Addressing the Psychosocial Needs of Individuals with Communication Disorders: The Integration of Animal-Assisted Therapy within Counseling.

Individuals with speech, language, and communication disorders often present with psychosocial concerns that span the physiological, intrapersonal, and interpersonal domains of functioning. Despite this fact, the provision of counseling service by speech-language pathologist (SLP) that directly addresses clients' psychosocial needs is sparse. Research shows the primary counseling strategy used by therapists is psychoeducation, failing to effectively address the psychosocial concerns. Integrating complementary approaches to traditional counseling in SLP can enhance both the quality of therapeutic intervention and client outcomes. The purpose of this article is to demonstrate the potential of animal-assisted therapy (AAT) as an adjunctive or complementary approach for counseling within SLP. A review of literature demonstrates a need for improved counseling service provision within SLP treatment, as well as the benefits of integrating AAT. A framework for how AAT intentions and techniques fit within SLP Scope of Practice counseling activities is presented, along with case examples to demonstrate how AAT can be integrated within SLP treatment. It is concluded that the integration of AAT as a complementary approach to traditional SLP counseling can enhance both the frequency of counseling services provided and clients' psychosocial outcomes.

Possible source term of high concentrations of mecoprop-p in leachate and water quality: impact of climate change, public use and disposal.

Mecoprop-p herbicide is often found in wells and water abstractions in many areas around Europe, the UK inclusive. There is a growing environmental and public health concern about mecoprop-p herbicide pollution in ground and surface water in England. Reviews suggest that extensive work has been carried out on the contribution of mecoprop-p herbicides from agricultural use whilst more work needs to be carried out on the contribution of mecoprop-p herbicide from non-agricultural use. The study covers two landfill sites in Weaver/Gowy Catchment. Mecoprop-p herbicide concentrations in the leachate quality range between 0.06 and 290 microg l1 in cells. High concentration ofmecoprop-p herbicide in the leachate quality suggests that there is a possible source term in the waste stream. This paper addresses the gap by exploring possible source terms of mecoprop-p herbicide contamination on landfill sites and evaluates the impact of public purchase, use and disposal alongside climate change on seasonal variations in mecoprop-p concentrations. Mecoprop-p herbicide was found to exceed the EU drinking water quality standards at the unsaturated zone/aquifer with observed average concentrations ranging between 0.005 and 7.96 microg l1. A route map for mecoprop-p herbicide source term contamination is essential for mitigation and pollution management with emphasis on both consumer and producer responsibility towards use of mecoprop-p product. In addition, improvement in data collection on mecoprop-p concentrations and detailed seasonal herbicide sales for non-agricultural purposes are needed to inform the analysis and decision process.

The medial approach for the treatment of children with developmental dysplasia of the hip.

The medial approach for the treatment of children with developmental dysplasia of the hip (DDH) in whom closed reduction has failed requires minimal access with negligible blood loss. In the United Kingdom, there is a preference for these children to be treated using an anterolateral approach after the appearance of the ossific nucleus. In this study we compared these two protocols, primarily for the risk of osteonecrosis. Data were gathered prospectively for protocols involving the medial approach (26 hips in 22 children) and the anterolateral approach (22 hips in 21 children) in children aged < 24 months at the time of surgery. Osteonecrosis of the femoral head was assessed with validated scores. The acetabular index (AI) and centre-edge angle (CEA) were also measured. The mean age of the children at the time of surgery was 11 months (3 to 24) for the medial approach group and 18 months (12 to 24) for the anterolateral group, and the combined mean follow-up was 70 months (26 to 228). Osteonecrosis of the femoral head was evident or asphericity predicted in three of 26 hips (12%) in the medial approach group and four of 22 (18%) in the anterolateral group (p = 0.52). The mean improvement in AI was 8.8° (4° to 12°) and 7.9° (6° to 10°), respectively, at two years post-operatively (p = 0.18). There was no significant difference in CEA values of affected hips between the two groups. Children treated using an early medial approach did not have a higher risk of developing osteonecrosis at early to mid-term follow-up than those treated using a delayed anterolateral approach. The rates of acetabular remodelling were similar for both protocols.

Implementation of a "learner-driven" curriculum: an screening, brief intervention, and referral to treatment (SBIRT) interdisciplinary primary care model.

Although screening, brief intervention, and referral to treatment (SBIRT) has been a popular model to address potential substance abuse issues in primary care, there is a need for innovative approaches for training providers and staff on SBIRT protocols. An interdisciplinary approach to SBIRT training, named ICARE, was implemented at 3 different medical settings. The ICARE team trained 85 employees at an academic family medicine residency center and 37 employees across 2 rural community health care clinics. Using an innovative "learner-driven" approach, the authors implemented a combination of didactic and interactive training strategies that included on-site coaching, patient simulation exercises, as well as large- and small-group learning.

The success of management with the Pavlik harness for developmental dysplasia of the hip using a United Kingdom screening programme and ultrasound-guided supervision.

We present the results of treatment of developmental dysplasia of the hip in infancy with the Pavlik harness using a United Kingdom screening programme with ultrasound-guided supervision. Initially, 128 consecutive hips in 77 patients were reviewed over a 40-month period; 123 of these were finally included in the study. The mean age of the patients at the start of treatment was five weeks (1 to 12). All hips were examined clinically and monitored with ultrasound scanning. Failure of treatment was defined as an inability to maintain reduction with the harness. All hips diagnosed with dysplasia or subluxation but not dislocation were managed successfully in the harness. There were 43 dislocated hips, of which 39 were reducible, but six failed treatment in the harness. There were four dislocated but irreducible hips which all failed treatment in the harness. One hip appeared to be successfully treated in the harness but showed persistent radiological dysplasia at 12 and 24 months. Grade 1 avascular necrosis was identified radiologically in three patients at 12 months.

Head-at-risk signs in Legg-Calvé-Perthes disease: poor inter- and intra-observer reliability.

BACKGROUND: The head-at-risk signs are used as prognostic indicators in Legg-Calvé-Perthes disease. These signs have been assessed only once regarding inter-observer reliability, however. Intra-observer reliability seems not to have been studied to date. METHOD: 76 anteroposterior pelvic radiographs of unilateral Legg-Calvé-Perthes disease were assessed by 5 observers on 2 occasions, in order to assess the inter- and intra-observer reliability in identifying head-at-risk signs. The observers included 1 consultant pediatric orthopaedic surgeon, 1 consultant radiologist, 2 specialist registrars and 1 senior house officer. Inter- and intra-observer reliabilities were assessed using the kappa coefficient. RESULTS: The intra-observer reliability was good for lateral subluxation and metaphyseal cystic changes, moderate for lateral calcification, and fair for Gage's sign and horizontal growth plate. The inter-observer reliability was moderate for lateral subluxation, fair for lateral calcification and metaphyseal cystic changes, and slight for Gage's sign and horizontal growth plate. INTERPRETATION: There was considerable variation in the diagnosis of the head-at-risk signs between observers. This makes the classification difficult to use in clinical practice.

The reliability and validity of assessment of sagittal plane deviations in children who have spastic diplegia.

OBJECTIVE: To assess the reliability and validity of a newly described classification of sagittal plane alignment in spastic diplegic gait. DESIGN: Twenty split-screen videos of children with spastic diplegia, Gross Motor Function Classification System levels I to III, were viewed on 2 occasions, 6 weeks apart, by 5 raters. The sagittal plane alignments of the right and left lower limbs in gait were classified separately as true equinus, jump knee, apparent equinus, or crouch, based on the published classification. A fifth category, nonclassifiable, was used if classification was not possible. We then used sagittal plane kinematic data to confirm the classification for each subject and these were compared with rater classification scores, which used the video information only. SETTING: Tertiary-level children's hospital. PARTICIPANTS: Three pediatric orthopedic surgeons and 2 pediatric orthopedic residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait classification scores derived from visual observation were compared among and within raters. The gait classification scores derived from visual observation were compared with the scores derived from sagittal plane kinematic data to assess validity. RESULTS: A moderate correlation was found among the 5 raters within each session, with an interrater weighted kappa score of .45 in session 1 and .49 in session 2. The intrarater, weighted kappa scores showed a moderate to substantial level of agreement between sessions, ranging from .50 to .68. The classification scores of individual raters had moderate validity when compared with classifications derived from the sagittal plane kinematic data. However, there was a substantial level of agreement between the consensus opinion and the classification obtained using the kinematic data as well as the video recordings (weighted kappa=0.8). CONCLUSIONS: This classification has only moderate reliability and validity when a single experienced rater views the 2-dimensional gait videos. However, the consensus opinion derived from the scores of 5 raters considerably improves the validity of the assessment.

A year's trauma admissions and the effect of the weather.

PURPOSE OF THE STUDY: To study the admissions to a busy trauma unit on a day-by-day basis over a 1 year period, and to look for any correlation with local weather variation or temporal factors (day of the week, weekends/school holidays, etc.). METHOD: Admissions data for the Trauma Unit at the Leicester Royal Infirmary was collected from an administrative database and ward records for the calendar year of 1998. Admissions were split into four groups: all admissions, adult admissions, admissions for proximal femoral fractures (neck of femur (NOF)) and paediatric admissions. Weather information for the local area was obtained from the Meteorological Office. Details of school holidays were obtained from the local Education Department. The above variables were examined using Poisson regression analysis for their potential importance in explaining day-to-day variation in admission rates for the four groups. RESULTS: For adult and NOF admissions, none of the weather factors appeared to explain variation in incidence, only day of the week appears to be important, with the earlier part of the week yielding a highly statistically significant increase in the relative incidence of trauma admissions. For both paediatric and total admissions, a number of factors appear important, including maximum and minimum temperatures, hours of sunshine, day of the week and month of the year. Daily rainfall, significant weather and whether the day was a school day or school holiday did not appear to be important on univariate analysis. CONCLUSION: Trauma admissions are related to both weather and temporal factors. This may have implications both in terms of prevention and in planning of care provision in trauma units.

Inter- and intra-measurer error in the measurement of Reimers' hip migration percentage.

Reimers' hip migration percentage is commonly used to document the extent of subluxation of the hip in children with spasticity. In this study, two measurers, with six months paediatric orthopaedic experience, measured the migration percentage on 44 pelvic radiographs of children with cerebral palsy, aged between two and eight years. Unknown to the measurers, each radiograph was duplicated, giving 22 non-identical radiographs (44 hips) which were measured twice at time 0 and twice six weeks later. The intra-measurer, intra-sessional absolute differences between the first and second measurements ranged from 0% to 23%, with median values of 2.5% to 3.6%. The intra-sessional median absolute differences were not statistically different between the two measurers and measuring sessions (p = 0.42, Kruskal-Wallis test). The inter-sessional absolute differences for measurements made by the same measurers ranged from 0% to 18% with a median absolute difference of 1.7% to 3.2%. Overall, only 5% of the intra-measurer measurement differences, within and between sessions, were above 13%. Repeated measurements by one measurer over time must, therefore, vary by more than 13% in order to be 95% confident of a true change. The inter-measurer error was higher with median absolute differences between the two measurers' measurements of the same hip of 3.25% to 5% (0% to 26%) and a 95th upper confidence interval of 21% to 23%. Averaging the four separate measurements over the two sessions reduced the inter-measurer error to a median absolute difference of 2.8%, but did not improve the 95th upper confidence interval, which measured 22.4%. Such inter-measurer errors may be clinically unacceptable.

The empty sella.

OBJECTIVE: To discuss the diagnostic imaging findings of an empty sella in a chiropractic patient with emphasis on magnetic resonance imaging (MRI) of normal and abnormal pituitary appearances. CLINICAL FEATURES: A 44-year-old woman started having headache, dizziness, nausea, vomiting, and diarrhea after an argument with her boyfriend. She had been treated for acute torticollis for three weeks when the new symptoms began. Consultation with an internist led to an MRI examination of the cerebellopontine angles to exclude an acoustic neuroma. The MRI demonstrated an enlarged empty sella. There was no history of pituitary tumor or other sellar disease. INTERVENTION AND OUTCOME: There was complete remission of the symptoms after 1 additional dizzy spell that occurred 3 days after the initial symptom. No intervention was performed, but the stress levels in her life had been reduced. CONCLUSION: An enlarged empty sella can be present without symptoms and can represent an incidental finding on radiography and MRI. However, an enlarged sella seen on lateral cervical spine radiographs should prompt further evaluation to rule out pituitary disease. The normal pituitary has a varied appearance and signal intensity on MRI depending on the patient's age and pregnancy status.

Follow-up after carpal tunnel decompression - general practitioner surgery or hand clinic? A randomized prospective study.

We prospectively randomized 100 patients following carpal tunnel decompression who were having a 2-week postoperative assessment and removal of stitches to either their local general practitioner (GP) or the hospital outpatient department. All patients were seen at hospital 6 weeks postoperatively for a final assessment. The waiting time for assessment and suture removal was shorter at the GP surgery than in the outpatient department (mean 13 min and 28 min respectively) but significantly more patients were diagnosed as having wound infections (14% and 0% respectively); most were given antibiotics, perhaps unnecessarily.

Sodium and chloride transport across rabbit ileal brush border. I. Evidence for Na-H exchange.

A series of experiments were performed to demonstrate the presence of and characterize the Na-H exchanger on rabbit ileal brush border with a vesicle preparation. An outwardly directed proton gradient (pH 5.5 inside, pH 7.5 outside) stimulated Na uptake, and a fourfold "overshoot" was observed. Conversely, an inwardly directed proton gradient (pH 7.5 inside, pH 5.5 outside) inhibited Na uptake. This stimulation/inhibition of Na uptake could not be accounted for by a proton diffusion potential, because Na uptake was found to be potential insensitive. Amiloride and harmaline inhibited pH-stimulated Na uptake, but other transport inhibitors (acetazolamide, DIDS, SITS, furosemide, and bumetanide) had no effect. Amiloride also inhibited Na efflux in the presence and absence of a pH gradient. Proton gradient-stimulated Na uptake was saturable with a Km of 16.2 mM and a Vmax of 129 nmol X min-1 X mg protein-1. Tetramethylammonium did not affect pH-stimulated Na uptake, but other cations tested inhibited Na uptake, with NH4+ and Li+ causing greater inhibition than K+ or Cs+. Using the fluorescent probe acridine orange, an inwardly directed Na gradient was shown to stimulate proton efflux from the vesicles and an outwardly directed Na gradient stimulated proton influx.