Focus Article Research Articles

Innovation of hypervalent(iii) iodine in the synthesis of natural products

The focus article discusses the innovation of hypervalent(iii) iodine regarding skeletal rearrangement, cycloaddition and cyclization, and sp3 C–H functionalization in natural product synthesis.

Gestion des doses liées à l’imagerie de positionnement en radiothérapie

Image-guided radiotherapy (IGRT) has become a standard irradiation technique to improve the clinical outcome of patients in terms of toxicity and local control due to better targeting of radiation during the irradiation fraction. Positioning imaging systems, whether embedded or not, such as kV for 2×2D acquisitions and especially kVCBCT for 3D acquisitions are however irradiating in a large volume including the target volume but also healthy tissue, with a theoretical risk of increased toxicity and second cancer. It therefore appears very important both to optimize the absorbed dose due to IGRT practice but also to report it, especially in case of kVCBCT. The AAPM report published in 2018 (« Image guidance doses delivered during radiotherapy: Quantification, management, and reduction ») proposes a management of image guidance doses delivered during radiotherapy. This report is the basis of this focus article that aims at giving orders of magnitude and proposing a management of image guidance doses delivered during radiotherapy in clinical practice. The dose delivered per kVCBCT is about 0.5 to 2 cGy at isocenter according to treatment site. As long as the calculation algorithms are not available in the treatment planning systems, it seems appropriate to use at least the published dose orders of magnitude. This estimate should ultimately allow the clinician to decide on the therapeutic strategy in the event of accumulation of positioning imaging sessions.

Holistic Admissions: From Paper File to Live Interview

Purpose The holistic approach to admissions includes an evaluation of traditional measures (e.g., cumulative grade-point average), attributes unique to the applicant (e.g., leadership), and variables important to the field (e.g., interpersonal skills). Outlined in this clinical focus article is an innovative approach to holistic admissions that includes evaluation of a video-recorded response to a case-based prompt and a live interview that includes application of knowledge, demonstration of critical thinking skills, and assessment of personal attributes. Conclusions This comprehensive process includes evaluation of an applicant's knowledge, skills, and professional dispositions. Planning, implementation, outcomes, evaluation, and challenges of this approach are discussed.

The Quadrad of Performance: A Leadership Tool for Professional Growth

PurposeClinical care in all aspects of audiology and speech-language pathology requires a significant and diverse skill set in order to screen, assess, diagnose, treat, and monitor performance of their patients. Communication skills are paramount in all directions of their relationship with patients and coworkers. Additionally, clinicians rarely work in isolation and are most often in a group environment and setting with other peer professionals, as well as affiliated professionals with differing yet complementary multifaceted skills associated with neighboring professions.ConclusionsThe aggregate of skills spans an enormous set. Expectations are high, and much is expected as a clinician and a colleague! While clinical skill and performance are certainly what most hiring managers look for, this clinical focus article will discuss the critical importance of aspects of relationship courtesy and trust. Indeed, these characteristics will be presented as even more critical than clinical skills alone. Four sets of skills will be presented, which the author claims mandatory for all clinical providers. They includeknowledge and competence,efficiency and productivity,relationships with patients, andrelationships with peers.

Improving Conceptual Print Knowledge: A Description of Intervention Considerations for Children With Hearing Loss

PurposeThe purpose of this clinical focus article was to describe specific considerations for print-referencing interventions for children with hearing loss and present a case study.MethodOne preschool child with hearing loss who used amplification participated in this case study. The child participated individually in print-referencing book-reading intervention (10-min session once a week for 7 weeks), supplemented by parent carryover at home. Each session involved a dose of 20 print-referencing behaviors across two children's books, for a cumulative intervention intensity of 140 print references. Assessment of the child's print knowledge skills occurred at the beginning of each session.ResultsPrint-referencing book-reading intervention was associated with gains in conceptual print knowledge.ConclusionsPrint referencing, when implemented with specific considerations for children with hearing loss in mind, may be an effective emergent literacy intervention for increasing conceptual print knowledge in preschool children with hearing loss. More research is needed in this area to determine appropriate dose and dose frequency, as well as effect of interventionist on gains.Supplemental Materialshttps://doi.org/10.23641/asha.13093025

The Impact of COVID-19 on Speech-Language Pathology Practices in Western Kenya

This clinical focus article describes speech-language pathology practices of one nongovernment organization in Western Kenya and the professional shifts brought about by COVID-19 in East Africa. This first-person account presents a local overview of the situation, including practical challenges, which are ongoing.

Linking Peer-Mediated Interventions to Address Conversational Difficulties in Adolescents With Autism

PurposeAdolescents with autism spectrum disorder (ASD) commonly experience an array of pragmatic language difficulties that can interfere with their ability to engage in reciprocal or balanced conversations with their peers. Difficulties with the use of language during peer encounters can contribute to these students' social isolation even when in inclusive settings. Increasingly, researchers have identified effective approaches for teaching conversational skills to individuals with ASD, but there are few demonstrations of effective interventions in high school settings. Peer-mediated intervention (PMI) is one approach that can embody research-based recommendations for teaching conversational skills (e.g., direct instruction, teaching in natural settings, use of peer partners). This clinical focus article describes effective PMI strategies for improving the social conversations of high school students with ASD based on our (the authors') emerging research.ConclusionsUsingFey's (1986)classification scheme, the article begins with an illustration of different conversational profiles of adolescents with ASD and associated goals for intervention. Next, key components of our PMI approach are described, followed by detailed illustrations of three research-based intervention strategies that speech-language pathologists can use to address different conversational goals. Emphasis is placed on strategies for teaching students with ASD target skills and training peers to support conversation. Outcomes and clinical reflections of our intervention research are described. Finally, the article ends with a discussion of additional considerations for speech-language pathologists regarding implementation and generalization.Supplemental Materialhttps://doi.org/10.23641/asha.13308470

Down Syndrome and Autism Spectrum Disorder Dual Diagnosis: Important Considerations for Speech-Language Pathologists.

Purpose Individuals with Down syndrome (DS) often receive speech-language therapy services starting in infancy or toddlerhood. When providing speech-language therapy services for children with DS, speech-language pathologists (SLPs) need to consider the impact of other developmental and comorbid disorders that can affect language development, such as the presence of a dual diagnosis of DS and autism spectrum disorder (DS + ASD). The prevalence rate of ASD in DS is ~20%, which is higher than in the general population. Method This clinical focus article aims to provide SLPs with additional knowledge about DS + ASD to improve service delivery and support parents' ability to advocate for their child with confirmed or suspected DS + ASD. This is accomplished by summarizing the current evidence base on the presence of ASD in DS and discussing implications of a DS + ASD diagnosis for clinical practice with SLPs. Conclusions SLPs play a key role in supporting families of those with DS + ASD by advocating and educating. By understanding the unique profiles of strengths and weaknesses of individuals with DS + ASD, SLPs can provide appropriate service delivery (i.e., treatment and intervention approaches) and advocacy for their clients and their families.

Cover Image, Volume 11, Issue 1

The cover image is based on the Focus Article Advances in the prediction of mouse liver microsomal studies: From machine learning to deep learning by Alex Renn et al., https://doi.org/10.1002/wcms.1479. image

Psychosocial Adversity in Early Childhood and Language and Literacy Skills in Adolescence: The Role of Speech-Language Pathology in Prevention, Policy, and Practice

PurposeThis clinical focus article outlines key forms of childhood maltreatment (various types of abuse and neglect) and their co-occurrence with other developmental risk factors, such as parental poverty, living in crime-prone communities, and disrupted educational experiences, to focus on their implications for language and literacy skills in adolescence. Children exposed to psychosocial adversity early in life experience a range of poor outcomes in adolescence, relative to their typically developing peers, and language and literacy skills are particularly vulnerable skill sets in the face of this adversity.ConclusionsThe continuum from disrupted schooling to child protection and youth justice involvement is emphasized, and the expanding scope of practice for speech-language pathology at all stages of prevention, assessment, and intervention is outlined. Greater advocacy by speech-language pathologists is needed so that policy makers and practitioners in other service sectors have a better appreciation of the importance of language and literacy skills in early life.

Cognition and Cognitive Screeners in Audiological Management

Purpose Cognition is essential to communication, yet this topic is often neglected in discussions with aging patients in most clinical settings. Audiologists, however, represent a crucial role in assisting primary care physicians in the prevention of overlooking early signs of dementia. Audiologists can be viewed as the gatekeepers to an older adult's cognitive care due to more face-to-face time with patients and conversations that focus around communication. Therefore, it is important for audiologists to be familiar with the essential elements of cognition as well as how to screen for cognitive impairment. There are a number of cognitive screeners available for clinical use in audiology settings, with each screener having its own benefits and drawbacks. This clinical focus article discusses both of these concepts with the intent of increasing the appreciation of the complexity of cognition and its role in audiological management. Conclusions Cognitive screeners provide useful insight into understanding issues that our aging patients are experiencing. While there are benefits and downfalls to all cognitive screeners, each audiology practice has to determine which screening best fits their practice. By discussing cognition and utilizing cognitive screeners in practice, audiologists may be better able to meet their patient's needs and improve patient outcomes in relation to communication and overall health.

Muscle Tension Dysphagia Evaluation and Treatment

Purpose This clinical focus article introduces primary and secondary muscle tension dysphagia (MTDg) as a functional idiopathic dysphagia that is often encountered in the otolaryngology clinic setting. Critical aspects of clinical assessment and treatment approaches will be discussed. The presented case study will describe a multidisciplinary evaluation and efficacy of therapy. Conclusions MTDg is a diagnosis of exclusion for a functional idiopathic swallowing disorder associated with abnormal laryngeal muscle tension. Abnormal laryngeal muscle tension is often associated with disorders of laryngeal hyperresponsiveness such as muscle tension dysphonia, chronic cough, globus pharyngeus, and paradoxical vocal fold motion. MTDg patients may exhibit concurrent disorders of laryngeal hyperresponsiveness. Proper dysphagia and gastroesophageal screening are critical in diagnosis of MTDg and must not be omitted. Our studies have shown high treatment efficacy with unloading of laryngeal muscle tension with the use of voice therapy technique utilized in treatment of muscle tension dysphonia.

Target Selection Considerations for Speech Sound Disorder Intervention in Schools

Purpose Clinicians working with children who have speech sound disorders that involve multiple errors often prioritize particular errored sounds for intervention. However, this prioritization is not always an easy or clearly defined clinical decision, as there are many target selection considerations to weigh, some of which directly oppose one another. Conversely, sometimes there are multiple justified reasons to target a particular process or sound over others produced in error. Having a well-advised rationale regarding what sounds/sound classes to prioritize in treatment is a critical tenet of high-quality clinical service provision. Therefore, speech-language pathologists need to be mindful of differing rationales for prioritizing therapy targets and note that the same prioritization may not be appropriate for all children receiving therapy. Conclusions This clinical focus article provides an overview of a wide variety of pediatric target selection considerations (e.g., stimulability, complexity, frequency of occurrence, and interference with intelligibility) and offers clinicians theoretical and research-based rationales for each. Limitations and/or controversies that hamper practical clinical application of each target selection consideration are noted and described. Aspects in need of further research are highlighted. Additionally, through presentation of hypothetical case studies, the authors illustrate an individualized approach to target selection appropriate for a pediatric caseload.

A Community-Based Program for Exercise and Social Participation for Individuals With Parkinson's Disease: A Multidisciplinary Model

Purpose Parkinson's disease (PD) is a multifaceted condition characterized by motor and nonmotor symptoms that greatly reduce individuals' quality of life. Although treatment models in speech therapy have traditionally focused on a monodisciplinary approach, benefits from allied health care have been reported for over a decade. The purpose of this clinical focus article is to describe the multidisciplinary program developed at Long Island University Brooklyn to address the needs of individuals with PD in an inclusive and diverse setting. Conclusions This clinical focus article reviews the importance of multidisciplinary care models in the management of PD and highlights the efforts of our program in building a community-wide range of services to enhance exercise, social participation, and, above all, quality of life in our patients. Future directions of the program are also discussed.

We Are in a Book: Using Metafictive Picture Books to Facilitate Emergent Literacy Goals

PurposeLiterature-based intervention is used to facilitate both early language and emergent literacy goals, which supports success in later reading and writing. Best practices in choosing picture books to facilitate specific goals are limited, but one line of research asserts that different genres align with different goals. However, metafiction is one genre that is yet to be explored as a context for facilitating emergent literacy goals. Metafiction uses a variety of devices to draw attention to itself as an artifact providing unique learning opportunities. The purposes of this clinical focus article are to (a) introduce the different devices authors use in metafictive writing, (b) correlate individual devices with specific foundational literacy goals targeted in therapy (i.e., oral language, phonological awareness, print awareness, and alphabet knowledge), and (c) provide a sample session. A variety of metafictive picture books will be offered to illustrate these connections.ConclusionMetafictive picture books provide a rich context for facilitating emergent literacy goals because of the specific devices authors use in these texts.

Overview of Current Approaches to Aural Rehabilitation for Adults With Cochlear Implants

Purpose This clinical focus article provides an overview of clinical models currently being used for the provision of comprehensive aural rehabilitation (AR) for adults with cochlear implants (CIs) in the Unites States. Method Clinical AR models utilized by hearing health care providers from nine clinics across the United States were discussed with regard to interprofessional AR practice patterns in the adult CI population. The clinical models were presented in the context of existing knowledge and gaps in the literature. Future directions were proposed for optimizing the provision of AR for the adult CI patient population. Findings/Conclusions There is a general agreement that AR is an integral part of hearing health care for adults with CIs. While the provision of AR is feasible in different clinical practice settings, service delivery models are variable across hearing health care professionals and settings. AR may include interprofessional collaboration among surgeons, audiologists, and speech-language pathologists with varying roles based on the characteristics of a particular setting. Despite various existing barriers, the clinical practice patterns identified here provide a starting point toward a more standard approach to comprehensive AR for adults with CIs.

Dysphagia Management in Military Service Members With Polytrauma: Overview and Case Report

Purpose At Walter Reed National Military Medical Center, service members (SMs) with polytraumatic injuries, usually resulting from blast explosions, are routinely referred to the Speech Pathology Clinic for evaluation of swallowing function. The purpose of this clinical focus article is to advance the speech-language pathologist's (SLP) knowledge of polytrauma and to improve the care of individuals with traumatic injuries, especially related to nutrition and swallowing within a larger multidisciplinary team approach. Case Report Previous research within our center identified common demographic and injury characteristics of SMs with combat-related injuries that led to referrals for swallowing evaluation. An SM with polytraumatic injuries was selected for this case report to illustrate the relevance of the research findings and also the importance of multidisciplinary team support to appropriately manage such complex cases. Evaluations and relevant treatments are described across a 3-month acute care hospitalization, including swallowing and nutritional recommendations at the time of each swallowing evaluation. Discussion Comparisons of polytrauma cases at Walter Reed National Military Medical Center with literature from civilian trauma centers revealed somewhat longer hospitalizations and the particular influence of maxillofacial trauma on dysphagia outcomes. The complex case reported in this article illustrates the importance of multidisciplinary care and coordination, with particular emphasis on the intersecting roles of the SLP and registered dietitian. This report can serve as a guide for SLPs working in trauma settings for developing prognostic statements, treatment plans, and multidisciplinary interaction.

Promoting Reading Achievement in Children With Developmental Language Disorders: What Can We Learn From Research on Specific Language Impairment and Dyslexia?

PurposeSpecific language impairment (SLI; see also developmental language disorder) and dyslexia are separate, yet frequently co-occurring disorders that confer risks to reading comprehension and academic achievement. Until recently, most studies of one disorder had little consideration of the other, and each disorder was addressed by different practitioners. However, understanding how the two disorders relate to each other is important for advancing theories about each disorder and improving reading comprehension and academic achievement. The purpose of this clinical focus article is to integrate research on SLI and dyslexia as well as advocate for the consideration of comorbidities in future research and clinical practice.MethodThe first section reviews definitions as well as inclusionary and exclusionary criteria for SLI and dyslexia. The second section reviews research demonstrating that SLI and dyslexia are different disorders that often co-occur. Studies examining language, working memory, and academic achievement in children with separate versus co-occurring SLI and dyslexia are reviewed. The final section compares and contrasts school identification frameworks for children with SLI and dyslexia and considers the potential benefits of incorporating broad language skills into response to intervention (RTI) assessment frameworks.ConclusionsChildren with weak language skills are at a high risk of experiencing reading problems, but language difficulties are often hidden from view. Directly addressing language skills within school RTI frameworks can help improve the identification and treatment of children with SLI and dyslexia as well as support improved reading comprehension and academic achievement for all students.Presentation Video https://doi.org/10.23641/asha.13063793

Cross-Cultural Adaptation of Hearing Loss Self-Management Patient Education Materials: Development of the Caja de Instrumentos de Pérdida Auditiva.

Purpose The lack of culturally and linguistically appropriate interventions contributes to unsatisfactory hearing health care service delivery and outcomes for Spanish-speaking persons from Hispanic/Latino background. To address this issue, our objective was to cross-culturally adapt a "Hearing Loss Toolkit for Self-Management" for use with Spanish-speaking adults seen in a clinical setting. In this clinical focus article, we describe a process for translation and cross-cultural adaptation of patient education materials based on current best practices guidelines. Method We utilized guidelines from the International Society for Pharmoeconomics Outcomes Research Task Force for Translation and Cultural Adaptation, the World Health Organization, and the International Collegium of Rehabilitative Audiology to complete a comprehensive, systematic, cross-cultural adaptation process of the source materials. The adaptation stages included forward translation and reconciliation, back translation and review, field testing with representative end users from the target population, and finalization. Results We successfully cross-culturally adapted the source materials following best practice guidelines. The Spanish-language adaptation was deemed understandable, actionable, aesthetically pleasing, and culturally appropriate by a group of native Spanish speakers. Conclusions There is an unmet need for the development of hearing loss self-management materials that incorporate cultural and linguistic competence with best health literacy practices. High-quality cross-cultural adaptations that consider the intersection of culture, language, and health literacy are a positive step toward reducing barriers to hearing health care related to language access for U.S. Hispanic/Latino adults with hearing loss.

Advancing racial equity in oral health (research): more of the same is not enough.

By critically appraising the literature on the oral health effects of race-based oppression, this focus article makes four recommendations that may both facilitate more nuanced research on the topic and mitigate racial/ethnic inequities in (oral) health. The first is recognizing that science itself may perpetuate racial/ethnic injustice, such that adopting a 'neutral' position must be replaced with actively fostering anti-racist narratives. The second is to not imply that racial oppression is bad because it harms oral health. Rather, studies should help build a fairer world, wherein oral health inequities would not abound. The third recommendation is encouraging initiatives that understand systems of oppression as conjointly operating to shape oral health. The fourth and final recommendation is taking race-based oppression as a multi-level system that operates on three inter-related conceptual levels - intra-personal, inter-personal, and structural. The extent to which scholars, practitioners, and policymakers are willing to follow these recommendations may determine how successful attempts to eradicate (oral) health inequities might be. Learning from, and avoiding mistakes made in, previous publications is one ethical pathway towards this end.