Social validity of changes in informativeness and efficiency of aphasic discourse following linguistic specific treatment (LST).

This study presents the results of an analysis of pragmatic aspects of language samples obtained from five agrammatic aphasic individuals prior to and following Linguistic Specific Treatment (LST). Clinically and statistically significant positive changes in informativeness and efficiency were documented in posttreatment samples. Analysis of communicative competence (i.e., naïve listeners' ratings of pre- and posttreatment audiotaped samples), was undertaken to examine the social validity of quantified changes. Mean ratings across listeners were computed to evaluate their subjective perceptions of general communicative constructs. Results indicated that objectively measured changes in pragmatic aspects were perceptible to naïve listeners, however, to varying degrees across participants and constructs.

Cross-modal generalization effects of training noncanonical sentence comprehension and production in agrammatic aphasia.

The cross-modal generalization effects of training complex sentence comprehension and complex sentence production were examined in 4 individuals with agrammatic Broca's aphasia who showed difficulty comprehending and producing complex, noncanonical sentences. Object-cleft and passive sentences were selected for treatment because the two are linguistically distinct, relying on wh-and NP movement, respectively (Chomsky, 1986). Two participants received comprehension training, and 2 received production training using linguistic specific treatment (LST). LST takes participants through a series of steps that emphasize the verb and verb argument structure, as well as the linguistic movement required to derive target sentences. A single-subject multiple-baseline design across behaviors was used to measure acquisition and generalization within and across sentence types, as well as cross-modal generalization (i.e., from comprehension to production and vice versa) and generalization to discourse. Results indicated that both treatment methods were effective for training comprehension and production of target sentences and that comprehension treatment resulted in generalization to spoken and written sentence production. Sentence production treatment generalized to written sentence production only; generalization to comprehension did not occur. Across sentence types generalization also did not occur, as predicted, and the effects of treatment on discourse were inconsistent across participants. These data are discussed with regard to models of normal sentence comprehension and production.

Refractive astigmatism after oblique clear corneal phacoemulsification cataract incision.

PURPOSE: To determine the astigmatic effect of a supero-oblique clear corneal phacoemulsification cataract incision. SETTING: A university-based general ophthalmology practice. METHODS: All eyes having supero-oblique phacoemulsification cataract surgery using the right hand of a single surgeon between April 17, 1997, and July 24, 1997, were prospectively included. There were 52 eyes of 52 consecutive patients. Manifest refraction was performed preoperatively and 1, 3, and at least 6 months postoperatively. A Fourier method of vector analysis was used. RESULTS: Mean refractive error (Fourier corrected) for all eyes and all ages preoperatively was -1.422 + 0.085 x 35.85. At 6 months, it was -0.620 + 0.190 x 14.2. There was little difference between right and left eyes. Patients older than 80 years had greater induced astigmatism. CONCLUSION: This study provides evidence that making a supero-oblique clear corneal phacoemulsification incision while sitting in the more natural superior position does not induce a clinically important amount of oblique astigmatism.

Reproducibility of corneal flap thickness in LASIK.

BACKGROUND: The purpose of the microkeratome in laser assisted in situ keratomileusis (LASIK) is to create a corneal flap of desired thickness, thus exposing the stroma. The accuracy and repeatability of intended flap thickness with the current microkeratome system has not been documented. The purpose of this study was to determine the precision and consistency of creating a corneal flap thickness of 160 microns with the Moria LSK-One microkeratome (distributed by Microtech, Inc., Doylestown, PA). PATIENTS AND METHODS: The records of 93 eyes from 67 patients who underwent LASIK were reviewed. The central corneal thickness was measured at baseline. The microkeratome using a "130" footplate was used to create an intended flap 160 microns thick, and the corneal thickness was then remeasured. RESULTS: The mean flap thickness for both eyes combined was 159 microns (S.D. = 28). There was no significant correlation between pre-flap corneal thickness or average K and the corneal flap thickness. CONCLUSION: This study provides evidence that the Moria LSK-One microkeratome creates reproducible LASIK flaps consistently near the intended 160 microns corneal flap thickness. This knowledge enables the surgeon to make a corneal flap with great confidence in the thickness of the excision. In addition, this study provides a clinical, in vivo model for testing corneal flap thickness.

Training and generalized production of wh- and NP-movement structures in agrammatic aphasia.

The present research examines production of "complex" sentences, which involve movement of noun phrases (NPs), in 2 agrammatic aphasic subjects. According to linguistic theory (Chomsky, 1991, 1993), such sentences are derived using one of two movement operations, either wh- or NP-movement, subsumed under the general rule "move alpha." In this experiment recovery of both wh- and NP-movement derived sentences was investigated using a treatment research paradigm. Subjects were sequentially trained to produce either wh-movement (i.e., who questions, object clefts) or NP-movement (i.e., passives, subject-raising structures) derived sentences. Throughout training, generalization to untrained sentences relying on both types of movement was tested. The influence of training on aspects of narrative discourse also was examined. Results showed generalization patterns constrained to type of movement. Training wh-movement structures resulted in generalized production of untrained wh-movement structures without influencing production of NP-movement structures. Similarly, training of NP-movement structures resulted in generalization only to other sentence types also relying on NP-movement. Aspects of sentence production in narrative contexts also was improved with treatment. These data indicate that movement to an argument (A) position as in NP-movement is distinct from movement to a non-argument (A-bar) position, required in wh-movement. The site where movement terminates in the s-structure of noncanonical sentences appears to influence sentence production. These findings show that linguistic properties of sentences influence sentence production breakdown and recovery in aphasia.

Training wh-question production in agrammatic aphasia: analysis of argument and adjunct movement.

The present research utilized aspects of the Principles and Parameters Approach (P&PA; Chomsky, 1991, 1993) in linguistic theory as well as findings from the psycholinguistic literature as a basis for examining sentence production in aphasic individuals. We examined the production of particular wh-movement constructions--wh-questions requiring movement of an argument noun phrase (i.e., who and what questions) and those which require adjunct movement (i.e., when and where questions). Using a single-subject experimental treatment paradigm, subjects were sequentially trained to produce these wh-questions and, throughout training, generalization to untrained wh-questions relying on similar wh-movement processes was tested. As well, the influence of training on aspects of narrative and conversational discourse was examined. Seven agrammatic aphasic subjects who evinced difficulty producing (and comprehending) "complex" sentences (e.g., passives, object relative clauses, wh-questions)--sentences that involve movement of noun phrases (NPs) out of their canonical positions, leaving behind a "trace" of that movement or "gap"--participated in the study. Subjects were trained to produce wh-questions by taking them through a series of steps emphasizing the lexical and syntactic properties (e.g., thematic role assignment, movement processes, and proper selection of wh-morpheme) of declarative sentence counterparts of target sentences. Results revealed improved sentence production abilities in all subjects under study in both constrained sentence production and, importantly, in discourse tasks. The argument/adjunct distinction was observed in the sentence production recovery patterns noted in six of the seven subjects. Three of the subjects evinced correct argument movement across trained and untrained question structures when wh-questions relying on argument movement were trained; similarly, for these subjects, training structures relying of adjunct movement resulted in improved adjunct movement. Three of the remaining four subjects who required additional treatment to alleviate their wh-morpheme selection deficits, too showed covariance between argument and adjunct movement structures with each type of movement emerging across structures in temporal sequence. We discuss these data in terms of the operations necessary to produce wh-questions, the importance of considering linguistic and psycholinguistic data when designing treatment programs for language disordered patients, and the contribution that detailed recovery data can make both to understanding the nature of sentence production deficits and to issues regarding normal sentence production.

Professional liability insurance in obstetrics-gynecology.

A geographically stratified sample of Fellows and Junior Fellows of The American College of Obstetricians and Gynecologists (ACOG) responded to a questionnaire, describing the source, coverage, and cost of their professional liability insurance, and the effects this had on patterns of practice. Most physicians carry primary professional liability coverage, although 6% do not. The majority pay less than $8000/year for a wide variety of dollar coverages. Less than half of the surveyed obstetrician-gynecologists carry excess/umbrella liability insurance, and a majority pay less than $2000/year for this coverage. The liability problem has not had a substantial effect on restricting the number of obstetrician-gynecologists, but it has had a major effect on patterns of practice.