Background: Post-ERCP pancreatitis is poorly understood. The goal of this study was to comprehensively evaluate potential procedure- and patient-related risk factors for post-ERCP pancreatitis over a ...wide spectrum of centers.
Methods: Consecutive ERCP procedures were prospectively studied at 11 centers (6 private, 5 university). Complications were assessed at 30 days by using established consensus criteria.
Results: Pancreatitis occurred after 131 (6.7%) of 1963 consecutive ERCP procedures (mild 70, moderate 55, severe 6). By univariate analysis, 23 of 32 investigated variables were significant. Multivariate risk factors with adjusted odds ratios (OR) were prior ERCP-induced pancreatitis (OR 5.4), suspected sphincter of Oddi dysfunction (OR 2.6), female gender (OR 2.5), normal serum bilirubin (OR 1.9), absence of chronic pancreatitis (OR 1.9), biliary sphincter balloon dilation (OR 4.5), difficult cannulation (OR 3.4), pancreatic sphincterotomy (OR 3.1), and 1 or more injections of contrast into the pancreatic duct (OR 2.7). Small bile duct diameter, sphincter of Oddi manometry, biliary sphincterotomy, and lower ERCP case volume were not multivariate risk factors for pancreatitis, although endoscopists performing on average more than 2 ERCPs per week had significantly greater success at bile duct cannulation (96.5% versus 91.5%,
p = 0.0001). Combinations of patient characteristics including female gender, normal serum bilirubin, recurrent abdominal pain, and previous post-ERCP pancreatitis placed patients at increasingly higher risk of pancreatitis, regardless of whether ERCP was diagnostic, manometric, or therapeutic.
Conclusions: Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis. These data emphasize the importance of careful patient selection as well as choice of technique in the avoidance of post-ERCP pancreatitis. (Gastrointest Endosc 2001;54:425-34.)
A gas sensor based on quartz-enhanced photoacoustic spectroscopy and using near-infrared, fiber-coupled diode lasers as an excitation source was developed for chemical analysis of gas mixtures ...containing H
2
S, CO
2
, and CH
4
at concentrations from 0 to 100%. Analysis of physical phenomena affecting the sensor operation is performed, the sensor performance is evaluated, and simple algorithms are developed to derive concentrations of the gases from detected electrical signals.
Background
Academic programmes in speech–language pathology are increasingly providing telehealth/telepractice clinical education to students. Despite this growth, there is little information ...describing effective ways to teach it.
Aims
The current exploratory study analyzed the perceptions of speech–language pathology/therapy (SLP/SLT) faculty, student and SLP/SLT clinicians to ascertain effective pedagogical approaches for telepractice service delivery, rank the relative importance of telepractice skills and knowledge competencies, and define any pedagogical challenges to teaching them.
Methods & Procedures
Qualitative data were collected from two sources: three open‐ended questions within an online survey (SLP/SLT faculty n = 31, graduate students n = 16, telehealth (‘telepractice’) clinicians n = 16); and follow‐up telephone interviews (n = 22). Data were analyzed with a grounded theory approach followed by a summative rank‐order analysis of themes.
Outcomes & Results
All three groups agreed the most effective telepractice instructional approach was telepractice demonstrations (such as students role playing or watching a supervisor). Professional development approaches such as workshops or training manuals were less effective and didactic approaches such as lecture‐only were ineffective. Skills and knowledge competencies students needed before entering the workforce were, in order of implied importance: telepractice clinical skills, telepractice technology skills, legal knowledge pertinent to telepractice and knowledge of telepractice literature. The most important telepractice clinical skills students needed to acquire were appropriate selection of telepractice materials and engaging the client over the internet. Many participants said teaching and learning telepractice was more challenging than in‐person service delivery because of the difficulties in selecting appropriate telepractice clinical materials, managing technology problems and engaging with clients over the internet.
Conclusions & Implications
Despite substantial limitations to this investigation, findings imply that telepractice instruction, like other methods of SLP/SLT clinical education, may be most effective when students engage in critical thinking and problem‐solving issues through intense practice. Because the skills and competencies associated with telepractice appear to vary in their perceived value, academic programmes may wish to consider prioritizing how they are taught, giving students additional instruction in the selection of telepractice clinical materials and development of online interpersonal communication skills. For some clinical educators, the challenges associated with telepractice may necessitate additional educator training.
Purpose: Studies of infants' early vocalizations have proven helpful in describing the developmental characteristics of various communication disorders. However, few studies have addressed the early ...vocalizations of infants and toddlers who were later diagnosed, as older children, with childhood apraxia of speech (CAS). We refer to these infants and toddlers as "LCAS". Extant studies also often lack a comparison group of infants and toddlers who were later diagnosed, as older children, with a speech sound disorder (SSD). We refer to these infants and toddlers as "LSSD". We aimed to compare the volubility, consonant emergence, and syllabic structure from birth to age of 2 years, as observed in home videos, among 3 groups of infants and toddlers: LCAS, LSSD, and typically developing (TD). Method: We assessed the speech-language skills of 17 children (3.5-8.8 years old; 7 with CAS, 5 with SSD, and 5 TD) and transcribed home videos (obtained from parents) of these same children from birth to age of 2 years. Early vocalizations were coded as nonresonant or resonant. Nonresonant vocalizations could not be transcribed with the International Phonetic Alphabet. Resonant (speechlike) vocalizations were broadly transcribed, and resonant consonants were categorized by place, manner, and voicing. Results: Effect size comparisons revealed LCAS infants and toddlers were less voluble, used fewer resonant consonants, had a less diverse phonetic repertoire, and acquired resonant consonants later than either the LSSD or TD participants. For LSSD infants and toddlers, means for these dependent variables were lower than the means demonstrated by the TD group, but effect size were not strong due to LSSD variability. Conclusions: Findings imply there might be clinical "red flags" that could assist the identification of infants and toddlers at risk for later diagnosis of CAS. Data did not support red flags for identifying infants and toddlers at risk for later diagnosis of SSD. Because of significant study limitations, results obtained should be considered preliminary.
Purpose: This mixed-methods study aimed to obtain information regarding speech-language pathologists' (SLPs) perspectives about treatment of lateralization errors (LEs), challenges to implementing ...evidence-based LE treatment practice, and the sources SLPs' use to find evidence to treat LEs. This information can assist our understanding of ways to facilitate the uptake of evidence-based practice into the everyday treatment of clients with this disorder. Method: A convergent parallel mixed-methods design was used to collect data from SLPs (N = 214) using 24 questions from an online survey distributed through electronic mailing lists and Speech and Hearing State Associations. Quantitative data were analyzed using frequencies and averages; themes and subthemes of qualitative data were analyzed using a content analysis approach with no a priori codes. Quantitative and qualitative results were compared and integrated. Results: Participants believed that LEs required individualized treatment before the age of 5 years, were largely caused by structural and neuromuscular factors, and required an understanding of orofacial and dental structure and function. Challenges to implementing LE treatment included a lack of skills and knowledge specific to LEs, competing demands on clinicians' time and resources, and a research-practice gap. Sources of evidence frequently used to obtain information about LE treatment were colleagues, trainings, workshops, and American Speech-Language-Hearing Association journals. Conclusions: Clinicians believe that LE treatment is challenging and requires skill training. Future research in LEs will need to consider the real-world decisions clinicians must make when treating this disorder as well as clinicians' everyday constraints and challenges.
Introduction Despite the growth of telecommunication applications to provide clinical healthcare services, there has been little attention to the pedagogical framework needed to train healthcare ...students to deliver these services. Methods In this exploratory investigation, perceptions of speech-language pathology/therapy (SLP/SLT) faculty ( n = 31), graduate students ( n = 16), and telehealth ("telepractice") clinicians ( n = 16) were examined with a 15-item survey regarding the 1) comparative pedagogical importance of four skills common to telepractice and face-to-face service (f2f) delivery, and 2) relative pedagogical value of seven skills and competencies unique to telepractice. Results Statistical analyses revealed nonverbal communication skills and knowledge of the literature related to service delivery methods were more important in telepractice than in f2f service delivery. Among seven skills unique to telepractice, participants believed the most important was solving problems related to the Internet and recommended at least two hours of instruction each in telepractice technology, patient confidentiality, and role-playing telepractice. Results suggest that SLP/SLT students may need additional and/or focused academic training in nonverbal communication, telepractice literature, and in solving connectivity issues to enter the telepractice marketplace with sufficient preparation. Discussion Further study is needed to compare the relative importance of additional SLP/SLT skills and competencies, describe components of effective healthcare training telepractice programs, and explore effective pedagogical strategies for healthcare telepractice instruction.
Purpose: Although lateralisation errors (LEs) are a common speech sound disorder, no studies have examined their early development. The purpose of this exploratory small-scale investigation was to ...compare the early (birth-24 months) speech sound development between children later diagnosed with LEs and typically developing children.
Method: This was a between-group case-controlled design with six monolingual English-speaking participants. Participants were White, non-Hispanic girls with at least one college-educated parent. As children, three had been diagnosed with lateralisation speech sound errors and three demonstrated typical speech sound development. Participants' parents provided home video-recordings of the participants as infants/toddlers between birth and age 2. These videos were then analysed for the amount, type and diversity of sounds, and canonical babbling onset.
Result: There was no statistically significant between-group difference in the volubility (i.e. combined frequency of non-resonant and resonant utterances) or in the age at which s or z emerged. However, infants/toddlers who were later diagnosed with LEs showed reduced frequency/minute in production of resonant utterances and consonants (including s, z), used fewer different consonants/minute, and used fewer syllable shapes/minute compared to typically developing infants/toddlers. At 7-12 months, none of the infants/toddlers later diagnosed with LEs, but all participants in the comparison group had reached the canonical babbling stage.
Conclusion: Children who have LEs may have had a less robust speech sound system as infants/toddlers than their typically developing peers. However, these findings must be considered with caution due to the significant limitations of this investigation.
Limited evidence for early indicators of childhood apraxia of speech (CAS) precludes reliable diagnosis before 36 months, although a few prior studies have identified several potential early ...indicators. We examined these possible early indicators in 10 toddlers aged 14-24 months at risk for CAS due to a genetic condition: 7q11.23 duplication syndrome (Dup7). Phon Vocalisation analyses were conducted on phonetic transcriptions of each child's vocalisations during an audio-video recorded 30-minute play session with a caregiver and/or a trained research assistant. The resulting data were compared to data previously collected by Overby from similar-aged toddlers developing typically (TD), later diagnosed with CAS (LCAS), or later diagnosed with another speech sound disorder (LSSD). The Dup7 group did not differ significantly from the LCAS group on any measure. In contrast, the Dup7 group evidenced significant delays relative to the LSSD group on canonical babble frequency, volubility, consonant place diversity, and consonant manner diversity and relative to the TD group not only on these measures but also on canonical babble ratio, consonant diversity, and vocalisation structure diversity. Toddlers with Dup7 also demonstrated expressive vocabulary delay as measured by both number of word types orally produced during the play sessions and primary caregivers' responses on a standardised parent-report measure of early expressive vocabulary. Examining babble, phonetic, and phonotactic characteristics from the productions of young children may allow for earlier identification of CAS and a better understanding of the nature of CAS.
As digital educational media use becomes more widespread, an opportunity exists to develop new methods to present abstract ideas to provide a more meaningful learning experience. Drawing from ...psychology and dynamic visualization research, new interactive tools can be thoughtfully designed but it is also necessary to establish how these media are used and to study the effects the new interactive tools have on concept understanding. In this technology report, we present the Hybridization Explorer, a web-based interactive learning tool for manipulating and experimenting with hybridization concepts. The explorer has three modes of use to explore both the combination of atomic orbitals, and the visual representation of both atomic and hybrid orbitals and corresponding bond formation. Case studies from an undergraduate- and graduate-level demonstration of the explorer are described. Finally, self-reported student confidence levels on solving hybridization questions both before and after use of the explorer are analyzed and discussed.
Purpose: This archival investigation examined the relationship between preliteracy speech sound production skill (SSPS) and spelling in Grade 3 using a dataset in which children's receptive ...vocabulary was generally within normal limits, speech therapy was not provided until Grade 2, and phonological awareness instruction was discouraged at the time data were collected. Method: Participants (N = 250), selected from the Templin Archive (Templin, 2004), varied on prekindergarten SSPS. Participants' real word spellings in Grade 3 were evaluated using a metric of linguistic knowledge, the Computerized Spelling Sensitivity System (Masterson & Apel, 2013). Relationships between kindergarten speech error types and later spellings also were explored. Results: Prekindergarten children in the lowest SPSS (7th percentile) scored poorest among articulatory subgroups on both individual spelling elements (phonetic elements, junctures, and affixes) and acceptable spelling (using relatively more omissions and illegal spelling patterns). Within the 7th percentile subgroup, there were no statistical spelling differences between those with mostly atypical speech sound errors and those with mostly typical speech sound errors. Conclusions: Findings were consistent with predictions from dual route models of spelling that SSPS is one of many variables associated with spelling skill and that children with impaired SSPS are at risk for spelling difficulty.
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