Jerome Sheahan

Incidence and outcome of middle ear disease in cleft lip and/or cleft palate

OBJECTIVE Otitis media with effusion is known to be very common among children with cleft palate, however, less is known regarding the natural history and outcome in this group. The purpose of the present study was to examine the incidence, natural history, treatment, and outcome of middle ear disease in children with clefts. METHODS A questionnaire was sent to the parents of all children registered on the cleft lip and palate database at our institution. The medical records of all respondents were also reviewed. Statistical analysis of the results was performed using Fishers exact test in contingency tables and binary logistic regression analyses, where appropriate. RESULTS 397 fully completed questionnaires were returned. Ear disease was much more common in children with cleft palate, or cleft lip and palate, than in children with cleft lip. Among children with cleft palate, ear problems (infections and/or hearing loss) were most prevalent in the 4-6-year-old age group. However, ear problems persisted at a substantial level for many years after this; only after the age of 12 years did problems appear to settle. The incidence of below normal current hearing and of surgery for chronic otitis media was significantly related to history of ear infections (P=0.000 and 0.000, respectively), and to increased number of ventilation tube insertions (P=0.000 and 0.000, respectively). CONCLUSIONS Middle ear disease is common in children with cleft palate, and, unlike the case for children without clefts, has a prolonged recovery, and a substantial incidence of late sequelae. The higher incidence of below normal hearing and surgery for chronic otitis media in children undergoing a greater number of ventilation tube insertions, although most likely reflecting an increased underlying severity of otitis media in these children, also underlines the lack of long-term benefits of ventilation tubes in this group.

Predictors of Survival in Early Oral Cancer

OBJECTIVE Despite the substantial rate of neck conversion reported among patients with early oral cancer, a policy of routine elective neck dissection has been criticized on the grounds that it confers little survival advantage while subjecting many to potentially avoidable morbidity. However, the identification of factors predictive of survival may allow for the identification of those patients who are more likely to benefit from elective neck treatment. STUDY DESIGN AND SETTING The clinical and histologic material of 71 patients with stage I or II squamous carcinoma of the oral cavity were reviewed. Patients were followed up for a minimum of 3 years after their surgery, and the impact of these variables on 3-year survival was assessed. RESULTS Increased tumor thickness was significantly predictive of decreased survival (P = 0.030). Although having no prognostic value alone, when combined with thickness, both pattern of invasion and gender increased the significance of the latter in predicting outcome. Conclusion and significance Measuring tumor thickness and pattern of invasion in patients with early oral cancer may allow for the identification of those patients with more aggressive disease who are more likely to benefit from elective neck treatment.

Hydrology and management of turloughs (temporary lakes) affect marsh fly (Sciomyzidae: Diptera) communities

Abstract.  1. Hydrology and management affect dipteran communities in wetlands and they, themselves, have the potential to influence prey communities.

Middle ear disease in children with congenital velopharyngeal insufficiency.

Objective To examine the incidence and natural history of middle ear disease in children with congenital velopharyngeal insufficiency (VPI) without cleft palate. Setting and Subjects Children with congenital VPI attending the combined cleft clinic at a tertiary cleft center. The diagnosis of congenital VPI in all cases was confirmed be the observation of hypernasality, nasal air escape, or both by a speech and language therapist and the demonstration of incompetence of the velopharyngeal sphincter by means of nasoendoscopy or videofluoroscopy. Children with overt cleft palate or postsurgical VPI were excluded. Design The childrens medical records were reviewed, and a questionnaire regarding history of ear problems was sent to all parents. Children were divided into those with Pruzansky type I VPI (showing bifid uvula, midline diastasis of soft palate, or submucous cleft of the hard palate) and Pruzansky type II VPI (no visible stigmata). Main Outcome Measures Incidence of reported ear problems, ear infections, hearing loss, and surgical intervention for middle ear disease in the whole group and in each of the subgroups. Results Seventy-one parents returned completed questionnaires. The overall incidence of middle ear disease was 63%, with 28% reported to have below-normal hearing. There was no significant difference between children with Pruzansky types I and II VPI with respect to incidence of otopathology or hearing loss. Conclusions Irrespective of the presence of any visible palatal abnormalities, children with congenital VPI showed a substantial incidence of otopathology and should thus be closely monitored.

Validation of a Database of Formation Enthalpies and of Mid-Level Model Chemistries

In order to test new procedures for the calculation of basic molecular properties, a properly validated database and computational method appropriate to the range of species at hand is essential. Here formation enthalpies of chemical species CmHnNpOq from their constituent atoms are computed by midlevel composite model chemistries in order to check the contents of the best established and most accurate database, ATcT. Once discrepancies are identified alternative independent procedures and/or higher level model chemistries, which include CCSDT(Q) calculations, are employed to resolve the problems. Shortcomings of the midlevel methods used are signaled where these occur. In addition a more visual statistical analysis than is usual is presented which highlights the outliers and identifies the bias of each method together with associated error bars and the 95% limits of agreement and its error bars.

Long-Term Otological Outcome of Hamular Fracture During Palatoplasty

OBJECTIVE: It has been suggested that fracture of the hamulus during palatoplasty in children with cleft palate may lead to adverse otological sequelae, however, there is little evidence to support this. STUDY DESIGN AND SETTING: The otological records of 42 children with repaired cleft palate (excluding submucous cleft palate) aged 8 years old or older were examined. A questionnaire regarding the incidence, treatment, and outcome of middle ear problems was completed by the parents of 68 children with repaired cleft palate, aged 9 years old or older. RESULTS: There was no significant difference between children who did and did not undergo hamular fracture with regard to tympanic membrane appearance, audiometry, history of ear problems (P = 1.000), ear infections (P = 0.622), ventilation tube insertion (P = 0.532), or surgery for chronic otitis media (P = 1.000). Parents of children not undergoing hamular fracture reported a higher incidence of below normal hearing (P = 0.023). CONCLUSION AND SIGNIFICANCE: There is no evidence that hamular fracture during palatoplasty affects long-term otological outcome in cleft palate.

High-resolution ultrasound findings in the symptomatic residual limbs of amputees.

INTRODUCTION Amputations are increasingly prevalent because of medical complications associated with diabetes, meningitis, peripheral vascular disease, and neoplasms as well as road traffic accidents and war. The use of ultrasound (U/S) to diagnose the cause of pain in the residual limb of amputees is presented together with a review of the literature. PATIENTS AND METHODS 133 civilian patients with one or more amputations were included in the study. They were seen over a 2-year period, at the Douglas Bader Unit, Queen Marys Hospital, Roehampton, Surrey, United Kingdom, in an outpatient setting. Patients were scanned using a Philips ATL/HDI 5000 U/S scanner. RESULTS There were 89 male and 44 female patients, age range 14 to 91 years, with a total of 136 amputated sites. 80% of amputations involved the lower limb. Neuromas were the most frequently found lesions, followed by inflammatory edema, soft-tissue calcifications, bony spurs, soft-tissue infection, overuse injuries, bursae, and skin lesions. Scar tissue, bony erosion, bone infection, aneurysm formation, venous thrombosis, and myodesis failure were less frequently seen. CONCLUSIONS There is a wide spectrum of lesions in the amputated limb, which can be visualized by high-resolution U/S. Neuromas were the most frequent lesions seen.

The secretary problem for a random walk

The secretary problem for a random walk is described. A particle has equal probabilities of moving j steps up or j steps down. The optimal strategy of picking the maximum height in n steps without the opportunity of recall is found. The best strategy is shown to be exactly the same as the naive strategy of choosing the first element of the sequence. The theory is extended to symmetric continuous distributions.

Functional responses and adaptation of mesophilic microbial communities to psychrophilic anaerobic digestion

Psychrophilic (<20°C) anaerobic digestion (AD) represents an attractive alternative to mesophilic wastewater treatment. In order to investigate the AD microbiome response to temperature change, with particular emphasis on methanogenic archaea, duplicate laboratory-scale AD bioreactors were operated at 37°C followed by a temperature drop to 15°C. A volatile fatty acid-based wastewater (composed of propionic acid, butyric acid, acetic acid and ethanol) was used to provide substrates representing the later stages of AD. Community structure was monitored using 16S rRNA gene clone libraries, as well as DNA and cDNA-based DGGE analysis, while the abundance of relevant methanogens was followed using qPCR. In addition, metaproteomics, microautoradiography-fluorescence in situ hybridization, and methanogenic activity measurements were employed to investigate microbial activities and functions. Methanomicrobiales abundance increased at low temperature, which correlated with an increased contribution of CH4 production from hydrogenotrophic methanogenesis at 15°C. Methanosarcinales utilized acetate and H2/CO2 as CH4 precursors at both temperatures and a partial shift from acetoclastic to hydrogenotrophic methanogenesis was observed for this archaeal population at 15°C. An upregulation of protein expression was reported at low temperature as well as the detection of chaperones indicating that mesophilic communities experienced stress during long-term exposure to 15°C. Overall, changes in microbial community structure and function were found to underpin the adaptation of mesophilic sludge to psychrophilic AD.

Robust estimation in the linear model with asymmetric error distributions

In the linear model Xn - 1 = Cn - p[theta]p - 1 + En - 1, Hubers theory of robust estimation of the regression vector [theta]p - 1 is adapted for two models for the partially specified common distribution F of the i.i.d. components of the error vector En - 1. In the first model considered, the restriction of F to a set [-a0, b0] is a standard normal distribution contaminated, with probability [var epsilon], by an unknown distribution symmetric about 0. In the second model, the restriction of F to [-a0, b0] is completely specified (and perhaps asymmetrical). In both models, the distribution of F outside the set [-a0, b0] is completely unspecified. For both models, consistent and asymptotically normal M-estimators of [theta]p - 1 are constructed, under mild regularity conditions on the sequence of design matrices {Cn - p}. Also, in both models, M-estimators are found which minimize the maximal mean-squared error. The optimal M-estimators have influence curves which vanish off compact sets.