Objective
International outreach for cleft lip and/or palate care has traditionally been characterized by foreign groups and individuals holding surgical outreach trips in low- and middle-income ...countries. However, this “magic bullet” approach has often been criticized for prioritizing short-term results that may disrupt local workflow. The presence and impact of local organizations that support cleft care and take on capacity building initiatives has not been well explored.
Design
Eight countries previously studied as having the highest Google search demand for CL/P were chosen for the scope of the study. Local NGOs in regions were identified through a web search, and information was collected regarding the location, objectives, partnerships, and work conducted thus far.
Results
Countries with a strong combination of local and international organizations included Ghana, Philippines, Nepal, Kenya, Pakistan, India, and Nigeria. The country with minimal to no local NGO presence included Zimbabwe. Local NGOs often supported education and research, training of providers and staff, spreading community awareness, offering interdisciplinary care, and opening cleft clinics and hospitals. Unique initiatives included starting the first school for children with CL/P, enrolling patients in the national healthcare to cover CL/P care, and monitoring the referral system to improve efficiencies in the healthcare system.
Conclusions
Moving towards a mindset of capacity building not only involves bilateral partnerships between international host sites and visiting organizations, but also collaboration with local NGOs that have a deep understanding of local communities. Successful partnerships may help address the complex challenges regarding CL/P care faced by LMICs.
ABSTRACT The Grain Impact Analyzer and Dust Accumulator (GIADA) instrument on board ESA's Rosetta mission is constraining the origin of the dust particles detected within the coma of comet 67 ...P/Churyumov-Gerasimenko (67P). The collected particles belong to two families: (i) compact particles (ranging in size from 0.03 to 1 mm), witnessing the presence of materials that underwent processing within the solar nebula and (ii) fluffy aggregates (ranging in size from 0.2 to 2.5 mm) of sub-micron grains that may be a record of a primitive component, probably linked to interstellar dust. The dynamics of the fluffy aggregates constrain their equivalent bulk density to kg m−3. These aggregates are charged, fragmented, and decelerated by the spacecraft negative potential and enter GIADA in showers of fragments at speeds m s−1. The density of such optically thick aggregates is consistent with the low bulk density of the nucleus. The mass contribution of the fluffy aggregates to the refractory component of the nucleus is negligible and their coma brightness contribution is less than 15%.
Rosetta begins its COMET TALE Taylor, M. G. G. T.; Alexander, C.; Altobelli, N. ...
Science (American Association for the Advancement of Science),
01/2015, Letnik:
347, Številka:
6220
Journal Article
ABSTRACT
We present a physical model and spin-state analysis of the potentially hazardous asteroid (23187) 2000 PN9. As part of a long-term campaign to make direct detections of the ...Yarkovsky–O’Keefe–Radzievskii–Paddack (YORP) effect, we collected optical light curves of the asteroid between 2006 and 2020. These observations were combined with planetary radar data to develop a detailed shape model, which was used to search for YORP acceleration. We report that 2000 PN9 is a relatively large top-shaped body with a sidereal rotation period of 2.53216 ± 0.00015 h. Although we find no evidence for rotational acceleration, YORP torques smaller than $\sim 10^{-8}\, \rm rad\,{d}^{-2}$ cannot be ruled out. It is likely that 2000 PN9 is a YORP-evolved object, and may be an example of YORP equilibrium or self-limitation.
Background:
There are different types of grafts for rhinoplasty, each with certain advantages and disadvantages. Fresh frozen cadaveric costal allograft (CCA) provides an alternative to ...rhinoplasties. The aim of this study was to compare the outcomes of fresh frozen CCA and traditional autologous costal cartilage in cosmetic and reconstructive rhinoplasty procedures.
Methods:
This is a prospective, single-center, nonrandomized, open-label clinical trial. Objective assessment to evaluate warping, resorption, and displacement of the cartilage was achieved by measuring the differences of standardized values (deviation angle, nasofrontal angle, total facial convexity, nasofacial angle, and nasolabial angle) obtained at 6-months and 12-months postoperative follow-up on standard two-dimensional photographs (Δ = ∣measurement
6
− measurement
12
∣). Subjective assessment was measured by the FACE-Q assessment.
Results:
Fifty eligible patients between March 2017 and October 2020 were included. The average age was 43.9 ± 16.6 years and the mean follow-up period was 14.8 months. In the control group, the changes (Δ) in the deviation angle and nasolabial angle were greater than in the CCA group (
P
< 0.05). In the CCA group, the mean score of satisfaction with nose improved at 6 months and 1 year postoperatively (
P
< 0.05). The mean score of satisfaction with nostrils and overall facial appearance also increased in the CCA group at 6 months postoperatively (
P
< 0.05). Six patients from the CCA group and 10 patients from the control group experienced postoperative complications.
Conclusions:
Fresh frozen CCA is a safe and reliable source of rhinoplasty grafts. It is aseptic, readily available, and free of donor site complications.
Patients with cleft lip often undergo a primary rhinoplasty at the time of lip repair, and further surgical correction with secondary cleft rhinoplasty (SCR) is often warranted for improved form and ...function. The purpose of this study was to better elucidate current practice patterns and trends for how SCR is performed in the United States. MethodsWe administered a survey to team surgeons affiliated with cleft lip and palate care teams approved by the American Cleft Palate Craniofacial Association (ACPA). ResultsWe received responses from 40 ACPA-approved teams for a response rate of 20.7%, with 59 total ACPA team surgeons completing the survey. 88.1% of surgeons perform intermediate cleft rhinoplasties. Among those who perform an intermediate cleft rhinoplasty, the mean age at which they would first consider the procedure is 5.83±2.66 years. The mean age for consideration of definitive cleft rhinoplasty was 15.86 ± 1.73 years. In both unilateral and bilateral cleft lips, a closed approach was more common in intermediate rhinoplasty, while an open approach was more common in definitive rhinoplasty (P < 0.001). The use of autologous grafts was more common in definitive rhinoplasty (P < 0.001), with 65% of respondents utilizing autologous grafts in greater than three-quarters of their procedures. ConclusionsWhen comparing intermediate with definitive cleft rhinoplasty, we found significant increase in the use of open techniques, autologous cartilage use for augmentation of the nasal tip, dorsal nasal support, and columellar sup- port. The considerable variability among surgeons highlights the lack of consensus regarding SCR.
As natural disasters increase in frequency and severity, policy makers question the safety and sustainability of housing in flood zones. Areas along the St. John River in New Brunswick are prone to ...spring floods. In the past 11 years, three significant floods have damaged and destroyed housing. The tradition of staying in place despite property damage is becoming harder to practice. This paper investigates housing decisions after the 2018 St. John River flood. Data are analyzed from focus groups with residents who experienced residential damage and/or displacement during the flood and from semi-structured interviews with key informants. The analysis indicates that residents' decisions to stay and move reflect attachment to home, integration within the community, practical considerations such as finances, and a range of emotional responses. These findings reinforce several theoretical perspectives on place and place attachment and indicate that policy makers need to consider the emotional and social implications of relocating communities and individuals in disaster prone areas.
Context. The potentially hazardous asteroid (85990) 1999 JV6 has been a target of previously published thermal-infrared observations and optical photometry. It has been identified as a promising ...candidate for possible Yarkovsky-O’Keefe-Radzievskii-Paddack (YORP) effect detection. Aims. The YORP effect is a small thermal-radiation torque considered to be a key factor in spin-state evolution of small Solar System bodies. In order to detect YORP on 1999 JV6 we developed a detailed shape model and analysed the spin-state using both optical and radar observations. Methods. For 1999 JV6, we collected optical photometry between 2007 and 2016. Additionally, we obtained radar echo-power spectra and imaging observations with Arecibo and Goldstone planetary radar facilities in 2015, 2016, and 2017. We combined our data with published optical photometry to develop a robust physical model. Results. We determine that the rotation pole resides at negative latitudes in an area with a 5° radius close to the south ecliptic pole. The refined sidereal rotation period is 6.536787 ± 0.000007 h. The radar images are best reproduced with a bilobed shape model. Both lobes of 1999 JV6 can be represented as oblate ellipsoids with a smaller, more spherical component resting at the end of a larger, more elongated component. While contact binaries appear to be abundant in the near-Earth population, there are only a few published shape models for asteroids in this particular configuration. By combining the radar-derived shape model with optical light curves we determine a constant-period solution that fits all available data well. Using light-curve data alone we determine an upper limit for YORP of 8.5 × 10−8 rad day−2. Conclusions. The bifurcated shape of 1999 JV6 might be a result of two ellipsoidal components gently merging with each other, or a deformation of a rubble pile with a weak-tensile-strength core due to spin-up. The physical model of 1999 JV6 presented here will enable future studies of contact binary asteroid formation and evolution.
Currently, patient reported outcome scales used to assess scar impact focus solely on psychosocial well-being, symptoms, and appearance. There remains a need to develop a broadened measure of scar ...impact on patients, focusing on sexual and career aspects. This study investigates the content validity of the novel Career and Sexual Well-being (CS) Scar Impact Scale.
The CS scale contains five questions and was developed from previous patient thematic analysis interviews describing scar impact, and covers self-conscious behavior, new partners, hiding of the scar, being hindered in the workplace, and concerns regarding unprofessional appearance. Cognitive interviews and established guidelines were used to ensure that the scale was comprehensive, reproducible, and easily understandable.
In total, 86 patients completed cognitive interviews. Patients had a clear understanding of the questions and elicited their intent in the interviews. An estimated 86% of patients rated the CS scale coverage of scar impact on career and sexual health at a three or above out of four; 95% said the specific instructions were clear, and 92% stated it took them less than 4 minutes to complete the scale. After the first round of interviews, a question about "perception/self-consciousness in a professional environment" was added based on patient suggestions.
The CS scar scale demonstrated face validity, acceptability, and field-readiness through cognitive interviewing of patients at our institution. Sexual well-being and career performance are important yet often neglected themes with which scars should be assessed. Usage of these tools would serve to improve current scar scales.
Background
Locally advanced basal cell cancer is a rare and challenging clinical problem. Historically, these patients were treated with aggressive surgery or radiotherapy. Most sporadic basal cell ...carcinomas have somatic mutations in the hedgehog pathway. Oral hedgehog inhibitors induce rapid and often complete clinical responses in locally advanced basal cell tumors. Unfortunately, these responses are usually transient. We hypothesized that treatment failure represents persistence of drug resistant cells that could be eradicated by addition of localized radiotherapy.
Materials and Methods
We performed a retrospective review of our patients with locally advanced basal cell cancer treated with sonidegib or vismodegib induction therapy who were treated with added superficial radiotherapy at the time of maximal response.
Results
Twelve patients met inclusion criteria. All patients achieved a complete response following hedgehog inhibitor therapy with addition of radiotherapy. Progression‐free survival at 40 months was 89%, with a median follow‐up of 40 months. Relapses occurred in only 2 of 12 patients (16.6%). Nine patients experienced grade I–II toxicity from hedgehog inhibitor induction therapy (taste changes 3, weight loss 3, muscle cramps 3). Eight patients experienced mild radiotherapy‐induced skin toxicity during concurrent therapy. No patients had to discontinue treatment.
Conclusion
Induction therapy with hedgehog inhibitors followed by addition of concurrent radiation therapy resulted in an extremely high clinical response rate with relatively minor and reversible toxicity. This gave a high rate of progression‐free survival and a low disease‐specific progression rate. Further prospective evaluation of this treatment approach is needed to confirm the apparent clinical activity.
Implications for Practice
Locally advanced basal cell cancers are challenging to treat. Previously, aggressive surgical resection or radiotherapy represented the best treatment options. Most basal cell cancers have somatic mutations in the hedgehog pathway. Oral inhibitors of this pathway produce rapid but transient clinical responses. This study reports 12 patients treated with hedgehog inhibitor induction therapy to near‐maximal response. Addition of concurrent involved field radiotherapy resulted in a very high complete response rate with minimal toxicity. There was prolonged progression‐free survival in 90% of patients. This study identified a novel treatment approach for patients with advanced basal cell carcinoma.
Locally advanced basal cell cancer is a rare and challenging clinical problem. This article reports a novel treatment approach.
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