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Communication effects of prenatal alcohol exposure.

This paper surveys the literature on prenatal alcohol exposure. The focus is on studies of speech, language, and communication skills evidenced by children diagnosed with fetal alcohol syndrome and fetal alcohol effects. Concomitant physical, behavioral, intellectual, and learning patterns are reviewed. Symptoms presented by alcohol-exposed children are compared to those seen in other developmentally delayed children. Future needs in areas of identification, assessment, and treatment are discussed.

Child↗

Cell-cell interactions prevent a potential inductive interaction between soma and germline in C. elegans.

In each gonadal arm of wild-type C. elegans hermaphrodites, the somatic distal tip cell (DTC) maintains distal germline nuclei in mitosis, while proximal nuclei enter meiosis. We have identified two conditions under which a proximal somatic cell, the anchor cell (AC), inappropriately maintains proximal germline nuclei in mitosis: when defined somatic gonadal cells have been ablated in wild type, and in lin-12 null mutants. Laser ablations and mosaic analysis indicate that somatic gonadal cells neighboring the AC normally require lin-12 activity to prevent the inappropriate AC-germline interaction. The AC-germline interaction, like the DTC-germline interaction, requires glp-1 activity. In one model, we propose that the AC sends an intercellular signal intended to interact with the lin-12 product in somatic gonadal cells; when lin-12 activity is absent, the signal interacts instead with the related glp-1 product in germline. Our data illustrate the importance of mechanisms that prevent inappropriate interactions during development.

Animals↗

Molecular genetics of sex determination in C. elegans.

Sexual fate in the nematode Caenorhabditis elegans is controlled by a group of genetically well-characterized genes. Several of these sex-determining genes have now been analysed at the molecular level. Transcriptional regulation is likely to control both commitment to a single sexual fate and maintenance of that decision; in addition, intercellular signalling appears to coordinate the sexual fates of cells throughout the animal to adopt a single sexual fate.

Animals↗

The nursing student and the psychiatric patient with AIDS: a case study.

AIDS is one of the most pressing challenges facing health care professionals today. Nurse educators are determining the role of the student in this new clinical situation. This case study provides a look at some of the core issues that may be encountered when a nursing student cares for a patient with this deadly disease. A critical incidence format is used to outline the experience and to present the implications for nursing education.

Acquired Immunodeficiency Syndrome↗

Side-effects of a monoclonal antibody, muromonab CD3/orthoclone OKT3: bibliographic review.

Orthoclone OKT3 is a very powerful immunosuppressive drug marketed by Laboratory Cilag and the first monoclonal murine antibody to become available for therapy in humans. It is indicated in acute allograft rejection treatment and its side-effects are strongly linked with its mechanism of action, ORT/OKT3 is an Ig2a immunoglobulin produced by hybridoma technique that recognizes, binds and blocks the CD3 complex of the T-cell receptor. Two types of side-effects may occur that are either the consequences of overimmunosuppression or activation of immune system, since ORT/OKT3 behaves as a foreign antigen. This report is a bibliographic review of the suspected side-effects of this product.

Animals↗

Cortical sensory evoked potentials and communicative forebrain functions.

Cortical evoked potentials were measured to visual, auditory and somatosensory stimuli in 20 subjects with serious neurodevelopmental impairments due to various etiologies. The results were compared with behavioral observations to find out whether the absence/presence of the responses corresponded to the level of social functioning. No cortical evoked potentials were elicited in two subjects, responses to the stimulation of one modality were missing in three subjects (retinal b-waves and brainstem auditory and somatosensory evoked potentials were, however, preserved in them). No communicative behavior was observed in subjects with absent responses. Ten subjects had marked deviations in the evoked potentials, the behavioral observations in them, ranging from no communication to sentenced speech. Five subjects had normal response patterns and they showed a great variety of communicative skills, including speech. The results support the view that bilateral loss of cortical somatosensory, visual, and auditory evoked potentials is a sign of loss of neural substrates of communication.

Adolescent↗

Rett syndrome from a family perspective: The Swedish Rett Center survey.

The aim of this study was to make a description of the early development in individuals with the diagnosis Rett syndrome using parents' information. Information received from 125 cases of Rett syndrome in Sweden in 1997 provided us with families' description of early development in gross motor function, fine motor function and communication/social interplay. Best abilities before regression were presented, 62% lost their best abilities, 22% kept them and 5% kept them with deterioration. Seventy-three percent learnt to walk, 20% stopped walking and 2% retrained walking. Concerning feeding, 69% learnt to feed themselves, 57% lost this ability, 7% retrained the ability and 5% learnt to feed after regression. Sixty-four percent were one year or younger when there was a deviation in development. Sixty answers reported the girl was late in developing functions while 35 reported sudden loss of reached abilities. Seventy-four percent developed a scoliosis and 83% reported other deformities; of these, deformities in feet were the most common. Postural control was poor since all but 15 girls/women learnt in different directions when sitting. Transitional movements were difficult to perform. In 80% of cases, the families were those who suspected early that something was wrong in the child's development. Because of this it is essential that medical staff is aware of the different ways RS develops in order to give families early appropriate support and a plan for intervention. Since there is not only loss of function in this group but also kept abilities, retrained abilities and abilities achieved after regression, more research has to be focused on management and treatment to help persons with Rett syndrome keep and develop abilities according to their individual resources.

Activities of Daily Living↗

Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge.

UNLABELLED: There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. CONCLUSIONS: Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.

Adult↗

Communication interaction in ICU--Patient and staff experiences and perceptions.

Patients on intensive care units (ICU) have difficulty with communication [Menzel LK. Factors related to the emotional responses of intubated patients to being unable to speak. Heart Lung 1998; 27(4):245-52]. Feelings of anger and low mood have been reported, which can lead to reduced participation in rehabilitation. For members of the multidisciplinary team breakdown in communication with patients may be frustrating and related to a limited knowledge of strategies and resources to facilitate communication. The NHS Modernisation Agency Critical Care Programme (2002) identified speech and language therapists (SLTs) as having a role in the assessment and management of patients with communication difficulties on ICU. This multi-centre pilot study aimed to investigate staff and patient perceptions and experiences of communication within ICUs. A short questionnaire was devised using semi-structured interviews to collect quantitative and qualitative information. Patterns were identified including insights into SLT service delivery and possible directions for future research and development.

Adaptation, Psychological↗

A five-phase model for clinical-outcome research.

UNLABELLED: Through a variety of approaches, speech-language pathologists and audiologists have produced strong evidence that treatments are generally potent. However, we have largely ignored the accepted standards for clinical-outcome testing used throughout the broader research community (e.g., by other clinical disciplines, federal regulators, and third-party payers). Several clinical professions recognize a comprehensive model for organizing and scaffolding the many forms of clinical-outcome research. An adaptation of this five-phase model of clinical-outcome research is examined as a means for structuring forms of clinical research throughout audiology and speech-language pathology. Within the organizing structure, relationships become apparent between types and grades of scientific evidence and the processes underpinning evidence-based practice which ultimately lead to decisions on the status of intervention protocols. LEARNING OUTCOMES: Readers will be able to distinguish the phases of clinical-outcome research in a comprehensive model. Readers will be able to identify relationships between the structure of the model and broadly recognized concepts associated with the terms 'efficacy' and 'effectiveness.' Readers will be able to identify indicators of quality for controlled clinical trials.

Biomedical Research↗

Evidence for whom?: ASHA's National Outcomes Measurement System.

UNLABELLED: The growth of managed care and increasing demands by school systems resulted in of a number of new audiences looking for the evidence underlying the practice of speech-language pathology (SLP). Third-party payers, operating in an environment emphasizing "return-on-investment," sought data linking expenditures on SLP services with tangible outcomes affecting resource utilization, such as required level of care and ability to discharge. ASHA's National Outcomes Measurement System (NOMS) was developed to address these types of needs. This paper provides an overview of NOMS and its intended uses in the field. LEARNING OUTCOMES: (1) Readers will understand the rationale behind the development of NOMS. (2) Readers will be aware of the strengths and limitations of NOMS.

American Speech-Language-Hearing Association↗

Communicative ability conceptions among children who stutter and their fluent peers: a qualitative exploration.

UNLABELLED: Meta issues in stuttering were examined by analyzing verbal-descriptive data drawn from structured interviews with 23 male children who stutter (CWS) and their 23 fluent male peers. Participants described others' "good" and "bad" talk behaviors and provided their self-appraisals as talkers. Analysis of interview transcripts suggested that CWS favored unidimensional criteria for describing others' talk behaviors, where others' speech-language forms, particularly allusions to stuttering behaviors, were noted most commonly in the descriptions. In contrast, children who did not stutter used multidimensional criteria to describe others' talk behaviors, where others' speech-language forms and pragmatic behaviors were weighted evenly, particularly for positive descriptions. Additionally, many CWS expressed reservations in describing themselves as "good talkers," whereas their fluent peers provided mainly positive appraisals of their own talking abilities. Outcomes provide evidence that early conceptions of communicative abilities among CWS are influenced by their stuttering experiences and diverge from early communicative ability conceptions among their fluent peers. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to; (1) recognize the relevance of examining communicative ability conceptions among children who stutter within the context of educational research on ability conceptions in children; (2) identify qualitative methods used to analyze interviews with participants; and (3) appreciate the role of personal experiences in shaping communicative ability conceptions among children who stutter.

Child↗

The role of the temporal lobe semantic system in number knowledge: evidence from late-stage semantic dementia.

Previous reports have demonstrated that many aspects of number knowledge remain unimpaired in semantic dementia, despite severe comprehension problems in other domains. It is argued that this advantage for numbers arises because the disease spares the parietal lobe magnitude system thought to be critical for number processing. Models of numerical cognition that favour a separation between verbal and magnitude representations of number might, however, predict a restricted impairment of the verbal number code in this condition. We obtained support for this hypothesis in a patient with late-stage semantic dementia. She was impaired at a variety of tasks tapping the verbal number code; for example, reading and writing Arabic numerals, naming and word-picture matching with dot pictures, reading aloud number words, digit span and magnitude comparison/serial ordering tasks with number words. In contrast, she demonstrated good understanding of the magnitude and serial order of numbers when tested with Arabic numerals and non-symbolic representations. These findings suggest that although the magnitude meaning of numbers is isolated from the temporal lobe semantic system, the anterior infero-temporal lobe may play a critical role in binding English number words to their non-symbolic magnitude meaning.

Aged↗

Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC).

The purpose of this study, conducted in three phases, was to develop a clinically useful observational tool (i.e., the Pain Assessment Checklist for Seniors With Limited Ability to Communicate [PACSLAC]) to assess pain in seniors with severe dementia. In Phase 1, professional caregivers of seniors with severe dementia were interviewed in order to generate a list of pain-related behaviors that are characteristic of care recipients living in long-term-care facilities. Based on a systematic examination of interview transcripts by experienced researchers and an independent coder, a behavioral checklist (i.e., the initial version of the PACSLAC) was developed. The checklist items were organized into conceptually based subscales (e.g., facial expressions, activity/body movement). Phase 2 focused on an assessment of the internal consistency of the checklist (alpha =.92). Following an item analysis, the subscales of the PACSLAC (Social/Personality/Mood Indicators, Facial Expressions, Activity/Body Movement, and Physiological Indicators/Eating/Sleeping Changes/Vocal Behaviors) were found to be internally consistent. Phase 3 focused on a preliminary validation of the PACSLAC. Analyses suggest that the PACSLAC discriminated among pain events (during which there was a clear and recognizable cause for the patients' pain), events during which patients were experiencing nonpainful distress, and situations during which patients were calm.

Adult↗