Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine.

OBJECTIVE: To assess the intraexaminer and interexaminer reliability of clinicians trained in flexion-distraction technique to determine the need for chiropractic adjustment of each segment of the lumbar spine. DESIGN: This was an intraexaminer and interexaminer reliability study of commonly used chiropractic assessment procedures, including static and motion palpation and visual observation. SETTING: Chiropractic college; by four licensed chiropractors trained in flexion-distraction technique, two with more than 20 years' experience and two with 3 or fewer years' experience. SUBJECTS: Subjects were 18 volunteers; 16 were symptom free, and 2 had low back pain at the time the study was conducted. MAIN OUTCOME MEASURE: The kappa statistic was computed for all comparisons and interpreted in categories ranging from "poor" (<0.00) to "almost perfect" (>0.80). RESULTS: Intraexaminer reliability was greater than interexaminer reliability. For intraexaminer reliability there was considerable variation by segment and among the four examiners, but intraexaminer reliability appeared generally higher than interexaminer reliability. Overall, more subluxations were identified on the second examination than on the first. For interexaminer reliability, kappa scores were generally in the "poor" to "slight" categories. DISCUSSION: The results of this study, similar to those of other studies, indicate that even chiropractors trained in the same technique seem to show little consensus on the indications for the necessity to adjust specific segments of the spine. A more standardized assessment approach might be helpful in improving the reliability of diagnostic assessments.

Specific developmental disorders. The language-learning continuum.

The goal of this article is to inform and educate those who work with children who present with language-learning disorders about phonologic processing deficits, because this area has been shown to have a significant impact on children and adults who exhibit reading disabilities. Mental health professionals who work with children with reading problems need to be aware of what is known about this source of reading disorders and the implications of this knowledge for prevention and treatment. Advocating for appropriate instruction for children with reading problems is an important role mental health professionals can play in working with this population.

Quick Incidental Learning (QUIL) of words by school-age children with and without SLI.

This study examined Quick Incidental Learning (QUIL) of novel vocabulary by two groups of school-age children, those who were developing language normally and those who demonstrated a specific language impairment (SLI). The experimental items consisted of 20 words that referred to one of four semantic classes: object, attribute, action, and affective state. Videotaped stories were used to introduce the novel words, and word learning was measured by a picture-pointing task. For the normally developing children, the results documented a robust ability to learn words in the early school years. Comprehension gains were observed for all four word types, with the greatest gain made on the object labels. The children with SLI also demonstrated some word-learning ability, but their gain was significantly less than that of their normally developing peers. Although the general pattern of word effects was similar across the two groups, the children with SLI demonstrated a particularly low gain on words from the action class.

Allopurinol-induced granulomatous hepatitis with cholangitis and a sarcoid-like reaction.

A 36-year-old man had pain in both knees and an elevated uric acid concentration; his liver function was normal. Allopurinol therapy was started, 100 mg twice daily. After one month fever, lethargy, and severe polyarthralgia developed. On admission to our hospital liver function was abnormal, and a liver biopsy specimen showed granulomas with cholangitis and pericholangitis. He also had lymphopenia with a reduced number of T cells and granulomas in the bone marrow. One month after discontinuation of allopurinol therapy the patient was clinically well with normal liver function and a normal lymphocyte count. A repeated liver biopsy specimen showed normal liver tissue with no granulomas. The onset of the symptoms and findings shortly after the initiation of allopurinol therapy, and their disappearance after the discontinuation of therapy suggest a drug-induced hypersensitivity.