Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.

Effect of Inoculation with Selected Isolates of Stagonospora nodorum on Field Evaluations of Host Resistance in Winter Wheat

Although Stagonospora nodorum blotch occurs annually in North Carolina, selection for resistance in wheat (Triticum aestivum) breeding nurseries is hampered by the infrequent occurrence of heavy and timely disease pressure. The objective of this study was to compare estimates of host resistance in a population of 147 random winter wheat lines evaluated in epidemics produced by natural infection versus epidemics supplemented by inoculation with selected isolates. Two isolates were chosen from a set of 43 collected in North Carolina based on their aggressiveness on four wheat cultivars in a controlled environment test. Field experiments utilized a split-plot design with three replications. The main plots were inoculation treatments and the subplots were the 147 wheat genotypes. The inoculation treatments were (i) selected isolate A (more aggressive) alone, (ii) selected isolate B (less aggressive) alone, (iii) a combination of isolates A plus B, and (iv) natural infection. Selected isolate treatments were applied at Feekes growth stage 9 to 10.1, and disease intensity was measured two or three times at 14-day intervals postinoculation. The study was conducted at one location in the 1996-97 season and two locations in the 1997-98 season. High levels of natural infection occurred, and no differences were observed among the four inoculation treatments for mean disease intensity in any of the three environments. Within environments, genotype-by-inoculation treatment variance was significant in the two environments inoculated with selected isolates at growth stage 9 but not in the environment inoculated at growth stage 10.1. Magnitudes of genetic variation and heritability for Stagonospora nodorum blotch resistance were not consistently associated with main plot treatments, and inoculation with selected isolates masked genetic variation for resistance in two treatments in one environment. Genotype rank correlations for Stagonospora nodorum blotch resistance between inoculation treatments varied from zero to 0.69 within environments, but only a single correlation between inoculation treatments in different environments was observed. Estimates of host resistance in epidemics supplemented with selected isolates did not consistently agree with estimates in epidemics produced by natural infection. Our results did not support the routine use of supplemental inoculation of wheat breeding nurseries with selected isolates of S. nodorum as a means of increasing genetic gain for host resistance.

Rapid resolution following chemotherapy of Broca's dysphasia due to recurrent anaplastic astrocytoma

A middle-aged man re-presented with a Broca's aphasia due to a recurrent fronto-cingulate anaplastic astrocytoma. Although the language disturbance did not improve with dexamethasone therapy, within 4 weeks of treatment with procarbazine, CCNU and vincristine, the dysphasia had almost completely resolved. The anatomico-functional aspects and possible mechanisms of production and resolution of the aphasia are discussed. Assessment of dysphasias in patients undergoing intensive therapy for brain neoplasms is often neglected, but it can provide good objective information about the efficacy of therapy.

Occupational health management of police officers involved in the Piper Alpha disaster

The Occupational Health Management of Police Officers involved in the Piper Alpha Incident is described with reference to the factors likely to cause either physical or psychological distress and the measures taken to overcome these. Once the enormity of the Piper Alpha Disaster became apparent with the realization that the recovery of the bodies would extend over a period of months, the problems of maintaining the physical and mental health of the Police Officers involved assumed prime importance.

Resolution of fluent dysphasia following excision of metastatic carcinoma from the arcuate fasciculus

The effect of therapy on aphasic syndromes in patients with brain tumours is poorly documented. A case in which resection of a metastatic lesion led to resolution of a fluent dysphasia that had not responded to corticosteroid therapy is presented. As well as surgical and neurolinguistic interest this case demonstrates that CT diagnosis of malignant glioma can be erroneous and may lead to sub-optimal treatment.

Isolation and characterization of cephalothin-susceptible Campylobacter coli from slaughter cattle

In a recent meat survey, 10 of 13 (77%) Campylobacter coli isolates were susceptible to cephalothin. These organisms were isolated from nine slaughter cattle from eight meat packing establishments. All 10 isolates grew at 43 degrees C but not at 25 degrees C, were catalase and oxidase positive, and were susceptible to nalidixic acid (30 micrograms) and cephalothin (30 micrograms). The cultures were subsequently identified as C. coli serogroup 20, biotype I (Lior scheme). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed that protein and lipopolysaccharide profiles of whole cell preparations of the 10 cephalothin-susceptible strains and the reference strain for C. coli serogroup 20 were very similar. The plasmid profiles of these 11 strains were identical.

Construction of an Escherichia coli strain which excretes abnormally large amounts of adenosine 3',5'-cyclic monophosphate

It has previously been shown that an Escherichia coli CRP- strain 5333 accumulates abnormally large amounts of adenosine 3',5'-cyclic monophosphate (cAMP). Using P1 transduction, the CRP- character was transferred to E. coli Crookes strain which is deficient for cAMP phophodiesterase (CPD-). The resulting strain HY22 (CRP-, CPD-) accumulates greater amounts of cAMP both intracellularly and extracellularly than does 5333. In glucose minimal medium, an HY22 cell accumulates 100 times more cAMP intracellularly and excretes cAMP 150 times faster than does a wild-type E. coli cell.