Facilitating communication in children with multiple disabilities: three case studies of girls with Rett syndrome

Purpose: To investigate the effect of cueing on communicative responses of children with multiple disabilities in an educational setting. It was hypothesized that differences would exist in teacher interactional styles and the use of orienting cues would increase the communicative responses of the participants. Method: A naturalistic observation research method was employed in order to examine the interaction of three student - teacher dyads in three special schools. Three different activity types were videotaped from which interactions were coded and analysed. Results: Multi-modal cueing facilitated communicative responses of children with Rett syndrome. However, increased communication opportunities provided by caregivers did not elicit increased responses from the girls. Conclusion: There is a difference in cueing by teachers in their interactions with children with multiple disabilities. Also, more frequent communicative interactions did not necessarily lead to increased student responses. It is suggested that amount and type of cueing may need to be considered to be effective in generating student responses. The small number of participants, however, means findings should be viewed cautiously and that more research is indicated.     

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders

OBJECTIVE AND METHOD: To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232). RESULTS: Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment. CONCLUSION: The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.     

Clinical consequences of first-trimester growth discordance in twins

OBJECTIVES: To evaluate the clinical consequences of size discordance in the first-trimester of pregnancy in twins. STUDY DESIGN: This study was performed in a university tertiary referral centre. Nineteen pairs of twins identified as discordant were compared with 41 concordant twins. The rates of intrauterine growth restriction (IUGR), congenital malformations, and growth discordance in late pregnancy and at delivery were compared using chi-squared test and Fisher's exact test. RESULTS: There was not a significant difference in the rate of congenital malformations between the studied groups. The rates of IUGR and fetal growth discordance in late pregnancy were significantly higher in the first-trimester discordant group (57.2 and 35.7%, respectively) than in the control group (24.4 and 7.3%; P = 0.03 and 0.02, respectively). CONCLUSIONS: First-trimester growth discordant twins have an increased risk of IUGR and growth discordance in late pregnancy, and therefore they are a high-risk subgroup among multiple pregnancies.     

The right to remain in ignorance about genetic information--can such a right be defended in the name of autonomy?

Within the field of medicine, it has become widely accepted that respecting the autonomy of individuals justifies their right to know. More recently, commentators have asked whether such respect also justifies an individual's right not to know; that is, their right to remain in ignorance. In this paper, I examine what the concept of autonomy entails and whether one is justified in exercising a right not to know genetic information about oneself in the name of autonomy. An important distinction is drawn between autonomous choices generally and autonomous choices about how we shall conduct our lives. Against this theoretical discussion, I consider two hypothetical cases. I conclude by claiming that ignorance cannot be justified in the name of autonomy, and furthermore that where genetic information is pertinent to one's future autonomy, one cannot exercise a right not to know.     

Ronacaleret, a calcium-sensing receptor antagonist, has no significant effect on radial fracture healing time: results of a randomized, double-blinded, placebo-controlled Phase II clinical trial

Background

Fractures cause significant morbidity, mortality, and use of health care resources. An oral agent that enhances fracture healing could reduce costs and prevent future disabilities. In Phase I studies, ronacaleret, a novel calcium-sensing receptor antagonist, stimulated parathyroid hormone (PTH) release and increased bone formation markers, suggesting that it may act as an effective oral anabolic agent to enhance fracture healing.

Methods

This was a randomized, double-blind, placebo-controlled, parallel-group, clinical trial in 85 male and female subjects who had sustained a closed, unilateral, extra-articular fracture of the distal radius and were receiving conservative treatment. Subjects were randomly assigned in a double-blind manner to ronacaleret 200 mg twice daily, ronacaleret 400 mg once daily or matching placebo and followed for 12 weeks. Fracture healing was assessed by radiographs and quantitative computed tomography (CT), and bone turnover markers were measured. The study was terminated early for futility based on the results of an unplanned interim analysis.

Results

There were no significant differences between treatment groups in time to radiographic fracture healing (74, 65 and 68 days for placebo, 200 mg twice daily and 400 mg once daily dose groups, respectively), cortical bridging, grip strength, pain and swelling, time to cast removal, or range of motion. Markers of bone formation and levels of whole PTH, intact PTH and serum calcium increased following treatment with ronacaleret.

Conclusion

Ronacaleret had no significant effect on duration of healing by radiograph or CT scan, time to cast removal, clinical symptoms, grip strength, or range of motion.