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Blood pressure monitoring plays a key part in the preoperative, intraoperative, and postoperative care of all patients. In patients with obesity, hypertension indicates increased metabolic and surgical risk and may signal the presence of significant medical comorbidities, including obstructive sleep apnea. Avoidance of hypertension postoperatively is necessary to minimize bleeding risk after surgery. Hypotension in the postoperative period may be the first sign of significant complications that require urgent management. With the problem of being overweight or obese now affecting two-thirds of adults in Western countries, the proportion of patients with obesity in perioperative environments is similarly increasing. Detection of aberrations in blood pressure is contingent on the accuracy of blood pressure measurement methods. Patients with obesity tend to have a large arm circumference and "cone-shaped arms." Standard blood pressure cuffs fit such patients poorly, and this compromises the accuracy of measurements. Alternatives to arm blood pressure cuffs, some made specifically for individuals with obesity, have been evaluated but are not widely available to clinicians. This focused narrative review will discuss the relevance of hypertension management in the care of patients with obesity, highlight the currently available methods for perioperative monitoring of blood pressure, and explore the opportunities that exist to improve the perioperative blood pressure care in patients with obesity undergoing surgical procedures.

Cross-language McGurk Effects are used to investigate the locus of auditory-visual speech integration. Experiment 1 uses the fact that [], as in 'sing', is phonotactically legal in word-final position in English and Thai, but in word-initial position only in Thai. English and Thai language participants were tested for 'n' perception from auditory [m]/visual [] (A[m]V[]) in word-initial and -final positions. Despite English speakers' native language bias to label word-initial [] as 'n', the incidence of 'n' percepts to A[m]V[] was equivalent for English and Thai speakers in final and initial positions. Experiment 2 used the facts that (i) [ð] as in 'that' is not present in Japanese, and (ii) English speakers respond more often with 'tha' than 'da' to A[ba]V[ga], but more often with 'di' than 'thi' to A[bi]V[gi]. English and three groups of Japanese language participants (Beginner, Intermediate, Advanced English knowledge) were presented with A[ba]V[ga] and A[bi]V[gi] by an English (Experiment 2a) or a Japanese (Experiment 2b) speaker. Despite Japanese participants' native language bias to perceive 'd' more often than 'th', the four groups showed a similar phonetic level effect of [a]/[i] vowel context × 'th' vs. 'd' responses to A[b]V[g] presentations. In Experiment 2b this phonetic level interaction held, but was more one-sided as very few 'th' responses were evident, even in Australian English participants. Results are discussed in terms of a phonetic plus postcategorical model, in which incoming auditory and visual information is integrated at a phonetic level, after which there are post-categorical phonemic influences.

Previous research indicates that children with speech sound disorders (SSD) have underlying phonological memory deficits. The SSD population, however, is diverse. While children who make consistent atypical speech errors (phonological disorder/PhDis) are known to have executive function deficits in rule abstraction and cognitive flexibility, little is known about their memory profile. Sixteen monolingual preschool children with atypical speech errors (PhDis) were matched individually to age-and-gender peers with typically developing speech (TDS). The two groups were compared on forward recall of familiar words (pointing response), reverse recall of familiar words (pointing response), and reverse recall of digits (spoken response) and a receptive vocabulary task. There were no differences between children with TDS and children with PhDis on forward recall or vocabulary tasks. However, children with TDS significantly outperformed children with PhDis on the two reverse recall tasks. Findings suggest that atypical speech errors are associated with impaired phonological working memory, implicating executive function impairment in specific subtypes of SSD.

Children's speech difficulties can be motor (phone misarticulation) or linguistic (impaired knowledge of phonological contrasts and constraints). These two difficulties sometimes co-occur. This paper reports longitudinal data from the Early Language in Victoria Study (ELVS) at 4 and 7 years of age. Of 1494 participants, 93 made non-age appropriate speech errors on standardised assessments at 4 years, and were able to be reassessed at 7 years. At 4 years, 85% of these children only made phonological errors, 14% made both articulation and phonological errors and one child only made articulation errors (a lateral lisp). In total, 8 of 13 children making both articulation and phonological errors at 4 years had resolved by 7 years. Unexpectedly, eight children who had demonstrated articulation of fricatives at 4 years, acquired distorted production of ≥ 50% of occurrences of/s, z/ by 7 years. In total, then, 22 children (24% of children with speech difficulties) made articulatory errors at one or both assessments. Case data for all children are presented. Theoretical and clinical implications are considered.

Objective: To examine predictors of speech disorder resolution versus persistence at age 7 years in children with speech errors at age 4 years., Study Design: Participants were drawn from a longitudinal, community cohort. Assessment at age 4 years (N?=?1494) identified children with speech errors. Reassessment at age 7 years allowed categorization into resolved or persistent categories. Logistic regression examined predictors of speech outcome, including family history, sex, socioeconomic status, nonverbal intelligence, and speech error type (delay vs disorder)., Results: At age 7 years, persistent errors were seen in over 40% of children who had errors at age 4 years. Speech symptomatology was the only significant predictor of outcome (P?=?.02). Children with disordered errors at age 4 years were twice as likely to have poor speech outcomes at age 7 years compared with those with delayed errors., Conclusions: Children with speech delay at age 4 years seem more likely to resolve, and this might justify a "watch and wait" approach. In contrast, those with speech disorder at age 4 years appear to be at greater risk for persistent difficulties, and could be prioritized for therapy to offset long-term impacts., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Given the arduous course of heart transplantation and follow-up care, recipients and their families face complex challenges and stressors warranting supportive interventions. This study explored the impact of a family camp as an intervention of education and social support for pediatric transplant recipients and their families. A total of 49 individuals participated in this evaluation, including eight children and nine youth with heart transplants, five siblings, 19 parents, and 13 health care providers. Participants ranked and described the 3-day family camp experience. Analysis of pre/post intervention measures on knowledge, social support, and coping revealed statistically significant improvements in knowledge, social support, self-esteem, and psychological stability. Satisfaction surveys revealed the camp to be an important resource for education, family fun, and peer support among transplant recipients, their families, and the health care team. Implications and recommendations are offered for clinical and community practice.

One in twenty Australian children suffers from a speech disorder. Early detection of such problems can significantly improve literacy and academic outcomes for these children, reduce health and educational burden and ongoing social costs. Here we present the development of a prototype and feasibility tests of a screening and decision support tool to assess speech disorders in young children. The prototype incorporates speech signal processing, machine learning and expert knowledge to automatically classify phonemes of normal and disordered speech. We discuss these results and our future work towards the development of a mobile tool to facilitate broad, early speech disorder screening by non-experts.

Two libraries of substituted benzimidazoles were designed using a 'scaffold-hopping' approach based on reported MDM2-p53 inhibitors. Substituents were chosen following library enumeration and docking into an MDM2 X-ray structure. Benzimidazole libraries were prepared using an efficient solution-phase approach and screened for inhibition of the MDM2-p53 and MDMX-p53 protein-protein interactions. Key examples showed inhibitory activity against both targets., (© 2014 John Wiley & Sons A/S.)

Experience from past nuclear and radiological emergencies shows that placing the radiological health hazard in perspective and having a definition of "safe" are required in order to prevent members of the public, those responsible for protecting the public (i.e., decision makers), and others from taking inappropriate and damaging actions that are not justified based on the radiological health hazard. The principle concerns of the public during a severe nuclear power plant or spent fuel pool emergency are "Am I safe?" and "What should I do to be safe?" However, these questions have not been answered to the satisfaction of the public, despite various protective actions being implemented to ensure their safety. Instead, calculated doses or various measured quantities (e.g., ambient dose rate or radionuclide concentrations) are used to describe the situation to the public without placing them into perspective in terms of the possible radiological health hazard, or if they have, it has been done incorrectly. This has contributed to members of the public taking actions that do more harm than good in the belief that they are protecting themselves. Based on established international guidance, this paper provides a definition of "safe" for the radiological health hazard for use in nuclear or radiological emergencies and a system for putting the radiological health hazard in perspective for quantities most commonly measured after a release resulting from a severe emergency at a light water reactor or its spent fuel pool.

The conventional split Hopkinson torsional bar (SHTB) system consists of two bars, which can successfully produce the data for the construction of dynamic torsional shear stress and strain relationships. However, the system cannot provide reliable information on the progression of the deformed micro-structure during the test. The reverberation of waves in the bars and the tested specimen can spoil the microstructural pattern formed during the effective loading. This paper briefly reviews a modified version of the SHTB system consisting of four bars that has been developed. This modified system can eliminate the reverberation of waves in the specimen and provide only a single rectangular torsional stress pulse, thus it can properly freeze the microstructure formed during the effective period of loading in the specimen. By using the advantage of the modified SHTB system, together with a new design of specimen, it is possible to perform a correlated study of the dynamic stress-strain response, shear localization and the evolution of the microstructure at a fixed view-field (position) on a given specimen during the sequence of the loading time. The principles, experimental set-up and procedure, calibration and some preliminary results of the correlated study are reported in this paper.

This study investigated cross-linguistic influence in acquisition of a second lexicon, evaluating Samoan-English sequentially bilingual children (initial mean age 4 ; 9) during their first 18 months of school. Receptive and Expressive Vocabulary tasks evaluated acquisition of four word types: cognates, matched nouns, phrasal nouns and holonyms. Each word type had varying phonological and conceptual difference between Samoan (L1) and English (L2). Results highlighted conceptual distance between L1 and L2 as a key factor in L2 lexical acquisition. The children acquired L2 lexical items earlier if their conceptual representation was similar to that of L1. Words with greater conceptual distance between L1 and L2 emerged more slowly. This suggests that L1 knowledge influences L2 lexical consolidation for sequential bilinguals. Words that require a conceptual shift from L1 take longer to consolidate and strengthen within the L2 lexicon.

Limited word production may be the first indicator of impaired language development. The unavailability of normative data and standardized assessments for young Maltese children hinders the identification of early language delays. This study aimed to document Maltese children's expressive vocabulary growth and accompanying range of variation, to assist identification of children at risk for language impairment. The expressive vocabularies of 44 typically developing children aged 12-30 months were measured through caregiver report. Mean scores at each age point were characterized by substantial individual variation. Gender was not related to mean growth in vocabulary production. Minimum scores were compared to clinical thresholds for English-speaking children. Results emphasized the assessment- and language-specific nature of identification criteria. Nevertheless, established thresholds may be referred to when normative data for particular languages/language pairs are limited. In such contexts, the consideration of other risk markers gains importance in supplementing findings on lexical expression.

Experience and studies show that for an emergency at a nuclear power plant involving severe core damage or damage to the fuel in spent fuel pools, the following actions may need to be taken in order to prevent severe deterministic health effects and reduce stochastic health effects: (1) precautionary protective actions and other response actions for those near the facility (i.e., within the zones identified by the International Atomic Energy Agency) taken immediately upon detection of facility conditions indicating possible severe damage to the fuel in the core or in the spent fuel pool; and (2) protective actions and other response actions taken based on environmental monitoring and sampling results following a release. This paper addresses the second item by providing default operational intervention levels [OILs, which are similar to the U.S. derived response levels (DRLs)] for promptly assessing radioactive material deposition, as well as skin, food, milk and drinking water contamination, following a major release of fission products from the core or spent fuel pool of a light water reactor (LWR) or a high power channel reactor (RBMK), based on the International Atomic Energy Agency's guidance.

Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice., Aims: To investigate the working practices and professional experiences of paediatric SLTs working in the UK through an online survey., Methods & Procedures: The survey was conducted online using Survey Monkey. Therapists were alerted to the survey through the Bulletin of the Royal College of Speech and Language Therapists and by e-mails to national special interest groups., Outcomes & Results: A total of 516 clinicians completed the survey. A large majority worked in the National Health Service (NHS). A varied pattern of working was revealed. Most worked in several settings and saw a range of clients. A typical clinician spends less than one-quarter of their time giving direct therapy and more than one-quarter training parents and other professionals. Nearly half of respondents felt that their time could be better used. Too little time for direct therapy and the time required for administration emerged as their principal concerns. Most clinicians have specialist knowledge of particular client groups and spend more time with them than do non-specialists. Nevertheless, clients are more likely to be treated by a therapist who does not claim to have specialist knowledge of their condition than by one who does. The only clients for whom this is not the case are those with dysphagia. Eighty per cent of respondents felt that proposed changes to the NHS would not benefit the children they treat and there was widespread concern about cuts and the effects of general practitioner commissioning. Despite this, a large majority expected to remain speech and language therapists 5 years from now., Conclusions & Implications: This survey provides an overview of the working practices of paediatric speech and language therapists. Its findings have significant implications for training and workforce development in the profession., (© 2012 Royal College of Speech and Language Therapists.)

Background: Sentence construction and syntactic organization are known to be poor in children with specific language impairments (SLI), but little is known about the way in which children with SLI approach language tasks, and static standardized tests contribute little to the differentiation of skills within the population of children with language impairments (LI). Information about the nature and intensity of prompts that facilitate sentence construction for a particular child may be useful in planning effective intervention., Aims: This paper describes the development of a dynamic assessment (DA) task which requires implicit knowledge of syntactic structure. The aim was to formulate a valid and reliable procedure for the DA of sentence formulation that could yield useful information for planning intervention for children with LI., Methods & Procedures: The Dynamic Assessment of Sentence Structure (DASS) was employed on 24 children aged 8-10 years, with identified language impairments, who were tested four times, at 4 monthly intervals., Outcomes & Results: A range of scores was elicited with no limiting ceiling or floor effects, and the test showed high internal reliability of α= 0.833. Inter-rater reliability was high. Concurrent validity was demonstrated by significant correlation with scores obtained on the CELF-3(UK) and predictive validity of the measure was also found to exceed that of the standardized test measure. Information about the ability of the children to use strategies and less directive prompts, and to transfer learning between items was elicited, and the information was thought to be useful by speech and language therapists involved in their management., Conclusions & Implications: The application of DA principles to the assessment of children previously diagnosed with LI, for the purposes of finding out more information about their potential to benefit from language intervention, was found to be effective. The tool developed was shown to be valid and reliable, and it has potentially important applications for the planning of individual intervention programmes and service delivery., (© 2011 Royal College of Speech and Language Therapists.)

Background: A randomized controlled trial was conducted of a whole-service cohort of children referred to the Paediatric Speech and Language Therapy Service of Middlesbrough Primary Care Trust between January 1999 and April 2000. The 730 children involved, aged up to 16 years, were diagnosed with primary speech and/or language impairment in the absence of any learning, physical or sensory difficulty., Aims: The study considered outcomes of treatment versus no treatment., Methods & Procedures: Treatment involved clinic-based interventions, provided according to local departmental criteria and care pathways, averaging 5.5 h (range 0-24 h) of contact during the 6-month period immediately following initial assessment. Assessments occurred within 8 weeks of referral and intervention began immediately thereafter., Outcomes & Results: Treatment was significantly more effective than no treatment, over 6 months, both overall (p < 0.001) and for each of the three diagnostic categories (comprehension, expression and speech, each p < 0.001)., Conclusions: An average of 6 h of speech and language therapy in a 6-month period can produce significant improvement in performance, and it has been shown to be more effective than no treatment over the same 6-month period for children with primary speech and/or language impairment., (© 2011 Royal College of Speech and Language Therapists.)

This article focuses on the development of a Literacy Assessment Battery for the diagnosis of Maltese children with specific learning difficulties. It forms part of a wider research study involving testing of 549 children in Malta as well as standardisation of the tool. Results of the children's performance and psychometric validation go beyond the scope of this article and therefore will not be recorded here.

Previous research has rarely compared the contributions of different underlying abilities to phonological acquisition. In this study, the auditory-visual speech perception, oro-motor and rule abstraction skills of 62 typically developing two-year olds were assessed and contrasted with the accuracy of their spoken phonology. Measures included auditory-visual speech perception, production of isolated and sequenced oro-motor movements, and verbal and non-verbal rule abstraction. Abilities in all three domains contributed to phonological acquisition. However, the use of atypical phonological rules was associated with lower levels of phonological accuracy and a linear regression indicated that this measure of rule abstraction had greater explanatory power than the measures of input processing and output skill.

Background: Sentence imitation has been identified as a good indicator of children's language skills, with performance differentiating children with specific language impairment and showing relationships with other language measures. It has a number of advantages over other methods of assessment. The assessment of morphosyntax in children who have severe speech difficulties presents unique challenges which currently available sentence imitation assessments do not address., Aims: This paper presents a new sentence imitation test (The Sentence Imitation Test (SIT-61)) and reports on an investigation which sets out to determine whether this test (1) reveals differences in performance between a group of children diagnosed with specific language impairment and a group of typically developing children (2) reveals distinct profiles of performance amongst children with different speech difficulties, and (3) provides information about morphosyntactic strengths and difficulties., Methods & Procedures: SIT-61 is a finely graded sentence imitation test in which the phonotactic structure, segmental phonology and length of words were kept as developmentally simple as possible. Responses are scored for number of content words, function words and inflections correct. A novel scoring system was devised to credit a child where there was evidence of targeting a morpheme even if it was mispronounced. The test was administered to four groups of children between the ages of 4 and 6 years: 33 children with typical development, 13 children with known expressive morphosyntactic difficulties (specific language impairment), and two groups of 14 children with different types of speech disorder: a group with consistent phonological disorder, who used atypical phonological error patterns consistently; and a group with inconsistent phonological disorder, who produced atypical phonological errors inconsistently., Outcomes & Results: SIT-61 found differences in performance between the group of typically developing participants and the three clinic groups. While the consistent phonological disorder group obtained extremely high scores for content and function words, they obtained lower inflection scores reflective of their speech difficulties. The scores of the specific language impairment and inconsistent phonological disorder groups were comparable for content and function words, but the groups were differentiated through an analysis of their errors. Further analyses confirmed that low scores obtained by some children in the inconsistent phonological disorder group were due to morphosyntactic difficulties and not speech difficulties., Conclusions & Implications: A new sentence imitation test, the SIT-61, is shown to be valuable tool for identifying expressive morphosyntactic difficulties in children. It is informative about the morphosyntactic abilities of children with speech disorders and raises questions as to the nature of their difficulties.

The synthesis of cyclic alkenyl boronic half acids from vinyl and propenyl boronic esters and homoallylic alcohols by ring-closing metathesis is reported. The method is compatible with both conventional and microwave heating and comparable yields are obtained under both conditions. The cyclic alkenyl boronic acids participate in Suzuki-Miyaura coupling reactions in good yields.

This study examined the lexical development of nine Samoan-English bilingual children during their first year in English speaking preschools in Australia. Receptive and expressive lexicon in Samoan and English was assessed when the children had completed their first term of school (approximately 10 weeks) and then 6 months later. The bilingual children's scores in each language and composite scores were examined over time. Performance was also compared with typically developing, age-matched (4-5-year-old) monolingual English-speaking peers. Results indicated that the group made significant gains in both languages over time. The bilingual children's receptive composite scores were comparable to monolingual English scores, with clear changes in lexical composition (singlets and translation equivalents) over time. Expressive composite scores of bilingual children were lower than scores of monolingual peers. Results appeared to be highly influenced by the language environment and patterns of language use in this group. The potential use of composite score methodology as a clinical assessment tool in bilingual children is discussed.

This study examines the literacy outcomes for children from socially disadvantaged backgrounds who had received specific whole-class phonological awareness (PA) and language intervention in preschool. The participants were 57 children who had been involved in the original intervention study. Their PA skills, letter-sound knowledge, real word and non-word spelling and reading comprehension were assessed in Grade 2. The results indicated that children who had received intervention in preschool performed similarly to the children who had not received intervention. The gains made in PA and language skills post intervention had failed to augment further literacy development. A post hoc examination of individual student profiles, however, revealed that a subgroup of children who had received intervention had maintained their enhanced performance and that the intervention cohort had similar scores on tests of PA ability to their age-matched peers in the population. It was concluded that whole-class, teacher-delivered, PA and language intervention, while effective in the short term, does not lead to a generalized improvement in literacy skills in Grade 2. Possible reasons for the failure of the program to produce medium term gains are discussed.

Background: Speech perception is often considered specific to the auditory modality, despite convincing evidence that speech processing is bimodal. The theoretical and clinical roles of speech-reading for speech perception, however, have received little attention in speech-language therapy., Aims: The role of speech-read information for speech perception is evaluated by considering evidence from hearing infants and adults, people with speech disorders, and those born profoundly hearing impaired., Methods & Procedures: Research studies are evaluated for evidence on lip-reading for speech perception: the mandatory role of speech-reading for hearing adults' perception of the McGurk effect and hearing infants' awareness of the congruence between lip movements and speech sounds; brain neuroimaging studies of speech-read and heard speech perception; the speech-reading abilities of people with disordered speech; and the phonological coding abilities of people with profound pre-lingual hearing loss. Theories of multimodal speech perception are explained., Main Contributions: Five pieces of evidence indicate that speech-reading is an integral part of speech processing. Hearing people's perception of speech is influenced by speech-read cues, and those speech-read cues cannot be ignored. Infants are aware that lip movements and speech sounds match from soon after birth and by four months of age have language specific speech-reading skills. Studies of brain activity show that the brain processes speech-read and heard speech similarly. Some children and adults with speech disorders are reported to rely less on speech-read cues than people without speech disorders, and children who are profoundly hearing impaired from birth have concepts of rhyme, match homophones, and can repeat and spell nonsense words., Conclusions & Implications: Speech-reading, a mandatory part of speech perception, should be appropriately assessed and be considered when developing strategies for speech and language intervention.

Background: Childhood apraxia of speech (CAS) is associated with phonological awareness, reading, and spelling deficits. Comparing literacy skills in CAS with other developmental speech disorders is critical for understanding the complexity of the disorder., Aims: This study compared the phonological awareness and reading development of children with CAS and children with inconsistent speech disorder (ISD)., Method & Procedures: Participants included twelve children with CAS aged 4-7 years. Their performance was compared with twelve children with ISD (and normal speech motor planning) and twelve children with typical development on tasks measuring phonological awareness, letter-sound knowledge, real and non-word decoding, and access to underlying phonological representations of words. There was no significant difference in the age, gender, socio-economic status, and receptive vocabulary of the groups. The two groups with speech disorder were matched for severity and inconsistency of their speech impairment., Outcomes & Results: The results indicated that the CAS group had inferior phonological awareness than the ISD and typical development groups. The CAS group had a greater proportion of participants performing below their expected age level than the comparison groups on phonological awareness, letter-sound knowledge and decoding tasks. There was no difference in the performance of the CAS and ISD groups on the phonological representation task., Conclusions & Implications: Children with CAS are particularly susceptible to phonological awareness and reading delay. Intervention for children with CAS must facilitate skills underlying reading development in addition to resolving speech deficits in order to improve the spoke and written language outcomes of this population.

Self-shielded 137Cs irradiators have been used for many years to irradiate blood products to prevent graft vs. host disease and to irradiate cells and small animals in research. A report by the National Academy of Sciences recommends that careful consideration be given to replacement of 137Cs irradiators with x-ray irradiators. Several manufacturers and users of x-ray irradiators were contacted to determine costs of replacing and maintaining 137Cs irradiators with x-ray units and to assess users' experience with x-ray irradiators. Purchase costs of x-ray units are similar to 137Cs irradiators, but maintenance costs are significantly higher if annual service contracts are used. Performance of the two irradiator types appears to be equivalent, but in some cases x-ray irradiations may need to be performed in multiple configurations to achieve adequate uniformity in dose. No literature reports were found that evaluated the biological effectiveness of x rays vs. 137Cs gamma rays; therefore, a careful study should be conducted to determine the biological effectiveness of x rays vs. 137Cs gamma rays for biological responses relevant to transfusion medicine and immunological research. Throughput may be problematic for large transfusion medicine programs, and back-up plans may be necessary in case the x-ray unit needs to be taken out of service for extended maintenance. Disposition of a 137Cs irradiator will add to the cost of replacement with an x-ray unit, but disposal may be possible through the U.S. Department of Energy's Off-Site Source Recovery Program.

This study is an examination of the longitudinal effects of an integrated phonological awareness approach for identical twin boys with childhood apraxia of speech (CAS). Genetic and environmental factors in the boys' responses to the intervention were also examined. Theo and Jamie (aged 4;5) each participated in 18 hours of intervention prior to school entry and were re-assessed at age 4;9, 5;3, and 5;9 respectively. Their speech, expressive morpho-syntactic, phonological awareness, reading, and spelling development were evaluated over their first year of schooling. Theo and Jamie experienced continued growth in speech and phonological awareness skills following participation in the intervention. They exhibited age-appropriate reading and spelling development during their first year of formal literacy instruction. They had persistent deficits in expressive morpho-syntactic skills despite speech production gains over the study. The results pointed to the benefit of integrating speech and phonological awareness goals within a preventative framework to ensure successful early literacy development for children with CAS. Findings suggested that language difficulties in children with CAS should be targeted during intervention as they do not resolve as the children's speech production difficulties minimize.

Problem-based learning (PBL) is hypothesized to enhance the development of deep learning. Most previous studies, however, have focused on outcomes (knowledge and skills) rather than students' approaches to learning, or how learning approach correlates with learning outcomes. Undergraduates in a speech-language pathology program (n = 114) completed the revised 2-factor Study Process Questionnaire (R-SPQ-2F) twice in an academic year to identify their approaches to learning and to compare these results with academic outcomes. Two findings emerged. Although the mean of scores for the deep approach (DA) to learning was consistently higher than the mean of scores for the surface approach (SA) to learning, exposure to PBL led to significant increase in DA and SA to learning during an academic year for students in Years 1 to 3. Students who did well in a PBL examination showed a much stronger DA than SA to learning, while students who performed less well showed a smaller difference between DA and SA to learning. Possible explanations for these findings are evaluated and implications for further studies are discussed.

Background: Although children with speech disorder are at increased risk of literacy impairments, many learn to read and spell without difficulty. They are also a heterogeneous population in terms of the number and type of speech errors and their identified speech processing deficits. One problem lies in determining which preschool children with speech disorder will have difficulties acquiring literacy skills., Aims: Two studies are presented that investigate the relationship between speech disorders and literacy. The first examined the phonological awareness abilities of children with different types of speech difficulties. The second study investigated the literacy skills of children with a history of inconsistent speech disorder., Methods & Procedures: Experiment 1 measured the syllable segmentation, rhyme awareness and alliteration awareness of 61 preschool children: 46 with speech disorder (14 with delayed development, 17 who made consistent non-developmental errors, and 15 who made inconsistent errors) and 15 typically developing controls. Experiment 2 assessed the reading accuracy, spelling and phonological awareness abilities of nine 7-year-old children with a history of inconsistent phonological errors., Outcomes & Results: The first study indicated unexpected patterns of performance. While the Delayed group performed less well than controls on all tasks, the Consistent group showed poor performance on rhyme and alliteration but appropriate performance on syllable segmentation. The Inconsistent group performed most poorly on syllable segmentation but no differently from controls on the other two tasks. The second study indicated that children with a history of inconsistent phonological disorder performed no differently from controls on measures of phonological awareness and reading, but less well on measures of spelling ability., Conclusions: The results support classification of speech disorders and show a differentiation of phonological awareness skills across groups. Children with consistent atypical speech errors have poor phonological awareness and are most at risk for literacy difficulties. Those with inconsistent phonological disorder are at increased risk of spelling difficulties. The findings indicate that phonological awareness and spelling skill are distinct processing systems and highlight the role of phonological assembly skills (i.e. storing and/or retrieving phonological output plans) in spelling output. The interactive processes between reading and spelling are discussed.

The potential of soil microorganisms to enhance the retention of (137)Cs and (85)Sr in organic systems was assessed in a series of experiments. A biologically active, 'mineral-free', organic material, produced under laboratory conditions from leaves, was used as the uptake matrix in all experiments to minimise potential interference from competing clay minerals. Biological uptake and release were differentiated from abiotic processes by comparing the sorption of radionuclides in sterilised organic material with sterile material inoculated with soil extracts or single fungal strains. Our results show conclusively that living components of soil systems are of primary importance in the uptake of radionuclides in organic material. The presence of soil microorganisms significantly enhanced the retention of Cs in organic systems and approximately 70% of the Cs spike was strongly (irreversibly) bound (remained non-extractable) in the presence of microorganisms compared to only approximately 10% in abiotic systems. Sorption of (85)Sr was not significantly influenced by the presence of soil microorganisms. A non-linear temperature response was observed for the retention in biotic systems with increased uptake at between 10 and 30 degrees C and lower retention at temperatures above or below the optimum range. The optimum temperatures for biological uptake were between 15 and 20 degrees C for Cs, and 25 and 30 degrees C for Sr. Our results indicate that single strains of soil and saprotrophic fungi make an important contribution to the sorption of Cs and Sr in organic systems, but can only account for part of the strong, irreversible binding observed in biotic systems. Single strains of soil fungi increased the amount of non-extractable (137)Cs (by approximately 30%) and (85)Sr (by approximately 20%) in the organic systems as compared to abiotic systems, but the major fraction of (137)Cs and (85)Sr sorbed in systems inoculated with saprotrophic fungi remained extractable.

An example of the auditory-visual illusion in speech perception, first described by McGurk and MacDonald, is the perception of [ta] when listeners hear [pa] in synchrony with the lip movements for [ka]. One account of the illusion is that lip-read and heard speech are combined in an articulatory code since people who mispronounce words respond differently from controls on lip-reading tasks. A same-different judgment task assessing perception of the illusion showed no difference in performance between controls and children with speech difficulties. Another experiment compared children with delayed and disordered speech on perception of the illusion. While neither group perceived many illusions, a significant interaction indicated that children with disordered phonology were strongly biased to the auditory component while the delayed group's response was more evenly split between the auditory and visual components of the illusion. These findings suggest that phonological processing, rather than articulation, supports lip-reading ability.

Previous research indicates that the extent of progress made by children with phonological disorders depends upon the nature of the word pairs contrasted in therapy. For example, phonemes that differ maximally in terms of place, manner, voicing and sound class (e.g., fan - man) in comparison to therapy where the word pairs presented differ minimally (e.g., fan - van). To investigate the implications of target selection within a typical clinical context (as opposed to a rigorous research setting) eight speech-language pathologists implemented intervention with appropriate children from their caseloads. Nineteen children each received 6 hours of therapy over one school term. They were randomly allocated to two groups. One group (of nine children) received intervention based on a traditional minimal pair approach, targeting homonymy as well as distinctive feature contrast. The other group (ten children) received intervention targeting contrasts differing across a range of distinctive features. Children made considerable progress in therapy in terms of speech accuracy and number of error patterns suppressed. However, there was no difference between the progress of the two groups. Follow-up assessment of 14 of the 19 children indicated maintenance of progress by both groups. Reasons for the lack of difference between the groups in the current study are considered and clinical implications are drawn.

Children with speech difficulty of no known etiology are a heterogeneous group. While speech errors are often attributed to auditory processing or oro-motor skill, an alternative proposal is a cognitive-linguistic processing difficulty. Research studies most often focus on only one of these aspects of the speech processing chain. This study investigated abilities in all three domains in children with speech difficulty (n = 78) and matched controls (n = 87). It was hypothesized that groups of children with speech difficulty would perform less well than controls on all tasks, but that the proportion of children with speech difficulty performing within the normal range would differ across tasks. The input processing task required children to perceive the auditory-visual illusion in speech perception, where listeners perceive [Formula: see text] when they hear [Formula: see text] presented in synchrony with the lip movements for [Formula: see text]. Diadochokinetic, isolated and sequenced movements tasks assessed oro-motor skills. Two non-verbal tasks evaluated rule derivation. The results indicated that rule derivation best discriminated typically developing and speech difficulty groups. Few children were identified as having an input or output difficulty, whereas difficulties with rule-derivation were common. The data support the notion that speech difficulty is, most often, associated with a central processing difficulty.

Background: In young, typically developing children, some word production variability is expected, but highly inconsistent speech is considered a clinical marker for disorder. Speech-language pathologists need to identify variability versus inconsistency, yet these terms are not clearly differentiated. Not only is it important to identify inconsistency, but also it needs to be defined and measured so that clinical decisions are evidence based. In order to understand inconsistent speech production, typical variability must be described., Aims: This paper differentiates between variability and inconsistent productions. Variability is defined as productions that differ, but can be attributed to factors described in normal acquisition and use of speech. Inconsistency is speech characterized by a high proportion of differing repeated productions with multiple error types, both segmental (phoneme) and structural errors (consonant-vowel sequence within a syllable). The study describes and quantifies the consistency of word production in typically developing children aged between 3;0 and 6;11 years., Methods and Procedures: This paper reports a large cross-sectional study (n = 409) of the consistency of children's production of words within the same linguistic context., Outcomes and Results: The study found that the speech of typically developing children is highly consistent. Children in the youngest age group demonstrated the highest levels of variability, but it remained below 13% with 10% reflecting maturational influences., Conclusions: Inconsistent production cannot be considered a typical feature of speech development. The results inform differential diagnosis of speech disorder.

Speech-language pathologists are increasingly required to demonstrate that their practice is based on evidence. While the concept of evidence-based practice has strengths, there have been some weaknesses in its application in speech-language pathology. Nevertheless, since current health care demands compliance, the profession must consider the opportunities and threats that evidence-based practice poses. This paper reviews the literature to provide an understanding of the relevance of evidence-based practice for speech-language pathology. It considers the assumptions on which definitions of evidenced-based practice rely and reviews the ways in which clinicians might base their practice on evidence. While the medical model of evidence-based practice research is controversial even in the medical field, the concept provides opportunities for the profession of speech-language pathology. Evidence-based practice has the potential to improve intervention for people with communication disorders, increase resources for services and enhance perception of the profession., (Copyright 2007 S. Karger AG, Basel.)

To investigate the importance of the connection between being able to speak and the emergence of phonological awareness abilities, the performance of children with cerebral palsy (five speakers and six non-speakers) was assessed at syllable, onset-rime, and phoneme levels. The children were matched with control groups of children for non-verbal intelligence. No group differences were found for the identification of syllables, reading non-words, or judging spoken rhyme. The children with cerebral palsy who could speak, however, performed better than the children with cerebral palsy who could not speak and the control group of children without disabilities, judging written words for rhyme. The children with cerebral palsy who could not speak performed poorly in comparison to those who could speak (but not the control group of children) when segmenting syllables and on the phoneme manipulation task. The findings suggest that non-speaking children with cerebral palsy have phonological awareness performance that varies according to the mental processing demands of the task. The ability to speak facilitates performance when phonological awareness tasks (written rhyme judgment, syllable segmentation, and phoneme manipulation) require the use of an articulatory loop.

This paper reviews the International Atomic Energy Agency's "International Conference on the Safety and Security of Radioactive Sources: Towards a Global System for the Continuous Control of Sources throughout their Life Cycle," which was held in Bordeaux, France, from 27 June to 1 July 2005. Some high points of the progress in controlling radioactive sources since the similar meeting in Dijon (1998) are discussed. The impact of the IAEA's Code of Conduct on the Safety and Security of Radioactive Sources for radioactive material licensees in the United States of America is summarized.

Objective: This paper outlines the education of speech and language therapists in the UK and Ireland, and presents a preliminary study of student therapists' perceptions of problem-based learning (PBL) as a learning strategy in preparation for clinical work. PBL has been used extensively in medical and dental education in Europe, in Canada, and in the Middle East, and has been applied to speech and language therapist education in Sweden and in Australia. Its implementation in the UK and Ireland is relatively new., Methods: A survey questionnaire was circulated to students in two centres via e-mail. Questions posed included student impressions of the most and least useful elements of PBL in their preparation for clinical practice, as well as how they considered improvements could be made; student reflections regarding PBL were also sought., Results and Conclusions: Findings support the implementation of PBL in the education of speech and language therapists, with more experienced students showing more positive support for PBL. Issues raised by the study include emphasis on clinical relevance of problems, particularly in the early years of the course. The majority of students regarded PBL as directly relevant for clinical preparation., (Copyright (c) 2006 S. Karger AG, Basel.)

An analysis of the possible goals of terrorists and the means of achieving them leads to an assessment of the most likely target materials and facilities for radiological terrorism. International efforts in countering these terrorist goals cover several objectives. The first is to prevent acquisition of the target radioactive materials, or access to the target facilities. This has to be achieved throughout the life cycle for radioactive sources. The second objective is to detect attempts to acquire, or actual acquisition of, radioactive materials. The third objective is to effectively detect and respond to the use (or threat of use) of these materials, or sabotage of the facilities. An additional goal is to minimize the consequences of any such use or sabotage. The number of international bodies, groups, agencies, and organizations contributing to these goals is very large and almost impossible to catalogue. However, this paper groups the types of efforts that are being undertaken, identifies the key agencies involved, and provides some specific examples of their work.

Purpose: This study examined the effect of phonological awareness intervention that focused on syllable and rhyme awareness on the acquisition of literacy and the development of phonological awareness skills 2 years post intervention. The longitudinal study compared two groups of children from deprived socioeconomic backgrounds in the United Kingdom. One group received a program of phonological awareness intervention and one did not., Method: Ninety-nine children received a 9-week program of phonological awareness intervention in the summer term of their final preschool year. These children were then assessed on measures of phonological awareness and language in the first term of their first year at school (M age = 4;7 [years; months]) and again 2 years later (M age = 6;8) on measures of phonological awareness and literacy. One year earlier, a control group of 114 children from the same schools were also assessed at these two points in their schooling on the same measures. This group did not receive any phonological awareness intervention., Results: At the second assessment, the group of children who received phonological awareness intervention performed better than those children who received no intervention (control group) on rhyme awareness and nonword spelling. Surprisingly, however, the control group performed better than the children who had received intervention on the phoneme segmentation task., Conclusion: The phonological awareness intervention that was implemented, which focused on enhancing syllable and rhyme awareness, had little effect on later literacy development and may have interfered with the acquisition of phoneme awareness. Implications for intervention with children from deprived socioeconomic backgrounds are discussed in the context of current research.

Background: Children with speech disorder are a heterogeneous group (e.g. in terms of severity, types of errors and underlying causal factors). Much research has ignored this heterogeneity, giving rise to contradictory intervention study findings. This situation provides clinical motivation to identify the deficits in the speech-processing chain that underlie different subgroups of developmental speech disorder. Intervention targeting different deficits should result in a differential response to intervention across these subgroups., Aims: To evaluate the effect of two different types of therapy on speech accuracy and consistency of word production of children with consistent and inconsistent speech disorder., Methods & Procedures: Eighteen children (aged 4;08-6;05 years) with severe speech disorder participated in an intervention study comparing phonological contrast and core vocabulary therapy. All children received two 8-week blocks of each intervention. Changes in consistency of production and accuracy (per cent consonants correct) were used to measure the effect of each intervention., Outcomes & Results: All of the children increased their consonant accuracy during intervention. Core vocabulary therapy resulted in greater change in children with inconsistent speech disorder and phonological contrast therapy resulted in greater change in children with consistent speech disorder., Conclusions: The results provide evidence that treatment targeting the speech-processing deficit underlying a child's speech disorder will result in efficient system-wide change. Differential response to intervention across subgroups provides evidence supporting theoretical perspectives regarding the nature of speech disorders: it reinforces the concept of different underlying deficits resulting in different types of speech disorder.

There is a vast body of literature on the causes, prevalence, implications, and issues of vocal dysfunction in teachers. However, the educational effect of teacher vocal impairment is largely unknown. The purpose of this study was to investigate the effect of impaired voice quality on children's processing of spoken language. One hundred and seven children (age range, 9.2 to 10.6, mean 9.8, SD 3.76 months) listened to three video passages, one read in a control voice, one in a mild dysphonic voice, and one in a severe dysphonic voice. After each video passage, children were asked to answer six questions, with multiple-choice answers. The results indicated that children's perceptions of speech across the three voice qualities differed, regardless of gender, IQ, and school attended. Performance in the control voice passages was better than performance in the mild and severe dysphonic voice passages. No difference was found between performance in the mild and severe dysphonic voice passages, highlighting that any form of vocal impairment is detrimental to children's speech processing and is therefore likely to have a negative educational effect. These findings, in light of the high rate of vocal dysfunction in teachers, further support the implementation of specific voice care education for those in the teaching profession.

The McGurk effect, in which auditory [ba] dubbed onto [ga] lip movements is perceived as "da" or "tha," was employed in a real-time task to investigate auditory-visual speech perception in prelingual infants. Experiments 1A and 1B established the validity of real-time dubbing for producing the effect. In Experiment 2, 4 1/2-month-olds were tested in a habituation-test paradigm, in which an auditory-visual stimulus was presented contingent upon visual fixation of a live face. The experimental group was habituated to a McGurk stimulus (auditory [ba] visual [ga]), and the control group to matching auditory-visual [ba]. Each group was then presented with three auditory-only test trials, [ba], [da], and [(delta)a] (as in then). Visual-fixation durations in test trials showed that the experimental group treated the emergent percept in the McGurk effect, [da] or [(delta)a], as familiar (even though they had not heard these sounds previously) and [ba] as novel. For control group infants [da] and [(delta)a] were no more familiar than [ba]. These results are consistent with infants' perception of the McGurk effect, and support the conclusion that prelinguistic infants integrate auditory and visual speech information., (Copyright 2004 Wiley Periodicals, Inc.)

Background: There has been no previous incidence survey of children referred to a speech and language therapy service in the UK. Previous studies of prevalence of specific communication difficulties provide contradictory data from which it is difficult to plan speech and language therapy service provision. Reliable data are needed concerning the nature and severity of impairments as well as the age and source of referral and the effects of cultural and socio-economic profiles of the population served., Aims: To describe referrals received between January 1999 and April 2000 by the paediatric speech and language therapy service of Middlesborough Primary Care Trust, an area of social deprivation., Methods & Procedures: All referrals were offered an initial assessment appointment within 8 weeks of referral. Standardized tests and quantitative measures of communication difficulties, determined by age, were undertaken. Population and case history information was also gathered., Outcomes & Results: The incidence rate of referrals who attended for assessment in a single year was calculated as 16.3% for primary communication disability and 14.6% for speech/language disability. Of the 1100 referrals, 14.9% failed to attend and 9.8% had normal functioning. The distribution of disorder type was dysfluency 5.3%, voice or nasality disruption 2.0%; receptive language difficulties 20.4%, expressive language difficulties 16.9% and speech difficulties 29.1%. A further 0.7% had special educational needs and 0.9% had speech and language impairment but refused consent. The majority of referrals were between 2 and 6 years old, more boys than girls were referred, and socio-economic status matched that of the local population. Both gender and socio-economic status affected diagnosis., Conclusions: Based on the Middlesborough data, the estimated national incidence rate of referrals who attend for assessment and who have speech and language disability is 85 000-90 000 children per year (14.6% of births). While findings from only one Primary Care Trust must be treated cautiously, they provide paediatric speech and language therapy services managers with information that might guide service planning.

This paper reports a normative study on the phonological development of British English-speaking children. Speech samples of 684 children, aged between 3;0 and 6;11 years, randomly selected from nurseries and schools in eight different areas throughout the UK, were collected and analysed to obtain normative data. This paper reports on two aspects of speech development: the age of acquisition of sounds (phonetic acquisition) and the age that error patterns were suppressed (phonemic acquisition). It discusses the effects of age, gender and socio-economic status on speech sound development. The study found that older children had more accurate production and fewer error patterns in their speech. It found no gender differences in the younger age groups. However, in the oldest age group, it found the phonological accuracy measures of girls' better than boys. It found no significant effects of socio-economic status on any of the phonological accuracy measures.

Background: The UK is a multicultural, multilingual society and the majority of paediatric speech and language therapists in England have at least one bilingual child on their caseload. There are many imperatives driving the profession to provide an equitable service for bilingual children. Evidence is beginning to emerge, however, that bilingual children with specific language impairment are not being identified and are, therefore, not accessing services. The situation facing clinicians in the UK is not unique: it is mirrored around the world., Aims: This paper reviews the literature relating to speech and language services for bilingual children and begins by providing an overview of the forces driving the need to provide equity of service. All aspects of the therapeutic process are then examined, from referral to therapy, in order to identify features that are regarded as best practice. Whilst the focus is on delivery of services in the UK, research findings from around the world are considered., Main Contribution: Certain themes emerged during the review and their implications are discussed. In particular, the need for assessment tools, training and research is highlighted., Conclusions: Features indicative of best practice are highlighted and tentative suggestions made that would enable services to address the challenges of serving bilingual paediatric caseloads.

Purpose: This study compares three essential skills in early literacy: letter-sound recognition, letter-sound recall, and letter reproduction. Previous research comparing these aspects of letter-sound knowledge is limited., Method: Eighty-three normally developing children between the ages of 4:11 (years:months) and 6:4 were asked to recognize (i.e., point to the appropriate letter when the letter's sound is given), recall (i.e., say the letter's sound), and reproduce (i.e., write the letter when the letter's sound is given) 32 letter sounds., Results: The children performed better in letter-sound recognition than in letter-sound recall, and better in letter-sound recall than in letter reproduction. Girls performed no differently from boys. Younger children performed as well as older children. Socioeconomic status had significant influence on the level of development for all tasks., Clinical Implications: Clinicians and educators need to be aware of the different aspects of letter-sound knowledge development and how it can be assessed so that intervention can follow the normal developmental sequence of acquisition.