OBJECTIVE: To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings.
METHODS: Cross-sectional analysis of prospectively collected data from 2019-2022.
METHODS: Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol.
METHODS: 714 English-speaking children and adolescents with non-syndromic cleft lip/palate.
METHODS: Routine multidisciplinary care and systematic outcomes measurement by cleft teams.
METHODS: Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress.
RESULTS: 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes.
CONCLUSIONS: This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of \"real-world\" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.

OBJECTIVE: To present the design and methodology for an actively enrolling comparative effectiveness study of revision palatoplasty versus pharyngoplasty for the treatment of velopharyngeal insufficiency (VPI).
METHODS: Prospective observational multicenter study.
METHODS: Twelve hospitals across the United States and Canada.
METHODS: Individuals who are 3-23 years of age with a history of repaired cleft palate and a diagnosis of VPI, with a total enrollment target of 528 participants.
METHODS: Revision palatoplasty and pharyngoplasty (either pharyngeal flap or sphincter pharyngoplasty), as selected for each participant by their treatment team.
METHODS: The primary outcome is resolution of hypernasality, defined as the absence of consistent hypernasality as determined by blinded perceptual assessment of a standard speech sample recorded twelve months after surgery. The secondary outcome is incidence of new onset obstructive sleep apnea. Statistical analyses will use propensity score matching to control for demographics, medical history, preoperative severity of hypernasality, and preoperative imaging findings.
RESULTS: Study recruitment began February 2021. As of September 2022, 148 participants are enrolled, and 78 have undergone VPI surgery. Enrollment is projected to continue into 2025. Collection of postoperative evaluations should be completed by the end of 2026, with dissemination of results soon thereafter.
CONCLUSIONS: Patients with VPI following cleft palate repair are being actively enrolled at sites across the US and Canada into a prospective observational study evaluating surgical outcomes. This study will be the largest and most comprehensive study of VPI surgery outcomes to date.

Previous research has identified alliteration as a powerful device for investigating implicit memory effects. For example, alliterative phrases can provide retrieval cues that extend to a sublexical level and reactivate previous information that shares alliterative content (Lea et al., Psychological Science, 19[7], 709-716, 2008). But it is an open question if other surface forms might provide similar effects in line with these empirical findings, and in accord with writer intuitions. The present study examined whether rhyme produces analogous memory-reactivation effects, given the ubiquity of its use and endorsement of its power in a range of materials and experiences. We also examined whether the surface benefits attributed to rhyme might support anticipatory processes such as those traditionally examined with semantic content. In Experiment 1, participants exhibited faster recognition responses to previous poetic content as a function of rhyming cues. In Experiment 2, we recruited participants identified as experts on the study and use of rhyme, replicating the probe facilitations obtained in Experiment 1, but also revealing anticipations of imminent rhymes. The results are discussed in terms of implications for theories of memory-based text processing and of nonsemantic anticipatory processes during the reading of poetry, and perhaps for discourse experiences more generally.

Vibrational Raman optical activity (ROA) spectra were calculated under off-resonance, near-resonance, and at-resonance conditions for [ Co ( en ) 3 ] 3 + (A) and under off-resonance conditions for [ Rh ( en ) 3 ] 3 + (B) using a new driver software for calculating the ROA intensities from complex (damped) time-dependent linear response Kohn-Sham theory. The off-resonance spectra of A and B show many similarities. At an incident laser wavelength of 532 nm, used in commercial ROA spectrometers, the spectrum of A is enhanced by near-resonance with the ligand-field transitions of the complex. The near-resonance spectrum exhibits many qualitative differences compared with the off-resonance case, but it remains bi-signate. Even under full resonance with the ligand-field electronic transitions, the ROA spectrum of A remains bi-signate when the electronic transitions are broadened such as to yield absorption line widths that are comparable with those in the experimental UV-vis absorption and electronic circular dichroism spectra.

BACKGROUND: Materials used for posterior pharyngeal wall augmentation have been associated with important complications (exogenous materials) or variable and unpredictable durability (exogenous and endogenous materials); therefore, introducing a different material for augmenting the posterior pharyngeal wall seems necessary for reviving this relatively forgotten technique.The purpose of this study was to emphasize on the use of a material associated with minimal complications and maximum recovery and durability in correcting VPI and the use of evaluative adjuncts such as nasoendoscopy and videofluoroscopy to assess surgical outcomes.
METHODS: In a pilot study, 24 patients underwent posterior pharyngeal wall augmentation with dermal fat graft harvested from the low crease abdominal region. Early and late complications, autologous graft durability in posterior pharynx, and speech improvement were assessed.
RESULTS: There was a significant improvement in hypernasality, nasal emission, and nasal grimace after posterior pharyngeal wall augmentation with dermal fat graft (p<0.0001). The authors observed no significant life-threatening complication. The most evident short-term complication was snoring, which occurred in five patients, and all relieved uneventfully.
CONCLUSIONS: The authors believe that augmenting the posterior pharyngeal wall with dermal fat graft is effective in improving hypernasality in patients with moderate velopharyngeal gap size and relatively adequate velar motion. This method has minimal complication profile because of autologous tissue application.

In pediatric cardiac surgery patients, when an artifact due to overdamping or to underdamping is suspected to affect the invasive arterial blood pressure (IABP) measure and waveform, a check against non-invasive blood pressure (NIBP) could be useful. In this study, we aimed to retrospectively analyze the differences between IABP (single site) and NIBP, measured at four limbs in children admitted to pediatric cardiac intensive care unit. Overall, 51 patients were enrolled for a total of 546 measurements. Average differences between IABP and NIBP measurements were relatively high with 42% of differences laying within the benchmark value of ± 5 mmHg. Differences on the measures on one limb vs. the others for systolic, diastolic, and mean arterial pressures were not significant (p = 0.16, 0.98, and 0.89, respectively). The systolic invasive-non-invasive differences were generally negative and diastolic and mean ones were generally positive. Correlations of clinical variables with arterial pressures at different sites were rather weak: age was associated with increased IABP-NIBP differences, whereas heart rate and vasoactive-inotropic score showed inverse correlation with IABP-NIBP deltas. Average systolic, diastolic, and mean IABP-NIBP differences of 45 patients without underdamping artifacts were not significantly different compared to those of 6 patients with underdamping (p = 0.17, 0.84, and 0.08, respectively). In conclusion, a wide bias can be detected in post-cardiac surgery children between IABP and NIBP pressures in more than half of measurements, with underdamping/resonance incidence being relatively low. Measurement of both methods without a limb preference should be considered in cardiac surgery children.

Keto-enol equilibrium is known to depend on the difference in the free energy between the keto and enol tautomers and is greatly influenced by the nature of the substituents, temperature, and the polarity of the solvents. New insight was gained into the series of twelve differently substituted β-diketones (A-L), showing that the keto form of each β-diketone has a lesser tendency towards resonance formation, compared to their enol forms. For molecules G and H (which contain an electron-withdrawing CF3 substituent), the experimentally reported high tendency towards the enol tautomer, was computationally traced to a high level of the alternative enolic resonance weight also in their keto structure, as well as to the highly favourable enolic inter-fragment stability of the energy of interaction. Computational results further showed that the polar solvent dioxane enhances the enol form of these twelve molecules more effectively than water and chloroform media. The abundance of either the enol or keto tautomer, was also found to be dependent on the competitive ratio of both the forward and reverse reaction rate constants (namely the computed values for Kforward/Kreverse). High similarity was observed between the experimental and computed UV spectra of the selected molecules in their enol forms, which provides further evidence supporting predictions for the most favourable position of the enolization (for unsymmetrical molecules E and G-L with two possible enol positions), as well as confirming the previously reported trend of their experimental equilibrium Ke/k values.

In the process of wood grading with the focus on detecting wood knots, nondestructive testing methods based on sound transmission can assist the traditional characterization methods to achieve a higher efficiency and better results. In this paper, we use two independent methods based on resonance and sound speed measurements to evaluate the elastic modulus of wood beams containing different knots. The results show that the method based on sound speed measurements offers a fast procedure to evaluate whether the knot is in the middle of the cross-section of the beam or not. In this case, both measuring methods are reliable in determining the knot\'s characteristics. In the off-center case, the resonance method performs better to quantify the size of the knots.

Very few studies have quantitatively analyzed influence of the loading frequency on time-domain vibration response of the whole lumbar spine in the presence of a physiologic compressive preload. In this study, a three-dimensional non-linear finite element model of ligamentous L1-S1 segment was developed to predict time-domain dynamic response of the whole lumbar spine to axial cyclic loading with different frequencies. A compressive follower preload of 400 N was applied to the model to simulate the physiologic compressive load. Modal analysis was initially performed to extract axial resonant frequency of the model under a 40 kg upper body mass and the 400 N preload. The result showed that the axial resonant frequency was 7.77 Hz. Subsequently, transient dynamic analyses were performed on the model under a sinusoidal axial load of ±40 N at frequencies of 3, 5, 7, 9, 11, 13 and 15 Hz with the 400 N preload and 40 kg mass. The computational results (strains and stresses in the spinal components) were collected and plotted as a function of time. These predicted results were found to be frequency-dependent and consistent with the notion in engineering dynamics texts that the closer the loading frequency approaches the resonant frequency, the larger the response is. For example, the results for 5 Hz load compared to 3 Hz load showed a 68.6-111.5% increase in peak-to-bottom variations of the predicted response parameters, and the results for 13 Hz load compared to 11 Hz load showed a 26.4-37.8% decrease in these variations.

OBJECTIVE: To evaluate the scoring of whole-body magnetic resonance imaging (WBMRI) for efficacy assessment in rheumatoid arthritis (RA) patients receiving biological disease-modifying anti-rheumatic drugs (bDMARDs).
METHODS: Thirty consecutive RA patients receiving bDMARDs were included in this retrospective study. Contrast WBMRI was performed before and 1 year after bDMARDs initiation.
RESULTS: At baseline, mean age was 57.1 years and mean disease duration was 3.0 years. Median disease activity score in 28 joints improved from 5.1 to 2.1. Treatment with bDMARDs improved mean whole-body synovitis score from 31.2 to 23.2 and median whole-body bone-edema score from 11 to 3. Whole-body bone-erosion score improved in seven patients and deteriorated in 17 patients. Logistic regression analysis identified whole-body synovitis score as a poor prognostic factor for whole-body bone-erosion progression. Bone-edema score in individual bones was identified as a poor prognostic factor for the progression of bone-erosion. Changes in hand synovitis score correlated with those of other joints, but neither changes in bone-edema nor erosion score of hands correlated with those of other joints in WBMRI.
CONCLUSIONS: WBMRI scoring may be a novel useful tool to evaluate the efficacy of anti-rheumatic drugs, as well as a potential predictor of joint prognosis, in patients with RA.