Classroom observations were made on staff and stu dents with severe disabilities to record opportunities to express preferences and make choices. Included in the study were 48 staff members and 37 students located in public schools, institutions, and university demonstra tion sites. An observational code was used to record staff-and student-initiated expressions of preference and choice in structured and nonstructured classroom activ ities. Results indicated that, regardless of age level or setting, classroom staff responded at very low rates to student-initiated expressions of choice or preference and that staff-initiated opportunities for student expressions of choice or preference were significantly higher in the 0 to 5 age range. Additional findings indicated that staff and students used distinctly different response modali ties to communicate. Results are discussed in relation to the development of communication and social skills, with implications for current educational practices, per sonnel training, and further research.

Two cases of lobular breast carcinoma metastatic to an endometrial polyp are described. Both patients had been treated with tamoxifen and presented with abnormal uterine bleeding. Histology of endometrial biopsy in both cases showed typical tamoxifen-associated endometrial polyps with focal subtle stromal infiltration by metastatic lobular breast carcinoma. This was confirmed by positive immunohistochemical staining with cytokeratin epithelial markers. Metastatic breast carcinoma may rarely involve tamoxifen-associated endometrial polyps. Because primary endometrial carcinomas may also arise within tamoxifen polyps, these should be extensively sampled. We briefly review polypoid uterine lesions that may occur secondary to tamoxifen therapy.

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