bluuebunny/crossref_metadata_2025 huggingface dataset:
Policy Making and Local Governance: how Bristol failed to secure City Challenge funding (twice)
Authors: Malpass Peter
Published: November 2007

This article is concerned with the shift away from local government, with its emphasis on direct service provision by elected local authorities, to a system of local governance, in which authorities play roles as client, enabler and partner to a variety of private, voluntary and community organisations. The empirical focus of the paper is the City Challenge initiative, introduced by the British government in 1991. Drawing on interviews with the key actors involved with the initiative in Bristol, the paper explores the extent to which City Challenge opened up the policy making process, and seeks to explain why Bristol became almost the only city to fail to secure funding in two successive rounds of City Challenge bidding.
Toeing the Line: compliance cost assessment in Britain
Authors: Froud Julie , Boden Rebecca , Ogus Anthony , Stubbs Peter
Published: November 2007

This paper sets out the background and operation of the compliance cost assessment (CCA) procedure currently used in British Government and the objectives of a research project which aims to investigate it. A product of the general drive to deregulate, CCAs are designed to assess the potential impact on business costs of proposed regulations. The article outlines an initial set of questions which relate both to the philosophy and intended purpose of the CCA initiative generally and also to more detailed issues of how the cost assessments themselves are arrived at.
What can you do for your Country? Arguments for and against Clinton’s National Service Legislation
Authors: Mohan John
Published: November 2007

This paper outlines the National Service legislation in the USA introduced by President Clinton in 1993. It summarises some of the reasons why national service has attracted widespread popular and political support and considers the claims made for national service. These include: the potential of service for helping to over-come growing socio-spatial segregation in the USA; its contribution to solving urgent social problems; and its value in reconstructing the welfare agenda, replacing entitlements with programmes which emphasise the reciprocal responsibilities of those receiving aid. Some pilot programmes are examined and the claims of proponents of national service are then examined, putting service legislation in the wider context of the challenges facing the American welfare state and drawing lessons which may be of wider applicability.
Delivering Technical Assistance in Eastern Europe and Russia: lessons from the field
Authors: Struyk Raymond J.
Published: November 2007

Successful provision of sectoral technical assistance to the countries of Eastern Europe and the former Soviet Union is a singular challenge because the lessons learned from years of work in developing countries are only partially applicable. This paper describes a successful housing sector assistance program in the Russian Federation and recounts several lessons that might be drawn from this experience. Among these lessons, for example, is the necessity for genuine technical experts to be in residence in the country, as opposed to those with more general skills. This, in turn, requires that the assigned task be relatively well defined before dispatching the resident advisers. Such experts are more likely to win the professional respect of their counterparts, and can provide the ‘immediate’ policy work that is often required.
Putting Performance Measurement into Context: classifying social housing organisations
Authors: Walker Richard
Published: November 2007

The increasing role of performance measurement in the public sector raises questions about the comparability of comparisons. This paper examines the context which determines the performance of housing associations. This is achieved through an examination of the background to performance measurement in housing and housing associations in particular. The paper then explores methodological issues involved in developing a ‘standard classification’ of housing associations which aims to allow for meaningful comparisons. Conclusions point to data and methodological difficulties, whilst highlighting policy issues based around the growing number of comparisons in social housing, resource allocation and compulsory competitive tendering of housing management.
Producing the Right Sort of Chap: the senior Civil Service as an exclusionary culture
Authors: Watson Sophie
Published: November 2007

This paper draws on a series of detailed, qualitative interviews with senior British civil servants to explore the development and implementation of equal opportunity policy in the Civil Service. Introduced in the early 1980s, it was designed to reduce the importance attached to masculine traits in the recruitment and promotion of staff, including those on the fast track to senior positions. The paper concludes by arguing that career progression still depends heavily on giving the impression of being ‘the right sort of chap’, which itself embodies a set of attributes which happen to be more prevalent in men than in women.
The Politics of Community Care: social rights and welfare limits
Authors: Salter Brian
Published: November 2007

Community care policy forms part of the political and ideological problem of matching the dimensions of the welfare state to the resources available. In trying to implement a policy which increases citizenship rights and expectations yet further, health and local authorities are likely to deal with the consequent rationing problem by seeking both to control the demand upon their services and to protect their supply. This will mitigate against the cooperative intent at the heart of the policy and produce local tensions and conflicts.
Balancing User Choice and Resource Constraints: the role of review panels in social services departments
Authors: Parsloe Phyllida
Published: November 2007

The National Health Service and Community Care Act and subsequent guidance leave to complaints procedures the question of how conflicts, between users’ choice and local authority rationing of limited resources, are to be managed. These complaints procedures are flawed in two ways: the panels they establish are neither independent of the local authority whose work they are reviewing, nor can they obtain access to the information necessary to judge the level of need of the complainant relative to that of other users. The author writes from personal experience of acting as chairperson to one such review.
Managing Conception: Self-insemination and the limits of reproductive freedom
Authors: Doyal Lesley
Published: November 2007

This short paper provides an initial consideration of the social context of self-insemination. It examines the situation facing fertile women who wish to have children without the direct involvement of male partners or doctors and discusses some of the issues facing policy makers. The paper challenges the notion that children ‘need’ two parents and that they should be of different sexes.
Poverty in the 1980s: a comparison of the United States and the United Kingdom
Authors: Gaffikin Frank , Morrissey Mike
Published: November 2007

Historically, the ways in which poverty and welfare have been conceptualised in the US have substantially differed from the UK. This article explores the extent to which there has been a convergence in the distribution and characterisation of poverty in the 1980s in both. It reviews changing patterns of poverty, examines the theoretical debates and explores the manner in which the issue has been politicised. It concludes by arguing the case for convergence, qualified by the recognition that a common vocabulary has been deployed despite different nuances in each state.
Reflexivity and Uncertainty in the Research Process
Authors: Hoggett Paul , Jeffers Syd , Harrison Lyn
Published: November 2007

In this article we provide an account of the process of doing social scientific research–in this case an eighteen month study of ‘multi-racial’ community initiatives in three different localities in the UK. Given the transience of many such initiatives and the contested meanings that both ‘race’ and ‘community’ have acquired the experience of doing research in this area is one surrounded by uncertainty. We describe the mistakes made, blind allies pursued, accidents encountered and successes achieved in the belief that this is how research normally is and that others might learn more from this kind of account than from sanitised versions of how research ought to be.
The Contest for Control in Community Health Services: general managers and professionals dispute decentralisation
Authors: Exworthy Mark
Published: November 2007

General Managers (GMs) represent a relatively new cadre in the British National Health Service (NHS) who have become closely aligned with central government policy in recent years. GMs have increasingly been appointed to local levels in the NHS which could potentially lead to a clash with other professional domains. This paper uses the example of a decentralisation policy to trace the contest between GMs and professionals during its implementation. The paper focuses on Community Health Services (CHS) where the negotiated order of the hospital does not apply, where professional interests are more fluid and where organisational boundaries are ill-defined. It concludes that, at the local level, GMs are not simply agents of the centre but actively negotiate with other stakeholders and modify the policy according to local exigencies. The conclusion explores the implications for CHS of locally and centrally inspired policy initiatives and the place of CHS in the emerging mixed economy of welfare.
Joint Commissioning: organisational revolution or misplaced enthusiasm?
Authors: Hudson Bob
Published: November 2007

One of the paradoxes of the shift towards markets in health and social care has been the renewed emphasis upon more effective collaboration between the professionals and agencies involved. This has led to a search for ways of developing a range of joint ventures such as information sharing, joint community care planning and joint assessment of needs. However, the most ambitious collaborative vehicle is the emergence of joint commissioning between health and social care and possibly additional agencies. This article explores the background to the development of joint commissioning and the nature of joint commissioning, and examines some of the obstacles which will need to be overcome if the new joint commissioning ventures are to succeed. It concludes that joint commissioning is more than a merely ‘technical’ purchasing activity, and that the political dimensions also need to be confronted.
Population Size and Economies of Scale in Local Government
Authors: Boyne George
Published: November 2007

The existence of scale economies in the production of local government services is increasingly questioned by policy makers and academics. In place of the old orthodoxy that big is beautiful, a new orthodoxy is emerging that there are no significant scale effects. However, the empirical evidence does not warrant this conclusion. There may be scale economies in local services, but these relate to the output of service plants, not the size of the population; and there may be population effects on local performance, but these concern effectiveness and responsiveness rather than efficiency. Thus, economies of scale and population effects need to be tested separately but considered together in decisions on local government reorganisation.
Equity and Efficiency in Community Care: from muddle to model and model to …?
Authors: Davies Bleddyn
Published: November 2007

The community care reforms were partly a response to critiques of inequity and inefficiency in targeting and weak impacts of services on outcomes of value in their own right. The article revaluates criticisms made in the 1980s in the light of reform outcomes. The evidence is from a before-after study of the perceptions of triads of users, caregivers and care managers in cohort of new users recruited in 1984/5 and 1995. The provisional findings suggest reallocation of resources in the direction suggested by the critiques and policy statements, greater flexibility in packages, higher productiveness but higher unit costs of service inputs. However, the reforms still fall short of the goals, and raise important dilemmas.
Implementation Theory: yesterday’s issue?
Authors: Hill Michael
Published: November 2007

This article reviews the debate about implementation that has occurred over the past 20 years. It concludes that it has been helpful to focus attention upon ‘downstream’ events in the policy process. But it sees the ‘top down/bottom up debate’ as often unhelpfully confusing prescriptive concerns with analytical ones. In particular it suggests that there has been a dangerous tendency to separate implementation issues from policy-making issues, when what is important is to understand their inter-relationships.
Urban Policy and the Myth of Progress
Authors: Burton Paul
Published: November 2007

The article looks back over the last 22 years of urban policy development in the UK to consider three linked themes: the extent of progress in meeting the goals of urban policy; the degree of policy learning that has taken place within and beyond government; and the changing nature of the relationship between the state, the academy and civil society. These themes are further explored in an analysis of one of the key characteristics of urban policy - the continuing attempt to manage urban processes which result in racial discrimination and disadvantage. The paper concludes by posing a series of questions which might stimulate fresh debate on the purpose and scope of urban policy as we move into the next millennium.
Housing Policy: a case of terminal decline?
Authors: Bramley Glen
Published: November 2007

Housing policy in Britain in the postwar decades was important, politically, administratively and financially. In the I980s and 1990s, despite growing academic interest, professionalisation and sophisticated lobbying, housing is manifestly losing out as a policy priority to other areas such as health, social security and law and order. How does one account for this major shift, involving the progressive marginalisation of one ofthe major pillars ofthe welfare state? This article will examine a number of major explanations including crude demographics, structural economic change, ideology and electoral arithmetic. By looking at recent fluctuations in policy interest in housing some inferences are drawn on the circumstances which are still capable of bringing housing up the policy agenda. This also raises issues about the relationship between trends, long waves, and cycles in policy analogous to these phenomena in economics. Looking at the situation in other advanced countries casts further light on the general relationship between housing policy and stages of development. The paper concludes by drawing attention to the ways in which key aspects of housing policy have diffused into other adjacent policy arenas where they may attract different labels.
Beyond Policy and Politics: contingencies of employment equity
Authors: Young Ken
Published: November 2007

After an apparent hiatus, equal opportunity policies now seem set to enjoy a revival under the impetus of Eurepean Union initiatives. New initiatives build upon earlier approaches, but to be effective must avoid repeating the mistakes of the past. Among these mistakes is the assumption that ‘cultural change’ within organisations is both attainable and required in order to remedy inequalities. In this paper, the pursuit of cultural change is subjected to critical analysis, together with some common misunderstandings about the factors making for unequal employment outcomes. A number of real-world exclusionary barriers are then examined, drawing upon evidence generated from a survey of more than 1,000 women managers in local government. It is argued that these barriers provide a more appropriate subject for policy and politics, and that their removal can facilitate the organisational impact of more gradual societal change.
Community Development at the Crossroads: a way forward
Authors: Millerand Chris , Ahmad Yusuf
Published: November 2007

This article considers the resurgence within recent policy debates of community development as one of the most effective intervention strategies both for purposes of social legitimation and effective service delivery. It locates this new found prominence within the overall restructuring of social welfare dominated by market oriented philosophies. The article considers a range of explanations for this growing popularity and examines the contribution of occupational networks in promoting community development’s effectiveness across both a range of services and in respect of local governance. Finally. whilst highlighting what we see as some of the shortcomings in the current debates, we explore the possibilities for a progressive practice that goes beyond the politics of welfare.
The ‘Active Society’: new designs for social policy
Authors: Walters William
Published: November 2007

This paper interrogates the idea of the ‘active society’, a design for social policy recently proposed by the Organisation for Economic Cooperation and Development. First, it compares the active society with an earlier organising principle for public policy, the welfare society. Whereas the welfare society governed populations by dividing them into workers and various categories of non-worker, the active society makes participation in paid employment the norm for most social groups. Second, the paper can be read as a contribution to a genealogy of social policy. For the active society challenges the logic of social security: it stakes the welfare of individuals upon their ability to constantly work on themselves, through practices like lifelong learning, to become or remain employable.
Evaluating Special Measures for the Unemployed: some reflections on recent UK experience
Authors: Fletcher Del Roy
Published: November 2007

The growing significance of long term unemployment across Europe in the last decade has underlined the need for policy makers to understand and improve responses to unemployment. However, there is a growing debate about the relationship between research and policy development with concerns being expressed both by researchers and policy makers. While working for the Employment Service the author evaluated measures to reintegrate the long term unemployed into the labour market. This article draws upon that experience to examine critically the relationship between research and policy development.
The Reformed System of Local Government Finance in Scotland
Authors: Midwinter Arthur , McGarvey Neil
Published: November 2007

This article examines the principles behind recent reforms in local government finance in Scottish local government. It is argued that whilst the local tax reform has been implemented relatively smoothly, the other reforms which accompanied it have been more problematic. In particular the switch from selective to universal capping has resulted in the unintended consequence of previous ‘underspenders’ spending much closer to their centrally determined level. Accountability has also become increasingly blurred due to increased local dependence on grant. The large mismatches between Government Assessed Expenditure levels and notional budgets have clouded the picture still further.
European Policy and the Politics of Environmental Governance
Authors: O’Brien Martin , Penna Sue
Published: November 2007

In this paper we focus on identifying some of the important sociological dimensions of the process of environmental governance through a review of European regulatory frameworks and instruments, specifically in regard to the European Union’s Fifth Action Programme on the Environment (5EAP). We show that such policies and the institutions and social networks that promote them are locked into wider social dynamics in the political regulation of European economic and social integration and development. We argue that the 5EAP is a ‘redrafting of Rio’ in the context of these processes of regulation and integration rather than a systematic rearrangement of society-economy-environment relationships. These processes can be described through the three political dynamics of veto, deflection and differentiation. Focusing on the level of political dynamics provides methodological resources that can contribute to the programme of research developed by the Regulation Approach (RA) (Jessop, 1994a et passim), in particular by accounting for the conflicts and struggles between organised socio-economic actors rather than their (quasi-functionalist) cohesive structural relations that serve a dominant ‘strategic line’ of accumulation.
The Local Councillor and Party Group Loyalty
Authors: Copus Colin
Published: November 2007

English

The political party group, that coherent and disciplined body of councillors acting under the same political label within the council chamber, has long been an important influence within British local government. The party group brings form and substance to the activities of political colleagues; it is the private venue where councillors conduct representation, and make decisions, binding councillors in their public activities. This article examines the factors responsible for British councillors’ willingness to give the group their loyalty. It questions assumptions that group disciplinary mechanisms are the only reason why councillors act in a coherent fashion within the council chamber. Such arguments underestimate the ability of the party group to command the loyalty of its members and to exert a powerful influence over the processes of local representation.
The Introduction of Strategic Management to Local Authority Museums in Britain: a missing link between policy and organisation theory
Authors: Kawashima Nobuko
Published: November 2007

English

Public authorities in charge of museums have over the last decade been recommending the introduction of strategic management to the museum sector in the UK. However, in the local authority museum sector at least, the recommended procedure has not been as useful as is generally thought. This article delineates some of the distinctive features of museum organisation which have contributed to making the standard model of museum management difficult to operationalise in practice, and questions the basic assumptions of the model. The article concludes by calling for the need to enhance the relationship between organisation theory and policy analysis.
The Constructive Potential of Citizenship: building European union
Authors: Wiener Antje
Published: November 2007

English

This article seeks to develop a way of assessing the constructive potential of citizenship based on its newly institutionalised terms such as the shared values, objectives and regulations that have been established by citizenship policy over time. It builds on a study of European citizenship policy making over two decades. Beyond describing the emergence of citizenship, it promotes a systematic approach to reconstructing the policy in this supranational context. It is assumed that citizenship did not emerge out of the blue on the agenda of the Maastricht Intergovernmental Conference which negotiated the Treaty of European Union in 1990–91, but that it is possible to identify agenda-setting steps in earlier stages of the policy process.
The Theory and Practice of Citizens’ Juries
Authors: Smith Graham , Wales Corinne
Published: November 2007

English

Citizens’ juries are currently being promoted by a range of organisations which claim that they offer an institutional setting in which citizens are afforded a meaningful opportunity to deliberate on matters of public policy. This article argues that the emphasis on deliberation in citizens’ juries should be of interest to theorists of deliberative democracy who often fail sufficiently to address the question of institutional design. The practice of citizens’ juries is considered in light of the ideals of deliberative democratic theory. It is argued that with careful attention to the design of the different stages of the jury process, citizens’ juries can offer a legitimate and innovative approach to public participation in decision-making processes in contemporary democracies.
Towards Sustainable Waste Management: central steering, local enabling or autopoiesis?
Authors: Entwistle Tom
Published: November 2007

English

As the UK’s Labour government prepares a new strategy for sustainable waste management, this article considers the efficacy of the previous Conservative government’s endeavours. Confusion over the relative merits of reclamation, incineration and landfill has diverted attention from the key priority of minimising waste and increasing recycling. This article considers the muddled aspirations of the Conservative government’s policy; its reliance on indirect policy instruments; the capacity of local authorities to respond to these aspirations; and the suggestibility of the greater waste management system. Sustainability may require more sweeping a reconfiguration of the waste management system than has hitherto been considered.
Insomnia and cerebral hypoperfusion
Authors: Káposzta Zoltán , Rácz Klára
Published: November 2007

Az insomnia elalvási és átalvási nehezítettséget jelent, mely az alvás mennyiségének és minőségének elégtelensége révén a másnapi fizikai és szellemi teljesítőképesség csökkenését okozza. Világszerte csaknem minden harmadik ember szenved alvászavarban. Az insomniának primer és szekunder formáját lehet megkülönböztetni. A primer kórforma oka ismeretlen, de a vizsgálatok szerint az anyagcsere felfokozott szintje, egyfajta készenléti állapot jellemzi. A szekunder kórforma egyik oka lehet a cerebralis hypoperfusio. A parenteralis vascularis terápián túl a primer insomniában is alkalmazott korszerű, „alvásbarát” készítmények (Zolpidem, Zopiclone, Zaleplon) használhatók insomniában szenvedő agyi érbetegekben. Midazolam altatószerként való alkalmazása nem tanácsos, mert ez további agyi vérátáramlás-csökkenést okozva növeli a betegek egyébként is magas stroke-rizikóját. Hazánkban még kiépítésre vár a multidiszciplináris insomnia-szakambulanciák hálózata. Létrehozásuk azért szükséges, mert századunkban az alvászavar nemcsak kezelendő betegség, hanem jelentős népegészségügyi problémává is vált.
The Effects of Temperature, Dissolved Oxygen, and Asian Tapeworm Infection on Growth and Survival of the Topeka Shiner
Authors: Koehle Jessica J. , Adelman Ira R.
Published: November 2007

The Topeka shiner Notropis topeka is an endangered fish species, historically described as inhabiting cool, headwater prairie streams. However, Topeka shiners recently have been found in off‐channel habitats with high temperatures and low concentrations of dissolved oxygen. In laboratory experiments to determine whether Topeka shiners can tolerate the conditions in these off‐channel habitats for extended periods, we found that their optimum temperature for growth was approximately 27°C and their critical thermal maximum was 39°C at a 31°C acclimation temperature. Topeka shiners grew at dissolved oxygen concentrations as low as 2 mg/L, but at a considerably lower rate than at 4 mg/L and above. The concentration of dissolved oxygen that was lethal for 50% of the fish after 96 h at 26°C was 1.26 mg/L. Growth was reduced by Asian tapeworm infections. Overall, high temperatures and low dissolved oxygen are probably not limiting factors for Topeka shiner populations in most off‐channel habitats.
Speech Intelligibility of Patients with Cleft Lip and Palate after Placement of Speech Prosthesis
Authors: Pinto João Henrique Nogueira , Dalben Giseleda Silva , Pegoraro-Krook Maria Inês
Published: November 2007

Objective:

To evaluate the speech intelligibility of patients with clefts before and after placement of a speech prosthesis.

Design:

Cross-sectional.

Setting:

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, Brazil.

Patients:

Twenty-seven patients with unoperated cleft palate or operated cleft palate presenting with velopharyngeal insufficiency (VPI) after primary palatoplasty, treated with speech prosthesis, aged 8 to 63 years.

Interventions:

Patients were fitted with palatopharyngeal obturators or pharyngeal bulbs, suitable to their dental needs. Five speech-language pathologists blindly evaluated speech samples of the patients with and without the prosthesis.

Main Outcome Measures:

Classification of speech samples according to a scoring system developed for speech intelligibility problems: 1 (normal), 2 (mild), 3 (mild to moderate), 4 (moderate), 5 (moderate to severe), and 6 (severe). Results were evaluated by the calculation of means of all judges for each patient in both situations.

Results:

The judges presented significant agreement (W = .789, p < .01). Speech intelligibility was significantly better after placement of the prosthesis for both unoperated patients (Z = 1.93, p = .02) and operated patients with VPI after primary palatoplasty (Z = 1.78, p = .03).

Conclusions:

Speech intelligibility may be improved by rehabilitation of patients with cleft palate using a speech prosthesis. Speech therapy is needed to eliminate any compensatory articulation productions developed prior to prosthetic management.
Van der Woude Syndrome: Clinical Presentation in 64 Patients
Authors: Huang Jung-Ju , Hou Jia-Woei , Tan Ying-Chien , Chen Kuo-Ting , Lo Lun-Jou , Chen Yu-Ray
Published: November 2007

Objective:

Van der Woude syndrome, characterized by lip pits and cleft lip/ palate, presents with variable expressions. This retrospective study was designed to obtain a better understanding of its clinical pattern in Taiwanese patients.

Materials and Methods:

Of 13,147 cleft patients treated at the Chang Gung Craniofacial Center from 1976 to 2004, there were 64 with Van der Woude syndrome. Clinical expressions and family histories were collected and analyzed.

Results:

The male to female ratio was 1:1. The majority had complete cleft types. Severe cleft was found among the patients, with 52% having bilateral cleft lip and palate, 31% having unilateral cleft lip and palate, and 17% having isolated cleft palate. A positive family history was found in 53.1% of the patients. The size, shape, location, and depth of the pits varied among patients.

Conclusion:

Clinical presentations did not always parallel those reported in the literatures. These differences warrant further investigation.
Describing Cleft Lip and Palate Using a New Expression System
Authors: Koul Rakesh
Published: November 2007

The wide spectrum of variations in the types of cleft lip and cleft palate has made standardized and inclusive classification difficult. This article introduces a new method for recording all types of cleft lip and cleft palate for data storage and communication. The proposed Expression System incorporates the actual words for the anatomical structures affected by clefts and can describe in a quickly understood form, without the need to consult reference materials, the location and extent of both typical and atypical clefts. The Expression System overcomes several limitations of previous cleft registration methods, and its simplicity and precision will benefit dental and medical specialists by furthering inter- and intradisciplinary communication.
Supernumerary Nostril with Complete Unilateral Cleft Lip: A Case Report and Review
Authors: Powar Rajesh S. , Tubaki Vijay R.
Published: November 2007

The supernumerary nostril is an extremely rare congenital anomaly of duplication. A review of the literature shows that only 17 cases have been reported in the world. The supernumerary nostril in association with facial clefting is even more rare, with only three cases reported so far. We are reporting a case of supernumerary nostril in association with complete unilateral cleft lip without cleft palate, which happens to be the first case of its kind to be reported. Most supernumerary nostrils are situated superior to the normal nostrils and very few of them are situated at the same level or below the normal nostrils. In this case, the supernumerary nostril was placed lateral to the normal nostril.
Radiological Findings and Dynamic Aspects of Stomatognathic Structures in Treacher Collins Syndrome: Clinical Case Report
Authors: de Oliveira Lira Ortega Adriana , Liarte Figueiredo Zwir Liete Maria , Ciamponi Ana Lídia , Guimarães Antônio Sérgio , Alonso Luis Garcia
Published: November 2007

Treacher Collins syndrome usually affects bilateral and symmetric structures that include the orbits, mandible, and ears. The purpose of this report is to describe a clinical case of the syndrome, focusing on the anatomy of the temporomandibular joint, which was assessed using the computed tomography method. Clinical examination included evaluation of mandibular dynamics, investigation of temporomandibular dysfunction, and measurement of bite force. Significant morphological and functional alterations were observed but without significant documented clinical consequences.
Cases of True and False Median Cleft with Polypoid Masses in the Facial Midline
Authors: Imai Yoshimichi , Seino Hiroto , Toriyabe Souhachi , Tachi Masahiro , Yamada Atsushi
Published: November 2007

We describe cases of true and false median cleft combined with polyps. The polyp in the true median cleft was microscopically a skin polyp consisting of fatty tissue and was considered to be subsequent compensatory partial excess caused by impediment at the embryonic stage. The polyp in the false median cleft was considered to be a failure of the nasal septum derived from the nasal (ectethmoid) capsule. The features of these cases were considered of interest because they exhibited transient forms of the cleft. The histological findings of each polyp reflected the distinctive features of each median cleft.
Functional Outcomes of Cleft Lip Surgery. Part IV: Between- and Within-Participant Variables Affecting Lip Vermilion Sensory Thresholds
Authors: Essick Greg K. , Phillips Ceib , Trotman Carroll-Ann
Published: November 2007

Objective:

Compare neurosensory assessments for participants with and without a cleft lip; identify between- and within-participant variables affecting sensory thresholds on the vermilion of participants with cleft lip.

Design:

A parallel group, nonrandomized clinical trial.

Subjects:

There were 56 participants with cleft lip and 37 noncleft participants.

Analysis:

Two-point perception and warmth and cool detection thresholds were measured on the right and left sides of the upper and lower vermilion. A cotton-tip stick, stroked across the skin, was used to identify altered sensation. Linear mixed effects modeling was used to examine the effects of between- and within-participant variables on the thresholds.

Results:

Threshold values on the upper and lower vermilion were similar for cleft and noncleft participants and were unaffected by the presence of a cleft on the side tested. Participants with cleft lip who reported hyposensitive altered sensations had higher two-point thresholds on the upper lip than those who reported hypersensitivity. Participants with cleft lip who reported altered midface sensation had lower warmth detection, but higher cool detection thresholds, on the lower vermilion than participants with cleft lip who did not report altered sensation. Participants with bilateral cleft lip had lower warmth detection thresholds on the upper vermilion than participants with unilateral cleft lip.

Conclusions:

Although participants with cleft lip and noncleft participants exhibit similar thermal and two-point discrimination, on average, differences exist among subgroups of participants with cleft lip that may reflect central disturbances in the processing of somatosensory stimuli.
Functional Outcomes of Cleft Lip Surgery. Part III: Measurement of Lip Forces
Authors: Trotman Carroll-Ann , Barlow Steven M. , Faraway Julian J.
Published: November 2007

Objective:

To investigate lip force dynamics among participants with a repaired cleft of the lip and noncleft control participants.

Design:

A parallel, three-group, nonrandomized clinical trial.

Subjects:

Forty-eight participants with cleft lip and 36 noncleft participants.

Analysis:

Participants attended two separate visits. At each visit, they were instructed to produce fine motor control and maximum compression forces with each upper and lower lip in response to visual force targets. Measures of force were extracted, and the data were fit using regression techniques.

Results:

The upper and lower lips of the participants with a cleft lip demonstrated less time on target, while the lower lips had shorter rise time but higher peak forces, a higher rate of force recruitment, and increased maxima of the first derivative of force compared with the noncleft participants. For all participants, there was a learning effect for certain force variables between the two visits and with increasing age.

Conclusion:

For participants with a cleft lip, force regulation of the circumoral region within the operating range presumed important for facial and speech animation is compromised because of impairments in force recruitment, gradation, fractionation, and stability. In the presence of a change in upper lip tissue mechanics due to scarring or neuromotor impairment, such as a cleft, the lower lip typically exhibits compensatory motor actions.
The Square Flap Method for Cleft Palate Repair
Authors: Xu Jing-Hong , Chen Hong , Tan Wei-Qiang , Lin Jun , Wu Wei-Hua
Published: November 2007

Objective:

To introduce a new surgical technique for repair of cleft palate using the square flap method.

Design and Setting:

A retrospective analysis of prospectively collected data.

Patients and Methods:

The procedure was performed from 1995 to 2004 in 21 males and 16 females with cleft palates of different types; the patients had a median age of 6.0 years and an average age of 9.4 years (range from 22 months to 23 years). In these patients, the square flap method, consisting of one rhombic flap and four triangular flaps, designed on the soft palate across the defect, was applied to the von Langenbeck procedure. After incisions, the flaps were rotated and advanced, and each flap was inserted into the opposite side and then sutured. The patients were followed from 6 months to 2 years, the velopharyngeal closure was examined by nasopharyngeal fiberscope and/ or x-ray radiography, and a clinical speech evaluation was performed.

Results:

In all cases, no problem of flap viability was encountered and all healed well. The postoperative results were satisfactory without any complications such as dehiscence, perforation, palatal fistula, or functional disturbance. The velopharyngeal closure and clinical speech evaluation were satisfactory, and the effects of the operation were stable.

Conclusions:

The technique presented has been effective, with the advantages of palatal closure without tension, good muscular reconstruction, and sufficient lengthening of the soft palate.
Oral Rehabilitation of a Patient with Complete Unilateral Cleft Lip and Palate Using an Implant-Retained Speech-Aid Prosthesis: Clinical Report
Authors: Abreu Amara , Levy Daniel , Rodriguez Enrique , Rivera Irma
Published: November 2007

Objective:

To report the oral rehabilitation of velopharyngeal insufficiency due to a congenital anatomic defect using an implant-retained speech-aid prosthesis.

Case Report:

A 65-year-old man with a diagnosis of complete unilateral cleft lip and palate on the left side with an unrepaired palate was examined. A removable partial denture with a speech bulb had been used for approximately 40 years. After primary care for gross caries and tooth mobility, an implant-retained obturator with a speech bulb was fabricated.

Results and Conclusion:

Improvement in mastication, speech, and velopharyngeal function was achieved with a satisfactory esthetic result.
The Pittsburgh Fistula Classification System: A Standardized Scheme for the Description of Palatal Fistulas
Authors: Smith Darren M. , Vecchione Lisa , Jiang Shao , Ford Matthew , Deleyiannis Frederic W. B. , Ann Haralam Mary , Naran Sanjay , Worrall Christine I. , Dudas Jason R. , Afifi Ahmed M. , Marazita Mary L. , Losee Joseph E.
Published: November 2007

Objective:

Vague terminology is a problem in cleft palate research. No classification scheme for palatal fistulas has been proposed to date. Although a well-healed velum is a significant outcome of palatoplasty, it is nearly impossible to compare fistula-related palatoplasty results in the literature or in medical records without a standardized vocabulary. We endeavor to devise a palatal fistula classification system that may have clinical and research applicability.

Design:

PubMed was searched for definitions and classifications of palatal fistula as well as incidence and recurrence rates of this outcome. Next, a 25-year retrospective review of our Cleft Center's records was performed, and fistulas were identified (n = 641 charts reviewed). The fistula descriptions yielded by this chart review were evaluated in the context of anatomical descriptions in the literature, and a clinician-friendly classification scheme was designed.

Results:

A literature review failed to reveal a standardized fistula classification system. An anatomically based numerical fistula classification system was devised: type I, bifid uvula; type II, soft palate; type III, junction of the soft and hard palate; type IV, hard palate; type V, junction of the primary and secondary palates (for Veau IV clefts); type VI, lingual alveolar; and type VII, labial alveolar.

Conclusions:

We propose a standardized numerical classification system for palatal fistulas. Its clinical adoption may prospectively clarify ambiguities in the literature and facilitate future cleft palate research and clinical practice.
Buccal Anomalies, Cephalometric Analysis and Genetic Study of Two Sisters with Orofaciodigital Syndrome Type I
Authors: Romero Martín , Franco Brunella , del Pozo Jaime Sánchez , Romance Ana
Published: November 2007

Orofaciodigital syndromes have many clinical and cephalometric anomalies, including facial irregularities, oral cavity abnormalities, and malformations of fingers and toes. In this case of twin girls, buccal exploration, cephalometric examination, and genetic analysis were performed to diagnose Orofaciodigital I or Orofaciodigital II syndrome. Clinically, the twins had several dental and skeletal irregularities. Genetic analysis revealed a DNA segment abnormality corresponding to exon 3 and presence of nucleotide change, 243C>G, leading to the missense mutation H81Q. This causative mutation associated with the OFD1 gene has not been reported previously. Both patients were diagnosed as having Orofaciodigital I syndrome.
Cardioinductive Network Guiding Stem Cell Differentiation Revealed by Proteomic Cartography of Tumor Necrosis Factor α-Primed Endodermal Secretome
Authors: Arrell D. Kent , Niederländer Nicolas J. , Faustino Randolph S. , Behfar Atta , Terzic Andre
Published: November 2007

In the developing embryo, instructive guidance from the ventral endoderm secures cardiac program induction within the anterolateral mesoderm. Endoderm-guided cardiogenesis, however, has yet to be resolved at the proteome level. Here, through cardiopoietic priming of the endoderm with the reprogramming cytokine tumor necrosis factor α (TNFα), candidate effectors of embryonic stem cell cardiac differentiation were delineated by comparative proteomics. Differential two-dimensional gel electrophoretic mapping revealed that more than 75% of protein species increased >1.5-fold in the TNFα-primed versus unprimed endodermal secretome. Protein spot identification by linear ion trap quadrupole (LTQ) tandem mass spectrometry (MS/MS) and validation by shotgun LTQ-Fourier transform MS/MS following multidimensional chromatography mapped 99 unique proteins from 153 spot assignments. A definitive set of 48 secretome proteins was deduced by iterative bioinformatic screening using algorithms for detection of canonical and noncanonical indices of secretion. Protein-protein interaction analysis, in conjunction with respective expression level changes, revealed a nonstochastic TNFα-centric secretome network with a scale-free hierarchical architecture. Cardiovascular development was the primary developmental function of the resolved TNFα-anchored network. Functional cooperativity of the derived cardioinductive network was validated through direct application of the TNFα-primed secretome on embryonic stem cells, potentiating cardiac commitment and sarcomerogenesis. Conversely, inhibition of primary network hubs negated the procardiogenic effects of TNFα priming. Thus, proteomic cartography establishes a systems biology framework for the endodermal secretome network guiding stem cell cardiopoiesis.

Disclosure of potential conflicts of interest is found at the end of this article.
Concise Review: MicroRNA Expression in Multipotent Mesenchymal Stromal Cells
Authors: Lakshmipathy Uma , Hart Ronald P.
Published: November 2007

Mesenchymal stem cells, or multipotent mesenchymal stromal cells (MSC), isolated from various adult tissue sources have the capacities to self-renew and to differentiate into multiple lineages. Both of these processes are tightly regulated by genetic and epigenetic mechanisms. Emerging evidence indicates that the class of single-stranded noncoding RNAs known as microRNAs also plays a critical role in this process. First described in nematodes and plants, microRNAs have been shown to modulate major regulatory mechanisms in eukaryotic cells involved in a broad array of cellular functions. Studies with various types of embryonic as well as adult stem cells indicate an intricate network of microRNAs regulating key transcription factors and other genes, which in turn determine cell fate. In addition, expression of unique microRNAs in specific cell types serves as a useful diagnostic marker to define a particular cell type. MicroRNAs are also found to be regulated by extracellular signaling pathways that are important for differentiation into specific tissues, suggesting that they play a role in specifying tissue identity. In this review, we describe the importance of microRNAs in stem cells, focusing on our current understanding of microRNAs in MSC and their derivatives.

Disclosure of potential conflicts of interest is found at the end of this article.
Evaluation of Zone Soil Sampling Approaches for Phosphorus and Potassium Based on Corn and Soybean Response to Fertilization
Authors: Sawchik Jorge , Mallarino Antonio P.
Published: November 2007

Soil sampling approaches have been compared based on soil‐test variation. This study evaluated sampling approaches for P and K based on yield response to fertilization. Strip trials were established on four fields for P and three fields for K managed with corn (Zea mays L.) and soybean (Glycine max L. Merr.) rotations and evaluated 3 or 4 yr (27 site‐years). Treatments replicated three to four times were fertilizer and no fertilizer application. Soil test results from a dense grid‐point sampling (DG) approach (0.08 to 0.27 ha) were used to simulate six approaches: (i) 1.0‐ha grid cells (GC), and zones delineated based on (ii) soil series from digitized survey maps (SMZ); (iii) elevation (EZ); (iv) apparent soil electrical conductivity, ECa (ECZ); (v) EZ and ECZ (EECZ); and (vi) EZ, ECZ, and slope (EECSZ). Grain yield monitors, global positioning systems (GPS), and geographical information systems (GIS) were used to describe crop responses. Estimates of soil‐test variation were largest for DG, intermediate for GC, and less for other approaches. Crops responded (P ≤ 0.05) to fertilization in 20 site‐years. Sampling approaches DG, GC, EZ, EECZ or EECSZ, ECZ, and SMZ identified a differential within‐field yield response in 16, 8, 5, 3, 2, and 2 site‐years, respectively. Differential yield responses seldom were explained by zone‐mean soil‐test values. Zone approaches often identified areas with different yield levels but were less effective than DG or GC at describing within‐field variation of soil tests and yield response to fertilization. Zone approaches may be more effective in fields with shorter fertilization histories or soils with more contrast in properties.