Beneath the technological fix. Outliers and probability statements.
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Biomedical subjects
Publications and source records attributed to A F Johnson.
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This project aims: 1) to appraise the psycho-social development of a sample of latency-aged spina bifida children upon entry to school; 2) to learn about the social influences that promote or impede the child's development, and 3) to identify ways that psycho-social intervention can be useful to families in which there is a congenitally disabled child. A longitudinal, observational case study was conducted over a six month period. This approach provided information on the impact of social influences, disability, and trauma on the child's development. The results indicate that a delay in reaching the important physical milestones of independent locomotion and continence hinders the achievement of standard psycho-social developmental goals; it does not exclude their achievement. By the sixth month in first grade, all of the children had adapted satisfactorily to school. Thus, the difference between the able-bodied and the spina bifida child was not one of kind, but one of degree. Spina bifida was found to put no ceiling on the child's psycho-social development.
Cluster analysis was used to identify two homogeneous clusters of 8-9 1/2-year-old children who misarticulated /s/, /r/, or both. The analysis was based on the children's scores on 40 measures of language, reading, auditory processing, and other variables. Discriminant function analysis was then used to identify a subset of five measures and a means of computing classification scores. These measures and the classification scores can be used to identify the cluster membership of new subjects. The use of classification scores for identifying cluster membership was cross-validated against cluster analysis of a second group of children. The two clusters are described in terms of their performance on language and reading measures.
Two studies concerning preschool misarticulating children are reported. The first study was concerned with direct effects of two varieties of parent-administered listening training. The second study focused on the influence of that same training on children's responses to sound-production training. Subjects were assigned to one of three conditions: listening, reading-talking, and control. Children in the first group were provided training by their parents that was intended to focus the child's attention on consonants in syllables or words and to teach discrimination between correctly and incorrectly articulated consonants. Parents of children in the second group read to and talked with them about the material. Neither treatment group surpassed the control group in gains made on any auditory processing or articulatory measure employed, and some parents found the listening training frustrating. In the second study, a subset of the children in each of the three groups was given sound-production training. The data obtained did not show any effect from earlier listening experiences on sound-production performance.
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A multivariate, hierarchical clustering procedure was used to identify homogeneous subgroups among 98 misarticulating children age eight years through nine years, six months. Clustering was based on 40 tests or measures of language, auditory processing, school achievement, oral structure, oral form recognition, and other phenomena. Clusters were described and then compared for performance on measures of articulation status and articulation improvement with training. Clusters were also derived from subsets of children who misarticulated only one sound, either /s/or/r/. Also, the subset of children who misarticulated /s/ was compared with children who misarticulated /r/ for performance on the measures classified above. Few of the clusters identified differed in articulation status or improvement with training.
This study was concerned with the correspondence between the classification of measures by clinical judgement and by factor analysis. Forty-six measures were selected to assess language, auditory processing, reading-spelling, maxillofacial structure, articulation, and other processes. These were applied to 98 misarticulating eight- and nine-year-old children. Factors derived from the analysis corresponded well with categories the measures were selected to represent.
A delayed judgment test of speech-sound discrimination was correlated with measures of articulation status and articulation improvement with training in two groups of subjects, an /r/ group and an /s/ group. While the discrimination measures were reliable and internally consistent, discrimination-articulation correlations were low. Several possible psychometric explanations for the nonsignificant results are ruled out, and subject and task variables that might interfere with children's performance on discrimination measures are discussed.
Pulmonary telangiectasia is an uncommon developmental anomaly characterized by minute arteriovenous fistulae disseminated throughout both lungs. It should be suspected in patients with cyanosis and digital clubbing who do not have chronic lung disease or a cyanotic cardiac anomaly. The presence of telangiectases of skin or mucous membranes in the patient or members of his family is an important diagnostic clue. The chest film usually shows a coarse spidery appearance of the peripheral vascular markings in the lungs. More specific findings are obtained in the pulmonary angiogram where the normally invisible capillary phase is replaced by irregular vascular channels bridging the peripheral branches of pulmonary arteries and veins. The intrapulmonary right-to-left shunt may be confirmed by pulmonary scintigraphy using technetium-labeled albumin. Two cases are presented with a brief review of the literature.
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The article by Drill and Calhoun (219: 583, 1972) and subsequent comments (220: 416, 1972, and 221: 194, 1972) on the problem of thromboembolic episodes and oral contraceptives consider at length the problems of retrospective and prospective studies. If the critical standards presented had been applied to the articles cited by Drill and Calhoun, there would not have been much left to discuss. The citations of Goldzieher and of Tyler, for example, are not to research reports but to short sections of articles of a very general nature. Tyler's comments are not even quantitative. 10 of the 15 articles cited by Drill and Calhoun in their principle tabulation (Table 3) were readily available to me. When I arranged these articles in order of scientific merit as regards the embolism problem, it became apparent that the better the quality of the scientific effort, the higher was the reported incidence of thromboembolism and the lower the number of subjects. It is very possible that the inclusion of a few casual reports with large numbers of subjects is producing an erroneous, low, overall incidence of thromboembolic episodes.
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