Maximizing the clinical usefulness of a nomogram to select patients candidate to sentinel node biopsy for cutaneous melanoma.

AIMS: Investigators from the Memorial Sloan Kettering Cancer Centre (MSKCC) have proposed a nomogram for predicting the sentinel node (SN) status in patients with cutaneous melanoma. The negative predictive value (NPV) of this test, which might help identify low-risk patients who might be safely spared SN biopsy (SNB), has not been yet investigated. METHODS: We tested the discrimination (area under the curve [AUC]), the calibration (linear regression) and the NPV of MSKCC nomogram in 543 patients treated at our institution. Different cut-off values were tested to assess the NPV, the reduction of SNB performed and the overall error rate obtained with the MSKCC nomogram. RESULTS: SN was positive in 147 patients (27%). Mean predicted probability was 17.8% (95%CI: 16.8-18.8%). Nomogram discrimination was significant (area under the curve = 0.68; P < 0.0001) and mean predicted probabilities of SN positivity well correlated with the observed risk (R(2) = 0.99). Cut-off values between 4% and 9% led to a NPV, SNB reduction and overall error rates ranging between 100 and 91.2%, 2.2 and 27.2%, and 0 and 2.3%, respectively. CONCLUSION: In our series, the nomogram showed a significant predictive accuracy, although the incidence of SN metastasis was higher than that observed in the MSKCC series (27% vs 16%). Using the nomogram, a NPV greater than 90% could be obtained, which would be associated with a clinically meaningful reduction of the SNB rate and an acceptable error rate. If validated in large prospective series, this tool might be implemented in the clinical setting for SNB patient selection.

Prosodic aspects of motherese: effects on gaze and responsiveness in developmentally disabled children.

This study was conducted to examine the effectiveness of using voice tones (prosody) typical of "motherese" (O. K. Garnica, 1977, in C. E. Snow & C. A. Ferguson (Eds.), Talking to Children: Language Input and Acquisition, pp. 63-88, Cambridge: Cambridge Univ. Press) on responsiveness and eye gaze in children with severe handicaps. Specifically, two conditions, "motherese" and "conversational" voice tones, were compared. The current study presents data from naturalistic observations of six children, and controlled experimental manipulations with four children. The results of the naturalistic observations in Study 1 suggested a positive relationship between the use of voice tones typical of "motherese" and responsiveness and eye gaze. Further analysis using an alternating treatments design in Study 2 revealed similar results. Specifically, the use of prosody associated with "motherese" showed increased levels of eye gaze when compared to the use of "conversational tones." The results suggest the importance of considering normal development in analyzing social and teaching interactions between teachers and severely handicapped children.

Developmental influences in teaching language forms to individuals with developmental disabilities.

The purpose of this experiment was to test the assumption that the sequencing of language goals for individuals with developmental disabilities should be based on the normal developmental sequence. In a series of two studies, phonetic sounds and syntactic structures representing different levels of normal development were taught to individuals with developmental disabilities. The results showed that (a) the majority of earlier emerging forms were acquired in fewer trials, (b) there was never an instance when the later emerging form was acquired and the earlier emerging form was not, and (c) the majority of earlier emerging forms were correctly produced at higher levels than the later emerging forms during probe sessions conducted 6 months after training. The results are discussed in terms of their implications for the development of language curricula for individuals with developmental disabilities.