Editorial Putting communication disorders in context after traumatic brain injury

In this editorial, the importance of context in communication after traumatic brain injury (TBI) is discussed. Context is defined in a number of ways including the socio-cultural background of the individual, the specific social context of any given communicative setting and the cognitive context of the individual including their prior knowledge and coexisting cognitive deficits. Each of these is covered elsewhere in this special issue of Aphasiology and mentioned perfunctorily here. In addition, however, it is argued that social perception, the ability to read social contextual cues, while critical to language competence is an area that has received relatively little attention in the research literature. However there is evidence that TBI individuals have problems understanding paralinguistic information (e.g. tone of voice), non-verbal cues (e.g. facial expression) and contextual information (e.g. relationship between speakers). The potential role of cognitive disturbances in producing such deficits is briefly considered.     

Integrating Email Communication with Counseling at School

Children are immersed in technology, from television to the Internet, and increasingly, education curricula have embraced the powerful potential of integrating technology to facilitate student learning and success. However, to date, researchers and practitioners have not fully considered the potential for technology to help counselors access and enhance their empirically supported counseling services in schools. This article aims to fill this gap by initiating a discussion about the key considerations, merits, and limitations of using email with counseling services in schools. Beginning with a brief literature review, recent research describing the scope and potential benefits of telemental health is discussed. Specific legal and ethical considerations are outlined, as well as recommendations for counselors to consider when implementing this tool in counseling. This article also presents a case study to illustrate the key considerations in using email when counseling a student. Finally, future directions related to use of technology with counseling at school are explored.     

The relationship between incidence of fractures and anemia in older multiethnic women

OBJECTIVES: To prospectively examine the relationship between anemia and incident fractures of the hip, spine, and all skeletal sites in women from diverse racial and ethnic backgrounds enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials. DESIGN: Prospective cohort study. SETTING: Forty WHI clinical centers across the United States. PARTICIPANTS: Postmenopausal women (n=160,080), mean age 63.2 ± 7.2, were recruited and followed for an average of 7.8 years. MEASUREMENTS: Anemia was defined as hemoglobin levels at baseline less than 12 g/dL. All fractures were self‐reported. Trained physicians further confirmed hip fractures using medical records. RESULTS: Eight thousand seven hundred thirty‐nine of the participants (5.5%) were anemic. The age‐adjusted incidence rate of hip fractures per 10,000 person‐years was 21.4 in women with anemia and 15.0 in women without anemia; higher incidence rates for spine and all fractures were also observed in anemic women. After multiple covariates were included in the Cox proportional hazards models, significantly greater fracture risk associated with anemia still existed, as demonstrated by hazard ratios of fractures associated with anemia of 1.38 (95% confidence interval (CI)=1.13–1.68) for hip, 1.30 (95% CI=1.09–1.55) for spine, and 1.07 (95% CI=1.01–1.14) for all types. No significant racial or ethnic difference was found in these relationships. CONCLUSION: A significantly greater fracture risk was observed in multiethnic postmenopausal women with anemia. Given the high prevalence of anemia in the elderly population, it is important to better understand the relationship and mechanisms linking anemia to fracture risk.     

Dosimetric analysis and comparison of three-dimensional conformal radiotherapy and intensity-modulated radiation therapy for patients with hepatocellular carcinoma and radiation-induced liver disease

PURPOSE: This study compares the difference in dose-volume data between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for patients with hepatocellular carcinoma (HCC) and previously documented radiation-induced liver disease (RILD) after 3D-CRT. MATERIALS AND METHODS: Between November 1993 and December 1999, 68 patients with HCC were treated with 3D-CRT at our institution. Twelve of them were diagnosed with RILD within 4 months of completion of 3D-CRT. RILD was defined as either anicteric elevation of alkaline phosphatase level of at least twofold and nonmalignant ascites, or elevated transaminases of at least fivefold the upper limit of normal or of pretreatment levels. Three-dimensional treatment planning using dose-volume histograms of normal liver was used to obtain the dose-volume data. These 12 patients with RILD were replanned with an IMRT planning system using the five-field (gantry angles 0 degrees, 72 degrees, 144 degrees, 216 degrees, and 288 degrees ) step-and-shoot technique to compare the dosimetric difference in targets and organs at risk between 3D-CRT and IMRT. Mean dose and normal tissue complication probability with literature-cited volume effect parameter of 0.32, curve steepness parameter of 0.15, and TD(50)(1) of 40 Gy, were used for the liver, whereas volume fraction at a given dose level was used for other critical structures. Paired Student t-test with 2-tailed p < 0.05 was used to assess the statistical difference between the two techniques. RESULTS: With comparable target coverage between 3D-CRT and five-field step-and-shoot IMRT, IMRT was able to obtain a large dose reduction in the spinal cord (5.7% vs. 33.2%, p = 0.007), and achieved at least similar organ sparing for kidneys and stomach. IMRT had diverse dosimetric effect on liver, with significant reduction in normal tissue complication probability (23.7% vs. 36.6%, p = 0.009), but significant increase in mean dose (2924 cGy vs. 2504 cGy, p = 0.009), as compared with 3D-CRT. CONCLUSIONS: IMRT is capable of preserving acceptable target coverage and improving or at least maintaining the nonhepatic organ sparing for patients with HCC and previously diagnosed RILD after 3D-CRT. The true impact of this technique on the liver remains unsettled and may depend on the exact volume effect of this organ.     

Female mice chimeric for expression of the simian virus 40 TAg under control of the MISIIR promoter develop epithelial ovarian cancer

In women, >80% of malignant ovarian tumors are of epithelial origin. Early detection of these tumors is very challenging,and extensive i.p. dissemination is common by the time of diagnosis.The lack of adequate geneticmouse models of ovarian carcinomas significantly delays advances in early detection and treatment. We report that female transgenic mice expressing the transforming region of SV40 under control of the Mullerian inhibitory substance type II receptor gene promoter develop bilateral ovarian tumors in approximately 50% of cases. Histologically, these tumors are poorly differentiated carcinomas with occasional cysts and papillary structures present at the surface of the ovary. These tumors disseminate i.p., invade omentum, and form ascites as do human ovarian carcinomas. The epithelial origin of these tumors is supported by detection of cytokeratins 8 and 19, and the absence of alpha-inhibin, a protein characteristically expressed in normal granulosa cells and most granulosa cell tumors. Cell lines derived from the ascites exhibit the properties of epithelial ovarian cancer, such as anchorage-independent growth, tumorigenicity in immunocompromised mice, expression of epithelial cell markers, and organotropic implantation. The availability of a transgenic mouse model of disseminated ovarian carcinoma and respective cell lines should advance our understanding of this neoplasm, and serve as a useful tool for the evaluation of emerging detection and treatment strategies.