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Children, and particularly infants, have physiological, anatomic, and social factors that increase vulnerability to temperature extremes. We performed a systematic review to explore the association between acute adverse infant outcomes (children 0–1 years) and exposure to high and low ambient temperatures. MEDLINE (Pubmed), Embase, CINAHL Plus, and Global Health were searched alongside the reference lists of key papers. We included published journal papers in English that assessed adverse infant outcomes related to short-term weather-related temperature exposure. Twenty-six studies met our inclusion criteria. Outcomes assessed included: infant mortality (n = 9), sudden infant death syndrome (n = 5), hospital visits or admissions (n = 5), infectious disease outcomes (n = 5), and neonatal conditions such as jaundice (n = 2). Higher temperatures were associated with increased risk of acute infant mortality, hospital admissions, and hand, foot, and mouth disease. Several studies identified low temperature impacts on infant mortality and episodes of respiratory disease. Findings on temperature risks for sudden infant death syndrome were inconsistent. Only five studies were conducted in low- or middle-income countries, and evidence on subpopulations and temperature-sensitive infectious diseases was limited. Public health measures are required to reduce the impacts of heat and cold on infant health.

BACKGROUND: Probabilistic linkage can link patients from different clinical databases without the need for personal information. If accurate linkage can be achieved, it would accelerate the use of linked datasets to address important clinical and public health questions. OBJECTIVE: We developed a step-by-step process for probabilistic linkage of national clinical and administrative datasets without personal information, and validated it against deterministic linkage using patient identifiers. STUDY DESIGN AND SETTING: We used electronic health records from the National Bowel Cancer Audit and Hospital Episode Statistics databases for 10,566 bowel cancer patients undergoing emergency surgery in the English National Health Service. RESULTS: Probabilistic linkage linked 81.4% of National Bowel Cancer Audit records to Hospital Episode Statistics, vs. 82.8% using deterministic linkage. No systematic differences were seen between patients that were and were not linked, and regression models for mortality and length of hospital stay according to patient and tumour characteristics were not sensitive to the linkage approach. CONCLUSION: Probabilistic linkage was successful in linking national clinical and administrative datasets for patients undergoing a major surgical procedure. It allows analysts outside highly secure data environments to undertake linkage while minimizing costs and delays, protecting data security, and maintaining linkage quality.

Purpose Speech-language pathologists (SLPs) may be approached by multilingual speakers seeking to improve their intelligibility in English. Intelligibility is an essential element of spoken language proficiency and is especially important for multilingual university students given their need to express complex ideas in an additional language. Intelligibility Enhancement is an assessment and intervention approach that aims to improve the intelligibility of consonants, vowels, and prosody with multilingual speakers who are learning to speak English. This article describes the student-led delivery of Intelligibility Enhancement with multilingual clients in a university clinic using a telepractice model after restrictions were imposed due to the COVID-19 pandemic. Conclusions Telepractice offered an appropriate mode of service delivery that facilitated a high-quality, best practice, and continuous service to Intelligibility Enhancement clients while also permitting student SLPs' ongoing clinical education employing an increasingly utilized technology. Previous research demonstrated the effectiveness of the Intelligibility Enhancement Assessment and Intervention Protocols in increasing English intelligibility in multilingual university students. The modifications necessary to provide this intervention via telepractice in a student-led clinic not only offer a possible solution to supporting multilingual university students' English intelligibility during the COVID-19 pandemic but also will inform the understanding of SLPs providing similar interventions in the future.

The aim was to compare early postoperative outcomes and 2-year cancer-specific mortality following colorectal cancer (CRC) resection in patients with and without inflammatory bowel disease (IBD) in England and Wales.Records for patients in the National Bowel Cancer Audit who had major CRC resection between April 2014 and December 2017 were linked to routinely collected hospital level administrative datasets and chemotherapy and radiotherapy datasets. Multivariable regression models were used to compare outcomes with adjustment for patient and tumour characteristics.In all, 63 365 patients were included. 1285 (2.0%) had an IBD diagnosis: 839 (65.3%) ulcerative colitis, 435 (33.9%) Crohn's disease and 11 (0.9%) were indeterminate. IBD patients were younger, had more advanced cancer staging and a higher proportion of right-sided tumours. They also had a higher proportion of emergency resection, total/subtotal colectomy, open surgery and stoma formation at resection, with longer hospital admissions and higher rates of unplanned readmission and reoperation. Fewer rectal cancer patients with IBD received neoadjuvant radiotherapy (24.8% vs. 36.0%, P = 0.005) whilst similar proportions of Stage III colon cancer patients received adjuvant chemotherapy. Ninety-day postoperative mortality was similar, but unadjusted 2-year cancer-specific mortality was significantly higher in patients with IBD (subdistribution hazard ratio 1.35, 95% CI 1.18-1.55). Risk adjustment for patient and tumour factors reduced this association (adjusted subdistribution hazard ratio 1.22, 95% CI 1.05-1.43).Patients with IBD and CRC are a distinct patient group who develop CRC at a younger age and undergo more radical surgery. They have worse cancer survival, with the difference in prognosis appearing after the early postoperative period.

Missing data is a common issue in research using observational studies to investigate the effect of treatments on health outcomes. When missingness occurs only in the covariates, a simple approach is to use missing indicators to handle the partially observed covariates. The missing indicator approach has been criticized for giving biased results in outcome regression. However, recent papers have suggested that the missing indicator approach can provide unbiased results in propensity score analysis under certain assumptions. We consider assumptions under which the missing indicator approach can provide valid inferences, namely, (1) no unmeasured confounding within missingness patterns; either (2a) covariate values of patients with missing data were conditionally independent of treatment or (2b) these values were conditionally independent of outcome; and (3) the outcome model is correctly specified: specifically, the true outcome model does not include interactions between missing indicators and fully observed covariates. We prove that, under the assumptions above, the missing indicator approach with outcome regression can provide unbiased estimates of the average treatment effect. We use a simulation study to investigate the extent of bias in estimates of the treatment effect when the assumptions are violated and we illustrate our findings using data from electronic health records. In conclusion, the missing indicator approach can provide valid inferences for outcome regression, but the plausibility of its assumptions must first be considered carefully.

Background Multivariate meta-analysis (MVMA) jointly synthesizes effects for multiple correlated outcomes. The MVMA model is potentially more difficult and time-consuming to apply than univariate models, so if its use makes little difference to parameter estimates, it could be argued that it is redundant. Methods We assessed the applicability and impact of MVMA in Cochrane Pregnancy and Childbirth (CPCB) systematic reviews. We applied MVMA to CPCB reviews published between 2011 and 2013 with two or more binary outcomes with at least three studies and compared findings with results of univariate meta-analyses. Univariate random effects meta-analysis models were fitted using restricted maximum likelihood estimation (REML). Results Eighty CPCB reviews were published. MVMA could not be applied in 70 of these reviews. MVMA was not feasible in three of the remaining 10 reviews because the appropriate models failed to converge. Estimates from MVMA agreed with those of univariate analyses in most of the other seven reviews. Statistical significance changed in two reviews: In one, this was due to a very small change in P value; in the other, the MVMA result for one outcome suggested that previous univariate results may be vulnerable to small-study effects and that the certainty of clinical conclusions needs consideration. Conclusions MVMA methods can be applied only in a minority of reviews of interventions in pregnancy and childbirth and can be difficult to apply because of missing correlations or lack of convergence. Nevertheless, clinical and/or statistical conclusions from MVMA may occasionally differ from those from univariate analyses.

Purpose Diversification of the profession is an important element of combating racism, bias, and prejudice in the speech-language pathology workforce at national and systemic levels. However, national and systemic change needs to be combined with equipping individual speech-language pathologists to adapt to the challenges that they face to engaging in culturally responsive practice. This paper presents four interacting levels of practice within the Culturally Responsive Teamwork Framework (CRTF): (a) intrapersonal practices, (b) interpersonal practices, (c) intraprofessional practices, and (d) the interprofessional practices. Conclusion CRTF is a practical, strengths-based framework that draws on international research and expertise to expand personal and professional practice and describe critical behaviors within the workplace that can be used to promote principles of evidence-based practice and social justice, especially when working with people from nondominant cultural or linguistic groups.

Objective: To compare the management and outcomes of colorectal cancer (CRC) patients during the first 2 months of the COVID-19 pandemic with the preceding 6 months. Background: The pandemic has affected the diagnosis and treatment of CRC patients worldwide. Little is known about the safety of major resection and whether creating “cold” sites (COVID-free hospitals) is effective. Methods: A national study in England used administrative hospital data for 14,930 CRC patients undergoing surgery between October 1, 2019, and May 31, 2020. Mortality of CRC resection was compared before and after March 23, 2020 (“lockdown” start). Results: The number of elective CRC procedures dropped sharply during the pandemic (from average 386 to 214 per week), whereas emergency procedures were hardly affected (from 88 to 84 per week). There was little change in characteristics of surgical patients during the pandemic. Laparoscopic surgery decreased from 62.5% to 35.9% for elective and from 17.7% to 9.7% for emergency resections. Surgical mortality increased slightly (from 0.9% to 1.2%, P = 0.06) after elective and markedly (from 5.6% to 8.9%, P = 0.003) after emergency resections. The observed increase in mortality during the first phase of the pandemic was similar in “cold” and “hot” sites (P > 0.5 elective and emergency procedures). Conclusions: The pandemic resulted in a 50% reduction in elective CRC procedures during the initial surge and a substantial increase in mortality after emergency resection. There was no evidence that surgery in COVID-free “cold” sites led to better outcomes in the first 2 months., Mini-abstract: Elective surgery for colorectal cancer dropped by 50% at the start of the COVID-19 pandemic in England. Mortality after major resection increased from 0.9% to 1.2% for elective and from 5.6% to 8.9% for emergency procedures. There was no evidence that using COVID-free hospitals improved outcomes during the initial surge.

AIM: The object of this work was to study how National Health Service hospitals in England and Wales aimed to maintain effective and safe colorectal cancer (CRC) services during the first peak of the COVID-19 pandemic (April 2020). METHOD: A national survey was performed among all 148 hospitals providing CRC services. Information was collected about changes in referrals, diagnostic, staging and therapeutic procedures, as well as whether there was access to a 'cold site' (a hospital facility free of COVID-19). Clinicians in each hospital were also asked to give the 'single most important lesson learned' about keeping services safe and effective. RESULTS: Full responses were received from 123 (83%) hospitals, and information about 'cold sites' was available for 146 (99%). Eighty hospitals (54%) had access to a 'cold site' and this was increased in regions with higher COVID-19 infection rates (p

This paper reports on 137 multilingual students enrolled at 14 English-speaking Australian universities who completed a 27-item online survey investigating the relationship between perceived English proficiency, intelligibility, and their academic, social and vocational participation. Open-ended responses described strategies used to enhance spoken English. Participants came from 44 countries and spoke 49 home languages. Self-ratings of English communication skills were significantly affected by age, English experience, number of languages spoken and home language. Participants reported spoken English proficiency impacted participation; however, results highlighted lack of awareness of intelligibility as an essential component of spoken language proficiency. Although environmental factors (e.g. more time using English in conversations) were associated with higher self-ratings of proficiency, participants preferred using individual strategies (e.g. listening/repeating) to support English intelligibility rather than social interactions with native speakers. The results demonstrate the importance of conversation practice in language learning to increase proficiency and confidence, as well as participation.

Multilingual speakers’ ability to communicate effectively and intelligibly in the language of their country of residence is crucial to their participation. This study explored multilingual speakers...

Purpose To use the ICF to classify characteristics and aspirations of multilingual university students and faculty who seek speech-language pathologists’ support for intelligibility in English and to identify activities, facilitators, and barriers that impact participation in society. Method A retrospective record review was conducted on files of 175 clients attending a university clinic for intelligibility enhancement (accent modification). Participants came from 35 countries and spoke 28 different home languages. Results Assessment and intervention for intelligibility enhancement involved consideration of ICF components of Body Functions and Structures (e.g., articulating phonemes, rate, prosody), Environmental Factors (e.g., support), and Personal Factors (e.g., motivation). Consonant substitutions and deletions were common, although participants were often unaware of these. For example, only 25.6% of participants reported English dental fricatives (/θ/ and /ð/) were difficult to pronounce; however, 94.9% substituted them with other phonemes such as [t] and [d]. The combination of substitutions/deletions, fast speech rate, low speaking volume, and differences in word stress exacerbated poor intelligibility. More time conversing in English was associated with greater confidence and less difficulty communicating in English, although more time knowing English was not. Difficult communication situations were reported to be conversing over the phone, talking to strangers, and communicating in English on professional fieldwork placements. Participants were motivated to seek intelligibility enhancement for academic, employment, and social reasons. Conclusions To ensure multilingual speakers are able to participate fully in society, intelligibility enhancement requires a multi-pronged approach where speech and environmental characteristics interweave.

© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group. Key drivers for migrants’ social integration are education, employment, and skills in the dominant language of the settlement country. Data from Building a New Life in Australia: The Longitudinal Study of Humanitarian Migrants were used to examine migrants’ English proficiency and how oral English proficiency facilitated or hindered participation in activities that may help them become self-sufficient and settle. Participants were 2399 humanitarian migrants interviewed in the first wave of data collection (during 2013/14). Before arrival in Australia, 80.1% reported they spoke English not well or not at all. After arrival, oral English proficiency was a statistically significant predictor of self-sufficiency (knowing how to look for a job, get help in an emergency, etc.) explaining 21% of the variance while controlling for confounding variables such as age and education. After English proficiency, age (neither too young nor too old), gender (male), education (more than 12 years), and time since arrival (more than one year) were significant predictors of self-sufficiency. Identification of factors that predict self-sufficiency informs the understanding of people who provide support for humanitarian migrants. These findings indicate poor oral English skills may profoundly hinder humanitarian migrants’ ability to settle and highlight the importance of supporting migrants’ English learning.

Speech-language pathologists (SLPs) may be approached by multilingual speakers wishing to improve their intelligibility in English. Intelligibility is an essential element of spoken language proficiency and is particularly important for multilingual international students given their need to express complex ideas in an additional language. Intelligibility Enhancement aims to improve the intelligibility and acceptability of consonants, vowels and prosody with multilingual speakers who are learning to speak English. This study aimed to describe the Intelligibility Enhancement Assessment and Intervention Protocols and determine whether the intervention changed multilingual university students' English intelligibility. A multiple-baseline single-case experimental design was applied with direct inter-subject replication across two female participants whose home languages were Vietnamese and Putonghua (Mandarin). English intelligibility was assessed at multiple intervals pre, post and during intervention. The intervention protocol consisted of 11 weekly 1-h sessions with an SLP targeting English consonants, vowels and prosody. Following intervention, both participants displayed increased performance across most measures. For example, the Vietnamese participant's percentage of consonants correct (PCC) increased from 62.5% to 85.0% in probe keywords. Effect sizes, when comparing baseline and withdrawal phases, were 5.5 for PCC, 4.6 for final consonants, 2.3 for consonant clusters and 1.6 for syllables indicating improvements in all variables measured. Her speech rate reduced, word stress increased in accuracy and she perceived less difficulty communicating in English. These promising results suggest further testing of the Intelligibility Enhancement Protocols is warranted to determine effectiveness as an intervention for multilingual speakers.

Intrathecal drug delivery systems offer an approach for medication administration that is appropriate for patients in whom oral or parenteral therapy is inadequate to control pain complaints or that suffer from deleterious side effects associated with medication administration. Due to rapidly escalating pain or a need for frequent titration of analgesic agents that is often associated with the natural progression of cancer, intrathecal therapy is ideally suited to this population. Intrathecal medications are easily titrated, highly potent, and associated with fewer systemic side effects than parenteral or oral medications. By targeting receptors present in the dorsal horn of the spinal cord, intrathecal drug delivery mechanisms allow for improved pain control with far smaller doses than those required with systemic administration. Multiple systems and medications are available and suitable for intrathecal drug delivery. Intrathecal delivery of medication should be considered in the management of pain associated with cancer.

Complementary treatments are important adjuncts to traditional pain management. While botanical therapies may be perceived as controversial, their use is grounded in traditional practices that far preceded the widely used innovations discussed elsewhere in this publication. With the development of the National Center for Complementary and Alternative Medicine, evidence-based research will continue to be produced increasing validation of the ancient techniques. Due to the unique and diverse benefits complementary therapies can afford, education and adoption of an integrated approach to medical care may result in reductions of the cost of treatment and improvement of the quality of life for patients.

Purpose This article describes the World Health Organization's International Classification of Functioning, Disability and Health (ICF) and its application to speech, language, and hearing. The art...

Electronic health records are a valuable data source for investigating health-related questions, and propensity score analysis has become an increasingly popular approach to address confounding bias in such investigations. However, because electronic health records are typically routinely recorded as part of standard clinical care, there are often missing values, particularly for potential confounders. In our motivating study-using electronic health records to investigate the effect of renin-angiotensin system blockers on the risk of acute kidney injury-two key confounders, ethnicity and chronic kidney disease stage, have 59% and 53% missing data, respectively. The missingness pattern approach (MPA), a variant of the missing indicator approach, has been proposed as a method for handling partially observed confounders in propensity score analysis. In the MPA, propensity scores are estimated separately for each missingness pattern present in the data. Although the assumptions underlying the validity of the MPA are stated in the literature, it can be difficult in practice to assess their plausibility. In this article, we explore the MPA's underlying assumptions by using causal diagrams to assess their plausibility in a range of simple scenarios, drawing general conclusions about situations in which they are likely to be violated. We present a framework providing practical guidance for assessing whether the MPA's assumptions are plausible in a particular setting and thus deciding when the MPA is appropriate. We apply our framework to our motivating study, showing that the MPA's underlying assumptions appear reasonable, and we demonstrate the application of MPA to this study.

This study explored an alternative methodology for analyzing communication interactions, to determine whether it could be applied to interventions designed to improve the communication competence o...

© 2016 The Speech Pathology Association of Australia Limited Published by Informa UK Limited, trading as Taylor & Francis Group. Purpose: Proficiency in the language of the country of residence has implications for an individual’s level of education, employability, income and social integration. This paper explores the relationship between the spoken English proficiency of residents of Australia on census day and their educational level, employment and income to provide insight into multilingual speakers’ ability to participate in Australia as an English-dominant society. Method: Data presented are derived from two Australian censuses i.e. 2006 and 2011 of over 19 million people. Result: The proportion of Australians who reported speaking a language other than English at home was 21.5% in the 2006 census and 23.2% in the 2011 census. Multilingual speakers who also spoke English very well were more likely to have post-graduate qualifications, full-time employment and high income than monolingual English-speaking Australians. However, multilingual speakers who reported speaking English not well were much less likely to have post-graduate qualifications or full-time employment than monolingual English-speaking Australians. Conclusion: These findings provide insight into the socioeconomic and educational profiles of multilingual speakers, which will inform the understanding of people such as speech-language pathologists who provide them with support. The results indicate spoken English proficiency may impact participation in Australian society. These findings challenge the “monolingual mindset” by demonstrating that outcomes for multilingual speakers in education, employment and income are higher than for monolingual speakers.

Multidrug resistance (MDR) mediated by overexpression of MDR1 P-glycoprotein (Pgp) is one of the best characterized barriers to chemotherapy in cancer patients. Furthermore, the protective function of Pgp-mediated efflux of xenobiotics in various organs has a profound effect on the bioavailability of drugs in general. Thus, there is an expanding requirement to noninvasively interrogate Pgp transport activity in vivo. We herein report the Pgp recognition properties of a novel 99m Tc(I)tricarbonyl complex, [ 99m Tc(CO)3(MIBI)3] + (Tc-CO-MIBI). TcCO-MIBI showed 60-fold higher accumulation in drug-sensitive KB 3-1 cells compared to colchicine-selected drug-resistant KB 8-5 cells. In KB 8-5 cells, tracer enhancement was observed with the potent MDR modulator LY335979 (EC50 = 62 nM). Similar behavior was observed using drug-sensitive MCF-7 breast adenocarcinoma cells and MCF-7/MDR1 stable transfectants, confirming that Tc-CO-MIBI is specifically excluded by overexpression of MDR1 Pgp. By comparison, net accumulation in control H69 lung tumor cells was 9-fold higher than in MDRassociated protein (MRP1)-expressing H69AR cells, indicating only modest transport by MRP1. Biodistribution analysis following tail vein injection of Tc-CO-MIBI showed delayed liver clearance as well as enhanced brain uptake and retention in mdr1a/1b( � // � ) gene deleted mice versus wild-type mice, directly demonstrating that Tc-CO-MIBI is a functional probe of Pgp transport activity in vivo. Mol Imaging (2002) 1, 24 – 35.

Chronic removal of infant rats from their mother prior to the onset of weaning is complicated by the fact that young rats do not easily suckle from an artificial nipple. Thus, a method of artificial raising is advantageous for developmental investigations of nutrition or ingestive behaviors during the suckling period. The intragastric cannula has become a popular method for this purpose. However, for many studies, it would be advantageous if the diet could be administered to the mouth and actually swallowed by the young rat. We developed a new cannulation procedure which accomplishes these goals. Infant rats were removed from their mother on postnatal day 13 and fitted with a cannula that opened into the oral cavity through the hard palate. Liquid diet was administered by an infusion pump through the cannula for the subsequent 5 days. Growth was assessed by daily measures of body and organ weight. The results indicate that from postnatal day 13 on, the palate cannula can allow the continuation of normal growth patterns and eliminates certain complicating factors associated with other forms of artifical raising.

Four patients with lymphoproliferative disease with immunoglobulin M lambda (IgMlambda) monoclonal proteins and severe autoimmune hemolytic anemia are described. These patients had many features in common that may warrant their recognition as a specific entity within the lymphoproliferative spectrum. In each case, a wide thermal range low titer cold agglutinin was present. The association of cold autoimmune hemolytic anemia with IgMlambda monoclonal protein and lymphoproliferative disease is unusual. The literature on IgM monoclonal proteins associated with lymphoproliferative disease is reviewed with emphasis on the presence of direct antiglobulin test positive autoimmune hemolytic anemia.

As reported previously, weanling rats will choose to consume more of a liquid diet composed of 12% lactose (low-L) than of an isocaloric liquid diet composed of 47% lactose (high-L) despite the greater sweetness of the latter diet. To investigate the basis for this, saccharin was added to the high-L diet to overwhelm any unpalatable qualities. The results of several choice tests indicate that pups initially prefer the saccharin-sweetened diet. However, if the low-L diet is the alternate choice, the preference shifts to the low-L diet after several days of exposure. This initial preference for the sweetened high-L diet suggests that the high lactose aversion is due to post-ingestive consequences rather than to low palatability of the high-L diet. Furthermore, it appears that the aversion to a high concentration of lactose takes precedence over a preference for the increased sweetness of the high-L diet.

Both adult and weanling rats are able to control their dietary intake of protein. The purposes of the current study were to determine: (1) the precision of this ability in the weanling rat and (2) when this ability makes its ontogenic appearance. We studied three overlapping age groups spanning the third, fourth and fifth postnatal weeks. Animals chose between two isocaloric liquid diets, one protein-free and the other composed of 50% protein. The intake volume of each diet was measured daily. Three days after introduction to the diets, pups were subjected to short-term tests designed to determine their ability to distinguish between the two diets. All three are groups responded to the protein conditions. However, the youngest group displayed comparatively weaker responses characterized by a prolonged period of reduced protein intake and weaker responses to the protein conditions of the short-term test. We conclude that young rats control protein intake by the end of the third postnatal week and that this ability strengthens throughout the remainder of the weaning period.