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There is a growing body of literature informing pedagogical content and strategies of diversity, equity, and inclusion in the education of speech-language pathologists. However, little discussion has included content related to LGBTQ+ people, even though LGBTQ+ people exist across all racial/ethnic groups. This article seeks to fill that void and provide instructors of speech-language pathology with practical information to educate their graduate students. The discussion uses a critical epistemology and invokes theoretical models, such as Queer/Quare theory, DisCrit, the Minority Stress Model, the Ethics of Care, and Culturally Responsive Pedagogy. Information is organized according to developing graduate students' awareness, knowledge, and skills and challenges instructors to modify current course content to disrupt systemic oppression., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose This study aimed to determine if African American students were disproportionately represented between the years of 2004 and 2014 in the primary disability category of Speech or Language Impairment (S/LI) under the 2004 reauthorized Individuals with Disabilities Education Improvement Act. Method S/LI enrollment data from the Office of Special Education Programs and general enrollment data from the National Center for Education Statistics were analyzed to compare the risk of primary S/LI category enrollment of African American students to that of all other students. Risk ratios with 99% confidence intervals were calculated for each state across the 10 years studied. Results An average of 75% of states disproportionately represented African American students in the S/LI category each year; on average, 62% underrepresented African American students, and 14% overrepresented them. A post hoc analysis of the relationship between African American student representation and population densities revealed that states with high African American population densities almost exclusively underrepresented African American students and states with low densities tended toward a proportionate representation. Conclusions African American students were largely underrepresented in the category of S/LI in the years studied. These findings, alongside historic and chronic overrepresentation in other categories of special education, are discussed in the context of the fragmented harm theory ( Payne, 1984 ; Voulgarides, 2018 ; Voulgarides, Zwerger, & Noguera, 2013 ) and the disability rights and critical race theory ( Annamma, Connor, & Ferri, 2013 ). Supplemental Material https://doi.org/10.23641/asha.7967024.

Pseudoenzymes have burst into the limelight recently as they provide another dimension to regulation of cellular protein activity. In the eudicot plant lineage, the pseudoenzyme PDX1.2 and its cognate enzyme PDX1.3 interact to regulate vitamin B 6 biosynthesis. This partnership is important for plant fitness during environmental stress, in particular heat stress. PDX1.2 increases the catalytic activity of PDX1.3, with an overall increase in vitamin B 6 biosynthesis. However, the mechanism by which this is achieved is not known. In this study, the Arabidopsis thaliana PDX1.2-PDX1.3 complex was crystallized in the absence and presence of ligands, and attempts were made to solve the X-ray structures. Three PDX1.2-PDX1.3 complex structures are presented: the PDX1.2-PDX1.3 complex as isolated, PDX1.2-PDX1.3-intermediate (in the presence of substrates) and a catalytically inactive complex, PDX1.2-PDX1.3-K97A. Data were also collected from a crystal of a selenomethionine-substituted complex, PDX1.2-PDX1.3-SeMet. In all cases the protein complexes assemble as dodecamers, similar to the recently reported individual PDX1.3 homomer. Intriguingly, the crystals of the protein complex are statistically disordered owing to the high degree of structural similarity of the individual PDX1 proteins, such that the resulting configuration is a composite of both proteins. Despite the differential methionine content, selenomethionine substitution of the PDX1.2-PDX1.3 complex did not resolve the problem. Furthermore, a comparison of the catalytically competent complex with a noncatalytic complex did not facilitate the resolution of the individual proteins. Interestingly, another catalytic lysine in PDX1.3 (Lys165) that pivots between the two active sites in PDX1 (P1 and P2), and the corresponding glutamine (Gln169) in PDX1.2, point towards P1, which is distinctive to the initial priming for catalytic action. This state was previously only observed upon trapping PDX1.3 in a catalytically operational state, as Lys165 points towards P2 in the resting state. Overall, the study shows that the integration of PDX1.2 into a heteromeric dodecamer assembly with PDX1.3 does not cause a major structural deviation from the overall architecture of the homomeric complex. Nonetheless, the structure of the PDX1.2-PDX1.3 complex highlights enhanced flexibility in key catalytic regions for the initial steps of vitamin B 6 biosynthesis. This report highlights what may be an intrinsic limitation of X-ray crystallography in the structural investigation of pseudoenzymes.

Purpose: This study explored how typically developing 1st grade African American English (AAE) speakers differ from mainstream American English (MAE) speakers in the completion of 2 common phonological awareness tasks (rhyming and phoneme segmentation) when the stimulus items were consonant-vowel-consonant-consonant (CVCC) words and nonwords., Method: Forty-nine 1st graders met criteria for 2 dialect groups: AAE and MAE. Three conditions were tested in each rhyme and segmentation task: Real Words No Model, Real Words With a Model, and Nonwords With a Model., Results: The AAE group had significantly more responses that rhymed CVCC words with consonant-vowel-consonant words and segmented CVCC words as consonant-vowel-consonant than the MAE group across all experimental conditions. In the rhyming task, the presence of a model in the real word condition elicited more reduced final cluster responses for both groups. In the segmentation task, the MAE group was at ceiling, so only the AAE group changed across the different stimulus presentations and reduced the final cluster less often when given a model., Conclusion: Rhyming and phoneme segmentation performance can be influenced by a child's dialect when CVCC words are used.

The Target of Rapamycin Complex is a central controller of cell growth and differentiation in eukaryotes. Its global architecture has been described by cryoelectron microscopy, and regions of its central TOR protein have been described by X-ray crystallography. However, the N-terminal region of this protein, which consists of a series of HEAT repeats, remains uncharacterised at high resolution, most likely due to the absence of a suitable purification procedure. Here, we present a robust method for the preparation of the HEAT-repeat domain, utilizing the thermophilic fungus Chaetomium thermophilum as a source organism. We describe construct design and stable expression in insect cells. An efficient two-step purification procedure is presented, and the purified product is characterised by SEC and MALDI-TOF MS. The methods described pave the way for a complete high-resolution characterisation of this elusive region of the TOR protein., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Vitamin B 6 is indispensible for all organisms, notably as the coenzyme form pyridoxal 5'-phosphate. Plants make the compound de novo using a relatively simple pathway comprising pyridoxine synthase (PDX1) and pyridoxine glutaminase (PDX2). PDX1 is remarkable given its multifaceted synthetic ability to carry out isomerization, imine formation, ammonia addition, aldol-type condensation, cyclization, and aromatization, all in the absence of coenzymes or recruitment of specialized domains. Two active sites (P1 and P2) facilitate the plethora of reactions, but it is not known how the two are coordinated and, moreover, if intermediates are tunneled between active sites. Here we present X-ray structures of PDX1.3 from Arabidopsis thaliana, the overall architecture of which is a dodecamer of (β/α) 8 barrels, similar to the majority of its homologs. An apoenzyme structure revealed that features around the P1 active site in PDX1.3 have adopted inward conformations consistent with a catalytically primed state and delineated a substrate accessible cavity above this active site, not noted in other reported structures. Comparison with the structure of PDX1.3 with an intermediate along the catalytic trajectory demonstrated that a lysine residue swings from the distinct P2 site to the P1 site at this stage of catalysis and is held in place by a molecular catch and pin, positioning it for transfer of serviced substrate back to P2. The study shows that a simple lysine swinging arm coordinates use of chemically disparate sites, dispensing with the need for additional factors, and provides an elegant example of solving complex chemistry to generate an essential metabolite., Competing Interests: The authors declare no conflict of interest.

Target of Rapamycin (TOR) plays central roles in the regulation of eukaryote growth as the hub of two essential multiprotein complexes: TORC1, which is rapamycin-sensitive, and the lesser characterized TORC2, which is not. TORC2 is a key regulator of lipid biosynthesis and Akt-mediated survival signaling. In spite of its importance, its structure and the molecular basis of its rapamycin insensitivity are unknown. Using crosslinking-mass spectrometry and electron microscopy, we determined the architecture of TORC2. TORC2 displays a rhomboid shape with pseudo-2-fold symmetry and a prominent central cavity. Our data indicate that the C-terminal part of Avo3, a subunit unique to TORC2, is close to the FKBP12-rapamycin-binding domain of Tor2. Removal of this sequence generated a FKBP12-rapamycin-sensitive TORC2 variant, which provides a powerful tool for deciphering TORC2 function in vivo. Using this variant, we demonstrate a role for TORC2 in G2/M cell-cycle progression., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The structure of F₁-ATPase from Saccharomyces cerevisiae inhibited by the yeast IF₁ has been determined at 2.5 Å resolution. The inhibitory region of IF₁ from residues 1 to 36 is entrapped between the C-terminal domains of the α(DP)- and β(DP)-subunits in one of the three catalytic interfaces of the enzyme. Although the structure of the inhibited complex is similar to that of the bovine-inhibited complex, there are significant differences between the structures of the inhibitors and their detailed interactions with F₁-ATPase. However, the most significant difference is in the nucleotide occupancy of the catalytic β(E)-subunits. The nucleotide binding site in β(E)-subunit in the yeast complex contains an ADP molecule without an accompanying magnesium ion, whereas it is unoccupied in the bovine complex. Thus, the structure provides further evidence of sequential product release, with the phosphate and the magnesium ion released before the ADP molecule.

The mitochondrial F₁-ATPase inhibitor protein, IF₁, inhibits the hydrolytic, but not the synthetic activity of the F-ATP synthase, and requires the hydrolysis of ATP to form the inhibited complex. In this complex, the α-helical inhibitory region of the bound IF₁ occupies a deep cleft in one of the three catalytic interfaces of the enzyme. Its N-terminal region penetrates into the central aqueous cavity of the enzyme and interacts with the γ-subunit in the enzyme's rotor. The intricacy of forming this complex and the binding mode of the inhibitor endow IF₁ with high specificity. This property has been exploited in the development of a highly selective affinity procedure for purifying the intact F-ATP synthase complex from mitochondria in a single chromatographic step by using inhibitor proteins with a C-terminal affinity tag. The inhibited complex was recovered with residues 1-60 of bovine IF₁ with a C-terminal green fluorescent protein followed by a His-tag, and the active enzyme with the same inhibitor with a C-terminal glutathione-S-transferase domain. The wide applicability of the procedure has been demonstrated by purifying the enzyme complex from bovine, ovine, porcine and yeast mitochondria. The subunit compositions of these complexes have been characterized. The catalytic properties of the bovine enzyme have been studied in detail. Its hydrolytic activity is sensitive to inhibition by oligomycin, and the enzyme is capable of synthesizing ATP in vesicles in which the proton-motive force is generated from light by bacteriorhodopsin. The coupled enzyme has been compared by limited trypsinolysis with uncoupled enzyme prepared by affinity chromatography. In the uncoupled enzyme, subunits of the enzyme's stator are degraded more rapidly than in the coupled enzyme, indicating that uncoupling involves significant structural changes in the stator region.

Purpose: The purpose of this preliminary investigation was to examine potential barriers to seeking services for communication impairments perceived by lesbian, gay, bisexual, and transgender (LGBT) people. Specifically, this clinical survey investigated (a) the rate and importance of disclosure of membership in the LGBT community by people with communication impairments to their clinicians and (b) the perception of bias of audiologists and speech-language pathologists against LGBT individuals with communication impairments., Method: A total of 192 people identifying as LGBT with a communication impairment responded to a web-based survey. The survey contained questions about the respondents' demographic information, living situation, and experiences with clinical services for communication impairments. In addition, the survey contained open-ended comment sections., Results: There were differences in the responses of LGBT people with speech-language impairments and those with hearing impairments. The majority of respondents did not disclose their membership in the LGBT community, although they felt it was important. Most respondents reported perceiving bias toward a heterosexual orientation from their clinicians., Conclusions: Exploration of issues important to the LGBT community contributes to the growing emphasis on diversity and cultural competency in communication sciences and disorders. Specific clinical recommendations and directions for future research are discussed.

Purpose: This study aimed to determine if the number and type of African American English (AAE) features that are spoken in sentences influence speech-language pathologists' (SLPs') judgments of (a) how noticeable the dialect is (dialect detectability) and (b) how understandable a speaker is to others (comprehensibility)., Method: Certified SLPs with little conversational experience with AAE were recruited from predominantly Caucasian American school districts in Michigan. They listened to sentences that contained varying amounts and types of AAE phonological features. The SLPs rated the sentences on 5-point scales regarding dialect detectability and comprehensibility. The ratings for the different sentences were compared to determine how the variables contributed to the SLPs' judgments of AAE., Results: Both dialect detectability and comprehensibility ratings were affected by the number of AAE features that were included in the sentences. The types of AAE features consistently affected the comprehensibility ratings but less consistently affected the dialect detectability ratings., Conclusion: Multiple factors may affect SLPs' perceptions of AAE. The outcomes have both theoretical and practical implications.

Purpose: To describe the instructional strategies reported for multicultural/multilingual issues (MMI) education at programs in speech-language pathology and audiology and the perceived ease and effectiveness of doing so., Method: A 49-item questionnaire elicited anonymous responses from administrators, faculty, and teaching clinical supervisors at educational programs accredited by the American Speech-Language-Hearing Association in the United States. The data were provided by 731 respondents from 79.6% of 231 accredited U.S. programs. They included instructors who taught courses dedicated to MMI and those who did not., Results: Respondents were generally committed to multicultural instruction, but they varied in their reported instructional practices and perceived levels of preparedness, effectiveness, and needs. General curricular infusion without an MMI-dedicated course was the most common instructional model used. Students were judged to be at least modestly prepared to deal with diversity issues as a result of their multicultural instruction, although current instructional approaches were not viewed as optimal. More positive outcomes were reported by instructors of MMI-dedicated than MMI-nondedicated courses., Conclusion: The instructional models and strategies used for MMI education vary, and programs are challenged by multiple issues in complying with the mandate for MMI curricular infusion.

Objectives: To determine the profile of risk of upper gastrointestinal toxicity during continuous treatment with, and after cessation of, non-steroidal anti-inflammatory drugs., Design: Cohort study with a prospectively constructed, population based, record linkage database containing details of exposure to all community dispensed non-steroidal anti-inflammatory drugs and also all admissions to hospital for upper gastrointestinal diagnoses., Setting: The population of Tayside, Scotland., Subjects: 52,293 subjects aged 50 and over who received one or more non-steroidal anti-inflammatory between 1 January 1989 and 31 December 1991 and 73,792 subjects who did not receive one during the same period (controls)., Main Outcome Measures: Admission to hospital for upper gastrointestinal bleeding and perforation, and admission for other upper gastrointestinal diagnoses., Results: About 2% of the non-steroidal anti-inflammatory cohort were admitted with an upper gastrointestinal event during the study period compared with 1.4% of controls. The risk of admission for upper gastrointestinal haemorrhage and perforation was constant during continuous non-steroidal anti-inflammatory exposure and carried over after the end of exposure. The results were similar for admissions for all upper gastrointestinal events., Conclusion: This study provides evidence that non-steroidal anti-inflammatory toxicity persists with continuous exposure. There seems to be carryover toxicity after the end of prescribing. These findings have implications for the management of patients requiring non-steroidal anti-inflammatory drugs.

Objective: To describe the causes, sites, and types of eye anomaly and associated handicaps in children identified in the last 30 years with ocular visual impairment of 20/200 (6/60) or worse in the better eye with correction., Design: Trend study., Study Population: Children in British Columbia younger than 19 years with visual loss diagnosed between January 1960 and December 1989 who were referred for multidisciplinary assessment., Results: The incidence of acquired ocular visual impairment has decreased from 0.6 to less than 0.2 per 10,000 people aged 19 years or younger during the last 30 years. The most common cause was a genetic cause, followed by tumor, injury, infection and autoimmune disorders. Optic nerve atrophy and retinal disorders together resulted in more than 90% of all ocular lesions. Gender distribution revealed more males than females to be affected. Sixty-six percent of children had enough sight to read. The percentage of affected children with neurologic disabilities has increased overall in the last 30 years because more children with profound brain damage have survived., Conclusions: Acquired ocular visual impairment is rare. The incidence of such impairment has been reduced by two thirds in the last 30 years. This decline has had little impact, however, because most cases of blindness are due to congenital conditions. The number of cases of acquired blindness is only one fourth that of congenital blindness, which has begun to increase again owing to the reemergence of retinopathy of prematurity.

A laboratory evaluation was performed on the Brüel and Kjaer multigas monitor 1304, incorporating a pulse oximeter. The instrument was tested for accuracy, stability, response and delay times, frequency response and the effects of water vapour, alcohol, cyclopropane and sevoflurane. The instrument's performance was found to be within or very close to the manufacturer's specifications for accuracy, stability and response and delay times. It was unaffected by water vapour and alcohol and the effect of cyclopropane on the vapour channel was lower than has been reported for other analysers. The response to sevoflurane was of the same order as that of the other vapours. A 90% response to square wave changes of gas composition was maintained up to 60 breaths.min-1 for CO2, O2, and N2O and up to 40 breaths.min-1 for the vapours when the nafion sampling tube was used.

Misoprostol is a synthetic analogue of naturally occurring prostaglandin E1. The basis of the damaging actions of non-steroidal anti-inflammatory drugs (NSAIDs) on the gastrointestinal (GI) tract is believed to be a consequence of two events: a direct damaging action on mucosal integrity and depletion of endogenous mucosal prostaglandins (PGs). Due to the latter effect, and because current evidence indicates that PGs play an important role in maintaining the integrity of the GI tract, misoprostol has been developed as a logical therapy to prevent and heal gastric and duodenal damage caused by NSAIDs. The purpose of this review is to consider the need for such a therapy, to describe its pharmaceutical development, to review its pharmacology and to review its efficacy compared with other available agents.

The maternal age of two groups of children with congenital handicaps, cerebral palsy and fetal alcohol syndrome (FAS), were examined and compared with a group of mothers of children with congenital optic-nerve hypoplasia (CONH). The maternal age of children with CONH was significantly less than for the cerebral-palsied children which, in turn, was significantly less than for the FAS children. In addition, about one-half of the children with CONH had associated handicaps which clustered into four progressively more severe combinations. Maternal age and the occurrence of endocrine problems did not differ significantly among the clusters.

Traumatic rupture of the main pulmonary artery in a surviving patient is very rare. The case history of a 37-year-old man who sustained blunt chest trauma in a motor vehicle accident is presented. A persistent, bloody right pleural effusion led to the diagnosis of a ruptured right main pulmonary artery, which was surgically repaired using cardiopulmonary bypass. Points of diagnostic interest and therapeutic decision making are discussed.

A retrospective analysis was done of multi-disciplinary neurodevelopmental assessments in 70 children who were legally blind because of cicatricial retinopathy of prematurity. The subjects lived in British Columbia and were born during a 37-year period between 1951 and 1987. The purpose of the study was to investigate changes in the perinatal characteristics and to evaluate the associated handicaps. All patients were assessed at least once in the Visually Impaired Program, British Columbia Children's Hospital. In the majority, the visual loss was profound. Since 1951, blinding retinopathy of prematurity has become a disease of progressively smaller and less mature infants. Since 1981, it has been almost entirely confined to infants of birth weight less than 1,000 g in British Columbia. The diagnosis of mild spastic diplegia was made more commonly in patients born after 1980 but, despite the progressive reduction in birth weight and gestational age during the study period, the number of patients without other associated handicaps remained constant (approximately 30%) during each successive decade.

Two second cousins with infantile polymyoclonus are described. All other published cases in the literature are sporadic,and the occurrence of two cases of this exceedingly rare disorder in one family raises the possibility of genetic transmission. Careful examination of the family pedigree is indicated in this disorder.

A careful and detailed cost analysis that measured all the costs, direct and indirect, generated in the course of an episode of surgical care demonstrated that there are very large savings from the substitution of surgical day care for inpatient care. Surgical day care appears to be an ideal alternative to inpatient care, from the points of view of those who pay for medical care (governments) as well as those who provide it (hospitals and health professionals) and those who receive it (patients). From an economic perspective the potential savings have not been achieved, and present policies provide no incentives to encourage these savings. These problems, together with strategies to encourage cost savings, are discussed.

A new method of surgical treatment is described for the Mallory-Weiss tear that is not controlled by conservative measures. This technique uses a team approach combining endoscopy with simultaneous laparotomy to plicate the Mallory-Weiss tear without opening the gastrointestinal tract. We believe this method offers equal or better vision of the lesion than gastrotomy and will significantly lower the morbidity and perhaps the mortality associated with violating the integrity of the gastrointestinal tract.

The authors were invited by the band council to carry out a study to determine the prevalence of alcohol embryopathy among children in a native Indian community in British Columbia. The mothers of the 123 children aged 18 years or less who lived in the community were interviewed. In addition, educational screening was carried out for children in grades 1 through 12, and 116 of the children underwent medical examination. A diagnosis of fetal alcohol syndrome or fetal alcohol effects (FAS/FAE) was made in 22 children aged 3 to 18 years. Each of these children was matched for age and sex with an unaffected child in the same community, and both groups underwent psychoeducational testing. The children with FAS/FAE showed a generalized depressed level of functioning compared with the unaffected children. The finding that two thirds of the children with FAS/FAE were mentally retarded points to a major health and education problem.

A total of 676 children born in British Columbia with congenital ocular blindness during the years 1945 through 1984 were studied. The birth prevalence rate of congenital blindness has decreased from eight per 10,000 live births in the late 1940s to three per 10,000 live births. Retinopathy of prematurity was replaced by genetic ocular disorders as the leading cause of congenital blindness, although the former is reemerging. The rate of congenital rubella infection also declined. There has been a significant increase in the rate of births with optic nerve lesions during the past 15 years, while the rate of births with lesions of the lens fell, reflecting the decline in the rate of maternal rubella infection. There are fewer children with congenital ocular legal blindness who have no light perception today, and they also have fewer associated handicaps.