This three-phase investigation used focus groups and a survey to identify factors that perceived by speech language pathologists as being related to long-term success versus inappropriate abandonment of augmentative and alternative communication (AAC) systems. Factors deemed most important by six focus groups were included in a 106-question survey that was returned by 275 ASHA Special Interest Division #12 (AAC) members. Factor analysis indicated the constructs of Support, Attitude, and System characteristics and Fit as most important to the long-term success of AAC systems. The constructs of Not Maintaining/Adjusting the System, Attitude, Lack of Training, Lack of Support, and Poor Fit were most often related to inappropriate abandonment of AAC systems. Systematic implementation of intervention targeting the constructs is recommended.

The purpose of this study was to determine (1) whether mothers simplify their speech during the second half of the first year of development when infants begin to comprehend words and use gestures to communicate intentionally, and (2) whether individual differences in mothers' speech adjustments influence their infants' later language acquisition. The subjects for the study were 14 mother-infant pairs from a medically low risk sample who were followed longitudinally. Mothers' mean length of utterance (MLU) was calculated from transcripts of face-to-face interaction when the infants were 0;3, 0;6, and 0;9 in age. Mothers who provided responsive and stimulating environments, as indicated by HOME scores, also reduced their MLU over the age range studied. Moreover, mothers' MLU adjustments during the first year were more predictive than the HOME scale in forecasting receptive language development at 1; 6. In contrast, expressive language abilities at 1; 6 were unrelated to the environmental variables measured but were predicted by child characteristics such as the infant's sex. These results suggest that a mother's ability to ‘fine-tune’ her early linguistic input may be predictive of her child's later receptive language functioning. Precursors of fine-tuning, such as maternal beliefs in reciprocity and infant object orientation, are discussed.

No abstract

No abstract

Compared with strict bacteriologic criteria for VAP, the NNIS definition has good overall agreement and seems to have utility as an epidemiologic benchmarking tool in trauma patients. However, the NNIS definition has less utility as a bedside decision-making tool in this population, leading to under-treatment in a significant number of patients.

Tumoral pseudoangiomatous stromal hyperplasia (PASH) is a rare benign proliferative disease of the breast. The majority of the literature reports of PASH have not contained detailed descriptions of the imaging characteristics of PASH. A 10-year retrospective study of patients with tumoral PASH and a 20-year Ovid MEDLINE® search were performed to determine whether specific imaging and needle biopsy results could characterize PASH preoperatively. We identified 22 patients with tumoral PASH. Seventeen (77%) of 22 women had a palpable lump and 14 (72%) of 21 had a density on mammography. Ultrasound (US) findings included mixed or hypoechoic echogenicity in 83 per cent and ill-defined borders in 62 per cent. Eight (36%) patients had lesions with a Breast Imaging Reporting and Data System (BI-RADS®) classification of 4 or 5. The sensitivity of preoperative core needle biopsy (CNB) to identify PASH was 83 per cent. A review of the literature revealed that 90 per cent of patients with PASH had some malignant imaging characteristics and 95 per cent had a mass on mammography. The imaging characteristics of PASH exhibited marked variability. Excision of PASH after CNB may be considered for patients with symptoms, enlarging lesions, or lesions classified as BI-RADS® 4 or 5. PASH diagnosed by CNB allows selected patients to avoid excision.

No abstract

Fibroepithelial lesions (FELs) are a common histologic finding on core needle biopsy (CNB) of the breast. Fibroepithelial lesions include fibroadenoma and phyllodes tumor, which can be difficult to distinguish with an initial CNB. An institutional experience was reviewed from February 12, 2001, to January 4, 2007, to determine the safety of selective rather than routine excision of FELs and to determine the factors associated with upgrading diagnosis of FELs to phyllodes tumors without definitive phyllodes tumor diagnosis by CNB. Of 313 patients, 261 (83%) with FELs diagnosed by CNB received observation with long-term follow-up (mean, 8 years). Of the observed patients, 3 (1%) were diagnosed with phyllodes tumor on follow-up. Eighteen of 52 patients (35%) who received excision had an upgrade of diagnosis to phyllodes tumor. Sensitivity and specificity of the pathologist's comment of concern for phyllodes tumor on a CNB demonstrating FELs without definitive phyllodes tumor diagnosis were 82% and 93%, respectively. Our policy of selective excision of FELs without definitive phyllodes tumor diagnosis resulted in safe avoidance of many surgical procedures.