ObjectiveTo determine the optimal radioactive colloid injection technique for sentinel lymph node (SLN) biopsy for breast cancer. Summary Background DataThe optimal radioactive colloid injection technique for breast cancer SLN biopsy has not yet been defined. Peritumoral injection of radioactive colloid has been used in most studies. Although dermal injection of radioactive colloid has been proposed, no published data exist to establish the false-negative rate associated with this technique. MethodsThe University of Louisville Breast Cancer Sentinel Lymph Node Study is a multiinstitutional study involving 229 surgeons. Patients with clinical stage T1-2, N0 breast cancer were eligible for the study. All patients underwent SLN biopsy, followed by level I/II axillary dissection. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed at the discretion of the operating surgeon. Peritumoral injection of isosulfan blue dye was performed concomitantly in most patients. The SLN identification rates and false-negative rates were compared. The ratios of the transcutaneous and ex vivo radioactive SLN count to the final background count were calculated as a measure of the relative degree of radioactivity of the nodes. One-way analysis of variance and chisquare tests were used for statistical analysis. ResultsA total of 2,206 patients were enrolled. Peritumoral, subdermal, or dermal injection of radioactive colloid was performed in 1,074, 297, and 511 patients, respectively. Most of the patients (94%) who underwent radioactive colloid injection also received peritumoral blue dye injection. The SLN identification rate was improved by the use of dermal injection compared with subdermal or peritumoral injection of radioactive colloid. The false-negative rates were 9.5%, 7.8%, and 6.5% (not significant) for peritumoral, subdermal, and dermal injection techniques, respectively. The relative degree of radioactivity of the SLN was five-to sevenfold higher with the dermal injection technique compared with peritumoral injection. ConclusionsDermal injection of radioactive colloid significantly improves the SLN identification rate compared with peritumoral or subdermal injection. The false-negative rate is also minimized by the use of dermal injection. Dermal injection also is associated with SLNs that are five-to sevenfold more radioactive than with peritumoral injection, which simplifies SLN localization and may shorten the learning curve.

Although legislation mandates that students with autism receive instruction linked to the general education core content, there is limited research supporting the effectiveness of interventions for teaching core content to these students. In this study, the author reviewed research conducted between the years 1997 and 2008 using computer-assisted instruction (CAI) to teach academic skills to students with autism. The author concluded that CAI was effective for teaching a limited set of academic skills to individuals with autism; however, functional relations were found in few of the single-case designs and none of the group designs included a control group. Future researchers should explore the use of CAI in various instructional arrangements, identify critical technology components, and evaluate commercially available software.

The purpose of this study is to evaluate the impact of functional communication training on elopement when consultation support is delivered via desktop videoconferencing. An ABAB design was used to evaluate the effectiveness of functional communication training to reduce the elopement of a preschool student with autism. Intervention development, teacher training, and data collection were conducted at a distance using technology. Results show that the teaching staff was able to implement the intervention with a high degree of fidelity and that elopement was significantly reduced during intervention phases. The authors discuss the implications of using desktop videoconferencing to deliver consultation support, along with future applications in early childhood settings.

ObjectiveTo determine the optimal experience required to minimize the false-negative rate of sentinel lymph node (SLN) biopsy for breast cancer. Summary Background DataBefore abandoning routine axillary dissection in favor of SLN biopsy for breast cancer, each surgeon and institution must document acceptable SLN identification and false-negative rates. Although some studies have examined the impact of individual surgeon experience on the SLN identification rate, minimal data exist to determine the optimal experience required to minimize the more crucial false-negative rate. MethodsAnalysis was performed of a large prospective multiinstitutional study involving 226 surgeons. SLN biopsy was performed using blue dye, radioactive colloid, or both. SLN biopsy was performed with completion axillary LN dissection in all patients. The impact of surgeon experience on the SLN identification and false-negative rates was examined. Logistic regression analysis was performed to evaluate independent factors in addition to surgeon experience associated with these outcomes. ResultsA total of 2,148 patients were enrolled in the study. Improvement in the SLN identification and false-negative rates was found after 20 cases had been performed. Multivariate analysis revealed that patient age, nonpalpable tumors, and injection of blue dye alone for SLN biopsy were independently associated with decreased SLN identification rates, whereas upper outer quadrant tumor location was the only factor associated with an increased false-negative rate. ConclusionsSurgeons should perform at least 20 SLN cases with acceptable results before abandoning routine axillary dissection. This study provides a model for surgeon training and experience that may be applicable to the implementation of other new surgical technologies.Sentinel lymph node (SLN) biopsy has become increasingly accepted as a minimally invasive alternative to level I/II axillary dissection for the staging of breast cancer. Because approximately 70% of patients with clinical stage T1 to 2, N0 breast cancer have pathologically negative axillary nodes, SLN biopsy has the potential to eliminate the complications of axillary dissection in most patients. Patients with axillary metastasis are then selected for completion axillary dissection.There are two key parameters of successful SLN biopsy: the SLN identification rate and the false-negative rate. The

Schools serve an essential function for individuals with autism spectrum disorder (ASD) and complex needs. However, school-based instruction may be interrupted due to pandemics, natural disasters, and school shootings, and as a result, schools are forced to stop traditional services and begin teaching students in their homes. Fortunately, distance education strategies are available to mitigate brick and mortar interruptions. When rural schools close, they face unique challenges, such as proximity to students, and technology limitations. In this article, we describe strategies for teachers to develop instructional materials, communication supports, and behavioral supports. We also describe how caregivers might provide support, and how to teach caregivers the skills necessary for effective support implementation.