parents report satisfaction with the child's facial features after surgery and 98% report being satisfied with the care received. These results are similar to those reported in 1998. There is no evidence of an adverse impact on families' ability to attend appointments at the cleft clinic following centralization. Levels of reported problems (around 30%) with attendance were similar to those reported by CSAG. Conclusion: Centralization of cleft services appears to have improved parental perceptions of some child outcomes but has made little difference to already high levels of parental satisfaction with cleft care services. Centralization is not associated with an increase in the proportion of families who find it difficult to attend appointments

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

Pengoperasian Beban Listrik Fase Tunggal Terkendali Melalui Minimum System Berbasis Mikrokontroler Dan Sensor Voice Recognition (Vr)

Minimum system berbasis mikrokontroler dan sensor voice recognition (VR) sebagai pengendali aktuator telah digunakan untuk pengoperasian beban listrik fase tunggal. Minimum system adalah suatu sistem yang tersusun melalui 2 (dua) tahapan, yaitu (a) diagram rangkaian dan bentuk fisis board dan (b) pengawatan terintegrasi terhadap minimum system pada sistem mikrokontroler ATmega16. Keberadaan sistem mikrokontroler pada minimum system perlu program tertanam melalui pemrograman berbasis bahasa BasCom AVR dengan sejumlah tahapan, yaitu (i) konfigurasi pin, (ii) deklarasi variabel (peubah), (iii) deklarasi konstanta (tetapan), (iv) inisialisasi, (v) program utama, (vi) ambil dan kirim data, dan (vii) keluaran. Uji verifikasi terhadap sistem mikrokontroler dilakukan melalui simulasi berbantuan aplikasi Proteus, berupa pemberian 5 (lima) macam perintah terhadap sensor VR, yaitu “LAMPU”, “NEON”, “KIPAS”, “HIDUP”, dan “MATI”. Hasil simulasi sesuai perintah terhadap sensor VR berupa tampilan pada Virtual Terminal. Kinerja minimum system berbasis mikrokontroler ATmega16 berbantuan sensor VR ditunjukkan, bahwa hasil pemantauan (i) saat sensor diberi perintah “LAMPU”, maka lampu pijar menyala (on), (ii) saat sensor diberi perintah “NEON”, maka lampu TL menyala (on), (iii) saat sensor diberi perintah “KIPAS”, (iii) saat sensor diberi perintah “KIPAS”, maka kipas angin beroperasi (on), (iv) saat sensor diberi perintah “HIDUP”, maka lampu pijar dan lampu TL menyala (on) dan kipas angin beroperasi (on), dan (v) saat sensor diberi perintah “MATI”, maka lampu pijar dan lampu TL padam (off) dan kipas angin tidak beroperasi (off). Pemberian perintah masukan terhadap sensor VR telah memberikan kinerja yang diharapkan

Leptogenesis implications in models with Abelian family symmetry and one extra real Higgs singlet

We show that the neutrino models, as suggested by Low, which have an additional Abelian family symmetry and a real Higgs singlet to the default see-saw do not hinder the possibility of successful thermal leptogenesis. For these models (neglecting radiative effects), we have investigated the situation of strong washout in both the one-flavor approximation and when flavor effects are included. The result is that while such models predict that theta_{13}=0 and that one light neutrino to be massless, they do not modify or provide significant constraints on the typical leptogenesis scenario where the final asymmetry is dominated by the decays of the lightest right-handed neutrinos.Comment: 18 pages, RevTeX4, accepted by Phys. Rev. D. v2: minor corrections, note and 1 ref. added, same content as published versio

Rare generalized form of fungal dermatitis in a horse: Case report

A rare case of Geotrichum spp. dermatitis in a horse is presented. After unrelated, previous surgery and antibiotic treatment, a saddle horse showed well-circumscribed areas of non-pruritic alopecia. Suspecting allergic skin disease, the horse was treated with corticosteroids. The skin lesion spread, and a second veterinarian was consulted. At clinical examination, the horse was lethargic, pyretic and hair was shedding/easily epilated over the head, neck, shoulders, and legs and the hind legs were swollen. Blood analysis revealed mild leucocytosis and hyperglobulinemia. Hair, skin scraping, and skin biopsy ruled out parasites and bacteria; cytology identified yeast-like structures with hyphae or pseudohyphae. Geotrichum candidum was isolated on culture. Treatment consisted of stable disinfection, topical application of an antifungal solution, vitamins C and E supplementation and allowing the horse to graze in sunlight for at least 6 h/day. At 3-weeks follow-up, the horse had gained weight, alopecia was decreased, and all other clinical parameters were normal. Antifungal treatment was continued twice a week for three months. This study suggests Geotrichum candidum may cause skin lesions in horses after long-term use of corticosteroids or antibiotics. To avoid unnecessary and prolonged suffering in cases of dermatitis, veterinarians should be promptly consulted, appropriate diagnostic procedures conducted, so that a definitive diagnosis can be reached, and an appropriate treatment regimen implemented

Observation of Amounts of Movement Practice Provided during Stroke Rehabilitation

Objective To investigate how much movement practice occurred during stroke rehabilitation, and what factors might influence doses of practice provided. Design Observational survey of stroke therapy sessions. Setting Seven inpatient and outpatient rehabilitation sites. Participants We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke. Interventions Not applicable. Main Outcome Measures We recorded numbers of repetitions in specific movement categories and data on potential modifying factors (patient age, side affected, time since stroke, FIM item scores, years of therapist experience). Descriptive statistics were used to characterize amounts of practice. Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps. Results Practice of task-specific, functional upper extremity movements occurred in 51% of the sessions that addressed upper limb rehabilitation, and the average number of repetitions/session was 32 (95% confidence interval [CI]=20–44). Practice of gait occurred in 84% of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 (95% CI=296–418). None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories. Conclusions The amount of practice provided during poststroke rehabilitation is small compared with animal models. It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally

Functional outcomes in the Cleft Care UK study - Part 3:Oral health and audiology

OBJECTIVES: To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION: Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS: Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS: Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS: Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented

Mycotic renal artery degeneration and systemic sepsis caused by infected renal artery stent

AbstractA case of Staphylococcus aureus renal artery stent infection was studied. Fourteen days after the procedure, the patient had a fever, hypotension, and an elevated white blood cell (WBC) count. Blood cultures were positive for S aureus on admission and during the patient's hospitalization, despite intravenous vancomycin therapy. Evaluation included serial CT scans, revealing increasing persistent inflammation with development of multiple renal intraparenchymal abscesses, and arteriography, showing marked degeneration of the renal artery. Therapy required resection of the renal artery/stent and nephrectomy. This case confirms the severe nature of S aureus stent infection; we recommend prophylactic antibiotics before these procedures, as well as expeditious evaluation and consideration for aggressive surgical therapy if this complication is suspected. (J Vasc Surg 1998;28:547-50.