The deformation behaviour of the collapsing and destructured soils of the Sana'a area and their response to field treatment

Previous work has indicated the presence of collapsing and structured soils in the surface layers underlying Sana's, the capital of Yemen Republic. This study set out initially to define and, ultimately, to alleviate the problem by investigating the deformation behaviour of these soils through both field and laboratory programmes. The field programme was carried out in Sana'a while the laboratory work consisted of two parts, an initial phase at Sana's University carried out in parallel with the field programme on natural and treated soils and the major phase at Aston University carried out on natural, destructured and selected treated soils. The initial phase of the laboratory programme included classification, permeability, and single (collapsing) and double oedometer tests while the major phase, at Aston, was extended to also include extensive single and double oedometer tests, Scanning Electron Microscopy and Energy Dispersive Spectrum analysis. The mechanical tests were carried out on natural and destructed samples at both the in situ and soaked moisture conditions. The engineering characteristics of the natural intact, field-treated and laboratory destructured soils are reported, including their collapsing potentials which show them to be weakly bonded with nil to severe collapsing susceptibility. Flooding had no beneficial effect, with limited to moderate improvement being achieved by preloading and roller compaction, while major benefits were achieved from deep compaction. From these results a comparison between the soil response to the different treatments and general field remarks were presented. Laboratory destructuring reduced the stiffness of the soils while their compressibility was increasing. Their collapsing and destructuring mechanisms have been examined by studying the changes in structure accompanying these phenomena. Based on the test results for the intact and the laboratory destructured soils, a simplified framework has been developed to represent the collapsing and deformation behaviour at both the partially saturated and soaked states, and comments are given on its general applicability and limitations. It has been used to evaluate all the locations subjected to field treatment. It provided satisfactory results for the deformation behaviour of the soils destructed by field treatment. Finally attention is drawn to the design considerations together with the recommendations for the selection of potential improvement techniques to be used for foundation construction on the particular soils of the Sana's region.

Functional outcomes in the Cleft Care UK study - Part 3:oral health and audiology

OBJECTIVES: To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION: Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS: Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS: Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS: Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.

Centralization of cleft care in the UK. Part 6:a tale of two studies

OBJECTIVES: We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). SETTING AND SAMPLE POPULATION: A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. MATERIALS AND METHODS: We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. RESULTS: We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. CONCLUSIONS: Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.