Evaluation of VIDAS® Salmonella (SLM) Immunoassay Method with Rappaport-Vassiliadis (RV) Medium for Detection of Salmonella in Foods: Collaborative Study

A collaborative study was conducted to compare the VIDAS Salmonella (SLM) with Rappaport-Vassiliadis (RV) method for detection of Salmonella in foods to the current standard method presented in the U.S. Food and Drug Administration's Bacteriological Analytical Manual (BAM) and the culture method presented in AOAC's Official Methods of Analysis. The VIDAS SLM with RV method uses tetrathionate broth in combination with RV medium in place of selenite cystine broth for selective enrichment, thereby eliminating the hazardous waste issue for laboratories. Twenty five laboratories participated in the evaluation, each testing one or more of 8 test products: nonfat dry milk, dried egg, soy flour, lactic casein, milk chocolate, raw ground pork, raw ground turkey, and raw peeled shrimp. Results of the study showed no significant differences in the numbers of confirmed positive samples with the VIDAS SLM with RV procedure and the BAM/AOAC culture procedure. The VIDAS SLM with RV method was effective for rapid detection of Salmonella in foods. It is recommended that AOAC INTERNATIONAL modify the VIDAS Salmonella SLM procedure to include the RV method.

Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis

Background

Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct).

Methods

For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, cinahl, and Psychinfo for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of hsct. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models.

Results

In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), l-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (smd): -0.52; 95% confidence interval (ci): -0.89 to -0.14] and with methylphenidate (smd: -0.36; 95% ci: -0.56 to -0.15); modafinil (or armodafinil) and corticosteroids were not effective.

Conclusions

Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of hsct. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.

Multi-component behavioral intervention to promote health protective behaviors in childhood cancer survivors: the protect study

BACKGROUND

Improved cure rates for childhood cancer have produced a growing population of survivors at risk for late toxicities of chemotherapy and radiation therapy. Healthy behaviors can modify these risks. We initiated a controlled prospective trial to determine if a multi-component behavioral intervention could induce change in childhood cancer survivors' health knowledge, health perceptions, and practice of health-protective behaviors.

PROCEDURE

Adolescent cancer survivors attending a long-term follow-up clinic were randomized to receive standard follow-up care or standard care plus the educational intervention. Baseline measures were obtained at randomization (T(0)) and repeated 1 year (T(1)) later during the survivors' annual check-up.

RESULTS

Of 272 patients enrolled and randomized, 251 are evaluable at both time points. Treatment and control groups were similar in regards to diagnosis, gender, race, and age. The change in outcome measures over the year (T(1)-T(0)) was not significantly different between the two groups as assessed by a two-sample pooled t test. However, additional exploratory analyses indicated a significant gender difference in knowledge with female survivors in the intervention group having higher scores. In addition, patients who choose certain individual health goals, such as breast/testicular self-examination, showed improved practice of the health behavior. In addition, in a very exploratory analysis, a gender difference in response to the intervention was noted, with females exhibiting a greater improvement in knowledge scores than did males.

CONCLUSIONS

Although the multi-behavioral educational intervention did not induce change in health knowledge, perceptions, and behaviors of childhood cancer survivors for the treatment group as a whole, gender differences and specific health goal differences were found. These findings suggest that future interventions should be tailored to reflect gender differences and the nature of the health goal under assessment.

NCCN Practice Guidelines for Cancer-Related Fatigue

These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue, using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for the five primary factors known to be associated with fatigue: pain, emotional distress, sleep disturbance, anemia, and hypothyroidism. If any of these conditions are present, it should be treated according to practice guidelines, and the patient's fatigue should be reevaluated regularly. If none of the primary factors is present or the fatigue is unresolved, a more comprehensive assessment is indicated--with referral to other care providers as appropriate. The comprehensive assessment should include a thorough review of systems, review of medications, assessment of comorbidities, nutritional/metabolic evaluation, and assessment of activity level. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, restorative therapies to decrease cognitive alterations and improve mood state, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs such as antidepressants for depression or erythropoietin for anemia. A few clinical reports of the use of corticosteroids and psychostimulants suggest the need for further research on these agents as a potential treatment modalities in managing fatigue. Basic to these interventions, the effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly and systematically and incorporates education and counseling regarding strategies for coping with fatigue (Johnson, 1999), as well as using institutional fatigue management experts for referral of patients with unresolved fatigue.

Feasibility of implementing health promotion interventions to improve health-related quality of life

Survivors of childhood cancer are a growing and vulnerable population. Cure rates for pediatric cancers now exceed 60% and, by the year 2000, an estimated 1 of every 1,000 young adults will be a cancer survivor. Because this population is at increased risk for late medical and neoplastic complications that impact adversely on health-related quality of life, it is important to investigate methods to promote risk reduction by motivating survivors to practice health-promoting behaviors. With this background, we initiated a prospective, randomized, controlled feasibility study in which survivors attending a long-term follow-up clinic were randomized to receive standard care or standard care plus an educational intervention. Our objectives were to determine if the intervention would improve the survivors' knowledge about their cancer treatment and risks of late effects and increase their practice of health-protective behaviors. Since July 1995, 272 of 318 families (86%) approached about the study agreed to participate. Of these, 266 are evaluable for assessment of baseline knowledge and health behaviors. Demographic features, baseline knowledge, health perceptions and health behaviors did not differ among randomized groups. Assessment of the intervention's efficacy at changing health behaviors of survivors randomized to the intervention group will be available when the 1-year follow-up evaluations are completed for the study cohort. Our preliminary experience with this pilot study supports the feasibility of educational intervention research in a specialty clinic dedicated to monitoring long-term childhood cancer survivors. Int. J. Cancer Suppl. 12:138-142, 1999.

A survey of pain services for pediatric oncology patients: their composition and function

The purpose of this survey was to examine the composition and function of pain services/teams at facilities that provide pain management services to pediatric oncology patients across the United States. A questionnaire was mailed to facilities identified by the 1994 Pain Facilities Directory as providing pain services to cancer patients. Thirty-five facilities that identified oncology patients as one of the primary pediatric populations treated at their institution were the focus of this study. Eight facilities that managed bone marrow aspirations and/or lumbar punctures for pediatric oncology patients also participated in a telephone interview regarding analgesia/sedation practices for procedure-related pain. Provision of direct patient care was a primary function of the pain services surveyed, although delivery of services varied across settings. Postoperative and chronic pain were the most frequent reasons for referral. Only 17% and 3% of facilities had established written standard guidelines for pharmacological and nonpharmacological approaches to pain management, respectively. Most facilities reported using a local anesthetic and conscious sedation to manage bone marrow aspiration and lumbar punctures. Implications from these findings and recommendations for provision of pediatric pain services are discussed.

The effects of infusion rate on platelet outcomes and patient responses in children with cancer: an in vitro and in vivo study

PURPOSE/OBJECTIVES

To determine the influence of infusion rate on quality of transfused platelets and patients' physical and subjective responses.

DESIGN

Linked in vitro and in vivo studies with repeated measures and crossover designs, respectively.

SETTING

A 52-bed pediatric cancer center in the midsouthern United States.

SAMPLE

In vitro: 12 randomly selected platelet units. in vivo: convenience sample of 26 children, ages 3-20 years, with cancer and thrombocytopenia requiring platelet transfusion.

METHODS

Four infusion rates studied in vitro: two infusion rates studied in vivo.

MAIN RESEARCH VARIABLES

Platelet count, morphology score, corrected count increment, and patients' physical and subjective responses.

FINDINGS

No clinically significant differences were found in outcomes across the four rates in vitro. Similarly, no statistically significant differences were found between the two in vivo rates on objective or subjective outcomes.

CONCLUSIONS

In this setting, the more rapid infusion rate is clinically preferable because it does not negatively affect platelet recovery or patient outcomes and it decreases the infusion time by half.

IMPLICATIONS FOR NURSING PRACTICE

Findings provided a basis for altering platelet infusion rates at the study setting. Benefits of the faster infusion rate include more rapid correction of thrombocytopenia, decreased time that outpatients must remain in the clinic for transfusion. Increased time available for other parenteral infusions in the impatient setting, and substantial savings in nursing time and associated costs.

Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions

PURPOSE AND METHODS

The current status of tobacco use among young cancer patients and the acute and chronic complications associated with tobacco use in these patients is reviewed.

RESULTS AND CONCLUSION

Studies report that adolescent cancer survivors use tobacco as much as their peers who have never been treated for cancer, despite the adverse consequences of engaging in this unhealthy habit. Health care professionals have the opportunity and responsibility to incorporate tobacco counseling as a routine component of medical care delivery. Nurse/physician-delivered smoking interventions have been found to promote smoking cessation in adults, although little effort has been devoted to the development of similarly effective smoking interventions for pediatric cancer patients who smoke. Components of existing smoking prevention/cessation curricula from successful school-based interventions and physician-delivered smoking interventions can be adapted and tailored to pediatric cancer patients in medical settings. Smoking interventions that educate patients about their increased vulnerability to tobacco-related consequences, relative to their healthy peers, may have an enhanced impact. Guidelines for conducting a comprehensive assessment of tobacco use and implementing smoking interventions with pediatric cancer patients is provided. Strategies for modifying the cancer patient's perceived vulnerability to tobacco-related consequences is also discussed.

The role of EMS systems in public health emergencies

INTRODUCTION

Until now, the public health response to the threat of an epidemic has involved coordination of efforts between federal agencies, local health departments, and individual hospitals, with no defined role for prehospital emergency medical services (EMS) providers.

METHODS

Representatives from the local health department, hospital consortium, and prehospital EMS providers developed an interim plan for dealing with an epidemic alert. The plan allowed for the prehospital use of appropriate isolation procedures, prophylaxis of personnel, and predesignation of receiving hospitals for patients suspected of having infection. Additionally, a dual notification system utilizing an EMS physician and a representative from the Office of Infectious Diseases from the hospital group was implemented to ensure that all potential cases were captured. Initially, the plan was employed only for those cases arising from the Centers for Disease Control and Prevention (CDC)/Public Health Service (PHS) quarantine unit at the airport, but its use later was expanded to include all potential cases within the 9-1-1 system.

RESULTS

In the two test situations in which it was employed, the plan incorporating the prehospital EMS sector worked well and extended the "surveillance net" further into the community. During the Pneumonic Plague alert, EMS responded to the quarantine facilities at the airport five times and transported two patients to isolation facilities. Two additional patients were identified and transported to isolation facilities from calls within the 9-1-1 system. In all four isolated cases, Pneumonic Plague was ruled out. During the Ebola alert, no potential cases were identified.

CONCLUSIONS

The incorporation of the prehospital sector into an already existing framework for public health emergencies (i.e., epidemics), enhances the reach of the public safety surveillance net and ensure that proper isolation is continued from identification of a possible case to arrive at a definitive treatment facility.

Quality of life and the cancer experience: the state-of-the-knowledge

PURPOSE/OBJECTIVES

To address the state-of-the-knowledge concerning quality of life (QOL) issues and the cancer experience from theoretical, research, clinical, and educational perspectives.

DATA SOURCES

Published books and articles and a panel of experienced QOL experts who convened at the Oncology Nursing Society's State-of-the-knowledge Conference on Quality of Life in February 1995.

DATA SYNTHESIS

Despite the evolution and support of QOL in oncology nursing practice, education, and research, there remains gaps in theory, research, and practice related to QOL. This article explores these gaps in knowledge and recommends future directions for QOL theory, research, education, and practice.

CONCLUSIONS

Further conceptual work and resolution of QOL methodologic issues to guide clinical practice and education are warranted. The impact of cultural variables and precancer life experiences on patients' perceptions of QOL also must be addressed.

NURSING IMPLICATIONS

Oncology nurse clinicians, educators, and researchers must continue to work collaboratively to enhance the knowledge base regarding QOL and to improve the nursing care provided to individuals with cancer.

Reversal of immunosuppression of lymphocyte proliferation caused by sera from persons with AIDS

Sera from persons with AIDS contain inhibitors of lymphocyte proliferation. Inhibitory activity can be detected before the development of AIDS in humans. There appear to be at least three distinct suppressive moieties, one of which is prostaglandin E2. We and others had previously shown that serum samples from subjects with AIDS contained antibody to the cell line HUT 102B2. We attempted to remove this antibody and to determine if that action would also remove the inhibitory activity present in human immunodeficiency virus-positive sera. We incubated sera from subjects with AIDS with HUT 102B2 cells and tested the resultant supernatants for inhibition of cell proliferation. We found that this procedure significantly reversed inhibition by serum. Other cells and cell lines were similarly tested, but only HUT 102B2 cells absorbed the inhibitory product(s). However, we determined that secretory material from another cell line, MLA 144, also reversed inhibition. The physical characteristics of the supernatant were investigated. Thus, two procedures and likely separate products, possibly cytokines, reverse immunosuppression by sera from persons with AIDS.

The effects of infusion methods on platelet count, morphology, and corrected count increment in children with cancer: in vitro and in vivo studies

PURPOSE/OBJECTIVES

To determine whether infusion method influences the quality of platelets transfused.

DESIGN

Linked in vitro and in vivo study. Quasi-experimental design for in vitro and cross-over design with balanced randomization for in vivo.

SETTING

Pediatric cancer center in the midsouthern United States.

SAMPLE

Pheresed/pooled platelet units in vitro (n = 12). In vivo convenience sample of 26 children, ages 2-19 years, with cancer and thrombocytopenia who required platelet transfusion.

METHODS

Two infusion pumps (IMED 980 and Gemini, IMED Corp., San Diego, CA) versus gravity flow for in vitro platelet infusion. Gemini infusion pump versus gravity flow for in vivo platelet transfusion.

MAIN OUTCOME MEASURES

Platelet count, morphology score, and corrected count increment.

FINDINGS

No significant differences noted in platelet count or morphology score among or across the three infusion methods in vitro. No significant differences noted between the two infusion methods in platelet count or corrected count increment in vivo.

CONCLUSIONS

Although limited to a specific patient population, setting, and infusion device, findings revealed that the pump was clinically acceptable because it did not negatively affect platelet recovery. Replication of this study with other infusion devices is recommended.

IMPLICATIONS FOR NURSING PRACTICE

Study findings validate the current nursing procedure for the administration of platelets at the study setting. Use of infusion pumps for platelet transfusions is time-efficient and energy-efficient for nurses because the pumps offer a well-controlled infusion rate, accurate volume measurement, and an alarm system for monitoring the infusion.

Serum inhibitors precede the development of SAIDS

Rhesus macaque monkeys infected with the simian immunodeficiency virus develop a syndrome mimicking AIDS in humans. We have demonstrated previously that sera from individuals infected with human immunodeficiency virus type 1 inhibit the proliferation of lymphocytes from healthy noninfected subjects and that this phenomenon is associated with the development of clinical AIDS. We have also shown that sera from monkeys infected with SIV also have such inhibitors. In this body of work, we attempted to document the onset of these inhibitors in relation to the time of SIV infection. Twenty rhesus macaques were injected with one of two tissue strains of SIV or media. Blood was drawn on a set schedule and the serum samples frozen at -70 degrees C. The animals were monitored and observed for up to 42 weeks. All test animals were autopsied. Sera from all the draws were assayed against the same populations of human peripheral blood mononuclear cells in the same experiment using suboptimal amounts of phytohemagglutinin (PHA). Sera from those animals that subsequently developed SAIDS were more likely to demonstrate serum inhibition. This inhibition could be seen as early as 8-10 weeks after infection. By week 14, the assay could differentiate animals into SAIDS or healthy groups with a sensitivity of 67% and a specificity of 89%.

Chest tube stripping in pediatric oncology patients: an experimental study

BACKGROUND

Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue.

OBJECTIVE

To determine whether pediatric oncology patients whose chest tubes were not stripped would differ in frequency of pain, fever or lung complications from patients who underwent routine tube stripping.

METHODS

Data were collected at multiple points during the first 72-hour postoperative period from 16 patients assigned to the stripped or unstripped groups. Pain was measured by the Faces Pain Scale and the Visual Analogue Scale; temperature, by electronic thermometer; and lung complications, by stethoscope and radiographs. Both groups, which were comparable for age, primary diagnosis and prior history of lung problems, received identical supportive nursing and medical care, with the physicians blind to group assignment.

RESULTS

The two groups did not differ significantly in frequency of pain, incidence of fever, breath sounds or radiographic findings across measurement points. A strong correlation was found between the pain scores using the two instruments.

DISCUSSION

Patients whose tubes were not stripped did not have an increased risk of infection or lung complications. Study findings indicated that stripping did not increase the frequency of pain.

CONCLUSIONS

Stripping of chest tubes as a routine postoperative measure is questioned.

Chest tube stripping in pediatric oncology patients: an experimental study

BACKGROUND: Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue. OBJECTIVE: To determine whether pediatric oncology patients whose chest tubes were not stripped would differ in frequency of pain, fever or lung complications from patients who underwent routine tube stripping. METHODS: Data were collected at multiple points during the first 72-hour postoperative period from 16 patients assigned to the stripped or unstripped groups. Pain was measured by the Faces Pain Scale and the Visual Analogue Scale; temperature, by electronic thermometer; and lung complications, by stethoscope and radiographs. Both groups, which were comparable for age, primary diagnosis and prior history of lung problems, received identical supportive nursing and medical care, with the physicians blind to group assignment. RESULTS: The two groups did not differ significantly in frequency of pain, incidence of fever, breath sounds or radiographic findings across measurement points. A strong correlation was found between the pain scores using the two instruments. DISCUSSION: Patients whose tubes were not stripped did not have an increased risk of infection or lung complications. Study findings indicated that stripping did not increase the frequency of pain. CONCLUSIONS: Stripping of chest tubes as a routine postoperative measure is questioned.

Sera from simian immunodeficiency virus-infected rhesus macaques inhibit lymphocyte proliferation

Rhesus macaque monkeys infected with the simian immunodeficiency virus (SIV) develop a syndrome mimicking acquired immunodeficiency syndrome (AIDS) in humans. We had demonstrated previously that sera from individuals infected with human immunodeficiency virus (HIV) inhibit the proliferation of lymphocytes from healthy noninfected subjects and that this phenomenon was associated with the development of clinical AIDS. Thus, we sought to determine whether sera from SIV-infected monkeys would also inhibit lymphocytes from healthy humans and SIV-negative rhesus monkeys. Sera from SIV-infected monkeys were compared with sera from uninfected animals and cultured with cells from healthy human volunteers or SIV-negative monkeys in the presence or absence of phytohemagglutinin (PHA). Cell proliferation was determined by measuring the incorporation of radiolabeled thymidine into cellular DNA. Sera from SIV-infected monkeys suppressed the proliferation of human and non-human primate lymphocytes. This activity appears to be similar to that described for sera from HIV-1-infected humans. Therefore, rhesus macaques infected with SIV provide a model for the study of serum inhibitory factors previously reported in AIDS patients.

Mutation is required to activate the p53 gene for cooperation with the ras oncogene and transformation

Previous experiments have brought into question which amino acid sequence of the p53 oncogene product should be considered wild type and whether the normal protein is capable of cooperating with the ras oncogene to transform cells in culture. To address these questions, a series of p53 cDNA-genomic hybrid clones have been compared for the ability to cooperate with the ras oncogene in transformation assays. From these experiments, it has become clear that the amino acid alanine at position 135, in either the genomic clone or the cDNA clone, failed to produce a p53 protein that cooperated with the ras oncogene and transformed cells. Replacing alanine with valine at this position in either the genomic or the cDNA clone activated for transformation in this assay. Using restriction enzyme polymorphisms in the p53 gene, it was shown that normal mouse DNA encodes alanine at position 135 in the p53 protein. Thus, mutation is required to activate the p53 protein for cooperation with the ras oncogene. After cotransfection with the activated ras gene, the genomic p53 DNA clone always produced more transformed cell foci (1.7-fold) than similar cDNA clones and these foci were more readily cloned (3.6-fold) into permanent cell lines. A series of deletion mutants of the genomic p53 clone were employed to show that the presence of intron 4 in the p53 gene was sufficient to provide much enhanced clonability of transformed foci from culture dishes. The presence of introns in the p53 gene constructions also resulted in elevated levels of p53 protein in the p53-plus-ras-transformed cell lines. Thus, qualitative changes in the p53 protein are required to activate p53 for transformation with the oncogene ras. Quantitative improvements of transformation frequencies are associated with the higher expression levels of altered p53 protein that are provided by having one of the p53 introns in the transforming plasmid.

Cellular gene expression in papillomas of the choroid plexus from transgenic mice that express the simian virus 40 large T antigen

Transgenic mice that contain the simian virus 40 (SV40) enhancer-promoter and large tumor (T) antigen gene develop papillomas of the choroid plexus. The tumors remain well differentiated on histological examination and express normal levels of tissue-specific mRNAs for transthyretin (TTR) and the 5-HT1C serotonin receptor, two differentiated cell markers. Both Northern (RNA) blot analysis and in situ cytohybridization have been used to monitor the steady-state levels of the mRNAs from the viral oncogene (T antigen) and from several cellular oncogenes. In situ hybridization demonstrated, in serial sections, increased levels of both T antigen mRNA and p53 mRNA localized in the tumor tissue but not in the normal brain tissue. The ratios of the steady-state levels of mRNA for p53/TTR and p53/L32, a ribosomal protein gene, were 2- to 20-fold higher in the tumor tissue than in the normal choroid plexus tissue. Several other oncogenes did not show elevated levels of mRNA in these tumors. p53 protein levels were not detectable in normal brain tissue, but p53 levels were very high in tumor tissue in which all of the p53 was found in a complex with the SV40 large T antigen. These data continue to show a close relationship between SV40 T-antigen-mediated tumorigenesis and the role of p53 in these tumors.

Modifications in deaf children's vowel production: perceptual evidence

This study examined the perceived changes in vowel articulation by profoundly deaf children as a function of the method of teaching: with visual feedback provided by the Computer Vowel Trainer (CVT) vs conventional methods. The assessment carried out by experienced listeners consisted in marking the sounds heard on the vowel quadrilateral. It was found that changes in perception were feedback and age dependent: younger children taught with the CVT were perceived as displaying more mobility in articulation and they approximated more closely the target vowels than their control counterparts or older children. Progress was evident in particular for back and central vowels. Analysis of perceived discrepancies between target and judged vowels, too, suggested that visual feedback was beneficial: perception of experimental children's utterances showed a marked reduction in substitutions with central vowels, a characteristic pattern of deaf speech. Comparison of these findings with the results yielded by the judgement of the same items by naive listeners indicated broad agreement between the two categories of assessors. Results were discussed in terms of the perceptual and articulatory intervening variables with reference to the specific advantages and constraints imposed by evaluating vowel quality on the vowel plane.

Acquisition of frication by severely hearing-impaired children

The ability of severely deaf school children to master fricative production and the fricative-affricate distinction was studied over a period of 6 months. The children were given daily speech therapy and half of them received, in addition, visual feedback from a microprocessor-based speech training aid - the 'Fricative and Timing Aid'. The speech of a third group of children, who received no training from us, was also monitored. Results were analysed in terms of the acquisition of fricatives and affricates, and of their position in a word. Results yielded by perceptual tests showed a substantial increase in the intelligibility of all trained children for almost all phonemes at the end of the training programme. Retention scores, i.e. intelligibility scores obtained by re-testing the children after a 2-moth period of non-practice, showed that practically no forgetting of articulatory skills occurred during this interval. Comparisons between children trained with or without visual feedback in general showed no difference between them; however, the former were more intelligible when producing affricates. No improvement in intelligibility was found when no systematic speech training was available. It was concluded that while frication may not be acquired spontaneously, it is a task within the reach of severely deaf children when adequately trained.

Acquisition of the voicing distinction by profoundly hearing-impaired children

The ability of profoundly deaf schoolchildren to learn the voicing distinction was studied over a period of 6 months. The children were given daily speech therapy and half of them received, in addition, visual feedback from a microprocessor-based speech training aid - the Fricative and Timing Aid. Their performance was analysed in terms of the acquisition of voiced v. voiceless stop consonants and of their position in a word. Results yielded by perceptual tests showed a substantial increase in the intelligibility of stop consonants at the end of the training programme. Retention scores, i.e. intelligibility scores obtained by re-testing the children after a 2-month period of non-practice, showed that practically no articulatory skills were forgotten during this interval. Measurements of vowel duration in word-final stop consonants indicated a considerable decrease in vowel length with training, and although this remained higher than for hearing children it probably contributed to higher intelligibility scores. Comparisons between children trained with or without visual feedback showed a definite advantage for the former. No improvement in intelligibility was found when no systematic speech training was available. It was concluded that while the voicing distinction may not be acquired spontaneously, it is a skill within reach of profoundly deaf children when they are trained adequately.

Vowel-learning and the vowel system of deaf children: age and feedback-related differences

A study comparing perceptual judgments of vowels produced by deaf children taught to speak by using a computer-based aid (experimental group, E) and by conventional techniques (control group, C) revealed feedback-related differences. These concerned the ability to reorganise articulatory performance, intelligibility of vowels after training, and the strength of the memory trace, which all showed an advantage for the E group. A phoneme-by-phoneme analysis indicated that the E group improved consistently on back and central vowels, whereas no consistent trend was found in the C group. The modifications observed were also age-dependent, more progress was found in the younger than in the older children's performance. An error analysis showed that asymmetric vowel confusions were predominant and that the major factor accounting for all errors was the small difference between second formant values. The findings are discussed in terms of the articulatory and perceptual variables intervening in the vowel intelligibility of deaf children.

Response bias in the perception of deaf speech by experienced and naive listeners

A comparative study of the attempts of naive listeners and listeners familiar with deaf speech to identify utterances of young deaf speakers showed that there were no differences between the intelligibility scores of the two groups. Significant differences emerged, however, in the type of errors made by each group, the naive listeners making more errors of omission and the listeners familiar with deaf speech more substitution errors. It is suggested that these results indicate different response biases towards the evaluation task, but fail to support the hypothesis that familiarity with the speaker confers a substantial advantage in understanding the speech of the deaf, in the absence of other clues.

Teaching vowel articulation with the computer vowel trainer. Methodology and results

The Computer Vowel Trainer (CVT) uses linear prediction to estimate and display the shape of the speaker's vocal tract during an utterance. The assessment of the CVT was carried out over a period of three years with 14 profoundly deaf children divided into an experimental and a matched control group. Two main results were obtained: (a) children learning to articulate with the CVT achieve consistently higher articulation scores than those trained with conventional methods; (b) the younger the children, the greater their progress in vowel learning, retention and generalization.

A model to integrate hospital board and health office functions at district level

Proposals to integrate the administrative responsibilities of a hospital board and a district health office, are described. Relevant literature advocating the combination of some of the operational functions of these two agencies is reviewed, as is the situation in the Gisborne district as it was at the time that the proposals were formulated. Possible constraints that may obstruct the implementation of the proposals are also discussed, and the need for empowering legislation to allow further development to proceed is emphasised.