The roles of letter names and letter sounds in connecting print and speech.

Three experiments were carried out to examine the cues that are used in learning to read and spell new words. In a reading task (Experiment 1), even preschoolers who could not read simple real words were able to benefit from print-sound relationships that were based on letter names. They found it easier to learn that the made-up word TM was pronounced as 'team" (name condition) than that TM was pronounced as "tame" (sound condition) or as "wide" (visual condition). The letter-name strategy persisted among college students (Experiment 2). In a spelling task (Experiment 3), prereaders and novice readers again did better in the name condition than in the sound condition. The ability to use relationships based on letter sounds emerged later than the ability to use relationships based on letter names. However, sound-based relationships were used to a greater extent in spelling than in reading.

Factors influencing ulcer healing in patients with combined arterial and venous insufficiency.

PURPOSE: The purpose of this study was to determine the effectiveness of treatment of patients with combined arterial and venous insufficiency (CAVI), evaluate variables associated with successful ulcer healing, and better define criteria for interventional therapy. STUDY DESIGN: We retrospectively reviewed the records of patients treated at four institutions from 1995 to 2000 with lower extremity ulcers and CAVI. Arterial disease was defined as an ankle/brachial index less than 0.9, absent pedal pulse, and at least one in-line arterial stenosis > 50% by arteriography. Venous insufficiency was defined as characteristic clinical findings and duplex findings of either reflux or thrombus in the deep or superficial system. Clinical, demographic, and hemodynamic parameters were statistically analyzed with multiple regression analysis and correlated with ulcer healing and limb salvage. RESULTS: Fifty-nine patients with CAVI were treated for nonhealing ulcers that had been present from 1 to 39 months (mean, 6.4 months). All patients had edema. The mean ankle/brachial index was 0.55 (range, 0-0.86). Treatment included elastic compression and leg elevation in all patients and greater saphenous vein stripping in patients with superficial venous reflux. Fifty-two patients underwent arterial bypass grafting, three underwent an endarterectomy, one underwent superficial femoral artery percutaneous transluminal angioplasty, and three underwent primary below-knee amputation. For purposes of analysis, patients were divided into four groups according to the pattern of arterial and venous disease and the success of arterial reconstruction. Group 1 consisted of 22 patients with a patent arterial graft, superficial venous incompetence, and normal deep veins. Group 2 consisted of seven patients with a patent graft, superficial reflux, and deep venous reflux. Group 3 included 22 patients with a patent graft and deep venous thrombosis (DVT), and group 4 included eight patients with an occluded arterial graft. Follow-up ranged from 2 to 47 months (mean, 21.6 months). Forty-nine patients remained alive, and 10 died of unrelated causes. During follow-up, 48 of the 56 treated arteries remained patent and eight occluded. Thirty-four ulcers (58%) healed, 18 ulcers (31%) did not heal, and 7 patients (12%) required below-knee amputation for nonhealed ulcers and uncontrolled infection. No patient with graft occlusion was healed, and 12 ulcers persisted despite successful arterial reconstruction. Twenty-one (78%) of 27 patients undergoing greater saphenous vein stripping were healed, but none of these patients had DVT. The mean interval from bypass graft to healing was 7.9 months. Thirty-two (68%) of 46 patients without prior DVT were healed, whereas only two (15%) of 13 patients with prior DVT were healed, and this variable, in addition to graft patency, was the only factor statistically significant in predicting healing (P <.05). CONCLUSIONS: Ulcers may develop anywhere on the calf or foot in patients with CAVI, and healing requires correction of arterial insufficiency. Patients with prior DVT are unlikely to heal, even with a patent bypass graft. Ulcer healing is a lengthy process and requires aggressive treatment of edema and infection, and successful arterial reconstruction. Patients with a prior DVT are unlikely to benefit from aggressive arterial or venous reconstruction.

Wound infections involving infrainguinal autogenous vein grafts: a current evaluation of factors determining successful graft preservation.

PURPOSE: The purpose of this study was to review the natural history and clinical outcome of patients with infrainguinal autogenous graft infection (IAGI), to evaluate the effectiveness of attempted graft preservation, to determine those variables associated with graft salvage, and to better determine optimal treatment. STUDY DESIGN: We retrospectively reviewed the records of patients undergoing infrageniculate vein grafts at three hospitals between 1994 and 2000 who had a wound infection involving the graft. Clinical and bacteriologic variables were analyzed and correlated with graft salvage, limb salvage, and clinical outcome. RESULTS: During this 7-year period, 487 patients underwent an infrageniculate vein graft, and 68 (13%) had clinical evidence of IAGI. Twenty-seven patients presented with drainage from the wound, 15 with wound separation and cellulitis, 18 with soft tissue infection extending to the graft, 4 with an abscess and cellulitis, and 4 with bleeding. Ten patients (15%) had systemic symptoms (defined as a white blood cell count > 15,000 and temperature > 38.5 degrees C). Forty infections developed in the thigh, 17 in the groin, and 11 in the lower leg. An anastomosis was exposed in 15 patients. Wound cultures were positive for bacteria in 52 patients, and most infections were due to Staphylococcus aureus (18 patients) and S epidermidis (12 patients). Pseudomonas was cultured from seven infections. Twelve patients had polymicrobial infections. The interval from operation to infection ranged from 7 to 180 days. All patients were treated with oral antibiotics, 48 after intravenous antibiotics. Forty-five patients had operative debridement, including 18 who had muscle flap coverage. Four patients presented with hemorrhage, and three had immediate graft ligation and one graft excision. Follow-up ranged from 5 to 68 months (mean, 24.3 months), with 61 patients currently alive. Two patients died as a result of the IAGI (mortality rate, 2.9%). One had undergone a below-knee amputation, and one had a nonhealed wound but intact limb. Overall, 61 wounds (91%) healed, 4 patients required below-knee amputations, and 3 wounds did not heal. Fifty-eight grafts remained patent, 6 thrombosed, and 4 were ligated to control hemorrhage. Of the 61 wounds that healed, the time required for healing ranged from 7 to 63 days. No patient with bleeding died because of the acute episode. No patient had delayed hemorrhage. All 18 patients treated with a muscle flap healed. Bleeding (P <.001), elevated white blood cell count (P <.029), fever (P <.001), and renal insufficiency (creatinine level > 1.5; P <.056) were the only variables statistically significant in predicting graft failure or limb loss. With the use of life-table analysis, graft patency was 94%, 72%, and 72% at 1, 3, and 5 years, and limb salvage was 97%, 92%, and 92% at the same intervals, respectively. CONCLUSIONS: Most patients with an IAGI can be successfully treated with graft and limb preservation. In contrast to earlier studies, an exposed anastomosis, interval to infection, or Pseudomonas infection is not associated with graft failure. Graft salvage is less likely in patinets with fever, leukocytosis, and renal insufficency, but because most grafts remained patent, graft preservation is recommended for these patients. Graft ligation or excision should be reserved for patients presenting with bleeding or sepsis.

Learning a novel grapheme: effects of positional and phonemic context on children's spelling.

Two experiments explored how children who encounter a new spelling for a phoneme generalize it to novel items. Children ages 5 1/2 to 9 (N = 123) were taught a CVC (consonant-vowel-consonant) nonword containing a new vowel spelling in the middle position (e.g., /gaik/ is spelled as giik). They were then asked to spell other nonwords containing the vowel or to judge spellings that had supposedly been produced by younger children. Children were sensitive to position in the spelling production task, being more likely to use the novel grapheme when the vowel appeared in the middle of a CVC target than when it appeared in word-initial or word-final position. Children were not significantly more likely to use the novel grapheme when the target shared the vowel and final consonant (rime) of the training stimulus than when it shared the initial consonant and vowel. Implications for views of spelling development are discussed.

The role of phonology in a letter detection task.

In two experiments, we investigated whether onsets and rimes have a role in the processing of written English. In both experiments, participants detected letter targets (e.g., t) in nonwords like vult faster than in nonwords like vust. This finding is consistent with Selkirk's (1982) view that sonorants (e.g., the /l/ of vult) cohere with preceding short vowels and are part of the vowel nucleus. In contrast, the /t/ of vust is part of the syllable's coda st and so is harder to isolate. Experiment 2 demonstrated that the time required for one to detect single-member codas following vowel digraphs (e.g., the t in veet) was similar to the time to detect the same target letter following a postvocalic sonorant (e.g., the t in vult). No evidence was found for onsets. The results provide support for a phonological organization among letters of printed rimes.

Dialect and authography: some differences between American and British spellers.

Two experiments examined whether American and British university students make different kinds of spelling errors as a function of the differences between their dialects. The American students spoke a rhotic dialect, pronouncing an /r/ in such words as leper, hermit, horde, and gnarl. The British students, with their nonrhotic dialect, did not include an /r/ in such words. The dialect differences led to different spelling errors in the 2 groups. For example, the British students sometimes misspelled horde as "haud" because its vowel has the alternative spelling au in their dialect. They sometimes spelled polka as "polker" because its final vowel is often spelled as er in other words. The U.S. students were much less likely to make such errors, although they did make other errors that reflected aspects of their dialect. Phonology, far from being superseded by other strategies in the development of spelling, continues to be important for adults.

What's in a name: Children's knowledge about the letters in their own names.

Two studies were performed to determine whether children's experiences with their own names boost their knowledge about the components of the name, the letters. The children in Study One showed a significant superiority for the initial letter of their own first name in tests of letter-name, but not letter-sound, knowledge. This pattern was found for Australian first graders (mean age 5 years, 5 months), U.S. kindergartners (mean age 5 years, 8 months), and U.S. preschoolers (mean age 4 years, 10 months). Study Two, with U.S. preschoolers (mean age 4 years, 11 months), again revealed an advantage for the initial letter of a child's first name in knowledge of letter names but not knowledge of letter sounds. Moreover, the children were better at printing the initial letter of their own first name than other letters. The results show that different factors are involved in the learning of letter names and letter sounds. They further suggest that children use letter-based strategies with their own names at a time when they are often considered to be "logographic" readers.

Children's phonological awareness: confusions between phonemes that differ only in voicing.

Given the role of phonemic awareness in learning to read and spell, it is important to examine the linguistic factors that influence children's performance on phonemic awareness tasks. We found that, contrary to some previous claims, children did not perform better with fricative consonants (e.g., /z/) than with stops (e.g., /d/) in a phoneme recognition task. However, preschoolers and kindergartners were more likely to mistakenly judge that a syllable began with a target phoneme when the initial phoneme of the syllable differed from the target only in voicing (e.g., /t/ for the target /d/) than when it differed in place of articulation (e.g., /b/-/d/) or in both place and voicing (e.g., /p/-/d/). These results shed light on the organization of children's phonological systems. They also have implications for the design and interpretation of phonemic awareness tasks.

The foundations of literacy: learning the sounds of letters.

Learning the sounds of letters is an important part of learning to read and spell. To explore the factors that make some letter-sound correspondences easier for children to learn than others, we first analyzed knowledge of letters' sounds (and names) by 660 children between 3 1/2 and 7 1/2 years old. A second study examined pre-schoolers' (M age 4 years, 11 months) ability to learn various sound-letter mappings. Together, the results show that an important determinant of letter-sound knowledge is whether the sound occurs in the name of the letter and, if so, whether it is at the beginning or the end. The properties of the sound itself (consonant versus vowel, sonorant versus obstruent, stop versus continuant) appear to have little or no influence on children's learning of basic letter-sound correspondences. The findings show that children use their knowledge of letters' names when learning the letters' sounds rather than memorizing letter-sound correspondences as arbitrary pairings.

Can children and adults focus on sound as opposed to spelling in a phoneme counting task?

Given the well-established link between phonemic awareness and literacy, it is important to better understand the foundations of phonemic awareness. The authors investigated the phoneme counting task, examining the degree to which children reading at a first-grade level and college students can focus on sound as opposed to spelling. In 2 experiments, both groups were found to be sensitive to some phonetic details that are not systematically represented in print. They had some ability to distinguish between monophthongs (as in he) and diphthongs (as in how), and they tended to count fewer "sounds" for syllables ending with the more sonorous (or vowel-like) consonant/r/than for syllables ending with less sonorous consonants. However, print-related knowledge also affected both groups. Even children judged syllables that were the names of letters to contain fewer "sounds" than syllables that were not letter names.

Ruptured visceral artery aneurysms.

Visceral artery aneurysms are uncommon lesions that are rarely identified in the absence of symptoms. Between February 1972 and April 1992, nine patients (5 men and 4 women) with rupture of visceral artery aneurysms were treated. The average age was 62 years old (range 39 to 86 years old). The arteries involved were the splenic (4), the common hepatic (2), the left hepatic (1), the celiac (1), and the superior mesenteric (SMA) (1). No ruptured renal artery aneurysm was identified. Six patients presented with abdominal distension, pain, and hemodynamic instability. Three patients had recurrent gastrointestinal bleeding with erosion into the duodenum, the common bile duct or the pancreatic duct. All three had unnecessary gastrointestinal operations despite preoperative (2 patients) or intraoperative (1 patient) identification of a visceral artery aneurysm. One patient with an SMA aneurysm had ligation and bypass. Three patients with splenic artery aneurysms had splenectomy. The remaining five patients had either ligation or resection without arterial reconstruction. No end-organ dysfunction was identified. There was one death (11%) due to the SMA aneurysm. Pathological findings in four patients were cystic medial necrosis, diffuse deficiency of the internal elastic lamina, fibromuscular dysplasia, and atherosclerosis, respectively. The remainder were thought to be due to atherosclerosis on gross examination. Rupture of visceral artery aneurysms occurs infrequently and can be treated by simple ligation in most cases. Recognition that rupture of splanchnic arterial aneurysms into adjacent viscera can cause recurrent gastrointestinal bleeding may prevent both substantial delays in diagnosis and inappropriate therapy.

The Fragility of the Alphabetic Principle: Children's Knowledge of Letter Names Can Cause Them to Spell Syllabically Rather Than Alphabetically

The present research was designed to investigate how children's early-acquired knowledge of letter names affects their spelling. Specifically, we asked whether kindergartners and first graders sometimes spell a sequence of phonemes such as /bi/ (the name of the letter b) or /zi/ (the name of the letter z) with the corresponding consonant letter rather than spelling the sequence alphabetically, with a consonant letter followed by a vowel letter. Children made a number of letter-name spelling errors, especially when the consonant and vowel formed a complete syllable. These results show that children's knowledge of letter names can cause them to deviate from the alphabetic principle-the principle that each phoneme should be represented with a single grapheme. The findings further suggest that syllables play a special role in early writing.

Effects of Morphology on Children's Spelling of Final Consonant Clusters

Most research on children's spelling has emphasized the role of phonological or sound-based processes. We asked whether morphology plays a part in early spelling by examining how children write words with final consonant clusters. In three experiments, children made different patterns of omission errors on the last two consonants of words such as tuned and bars, in which the consonants belong to different morphemes, and words such as brand and Mars, in which the consonants belong to the same morpheme. These differences emerged even among children reading at the first-grade level. Effects of morphology appeared whether children spelled single words to dictation (Experiments 1 and 3), finished partially completed spellings (Experiment 2), or wrote sentences containing specified words (Experiment 3). Children did not use morphological relations among words as much as they could have, given their knowledge of the stems, but they did use them to some extent. Although phonology plays an important role in early spelling, young children can also use other sources of information, including certain morphological relationships among words.

Spontaneous dissection of the internal carotid artery: a nineteen-year clinical experience.

PURPOSE: This article reviews our experience with internal carotid artery dissection (ICAD), evaluates the usefulness of Duplex scanning in diagnosis, provides current recommendations for treatment, and better defines long-term prognosis. METHODS: The records from 1976 to 1995 of 24 patients who had 28 ICAD were reviewed. All diagnoses were confirmed by arteriography. Presenting symptoms, diagnostic tests, clinical management, and outcome were examined. RESULTS: Nine patients had visual symptoms or headache, 10 had transient focal neurologic symptoms (TIA), and five had stroke. Five of the 19 who had visual symptoms or TIA had a stroke before the diagnosis of ICAD. Seventeen patients who had 19 ICAD underwent a Duplex scan at the time of presentation. Duplex scan identified 18 arterial abnormalities consistent with ICAD (sensitivity, 95%). Three patients died from stroke during the initial hospitalization. Of the 21 who survived, 12 were treated with anticoagulation therapy, six with aspirin, and three with aspirin and anticoagulation therapy. None of the 21 patients had a subsequent stroke. Six patients subsequently had an operation for residual occlusive disease or aneurysm. The mean duration of follow-up was 9.3 years. Two patients developed contralateral ICAD. During follow-up, 19 arteries were studied with Duplex scan, and seven had no residual evidence of ICAD. CONCLUSIONS: Patients who have ICAD often have prodromal symptoms before stroke. If diagnosed early, treatment with anticoagulation may prevent stroke. Duplex scans are accurate for defining carotid abnormalities consistent with ICAD and for indicating the need for arteriography. Patients should undergo a follow-up Duplex scan to identify contralateral ICAD.

Children's sensitivity to syllables, onsets, rimes, and phonemes.

It has been argued that children's performance on phonological awareness tasks varies with the linguistic level that is tapped by the task. For example, tasks that involve syllables are thought to be easier than tasks that involve lower-level linguistic units, and tasks that tap the level of onsets are thought to be easier than tasks that require access to single phonemes. In previous research, however, the linguistic status of a unit has often been confounded with its size. Five experiments were carried out in an attempt to disentangle these variables and so to provide a better test of the linguistic status hypothesis. In the first study, preschoolers and kindergartners more readily judged that two stimuli shared a beginning sound when that sound was an onset on its own than when it was part of a cluster onset. In two additional experiments, there was an advantage for syllables over rimes in kindergarten and first-grade children when the shared units occurred in the middle syllables of trisyllabic stimuli. The superiority for syllables was largely masked in two other studies in which the stimuli that shared a unit rhymed. This latter result suggests that children's familiarity with rhyme can override the syllable advantage. Overall, the results support the linguistic status hypothesis by indicating that effects of linguistic level on phonological sensitivity cannot always be reduced to effects of unit size.

Children's sensitivity to syllables, onsets, rimes, and phonemes.

It has been argued that children's performance on phonological awareness tasks varies with the linguistic level that is tapped by the task. For example, tasks that involve syllables are thought to be easier than tasks that involve lower-level linguistic units, and tasks that tap the level of onsets are thought to be easier than tasks that require access to single phonemes. In previous research, however, the linguistic status of a unit has often been confounded with its size. Five experiments were carried out in an attempt to disentangle these variables and so to provide a better test of the linguistic status hypothesis. In the first study, preschoolers and kindergartners more readily judged that two stimuli shared a beginning sound when that sound was an onset on its own than when it was part of a cluster onset. In two additional experiments, there was an advantage for syllables over rimes in kindergarten and first-grade children when the shared units occurred in the middle syllables of trisyllabic stimuli. The superiority for syllables was largely masked in two other studies in which the stimuli that shared a unit rhymed. This latter result suggests that children's familiarity with rhyme can override the syllable advantage. Overall, the results support the linguistic status hypothesis by indicating that effects of linguistic level on phonological sensitivity cannot always be reduced to effects of unit size.

Should percutaneous transluminal angioplasty be recommended for treatment of infrageniculate popliteal artery or tibioperoneal trunk stenosis?

PURPOSE: The purpose of this study was to determine the effectiveness of percutaneous transluminal angioplasty (PTA) for treatment of patients with localized stenosis of the infrageniculate popliteal artery and tibio-peroneal trunk (IGPA). METHODS: The records of 25 patients undergoing IGPA PTA from 1983 to 1993 were reviewed. Patients underwent follow-up with clinical examinations, ankle-brachial indexes, Duplex scanning, and arteriography. Demographic variables and cardiovascular risk factors were analyzed and correlated with outcome. RESULTS: Mean follow-up was 44 months. With life-table analysis, clinical and hemodynamic success was 59%, 32%, and 20% at 1, 2, and 3 years, respectively. Average time to recurrence was 17 months. Sixteen patients required a subsequent procedure; two had only repeat PTA, six had repeat PTA followed by arterial bypass, and eight had bypass alone. The mean additional benefit of repeat PTA was 8 months. Eleven of the 14 patients treated with bypass became symptom-free with patent grafts at a mean follow-up of 52 months. No risk factor was statistically significant in predicting success of IGPA PTA. CONCLUSIONS: IGPA PTA is an expensive temporizing measure with a high rate of recurrence requiring subsequent intervention. The procedure should be restricted to patients with limited life expectancy or contraindications to operation.

Errors in short-term memory for speech: a developmental study.

In a previous study (R. Treiman & C. Danis, 1988), adults who were presented with lists of spoken consonant-vowel-consonant (CVC) nonsense syllables for immediate recall produced many errors that combined the initial consonant onset of one to-be-remembered syllable with the vowel-consonant rime of another to-be-remembered syllable. These onset-rime recombination errors were more common than other types of recombination errors and also more common than serial position errors. These findings suggest that nonwords are remembered in terms of smaller phonological units. To replicate the previous results and to determine whether they generalize to children, the author tested kindergarteners, 3rd graders, 6th graders, and adults on lists of nonsense CVCs. Onset-rime conjunction errors were the most frequent type of recombination error, even among kindergarteners, suggesting that children code spoken syllables in terms of onset and rime units from a young age.

The special role of rimes in the description, use, and acquisition of English orthography.

The links between spellings and sounds in a large set of English words with consonant-vowel-consonant phonological structure were examined. orthographic rimes, or units consisting of a vowel grapheme and a final consonant grapheme, had more stable pronunciations than either individual vowels or initial consonant-plus-vowel units. In 2 large-scale studies of word pronunciation, the consistency of pronunciation of the orthographic rime accounted for variance in latencies and errors beyond that contributed by the consistency of pronunciation of the individual graphemes and by other factors. In 3 experiments, as well, children and adults made more errors on words with less consistently pronounced orthographic rimes than on words with more consistently pronounced orthographic rimes. Relations between spellings and sounds in the simple monomorphemic words of English are more predictable when the level of onsets and rimes is taken into account than when only graphemes and phonemes are considered.

Role of the syllable in the processing of spoken English: evidence from a nonword comparison task.

Previous research using monitoring tasks suggests that syllables do not play a role in the initial processing of speech by English listeners. The role of syllables in a different task, one involving the speeded comparison of 2 nonwords, was investigated. In 2 experiments, responses to nonword pairs that shared a complete syllable were significantly faster than responses to pairs that shared part of a syllable when the shared unit was at the beginning or in the middle of the nonwords. Results were mixed when the shared unit was at the end of the nonwords, possibly reflecting a confounding effect of rhyme. Findings suggest that syllabified representations of the nonwords may be used in a comparison task, even in English. Results are interpreted relative to different demands of the nonword comparison and monitoring tasks.