Faculty Bibliography

Background/Purpose: The World Cleft Coalition (WCC) is an alliance of international non-governmental organizations (NGO's) that work in the area of cleft lip and palate and engage in long-term local capacity-building partnerships. The WCC was initiated at the 13th International Congress of Cleft Lip and Palate and Related Craniofacial Anomalies in Chennai, India in 2017. The objective set forth by Congress delegates at the end of the first NGO day NGO's: Think, Treat, Teach, was to encourage international collaboration in the development of an agreed set of globally recognized minimum core practice and best practice guidelines for safe and comprehensive cleft care. In addition to creating these guidelines, it was the collaborative process between the founding NGO's that was the unexpected strength and success of this initiative. It is an example of diverse organizations collaborating in the enhancement of cleft care. Methods/Description: Through collaboration among participating organizations (American Cleft Palate Craniofacial Association, European Cleft Organization, Global Smile Foundation, Operation Smile, Smile Train, and Transforming Faces) and consultations with outside constituents and partnerships, the WCC created an International Treatment Program Standards. From Feb 2017 to Present (Aug 2019), the team has met on monthly/bimonthly basis via video conferencing. This exchange was built on sharing experiences between the founding NGO's on what is of primary importance for ensuring the delivery of high quality cleft care in outreach settings. The group was able to present the core standards at the European Cleft and Craniofacial Equality Conference in Nis, Serbia, September 2018. This was followed by the official launch of the Program Standards at the 76th Annual ACPA Conference in Arizona in April 2019. This was followed by a presentation at the European Cleft and Craniofacial Meeting in Utrecht, Netherland, in June 2019.
Result(s): The goal was to compile standards for safe, comprehensive, and sustainable cleft care. The starting point was a review of existing guidelines (internal and external) to create globally recognized international treatment program standards. Focus was kept on ethical, safe, accessible, and patient-centered care, not on technique and timing. Attention for wording these guidelines was focused on being inclusive and encouraging while avoiding mandatory and prescriptive language. These national and international presentations also allowed significant feedback from various participants and organizations. Statements of official support, versus endorsement, are being considered. A website was constructed to enhance awareness and dissemination of the proposed standards. Recent acceptance for publication in the Cleft-Palate Craniofacial Journal.
Conclusion(s): This is an example of diverse organizations collaborating in the enhancement of cleft care globally

Background/Purpose: The World Cleft Coalition (WCC) is an alliance of international nongovernmental organizations (NGOs) that work in the area of cleft lip and palate and engage in long-term local capacitybuilding partnerships. The WCC was initiated at the 13th International Congress of Cleft Lip and Palate and Related Craniofacial Anomalies in Chennai in 2017. The objective set forth by Congress delegates was to encourage international collaboration in the development of an agreed set of globally-recognized minimum core practice and best practice guidelines for safe and comprehensive cleft care. Methods/Description: Through collaboration among participating organizations (American Cleft Palate Craniofacial Association, European Cleft Organization, Global Smile Foundation, Operation Smile, Smile Train, and Transforming Faces) and consultations with outside constituents and partnerships, the WCC created an "International Treatment Program Standards." Results: A series of overarching principles have been established and include (1) Safety in all aspects of cleft care, especially surgical, is essential and cannot be compromised. (2) Comprehensive care using a multidisciplinary team approach provides for the best possible cleft care. (3) Within the range of international treatment programs, all health-care professionals, visiting or practicing locally, must have recognized credentials, appropriate licensure, and expertise with proven experience in their field of practice. (4) Cleft care should always support and strengthen local capacity for delivering comprehensive cleft care. (5) Medical care should always be delivered at the highest professional level, taking the variability of local circumstances into consideration. (6) Services must be offered in a culturally appropriate manner and regardless of race, ethnicity, religion, socioeconomic background or community resources, with the goal of enabling patients to fully integrate into their societies and enjoy the same opportunities as their peers. (7) Health-care professionals should take all steps to ensure compliance with child protection safety measures. Overarching principles are followed by a structured and detailed Recommended Practice for Ensuring Safe, Comprehensive and Sustainable Cleft Care which includes minimum core and best practice for the following areas: surgical safety, quality control, patient education and selection, patient follow-up, comprehensive care, partnership with the host nations and professionals, training for sustainability, and local capacity building.
Conclusion(s): This collaborative process has generated agreed upon guidelines aimed at improving safe comprehensive cleft care globally. It is an example of diverse organizations collaborating in the enhancement of cleft care. The WCC is securing endorsements from key organizations involved in cleft care, and is working toward a comprehensive document to guide International Treatment and Educational Programs in attaining these aforementioned guidelines

OBJECTIVES: The study evaluated the safety and efficacy of stent reconstruction of stenotic/occluded iliofemoral veins (IFV) and inferior vena cava (IVC). BACKGROUND: Patients with congenital heart defects and stenotic or occluded IFV/IVC may encounter femoral venous access problems during future cardiac surgeries or catheterizations. METHODS: Twenty-four patients (median age 4.9 years) underwent implantation of 85 stents in 22 IFV and 6 IVC. Fifteen vessels were severely stenotic and 13 were completely occluded. Although guide wires were easily passed across the stenotic vessels, occluded vessels required puncture through the thrombosed sites using a stiff wire or transseptal needle. Once traversed, the occluded site was dilated serially prior to stent implantation. RESULTS: Following stent placement, the mean vessel diameter increased from 0.9 +/- 1.6 to 7.4 +/- 2.6 mm (p < 0.05). Twenty-one of 28 vessels had long segment stenosis/occlusion requiring two to seven overlapping stents. Repeat catheterizations were performed in seven patients (9 stented vessels) at mean follow-up of 1.6 years. Seven vessels remained patent with mean diameter of 6.4 +/- 2.0 mm. Two vessels were occluded, but they were easily recanalized and redilated. Echocardiographic follow-up in two patients with IVC stents demonstrated wide patency. In four additional patients, a stented vessel was utilized for vascular access during subsequent cardiac surgery (n = 3) and endomyocardial biopsy (n = 1). Therefore, 13 of 15 stented vessels (87%) remained patent at follow-up thus far. CONCLUSIONS: Stenotic/obstructed IFV and IVC may be reconstructed using stents to re-establish venous access to the heart for future cardiac catheterization and/or surgeries.

The purpose of this study was to describe the electromyographic (EMG) pattern and relative intensities of 8 shoulder muscles during the volleyball serve and spike in 15 professional or collegiate-level athletes. The EMG analysis was synchronized with high-speed cinematography to discern phases of the spike and serve. During the spike, the anterior deltoid and supraspinatus functioned together to elevate and place the humerus throughout all phases. During cocking the infraspinatus and teres minor acted together to rotate the humerus externally. In acceleration, however, these muscles behaved independently; activity of the teres minor remained high, whereas the activity of the infraspinatus declined. The anterior wall muscles functioned to decelerate the humerus during cocking and acted as internal rotators during acceleration. Muscle activities recorded for the serve followed similar patterns as those seen for the spike, but with lower amplitudes. These data illustrate the complex sequence of shoulder muscle activity necessary to play competitive volleyball.