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Willadsen E, Jørgensen LD, Alaluusua S, Pedersen NH, Nielsen JB, Hölttä E, Hide Ø, Hayden C, Havstam C, Hammarström IL, Davies J, Boers M, Andersen HS, Aukner R, Jackson Morris D, Nielsen SF, Semb G, Lohmander A, Persson C. Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Speech proficiency at 10 years of age. Int J Lang Commun Disord 2023; 58:892-909. [PMID: 36541222 DOI: 10.1111/1460-6984.12830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/21/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND & AIM To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project. METHODS & PROCEDURES Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B-Lip and soft palate closure at 3-4 months, hard palate closure at 36 months, Arm C-Lip closure at 3-4 months, hard and soft palate closure at 12 months, and Arm D-Lip closure at 3-4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A-Lip and soft palate closure at 3-4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported. OUTCOMES & RESULTS The mean levels of consonant proficiency (PCC score) in the trial arms were 86-92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50-73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%). CONCLUSIONS & IMPLICATIONS The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years. WHAT THIS PAPER ADDS What is already known on the subject Speech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5-year-olds. What this study adds to the existing knowledge Speech outcomes based on standardized assessment in a large group of 10-year-old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy. What are the potential or actual clinical implications of this work? Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.
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Affiliation(s)
- E Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - L D Jørgensen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - S Alaluusua
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - E Hölttä
- Cleft Palate and Craniofacial Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Ø Hide
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - C Hayden
- The Royal Hospital for Sick Children, Belfast, UK
| | - C Havstam
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I L Hammarström
- Division of Speech and Language Pathology, Linköping University, Linköping, Sweden
| | - J Davies
- Greater Manchester Cleft Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - M Boers
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - H S Andersen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - R Aukner
- Department of Speech and Language Disorders, Statped sørøst, Oslo, Norway
| | - D Jackson Morris
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - S F Nielsen
- Copenhagen Business School, Center for Statistics, Copenhagen, Denmark
| | - G Semb
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A Lohmander
- Division of Speech and Language Pathology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - C Persson
- Region Västra Götaland, Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pedersen NH, Grøntved A, Brønd JC, Møller NC, Larsen KT, Debrabant B, Koch S, Troelsen J, Brage S, Schipperijn J, Hjelmborg J, Wedderkopp N, Christiansen LB, Kristensen PL. Effect of nationwide school policy on device-measured physical activity in Danish children and adolescents: a natural experiment. Lancet Reg Health Eur 2023; 26:100575. [PMID: 36895450 PMCID: PMC9989658 DOI: 10.1016/j.lanepe.2022.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
Background A new Danish school policy with a requirement for 45 min physical activity daily during school hours was introduced in 2014. The objective of this natural experiment was to evaluate the effect of this nationwide school policy on physical activity in Danish children and adolescents. Methods Four historical studies completed between 2009 and 2012 comprised the pre-policy study population. Post-policy data were collected in 2017/18. All post-policy schools were represented in the four pre-policy studies. Age-groups and seasons were matched. In total, 4816 children and adolescents aged 6-17 were included in the analyses (2346 pre-policy and 2470 post-policy). Children and adolescents were eligible if they had accelerometer measurements and did not have any physical disabilities preventing activity. Physical activity was measured by accelerometry. Main outcome was any bodily movement. Secondary outcomes were moderate to vigorous physical activity and overall movement volume (mean counts per minute). Findings The school policy interrupted a linear decreasing pre-policy trend in physical activity during school hours. All activity outcomes increased post-policy during a standardized school day (8:10 am-1 pm). Increases were more pronounced in the youngest children. Specifically, we observed a daily increase during a standardized school day in 2017/2018 of 14.2 min of movement (95% CI: 11.4-17.0, p < 0.001), 6.5 min of moderate to vigorous physical activity (95% CI: 4.7-8.3, P < 0.001), and 141.8 counts per minute (95% CI: 108.5-175.2, P < 0.001). Interpretation A national school policy may be an important strategy to increase physical activity during school hours among children and adolescents. Funding The Danish Foundation TrygFonden has funded the PHASAR project (ID 115606).
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Affiliation(s)
- Natascha H. Pedersen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Jan C. Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Niels C. Møller
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Kristian T. Larsen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Birgit Debrabant
- Data Science and Statistics, Department of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9, Odense C 5000, Denmark
| | - Sofie Koch
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Jens Troelsen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Søren Brage
- MRC Epidemiology Unit, Cambridge School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Jasper Schipperijn
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Jacob Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9, Odense C 5000, Denmark
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
| | - Lars B. Christiansen
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Peter L. Kristensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Campusvej 55, Odense 5230, Denmark
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Andersen MY, Pedersen NH, Brabrand H, Hallager L, Jørgensen SB. Regulation of a continuous yeast bioreactor near the critical dilution rate using a productostat. J Biotechnol 1997; 54:1-14. [PMID: 9188198 DOI: 10.1016/s0168-1656(97)01668-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Regulation of a continuous bioreactor with Saccharomyces cerevisiae is investigated. A number of different sensors are evaluated for this purpose and the process dynamics is investigated around the critical dilution rate. A sensor for reducing gas concentration in exhaust gases is selected for regulating the substrate flow rate. Closed loop identification experiments are carried out to enable identification of the process dynamics near the critical diluton rate. Due to the time-varying nature of this process an adaptive regulator seems to be a promising tool for providing good regulatory and setpoint tracking performance. A simple third order model is used for a model based control design with a Linear Quadratic (LQ)-regulator. The LQ-regulator performs well experimentally, both in an adaptive version where the model parameters are updated on-line, and in a non-adaptive version. During the test the process is exposed to a large disturbance in substrate feed concentration and to a small setpoint disturbance. The proposed regulator is a practical realisation of a productostat where the product in this case is an undesired primary metabolite. Thus, this paper demonstrates a more general principle of utilizing metabolic overflow metabolism for directing fluxes through a desired metabolic pathway. This principle is applicable in the presented form, if a (by-)product can be measured on-line.
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Affiliation(s)
- M Y Andersen
- Department of Chemical Engineering, Technical University of Denmark, Lyngby, Denmark
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