Possible demographic influences on differentiating normal from aphasic performance.

UNLABELLED: To determine the psychometric validity of current language impairment, communication activity limitation, and quality of life measures for differentiating normal from chronically aphasic adults, we examined possible threats to test accuracy by the demographic variables age, educational level, and gender. A total of 18 chronically aphasic and 18 nonaphasic adults were evaluated with six measures. The results of correlational analyses indicated that, within the normal adult and aphasic adult groups, there exist significant relationships between some, but not all, demographic variables and performance on language impairment, communication activity limitation, and quality of life measures. Moreover, for certain variables, the strengths of these relationships differ significantly between normal and aphasic groups. Thus, adjustments in test scores or norms may be necessary to diagnose the presence or absence of aphasia. Otherwise, the tests' ability to differentiate between normal and aphasic adults may be compromised. EDUCATIONAL OBJECTIVES: Readers will be able to: (1) explain the relationship between test accuracy and psychometric validity; (2) state the direction of significant relationships (i.e., positive or negative) among demographic variables and test performance, within normal and aphasic adult groups; (3) explain necessary considerations in the adjustment of general test norms or scores based on a particular subject's age, education, or gender.

Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures.

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinician's repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Inter- and intrajudge reliability of a clinical examination of swallowing in adults.

This study investigates inter- and intrajudge reliability of a clinical examination of swallowing in adults. Several investigations have sought correlations between clinical indicators of dysphagia and the actual presence of dysphagia as determined by videofluoroscopy. Whereas some investigations have reported interjudge reliability for the videofluoroscopic measures employed, none have reported reliability for clinical measures. Without established reliability for rating clinical measures, conclusions drawn regarding the utility of a measure for detecting aspiration can be called into question. Results of the present study indicate that fewer than 50% of the measures clinicians typically employ are rated with sufficient inter- and intrajudge reliability. Measures of vocal quality and oral motor function were rated more reliably than were history measures or measures taken during trial swallows. There is a need to define more clearly the measures employed in clinical examinations and to be consistent in reporting reliability for clinical measures of swallowing function in future research.

Programmed stimulation for simulation of atrial tachyarrythmias.

Swine have become the preeminent non-human animal model for testing of cardiac assistance devices. Such devices must be robust to perturbations in the EKG; therefore it is expeditious, as part of cardiac assistance device testing, to simulate arrhythmias such as atrial flutter and fibrillation in swine. Methods for producing atrial tachyarrythmias include surgical ablation or crushing of atrial tissue and the administration of drugs. These are dangerous, unreliable and usually irreversible; in varying combinations and degrees. When we applied rapid evenly spaced electrical atrial pacing in swine, the variability of ventricular response was less than expected from the corresponding arrhythmia in man. We will describe efforts to produce reversible atrial tachyarrythmias in swine, using programmed stimulation, with the desired degree of ventricular response variability.

Influenza A infections in young children. Primary natural infection and protective efficacy of live-vaccine-induced or naturally acquired immunity.

To assess the impact of an influenza A/Port Chalmers infection on normal young children, we monitored 147 children during an epidemic; 121 were seronegative. There was a high attack rate (61 of 147), and a high rate of symptomatic disease (38 of 147), which resulted in frequent physician visits (25 of 38). Influenza accounted for 76 per cent of the sick-child visits during the two-month epidemic period. Young children undergoing primary influenza infection produced hemagglutination inhibition and antineuraminidase antibodies. Because of the immunologic responsiveness of young children, we examined the serologic correlates of protection. Ten children previously infected with influenza A/London and 16 who received live, attenuated A/Hong Kong ts-1[E] vaccine were protected against infection with the non-homologous A/Port Chalmers strain. The morbidity of influenza and ability of the young child to produce protective antibody should encourage evaluation of life, attenuated influenza vaccines in this age group.