An investigation of sentence-level abilities in children with different types of speech disorder.

Recent studies have highlighted the co-occurrence of speech disorders with language disorders, yet few studies have attempted to explore the relationship between them. This thesis examines the sentence-level abilities of children with different types of speech disorders, and addresses the following questions: (i) Can children with different types of speech disorders be differentiated according to their sentence-level performance? (ii) Is there a more-than-chance co-occurrence of sentence-level difficulties in children with different types of speech disorders? (iii) What is the relationship between speech disorders and sentence production? (iv) Is sentence imitation an efficient, effective and reliable method of assessing expressive syntax in children with severe speech difficulties? The research focuses on two groups of children, each with a different type of speech disorder: one using atypical phonological processes consistently (CPD) and the other using atypical phonological processes inconsistently (IPD). Their performance was compared to children with SLI and typical development. Results of a group study assessing sentence imitation revealed that children with CPD were no more likely to have co-occurring sentence-level difficulties than typically developing children. The IPD group showed difficulties at the sentence level, with significant variation within the group. Further investigations of sentence processing-related skills found that the IPD group could be divided into those who had IPD only and obtained high sentence imitation scores, and those who had co-occurring IPD and sentence-level difficulties, reflected in their low sentence imitation scores. The performance of the low-scoring IPD children was similar to the SLI group's performance in terms of their sentence imitation accuracy scores and most sentence processing-related abilities. However, they could be differentiated by the types and proportions of their errors and their sentence imitation performance when repeating sentences containing multi-syllabic words. The theoretical and clinical implications of the research outcomes are explored

Sentence imitation as a tool in identifying expressive morphosyntactic difficulties in children with severe speech difficulties

Background: Sentence imitation has been identified as a good indicator of children's language skills, with performance differentiating children with specific language impairment and showing relationships with other language measures. It has a number of advantages over other methods of assessment. The assessment of morphosyntax in children who have severe speech difficulties presents unique challenges which currently available sentence imitation assessments do not address. Aims: This paper presents a new sentence imitation test (The Sentence Imitation Test (SIT-61)) and reports on an investigation which sets out to determine whether this test (1) reveals differences in performance between a group of children diagnosed with specific language impairment and a group of typically developing children (2) reveals distinct profiles of performance amongst children with different speech difficulties, and (3) provides information about morphosyntactic strengths and difficulties. Methods & Procedures: SIT-61 is a finely graded sentence imitation test in which the phonotactic structure, segmental phonology and length of words were kept as developmentally simple as possible. Responses are scored for number of content words, function words and inflections correct. A novel scoring system was devised to credit a child where there was evidence of targeting a morpheme even if it was mispronounced. The test was administered to four groups of children between the ages of 4 and 6 years: 33 children with typical development, 13 children with known expressive morphosyntactic difficulties (specific language impairment), and two groups of 14 children with different types of speech disorder: a group with consistent phonological disorder, who used atypical phonological error patterns consistently; and a group with inconsistent phonological disorder, who produced atypical phonological errors inconsistently. Outcomes & Results: SIT-61 found differences in performance between the group of typically developing participants and the three clinic groups. While the consistent phonological disorder group obtained extremely high scores for content and function words, they obtained lower inflection scores reflective of their speech difficulties. The scores of the specific language impairment and inconsistent phonological disorder groups were comparable for content and function words, but the groups were differentiated through an analysis of their errors. Further analyses confirmed that low scores obtained by some children in the inconsistent phonological disorder group were due to morphosyntactic difficulties and not speech difficulties. Conclusions & Implications: A new sentence imitation test, the SIT-61, is shown to be valuable tool for identifying expressive morphosyntactic difficulties in children. It is informative about the morphosyntactic abilities of children with speech disorders and raises questions as to the nature of their difficulties

Outcome of hepatitis C virus infection in Chinese paid plasma donors: A 12–19‐year cohort study

Background and Aims:  Commercial plasma donation was introduced in China in the 1970s. Cases of non‐A, non‐B hepatitis (hepatitis C) continued to occur, with multiple outbreaks among plasma donors in Guan county, Hebei province between 1972 and 1990. The outcomes of hepatitis C virus (HCV) infection in these paid plasma donors from six villages of Guan county were followed up for 12–19 years. Methods:  A total of 402 plasma donors with HCV infection were enrolled since anti‐HCV‐positive in 1991 or 1998. Follow up was maintained until death or the end of the observation period. No antiviral treatment was applied during the period of infection. Results:  Follow up was lost in 23 cases. After a 12–19‐year follow up, 31 donors died, with the cause of death directly related to liver disease in 15 cases, and an overall mortality of 8.18% (31/379). The incidence of liver cirrhosis was 10.03%, and hepatocellular carcinoma (HCC) was 2.90%. The rate of viral spontaneous clearing was 20.32% (77/379), and 13.69% (23/168) in males and 25.59% (54/211) in females. In May 2010, detections were performed in 348 cases. Abnormality of liver function was related to HCV viremia. Sex and alcohol intake impacted the outcome of HCV infection. There was no correlation between the viral spontaneous clearance with age of infection and genotype. Conclusions:  This area has a high rate of chronicity in HCV infection due to plasma donation. Twenty‐five years after virus infection, liver cirrhosis or HCC developed in one‐tenth of patients, with an overall mortality of 8.18%.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90418/1/j.1440-1746.2011.06880.x.pd

Impact of disease severity on outcome of antiviral therapy for chronic hepatitis C: Lessons from the HALT-C trial

In patients with chronic hepatitis C, advanced fibrosis and cirrhosis are associated with lower rates of sustained virologic response (SVR) to interferon (IFN)-based therapy. In this study, we assessed virologic response to retreatment with peginterferon alfa-2a and ribavirin (RBV), as a function of the baseline fibrosis score (Ishak staging) and platelet count, in 1,046 patients enrolled in the Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial. All patients had failed prior treatment with IFN or peginterferon ± RBV and had Ishak fibrosis scores ≥ 3. Four groups of patients with increasingly severe liver disease were compared: (A) bridging fibrosis (Ishak 3 and 4) with platelet counts >125,000/mm 3 (n = 559); (B) bridging fibrosis with platelet counts ≤125,000/mm 3 (n = 96); (C) cirrhosis (Ishak 5 and 6) with platelet counts >125,000/mm 3 (n = 198); and (D) cirrhosis with platelet counts ≤125,000/mm 3 (n = 193). SVR rates were 23%, 17%, 10%, and 9% in groups A, B, C, and D, respectively ( P < .0001 for trend). Reduction in SVR as a function of increasingly severe disease was independent of age, percent African American, HCV genotype, HCV level, and type of prior therapy. Dose reduction lowered SVR frequencies, but to a lesser extent than disease severity. By logistic regression, cirrhosis ( P < .0001) was the major determinant that impaired virologic response, independent of dose reduction or platelet count. In conclusion , disease severity is a major independent determinant of rate of SVR in patients with advanced chronic hepatitis C. New strategies are needed to optimize antiviral therapy in these “difficult-to-cure” patients. (H EPATOLOGY 2006;44:1675–1684.)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55880/1/21440_ftp.pd

The potential of sentence imitation tasks for assessment of language abilities in sequential bilingual children

Sentence repetition tasks are increasingly recognised as a useful clinical tool for diagnosing language impairment in children. They are quick to administer, can be carefully targeted to elicit specific sentence structures, and are particularly informative about children’s lexical and morphosyntactic knowledge. This chapter exlores the theoretical potential of sentence repetition for assessment of sequential bilingual children, and presents three studies comparing performance of sequential bilingual children with monolingual children’s performance on standardised sentence repetition tests in Hebrew (children with L1 Russian, age 5-7 years, and L1 English, age 4½-6½ years), German (children with L1 Russian, age 4-7 years) and English (children with L1 Turkish, age 6-9 years). Results differed across studies: distribution of children in the Hebrew studies was in line with monolingual norms, while the majority of children in the English-Turkish study scored in a range that would be deemed impaired for monolingual children, and performance in the German-Russian study fell between these extremes. Analyses of performance within studies revealed similar discrepancies in effects of children’s exposure to L2, with significant effects of Age of Onset in the Hebrew-Russian and Hebrew-English groups and some indication of Length of Exposure effects, but no effects of either factor in the English-Turkish group. Multiple differences between these studies preclude direct inferences about the reasons for these different results: studies differed in content, methods and scoring of sentence repetition tests, and in ages, languages, language exposure, and socioeconomic status of participants. It is possible that socioeconomic differences are associated with differences in language experience that are equally or more important than onset and length of exposure. Collectively, these studies demonstrate that sentence repetition provides a measure of children’s proficiency in their L2, but that the use of sentence repetition in clinical assessment requires caution unless norms are available for the child’s bilingual community. As a next step, it is proposed that sentence repetition tests using early-acquired vocabulary and targeting aspects of sentence structure known to be difficult for monolingual children with language impairments should be developed in different target languages. This will allow us to explore further the factors that influence attainment of basic morphosyntax in sequential bilingual children, and the point at which sentence repetition, as a measure of morphosyntax, can help to identify children requiring clinical intervention

Early vocabulary development in deaf native signers: a British Sign Language adaptation of the communicative development inventories

Background: There is a dearth of assessments of sign language development in young deaf children. This study gathered age-related scores from a sample of deaf native signing children using an adapted version of the MacArthur-Bates CDI (Fenson et al., 1994). Method: Parental reports on children’s receptive and expressive signing were collected longitudinally on 29 deaf native British Sign Language (BSL) users, aged 8–36 months, yielding 146 datasets. Results: A smooth upward growth curve was obtained for early vocabulary development and percentile scores were derived. In the main, receptive scores were in advance of expressive scores. No gender bias was observed. Correlational analysis identified factors associated with vocabulary development, including parental education and mothers’ training in BSL. Individual children’s profiles showed a range of development and some evidence of a growth spurt. Clinical and research issues relating to the measure are discussed. Conclusions: The study has developed a valid, reliable measure of vocabulary development in BSL. Further research is needed to investigate the relationship between vocabulary acquisition in native and non-native signers

Randomised clinical trial: Polyethylene glycol 3350 with sports drink vs. polyethylene glycol with electrolyte solution as purgatives for colonoscopy--the incidence of hyponatraemia.

BACKGROUND: Polyethylene glycol 3350 plus sports drink (PEG-SD) is a hypo-osmotic purgative commonly used for colonoscopy, though little safety data are available. AIM: To evaluate the effect of PEG-SD on serum sodium (Na) and other electrolytes compared with PEG-electrolyte solution (PEG-ELS). METHODS: We performed a single center, prospective, randomised, investigator-blind comparison of PEG-ELS to PEG-SD in out-patients undergoing colonoscopy. Laboratories were obtained at baseline and immediately before and after colonoscopy. The primary endpoint was development of hyponatraemia (Na/L) the day of colonoscopy. Changes in electrolyte levels were computed as the difference between the lowest value on the day of colonoscopy and baseline. Purgative tolerance and efficacy were assessed. RESULTS: A total of 389 patients were randomised; 364 took purgative and had baseline and day of colonoscopy labs (180 PEG-SD, 184 PEG-ELS). The groups were well matched except for a higher fraction of women and Blacks in PEG-ELS. Seven patients (3.9%) in PEG-SD and four patients (2.2%) in PEG-ELS developed hyponatraemia (OR = 1.82, 95% CI: 0.45-8.62, P = 0.376). Changes in electrolytes from baseline were small but significantly worse with PEG-SD for sodium, potassium and chloride (P = 0.001, 0.012, 0.001, respectively). Preparation completion, adverse events, and overall colon cleansing were similar between the groups, but PEG-ELS had more excellent preparations (52% vs. 30%; P = 0.001). CONCLUSIONS: Greater, but very modest, electrolyte changes occur with PEG-SD. Hyponatraemia is infrequent with both purgatives. A significant increase in hyponatraemia was not identified for PEG-SD vs. PEG-ELS, but the sample size may have been inadequate to identify a small, but clinically important difference. ClinicalTrials.gov identifier NCT01299779