Search

Indwelling silicone valves called voice prostheses (VPs) are the gold standard for speech rehabilitation in patients with laryngeal cancer following total laryngectomy. Reported VP lifespans amongst these patients are highly variable but when devices fail patients experience loss of voice and an increase risk of chest infection. Early failure of VP is a current clinical concern that is associated with regular hospital visits, reduced quality of life and associated medical cost. Poly-microbial biofilms comprised of both bacterial and fungal microorganisms readily colonize VPs and are linked to loss of device performance and its early failure in addition to providing a reservoir for potential infection. Our detailed analysis of poly-microbial biofilm composition on 159 early failing VPs from 48 total laryngectomy patients confirmed Candida albicans as the predominant fungal species and Staphylococcus aureus as the most common bacterial colonizer within our patient cohort. Using a combination of microbiological analysis, patient data and a high-throughput antifungal test assay mimicking in vivo conditions we established an evidence based precision antifungal treatment approach to VP management. Our approach has allowed us to implement a personalized VP management pathway, which increases device in situ lifespan by an average of 270%. Our study represents a significant step forward in both our understanding of the cause of VP failure and a new effective treatment pathway that offers tangible benefit to patients.

The literature reports controversy among teachers about the value of an alternate assessment for students with significant cognitive disabilities (SCD) (Kampfer, Horvath, Kleinert, & Kearns, 2001).The purpose of this study was to investigate the perceptions of special education teachers about the value and implementation of the Arizona Alternate Assessment (AIMS-A) for instructional planning.Twelve elementary special education teachers from three school districts in Southern Arizona were placed in one of two focus groups. They were asked questions about the value of the alternate assessment, the impact on instructional planning, the allocation of time to complete the assessment, and the usefulness of the data collected for the alternate assessment. Later, in-depth interviews were held with three of the 12 teachers representing each of the districts. The teachers' responses to the questions asked in the focus group and interview sessions were tape-recorded, transcribed, and organized into themes.Results revealed four major themes and 11 sub-themes. Most teachers valued the AIMS-A information in guiding their teaching. Some teachers, however, believed the instrument did not accurately assess students with the most severe disabilities. Teachers reported the assessment helped guide their instructional planning. The limited time allocated during the school day to complete the assessment resulted in an additional burden on teachers' personal time. Teachers found documenting and collection data throughout the school year was necessary to be able to accurately assess students during the spring testing period. Most of the teachers found the progress data useful.Six recommendations for State (SEAs) and Local Education Agencies (LEAs) resulted from the implications. The first recommendation is to acquire positive teacher perceptions and support for the AIMS-A by providing teachers with a thorough understanding of the benefits of the assessment. A second recommendation is for L