Efficacy of COVID-19 Public Health Measures in Philadelphia, New York City, Baltimore, and Chicago.

Introduction: From the early days of the pandemic, US cities have implemented a variety of public health measures to reduce the spread of COVID-19. This study investigates which policies were most effective in reducing cases of COVID-19 in four major cities: Philadelphia, New York City, Baltimore, and Chicago. Methods: Through a cross-comparative analysis, we developed a timeline that tracked the implementation of a range of public health measures along with changes in COVID-19 cases, hospitalizations, and deaths. Data were collected from publicly available government sites and from press releases. Results: The results from the stay-at-home orders illustrate the delayed impact it has in reducing COVID-19 cases and hospitalizations. The mask mandate led to the immediate and sustained reduction in cases across all four cities. During the spike of COVID-19 in the Fall of 2020, restrictions on indoor dining contributed significantly to reducing COVID-19 cases. Discussion: Of all the measures that were examined, the implementation of mask mandates was most closely associated with a decline in COVID-19 cases, hospitalizations, and deaths across all four cities. Restrictions on indoor dining were also associated with a reduction in COVID-19 cases. Future studies should further investigate the adherence to different policies to better understand their impacts.

Shear wave elastography detects novel imaging biomarkers of aromatase inhibitor-induced joint pain: a pilot study.

AIM: To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor-associated arthralgias compared to age-comparable healthy control women. METHODS: Postmenopausal women with stage I-III breast cancer who were taking adjuvant aromatase inhibitors and complained of joint pain were enrolled (n = 6). Postmenopausal women with no history of breast cancer, hormone treatment, or joint pain served as controls (n = 7). All subjects had bilateral hands and wrists evaluated by gray-scale and power Doppler ultrasound, and shear wave elastography ultrasound. RESULTS: Patients with AI-associated arthralgias had significantly stiffer tendons than controls in the 1st extensor compartment (long axis; p = 0.001), 4th extensor compartment (long axis; p = 0.014), 3rd metacarpophalangeal joint (p = 0.002), the pooled values of the extensor compartments, both long (p = 0.044) and short axes (p = 0.035), and the pooled values for the metacarpophalangeal joints (p = 0.002). On ultrasound, the patients (but not controls) presented with hyperemia and increased tenosynovial fluid in the flexor and extensor tendon sheaths, and the median nerves were symptomatic and bifid; however, these differences were not statistically significant. CONCLUSIONS: This is the first study to identify increased tendon stiffness as a putative physiological characteristic of aromatase inhibitor-associated arthralgias. Future studies should determine whether increased tendon stiffness is a risk factor for the development of aromatase inhibitor-associated arthralgias, or a result of aromatase inhibitor treatment.

Vocabulary and Phonological Abilities Affect Dual Language Learners' Consonant Production Accuracy Within and Across Languages: A Large-Scale Study of 3- to 6-Year-Old Spanish-English Dual Language Learners.

Purpose This study examined factors of language ability that predict consonant production accuracy in young Spanish-English dual language learners (DLLs). Method Participants were 695 Latino DLLs, ages 3;0-6;5 (years;months). Single-word productions were elicited using the Bilingual Phonological Assessment (Miccio & Hammer, 2006). Children's consonant productions were assessed using Percentage of Consonants Correct-Revised (PCC-R; Shriberg et al., 1997a). Vocabulary abilities were assessed using the Woodcock-Muñoz Language Survey-Revised (Woodcock et al., 2005). Multiple linear regression analyses were used to determine the effects of vocabulary abilities and cross-language consonant production abilities on children's consonant production accuracy in each language. Results Large amounts of the variance in PCC-R scores for English (R 2 = .65) and Spanish (R 2 = .43) were predicted by children's age, vocabulary scores within the same language, and PCC-R scores across languages. Conclusion Spanish-English DLLs' consonant production abilities in both languages improve with age between 3;0 and 6;5. DLLs' accuracy in each language is also affected by vocabulary abilities within the same language and by their consonant production abilities in the other language. In particular, children's consonant production abilities in each language were highly predictive of their consonant production abilities in the other language, which suggests that shared phonological skills support their development across languages.

A Patient Reported Approach to Identify Medical Errors and Improve Patient Safety in the Emergency Department.

OBJECTIVE: Medical errors in the emergency department (ED) occur frequently. Yet, common adverse event detection methods, such as voluntary reporting, miss 90% of adverse events. Our objective was to demonstrate the use of patient-reported data in the ED to assess patient safety, including medical errors. METHODS: Analysis of patient-reported survey data collected over a 1-year period in a large, academic emergency department. All patients who provided a valid e-mail or cell phone number received a brief electronic survey within 24 hours of their ED encounter by e-mail or text message with Web link. Patients were asked about ED safety-related processes. RESULTS: From Aug 2012 to July 2013, we sent 52,693 surveys and received 7103 responses (e-mail response rate 25.8%), including 2836 free-text comments (44% of respondents). Approximately 242 (8.5%) of 2836 comments were classified as potential safety issues, including 12 adverse events, 40 near-misses, 23 errors with minimal risk of harm, and 167 general safety issues (eg, gaps in care transitions). Of the 40 near misses, 35 (75.0%) of 40 were preventable. Of the 52 adverse events or near misses, 5 (9.6%) were also identified via an existing patient occurrence reporting system. CONCLUSIONS: A patient-reported approach to assess ED-patient safety yields important, complementary, and potentially actionable safety information.

Effects of Home Language, Oral Language Skills, and Cross-Linguistic Phonological Abilities on Whole-Word Proximity in Spanish-English-Speaking Children.

Purpose This study examined language use and language ability factors that predict phonological whole-word proximity in young Spanish-English-speaking children. Method Participants were 199 Latino children aged 3;0-6;6 (years;months) and their mothers. Children's speech sound production in English and Spanish was assessed using the Bilingual Phonological Assessment ( Miccio & Hammer, 2006 ). Vocabulary and story retell abilities were assessed using the Woodcock-Muñoz Language Survey-Revised ( Woodcock, Muñoz-Sandoval, Ruef, & Alvarado, 2005 ), and information regarding the children's exposure to and use of English and Spanish was collected by means of a parent survey. Hierarchical regression analyses were used to determine the degree to which exposure to and use of each language in the home, oral language abilities, and phonological proficiency as measured by the proportion of whole-word proximity (PWP; Ingram, 2002 ) in the other language were able to predict the PWP scores in English and Spanish. Results A large portion of the variance in English and Spanish PWP scores ( R 2 = .66 and .51, respectively) was predicted by the language children use when communicating with their mothers, children's vocabulary scores, and children's PWP scores in the other language. Conclusion Language use, vocabulary, and phonological whole-word proximity in the other language are significant factors in predicting bilingual children's whole-word proximity in English and Spanish. Children's phonological abilities in one language are highly predictive of those same abilities in the other, suggesting underlying shared phonological skills across languages.

Interlocutor differential effects on the expressive language skills of Spanish-speaking English learners.

PURPOSE: The primary objective of this study was to investigate the relationship between language use with different interlocutors, maternal education level and the expressive language skills of US English learners (ELs) in Spanish and English. METHOD: Two hundred and twenty-four Spanish-speaking ELs in kindergarten provided narrative language samples in Spanish and English. Parents completed a questionnaire of maternal education level and language use with parents, older siblings and peers. RESULT: Multiple linear regression analyses demonstrated that language used with different interlocutors and maternal education level had unique effects on participants' expressive language skills. ELs' expressive language skills in English were predicted by interactions with older siblings, peers and maternal education level; Spanish expressive language skills were predicted by interactions with older siblings. CONCLUSION: The findings from this study suggest that the determination of language experience of school-age bilingual children should examine differential language use with multiple interlocutors, particularly interactions with older siblings and peers.

Analysis of Bilingual Children's Performance on the English and Spanish Versions of the Woodcock-Muñoz Language Survey-R (WMLS-R).

The purpose of this study was to investigate the way in which items on the Woodcock-Muñoz Language Survey Revised (WMLS-R) Spanish and English versions function for bilingual children from different ethnic subgroups who speak different dialects of Spanish. Using data from a sample of 324 bilingual Hispanic families and their children living on the United States mainland, differential item functioning (DIF) was conducted to determine if test items in English and Spanish functioned differently for Mexican, Cuban, and Puerto Rican bilingual children. Data on child and parent language characteristics and children's scores on Picture Vocabulary and Story Recall subtests in English and Spanish were collected. DIF was not detected for items on the Spanish subtests. Results revealed that some items on English subtests displayed statistically and practically significant DIF. The findings indicate that there are differences in the difficulty level of WMLS-R English-form test items depending on the examinees' ethnic subgroup membership. This outcome suggests that test developers need to be mindful of potential differences in performance based on ethnic subgroup and dialect when developing standardized language assessments that may be administered to bilingual students.

Cross-linguistic generalization in the treatment of two sequential Spanish-English bilingual children with speech sound disorders.

PURPOSE: The effect of bilingual service delivery on treatment of speech sound disorders (SSDs) in bilingual children is largely unknown. Bilingual children with SSDs are typically provided intervention in only one language, although research suggests dual-language instruction for language disorders is best practice for bilinguals. This study examined cross-linguistic generalization of bilingual intervention in treatment of two 5-year-old sequential bilingual boys with SSDs (one with Childhood Apraxia of Speech), hypothesizing that selecting and treating targets in both languages would result in significant overall change in their English and Spanish speech systems. METHOD: A multiple baseline across behaviours design was used to measure treatment effectiveness for two targets per child. Children received treatment 2-3 times per week for 8 weeks and in Spanish for at least 2 of every 3 days. Ongoing treatment performance was measured in probes in both languages; overall speech skills were compared pre- and post-treatment. RESULT: Both children's speech improved in both languages with similar magnitude; there was improvement in some non-treated errors. CONCLUSION: Treating both languages had an overall positive effect on these bilingual children's speech. Future bilingual intervention research should explore alternating treatments designs, efficiency of monolingual vs bilingual treatment, different language and bilingual backgrounds, and between-group comparisons.

Dialect Density in Bilingual Puerto Rican Spanish-English Speaking Children.

It is still largely unknown how the two phonological systems of bilingual children interact. In this exploratory study, we examine children's use of dialect features to determine how their speech sound systems interact. Six monolingual Puerto Rican Spanish-speaking children and 6 bilingual Puerto Rican Spanish-English speaking children, ages 5-7 years, were included in the current study. Children's single word productions were analyzed for (1) dialect density and (2) frequency of occurrence of dialect features (after Oetting & McDonald, 2002). Nonparametric statistical analyses were used to examine differences within and across language groups. Results indicated that monolinguals and bilinguals exhibited similar dialect density, but differed on the types of dialect features used. Findings are discussed within the theoretical framework of the Dual Systems Model (Paradis, 2001) of language acquisition in bilingual children.

Phonological skills in English language learners.

PURPOSE: The purpose of this study was to examine the English phonological skills of English language learners (ELLs) over 5 time points. METHOD: Sound class accuracy, whole-word accuracy, percentage of occurrence of phonological patterns, and sociolinguistic correlational analyses were investigated in 19 ELLs ranging in age from 5;0 (years;months) to 7;6. RESULTS: Accuracy across all samples was over 90% for all sound classes except fricatives and increased for all sound classes across time. Whole-word accuracy was high and increased across time. With the exception of cluster reduction, stopping, and final consonant deletion, the frequency of occurrence for phonological patterns was less than or equal to 5% at every time point. Sociolinguistic variables such as age of arrival, age of exposure, and age were significantly related to phonological skills. CONCLUSIONS: The results were consistent with the hypotheses outlined in Flege's (1995) speech learning model in that the phonological skills of ELLs increased over time and as a function of age of arrival and time. Thus, speech-language pathologists (SLPs) also should expect phonological skills in ELLs to increase over time, as is the case in monolingual children. SLPs can use the longitudinal and connected-speech results of this study to interpret their assessments of the phonological skills of ELLs.

Continuous Time Level Crossing Sampling ADC for Bio-Potential Recording Systems.

In this paper we present a fixed window level crossing sampling analog to digital convertor for bio-potential recording sensors. This is the first proposed and fully implemented fixed window level crossing ADC without local DACs and clocks. The circuit is designed to reduce data size, power, and silicon area in future wireless neurophysiological sensor systems. We built a testing system to measure bio-potential signals and used it to evaluate the performance of the circuit. The bio-potential amplifier offers a gain of 53 dB within a bandwidth of 200 Hz-20 kHz. The input-referred rms noise is 2.8 µV. In the asynchronous level crossing ADC, the minimum delta resolution is 4 mV. The input signal frequency of the ADC is up to 5 kHz. The system was fabricated using the AMI 0.5 µm CMOS process. The chip size is 1.5 mm by 1.5 mm. The power consumption of the 4-channel system from a 3.3 V supply is 118.8 µW in the static state and 501.6 µW with a 240 kS/s sampling rate. The conversion efficiency is 1.6 nJ/conversion.

Predicting Spanish-English bilingual children's language abilities.

PURPOSE: In this study, the authors investigated factors that affect bilingual children's vocabulary and story recall abilities in their 2 languages. METHOD: Participants included 191 Latino families and their children, who averaged 59 months of age. Data on parental characteristics and children's exposure to and usage of Spanish and English were collected. The authors assessed children's Spanish and English vocabulary and story recall abilities using subtests of the Woodcock-Muñoz Language Survey-Revised ( Woodcock, Muñoz-Sandoval, Ruef, & Alvarado, 2005). RESULTS: Sizeable percentages of variation in children's English (R2 = .61) and Spanish (R2 = .55) vocabulary scores were explained by children's exposure to, and usage of, each language and maternal characteristics. Similarly, variations in children's story recall scores in English (R2 = .38) and Spanish (R2 = .19) were also explained by the factors considered in this investigation. However, the authors found that different sets of factors in each category affected children's vocabulary and story recall abilities in each language. CONCLUSIONS: Children's exposure to and usage of their two languages as well as maternal characteristics play significant roles in bilingual individuals' language development. The results highlight the importance of gathering detailed sociolinguistic information about bilingual children when these children are involved in research and when they enter the educational system.

CMOS low current measurement system for biomedical applications.

We present a micro-chip implementation of a low current measurement system for biomedical applications using capacitive feedback that exhibits 190 fA of RMS noise in a 1 kHz bandwidth. The sampling rate is selectable up to 100 kHz. When measuring the amplifier noise with a 10 GΩ resistor and a 47 pF capacitor at the input, typical of cell membrane capacitance in DNA and patch clamp experiments, the measured RMS noise was 2.44 pA on a 50 pA signal in a 10 kHz bandwidth. Two channels were implemented on 630 × 440 µm² using a 0.5-µm 3-metal 2-poly CMOS process. Each channel consumes 1.5 mW of power from a 3.3 V supply. We measured the characteristics of an artificial lipid bilayer similar to the ones used in DNA sequencing experiments via nanopores.

Lung transplantation in children with idiopathic pulmonary arterial hypertension: an 18-year experience.

BACKGROUND: The natural history of idiopathic pulmonary arterial hypertension (IPAH) in patients of all ages is one of relentless progression. For those who fail medical therapy, lung transplantation remains the ultimate palliation. In the USA, IPAH is the second leading indication for lung transplantation in children and first for children 1 to 5 years of age. In this study, we report our 18-year experience with lung transplantation in children with IPAH. METHODS: We performed a retrospective chart review of children with IPAH listed for lung transplant at our center between 1991 and 2009. Our data reflect a total of 26 children ranging in age from 1.6 to 18.9 years. Nineteen were transplanted and 7 died while waiting (27%). The impact of a number of pre-transplant variables on survival was evaluated. RESULTS: Median survival for those transplanted was 5.8 years, with 1- and 5-year survival rates of 95% and 61%, respectively. Survival was independent of pre-transplant considerations such as age, weight, need for intravenous (IV) inotropes, use of IV pulmonary vasodilators, year of transplant and severity of right-sided cardiac pressures. There was 1 hospital death. Compared with the transplanted group, children who died waiting had a significantly higher incidence of supra-systemic right heart pressures (p = 0.02) and hemoptysis (p = 0.01). CONCLUSIONS: Our study is the largest to date to look at outcomes for lung transplantation in children with IPAH. Their median survival compares favorably with that of all pediatric lung transplant recipients, 5.8 years vs 4.5 years, respectively. We did not identify any pre-transplant variables that presaged a poorer outcome. Thus, survival seemed more related to factors that influence long-term outcomes in all transplant recipients such as rejection and infection. Lung transplantation remains a viable option for children with IPAH, especially for those with supra-systemic right heart pressures despite maximal medical therapy.

The effects of measures of language experience and language ability on segmental accuracy in bilingual children.

PURPOSE: The present study investigated the effects of selected measures of language experience (parent-reported estimates of frequency of output and language use) and language ability (parent-reported language proficiency and mean length of utterance in words) on the segmental accuracy of Spanish- and English-speaking bilingual children. METHOD: The phonological skills of 50 typically developing bilingual Spanish-English children (mean age = 5;9 [years;months]) were examined. Independent variables included parent estimates of language use, language proficiency, and frequency of language output (5 groups), as well as a direct language measure (mean length of utterance in words) to predict the dependent segmental accuracy measures (percentage of consonants and vowels correct). RESULTS: Frequency of language output did not have an effect on any of the English or Spanish segmental accuracy measures. However, parent-reported language use and language proficiency as well as the direct measure of language ability (mean length of utterance in words) had various effects on segmental accuracy. Those effects differed, however, in language-specific patterns. CONCLUSIONS: Parental estimates of language use and language proficiency are useful for predicting the phonological skills of bilingual Spanish- and English-speaking children, and augmenting them with a direct measure of language ability as a predictor of segmental accuracy is desirable.

Whole word measures in bilingual children with speech sound disorders.

Phonological acquisition traditionally has been measured using constructs that focus on segments rather than the whole words. Findings from recent research have suggested whole-word productions be evaluated using measures such as phonological mean length of utterance (pMLU) and the proportion of whole-word proximity (PWP). These measures have been investigated mainly in typically-developing children, but their use with children with speech sound disorders has been limited. This study compares PMLU, PWP, and consonant accuracy in Spanish-English bilinguals with speech sound disorders (SSD) to age-matched monolingual peers. This study relates directly to the type of research that Adele Miccio favoured. First, it is focusing on bilingual children. For the past 5 years, she has been the principal investigator of a grant developing a comprehensive phonological assessment tool for bilingual speakers. Second, during her career, Miccio advocated using multiple analyses to gauge the phonological skills of children, especially those with speech sound disorders. Her work in stimulability is evidence of that perspective. This study examines one 'raditional' measure (consonant accuracy) and two newer ones (pMLU and PWP), thereby broadening the analyses of phonological skills in bilingual children with SSD and thus carrying out multiple analyses, just as Miccio recommended throughout her illustrious career.

Phonological acquisition in bilingual Spanish-English speaking children.

PURPOSE: In this study, the authors aimed to determine how between-language interaction contributes to phonological acquisition in bilingual Spanish-English speaking children. METHOD: A total of 24 typically developing children, ages 3;0 (years;months) to 4;0, were included in this study: 8 bilingual Spanish-English speaking children, 8 monolingual Spanish speakers, and 8 monolingual English speakers. Single word and connected speech samples were obtained for each child. This study examined interaction between the two languages of bilingual children during phonological acquisition through the measurement of (a) transfer (the frequency and types of phonological transfer present in the speech of bilingual children); (b) deceleration (a slower rate of acquisition for bilinguals as compared with monolinguals); and (c) acceleration (a faster rate of acquisition for bilinguals as compared with monolinguals. RESULTS: Findings demonstrated that (a) transfer was evident in the productions of bilingual children, (b) differences were found in accuracy between monolingual and bilingual children, and (c) sound frequency did not predict differential accuracy of either phonetically similar sounds between languages or phonetically dissimilar sounds specific to Spanish or English. IMPLICATIONS: The results from this study indicate that transfer, deceleration, and a possible variation of the acceleration hypothesis occur in bilingual phonological acquisition. Evidence was found for separation and interaction between the bilingual children's 2 languages (J. Paradis & F. Genesee, 1996).

Early-, middle-, and late-developing sounds in monolingual and bilingual children: an exploratory investigation.

PURPOSE: To examine the accuracy of early-, middle-, and late-developing (EML) sounds in Spanish-English bilingual children and their monolingual peers. METHOD: Twenty-four typically developing children, age 3-4 years, were included in this study: 8 bilingual Spanish-English-speaking children, 8 monolingual Spanish speakers, and 8 monolingual English speakers. Single-word speech samples were obtained to examine (a) differences on the accuracy of EML sounds between Spanish-English bilingual children and monolingual Spanish and monolingual English children and (b) the developmental trend on the accuracy of EML sounds within languages for Spanish-English bilingual children and monolingual Spanish and monolingual English children. RESULTS: Findings support those of Shriberg (1993) for English-speaking children and suggest possible EML categories for monolingual Spanish-speaking children and bilingual Spanish-English-speaking children. CONCLUSIONS: These exploratory findings indicate the need for longitudinal examination of EML categories with a larger cohort of children to observe similarities and differences between monolingual and bilingual development.

Phonological whole-word measures in 3-year-old bilingual children and their age-matched monolingual peers.

The present study investigated phonological whole-word measures and consonant accuracy in bilingual and monolingual children to investigate how target approximations drive phonological acquisition. The study included eight bilingual Spanish- and English-speaking 3-year-olds and their monolingual peers (eight Spanish and eight American English). Phonological whole-word measures (pMLU and Proximity) and consonant accuracy (PCC) were calculated on elicited single words. Differences were found on each measure between bilinguals and monolinguals in English, but in Spanish, only the PCC displayed differences between bilinguals and monolinguals. Bilinguals displayed language separation on the pMLU and the PCC but not the Proximity, indicating structural phonological differences between the Spanish and English of bilinguals but commensurate target approximations. This suggests that maintaining a consistent level of phonological proximity to the target is an important factor in phonological acquisition. The measures and their relationships are also discussed.