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Although many neurotypical children acquire untaught word-object relations incidentally from naturally occurring environmental experiences, many children with and without developmental disabilities require specific intervention. This study examined the effects of rotating listener (match and point) and speaker (tact and intraverbal-tact) responses with added echoics during multiple exemplar instruction (MEI) with training sets of stimuli on the acquisition of Incidental Bidirectional Naming (Inc-BiN). Listener-speaker MEI procedures reported in Hawkins et al. European Journal of Behavior Analysis, 10(2), 265-273, (2009) were replicated with procedural modification, new instructors, and new participants (four preschoolers with and without disabilities). The listener-speaker MEI with added echoics consisted of rotating across four response operants: match-with-echoics, point-with-echoics, tact, and intraverbal-tact responses. We measured the establishment of Inc-BiN through the number of the correct untaught listener (point) and untaught speaker (intraverbal-tact) responses for untaught stimuli during the listener-speaker MEI with added echoics. We found that listener-speaker MEI with added echoics was effective in establishing Inc-BiN for 3 of 4 participants.
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We conducted a systematic replication of Kodak et al.'s Journal of Applied Behavior Analysis, 53(1), 265-283 (2020) and Vladescu et al.'s Behavior Analysis in Practice, 14(1), 193-197 (2021) experiments on the effects of stimulus set sizes on skill acquisition. The researchers manipulated the stimulus set sizes by teaching 3, 6, and 12 sight words simultaneously during learn unit instruction. Researchers taught participants until the participant's responding reached the acquisition criterion for 12 different sight words per set size condition. The acquisition criterion was set for an individual operant, whereby when accuracy met criterion for a single sight word, that sight word was replaced in the following session. The results showed that the set-size-3 was more efficient in producing criterion-level responding during acquisition than the set-size-6, and -12, which was consistent with Vladescu et al.'s findings. However, the set-size-12 reliably produced the highest maintenance levels for all participants. The definition of "effectiveness" based on acquisition or maintenance was discussed.
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Incidental bidirectional naming (Inc-BiN) has been defined as a verbal developmental cusp whereby children demonstrate learning the names of things as listener and speaker as a function of observation alone. Stimulus characteristics have been found to affect performance in tests for Inc-BiN. To further explore this effect, Experiment 1 compared untaught listener and speaker responses for novel familiar-type versus novel nonfamiliar-type stimuli with 20 first-grade students following naming experiences in which the participants observed each visual stimulus five times while hearing its name. Participants performed significantly better with familiar-type than with nonfamiliar-type stimuli. Experiment 2 examined the effects of a repeated-probe intervention to induce Inc-BiN with nonfamiliar-type stimuli. Participants were six first-grade students who demonstrated incidental unidirectional naming (i.e., acquired names as listener from exposure alone). Implementation of the intervention was staggered across dyads of participants in a multiple-probe, simultaneous-treatments design. One participant in each dyad received the intervention with nonfamiliar-type stimuli only and the other with both nonfamiliar- and familiar-type stimuli. Pre- and postintervention Inc-BiN probes with stimuli not included in the intervention suggested both conditions were effective in establishing Inc-BiN for nonfamiliar-type stimuli. These findings have implications for understanding the mechanisms underlying Inc-BiN.
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Relational frame theory and verbal behavior development theory are two behavior-analytic perspectives on human language and cognition. Despite sharing reliance on Skinner's analysis of verbal behavior, relational frame theory and verbal behavior development theory have largely been developed independently, with initial applications in clinical psychology and education/development, respectively. The overarching goal of the current paper is to provide an overview of both theories and explore points of contact that have been highlighted by conceptual developments in both fields. Verbal behavior development theory research has identified how behavioral developmental cusps make it possible for children to learn language incidentally. Recent developments in relational frame theory have outlined the dynamic variables involved across the levels and dimensions of arbitrarily applicable relational responding, and we argue for the concept of mutually entailed orienting as an act of human cooperation that drives arbitrarily applicable relational responding. Together these theories address early language development and children's incidental learning of names. We present broad similarities between the two approaches in the types of functional analyses they generate and discuss areas for future research.
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Cognição , Aprendizagem , Criança , Humanos , Comportamento Verbal , Desenvolvimento da Linguagem , Formação de ConceitoRESUMO
The practice of horse rugging has important implications for horse welfare and performance, but in Australia, rugging practices have not been properly documented. The objective of this study was to obtain an understanding of Australian horse rugging practices. An online survey reviewed the management of 2659 Australian horses over 12 months. Of the reported horses a total of 84.8% were rugged, although most owners (69.5%) indicated that they were unsure whether horses needed to be rugged at all. Rugging was felt by 59.8% of owners to be a requirement for horses in competition. Riding and competition were significantly associated with the use of rugs. Nearly all respondents (89.0%) felt that 'over-rugging' was a concern. However, 4.8% of owners would use up to 4 rugs at any one time on their horse and 21.4% of horses were still rugged in temperatures above 20°C in Australia. Many Australian horse owners (42.8%) also believe that horses feel cold if they are not rugged. Anthropomorphism when it comes to rugging horses cannot be justified as the horse has a much wider thermoneutral zone (TNZ) than humans. Australian climate, owner opinions, equestrian discipline and whether a horse is used for riding influence Australian horse rugging practices. However, current practices are based on limited available research and are not necessarily to the benefit of the horse. The major limitation was that the survey likely attracted respondents who are interested in the topic creating a self-selection bias.
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Criação de Animais Domésticos , Doenças dos Cavalos , Humanos , Animais , Cavalos , Austrália , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Most cases of red-bellied black snake (RBBS) envenomation in dogs respond favourably to treatment comprising of tiger-brown snake antivenom (TBAV), intravenous fluid therapy, analgesia and, if indicated, mechanical ventilation and/or blood transfusion. However, there remains a subset of patients who develop fatal complications despite intensive treatment and risk factors for these occurring remain unknown. Here we present a retrospective cross-sectional survey of 91 canine and feline RBBS envenomation cases. METHODS: Cases seen between June 2010 and June 2020 were retrieved from the databases of seven practices in South East and coastal Queensland. From the canine case population, logistic regression analysis was performed to assess the impact of potential risk factors at presentation on the likelihood of death. A final multivariable model was developed using a manual backwards elimination approach based on overall likelihood ratio tests and Wald chi-square P-values for each variable. Where model convergence failed due to quasi-complete separation, Firth's penalised maximum likelihood method was implemented. Such separation may occur when an outcome is completely predicted by an explanatory variable in one group. RESULTS: Of the 88 canine cases, 7 died (8.0%), all after prognosis-based euthanasia. Of the three feline cases, one died after unsuccessful resuscitation following cardiopulmonary arrest. Compared to survivors, dogs that died were older, exhibited pigmenturia, received antivenom later and had a higher total plasma protein (TPP), activated clotting time (ACT) and lower packed cell volume (PCV) at presentation.
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Doenças do Gato , Doenças do Cão , Mordeduras de Serpentes , Animais , Antivenenos/uso terapêutico , Doenças do Gato/terapia , Gatos , Estudos Transversais , Doenças do Cão/terapia , Cães , Venenos Elapídicos , Elapidae , Eutanásia Animal , Estudos Retrospectivos , Mordeduras de Serpentes/terapia , Mordeduras de Serpentes/veterináriaRESUMO
INTRODUCTION: The sesamoid disease is a cause of lameness in dogs, and there is limited literature relating to diagnosis, treatment and outcome of treatment in dogs with the sesamoid disease. Our aim was to compare the efficacy of intra-articular metacarpophalangeal/metatarsophalangeal joint injection with methylprednisolone and bupivacaine (IMPB) or conservative management with nonsteroidal anti-inflammatories and rest (CMNR) for treatment of this disease. MATERIALS AND METHODS: We conducted a retrospective survey of dogs treated for the sesamoid disease with IMPB or CMNR. The medical records of all dogs that received IMPB or were recommended CMNR for treatment of sesamoid pain were reviewed, and a client questionnaire was delivered to owners. Response to treatment, rapidity of response, length of resolution and recurrence of clinical signs associated with the sesamoid disease were assessed. RESULTS: A total of 78 dogs were included in the study. One week after IMPB, 52/58 (89.7%) dogs demonstrated resolution of lameness compared with 1 week of CMNR, 0/18 (P < 0.001). There was limited statistical evidence in client satisfaction between treatment groups, IMPB 36/53 (67.9%) and CMNR 16/17 (94%) (P = 0.052). Dogs presenting with the sesamoid disease had comorbidities in 51/78 (65.4%) of cases. Elbow disease was the most common comorbidity 29/78 (37.2%). CONCLUSION: Our results support the use of IMPB for short-term (1 week) resolution of lameness associated with sesamoid disease in dogs. Dogs treated with CMNR had slower improvement; however, there was no difference in lameness or client satisfaction between treatment groups at long-term follow-up (12 months).
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Bupivacaína , Doenças do Cão , Animais , Bupivacaína/uso terapêutico , Doenças do Cão/tratamento farmacológico , Cães , Injeções Intra-Articulares/veterinária , Coxeadura Animal/tratamento farmacológico , Coxeadura Animal/etiologia , Metilprednisolona/uso terapêutico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Peer-mediated instructional strategies (e.g., peer tutoring) have been effective at teaching academic responses in previous research. This study extended the literature by programming for inference-making, or derived relations. Across two experiments, researchers investigated the use of peer tutoring and inference-making to teach fraction-pictogram-percentage relations to 8 third-grade participants. In each experiment, participants served as both tutors and tutees in homogenous, reciprocal tutoring sessions. In Experiment 1, one tutor taught fraction (A)-pictogram (B) relations and the other tutor taught percentage (C)-pictogram (B) relations. In Experiment 2, each tutor taught one half of each of the relations. Results of both experiments demonstrated that the tutors learned all relations they taught, the tutees learned all relations they were taught, and all participants derived equivalence relations and demonstrated transfer of functions for comparative relations. A comparison of the two experiments suggests instructors should consider the difficulty of training relations when they design peer-tutoring instruction that engineers inference-making.
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Aprendizagem , Grupo Associado , Humanos , EnsinoRESUMO
There remains a gap in the current literature as to how to reliably measure and increase students' "voluntary reading," based on research suggesting a relation between reading amount and reading achievement. We tested the effect of the establishment of conditioned reinforcement for reading via a collaborative shared reading (CSR) conditioning procedure on eight 2nd-grade students with and without learning disabilities and developmental disorders. This conditioning procedure was composed of opportunities for reciprocal reading and collaboration on comprehension and vocabulary tasks related to the reading content, such that partners (teacher-participant or participant-participant) were required to work together. We utilized a combined small-n experimental-control simultaneous-treatment design with a single-case multiple-probe design nested within each small group in order to compare within- and between-group differences for participants in the CSR procedure with a teacher or peer. All participants for whom conditioned reinforcement for reading was established (n = 7) demonstrated gains in reading achievement after a maximum of nine sessions (412 min), with grade-level increases between 0.2 and 2.5 on measures of reading comprehension and between 0.3 and 3.1 on measures of vocabulary. The students in the teacher-yoked condition (n = 3) demonstrated more significant gains in their average increases in achievement, although the peer-yoked procedure was also effective and possibly more viable in a classroom setting. These results suggest that a CSR procedure with a teacher or peer should be considered as a means of increasing the reading achievement of early elementary students via increases in the reinforcement value of reading.
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A facile synthesis of an americium complex with a sulfur-donor ligand has been developed, allowing characterization of americium bonding from multiple perspectives via several techniques. Reaction of 243Am with S2P(OEt)2- yields the tetrakis complex [Am(S2P(OEt)2)4]- that can be crystallized as the tetraphenylarsonium salt. Structures obtained from single crystal X-ray diffraction show bond length discrepancies from the neodymium analogue consistent with the soft-donor bond enhancement common to actinides. Solid state optical spectroscopy confirms interaction of the ligand with 5f orbitals. 31P nuclear magnetic reflects the minor paramagnetism of Am(III). Computational investigations through CASSCF calculations, ligand-field density functional theory, and quantum chemical topological analysis allow a quantification of covalency or orbital interaction effects via total energy density and nephelauxetic parameters, both of which indicate greater covalency in the americium species than in the neodymium analogue or the americium aquo complex.
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The objective of this study was to describe a new technique for urinary catheterisation of female dogs using a novel catheterisation device (NCD) and to compare the time taken to place a catheter using this technique with traditional techniques. A secondary objective was to survey participants on which of the techniques they preferred. Female canine cadavers of varying sizes were utilised and veterinary students who had not previously placed a urinary catheter were enrolled. Each participant performed three catheterisation techniques, Visual with speculum (SPEC), Blind Palpation (BP) and catheterisation with NCD on three sizes of dog. Time required using each technique was compared using Kaplan-Meier plots and mixed models Cox Proportional Hazards regression. Median times to catheterisation were 300 s (IQR 261-417 s) with the SPEC method, 420 s (IQR 253-545 s) with the NCD method and 725 s (574-1032s) with the BP method. Both SPEC and NCD methods were significantly faster compared to the BP method, with Hazard Ratios of 3.66 (95% CI 1.94-6.91, P < 0.001) and 3.57 (95% CI 1.87-6.81, P < 0.001), respectively. Six of nine participants found the NCD the easiest technique, 5/9 of the participants found the palpation technique most difficult and 4/9 found the speculum technique most difficult. BP appears to be the technique of least preference and increased time requirement. The novel urinary catheterisation device may provide a simpler method of visualisation of the urethral papilla and may provide a more sterile way of placing the catheter, although further investigation is needed to confirm this.
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Doenças do Cão , Infertilidade/veterinária , Infecções Urinárias/veterinária , Animais , Cães , Feminino , Masculino , Inquéritos e Questionários , Uretra , Cateterismo Urinário/veterináriaRESUMO
Building on Skinner's theory of verbal behavior, research over the last few decades confirmed verbal speaker operants, added the role of the listener, added the identification of speaker and listener interaction between and within individuals, and identified verbal behavior developmental cusps. Meanwhile, comparative biology focused on how and why language evolved in Homo sapiens. Findings about differences in behavior that neurotypical children demonstrated in their verbal development, and even more so in research that identified and established missing verbal behavior cusps, suggested changes analogous to metamorphosis. These striking changes in stimulus control found in the onset of cusps from the preverbal to the fully verbal child led us to an expansion of the concept of metamorphosis from morphology to the domain of behavior. The major findings of this comparative perspective are presented here as they have led us from experimental analyses of verbal development to metamorphosis as complex verbal behavior transformation and finally to a novel hypothesis about the evolution of language based on the concepts and research described here. To our knowledge, this is the first formulation of verbal development as behavioral metamorphosis in the context of evolutionary developmental biology.
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OBJECTIVE: Redistribution of cardiac output (CO) is responsible for the brain-sparing effect seen during periods of fetal stress. Our aim was to investigate prospectively the correlation between fetoplacental Doppler indices and measurements of cardiac function in uncomplicated term singleton pregnancy. METHODS: This was a prospective observational study of normotensive women with appropriately grown, non-anomalous singleton pregnancy. Participants underwent fortnightly ultrasound examinations from 36 weeks' gestation until delivery, and intrapartum and neonatal outcomes were recorded. The correlation between fetoplacental Doppler indices and various measurements of cardiac function was evaluated. RESULTS: The study cohort comprised 273 singleton pregnancies. The cerebroplacental ratio (CPR) was correlated positively with left ventricular CO (LVCO) (P < 0.001, rho = 0.29), left-to-right ventricular CO ratio (LVCO/RVCO; P < 0.001, rho = 0.41), global left ventricular strain (P < 0.01, rho = 0.17) and global right ventricular strain (P < 0.001, rho = 0.22). The CPR was correlated inversely with the left ventricular myocardial performance index (P < 0.01, rho = -0.18) and the RVCO (P < 0.001, rho = -0.28). The LVCO and global left ventricular strain were correlated positively with umbilical venous flow (P = 0.04, rho = 0.18 and P < 0.001, rho = 0.25, respectively). There was minimal or no correlation between either the mean uterine artery pulsatility index (PI) or umbilical artery PI with any cardiac indices. CONCLUSION: The fetal CPR, middle cerebral artery PI and umbilical venous flow are correlated positively with LVCO, LVCO/RVCO and global left ventricular strain in low-risk term pregnancies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Débito Cardíaco/fisiologia , Testes de Função Cardíaca/métodos , Circulação Placentária/fisiologia , Ultrassonografia Doppler/métodos , Adulto , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/epidemiologia , Feto , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiologia , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Fluxo Pulsátil/fisiologia , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/fisiologia , Artéria Uterina/diagnóstico por imagem , Artéria Uterina/fisiologiaRESUMO
Prior research found that without the naming cusp, children did not learn from instructional demonstrations presented before learn units (IDLUs) (i.e., modeling an expected response twice for a learner prior to delivering an instructional antecedent), however, following the establishment of naming, they could. The present study was designed to compare the rate of learning reading and mathematics objectives in children who showed naming using IDLUs compared to standard learn units (SLUs) alone (comparable to three-term contingency trials). In Phase 1, a pre-screening phase, we demonstrated that four typically developing males, 3 to 4 years of age, had naming within their repertoire, meaning they were able to master the names of novel 2-D stimuli as both a listener and a speaker without explicit instruction. Using the same participants in Phase 2, we compared rates of learning under two instructional methods using a series of repeated AB designs where conditions (IDLUs versus SLUs) were counterbalanced across dyads and replicated across participants. The participants learned more than twice as fast under IDLU conditions and showed between 30% and 50% accuracy on the first presentation of a stimulus following a model. The IDLU condition was more efficient (fewer trials to criterion) than the SLU condition. These findings, together with prior findings, suggest that the onset of naming allows children to learn faster when instructional demonstrations are incorporated into lessons.
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Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36â¯months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere. TRIAL REGISTRATION: NCT02722382.
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Falência Renal Crônica/terapia , Transferência de Pacientes , Assistência Centrada no Paciente , Insuficiência Renal Crônica/terapia , Tomada de Decisões , Atenção à Saúde , Progressão da Doença , Nefrologia , Equipe de Assistência ao Paciente , Navegação de Pacientes , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Autogestão , Apoio SocialRESUMO
OBJECTIVES: To assess prospectively fetal myocardial deformation at term in normally grown fetuses using the velocity vector imaging (VVI) two-dimensional speckle-tracking technique, and to explore myocardial deformation changes over the last 4 weeks of pregnancy. METHODS: This was a prospective, observational cohort study of 276 women with an uncomplicated singleton pregnancy who underwent fortnightly ultrasound from 36 weeks' gestation until delivery at the Mater Mother's Hospital, Brisbane, Australia. Fetal myocardial deformation (assessed by global and segmental longitudinal systolic myocardial strain and strain rate of both right and left ventricles) was measured using VVI software. RESULTS: Mean global longitudinal left and right ventricular strain and strain rate values decreased between each time point. At 36, 38 and 40 weeks' gestation, left ventricular global strain (%) and strain rate (/s) decreased, respectively, as follows: -14.6 ± 3.8% and -1.2 ± 0.3/s at 36 weeks; -13.6 ± 3.3% and -1.1 ± 0.3/s at 38 weeks; and -12.3 ± 3.1% and -1.0 ± 0.3/s at 40 weeks. At 36, 38 and 40 weeks, mean right ventricular global strain (%) and mean strain rate (/s) decreased, respectively, as follows: -14.2 ± 3.4% and -1.2 ± 0.2/s at 36 weeks; -13.4 ± 3.0% and -1.1 ± 0.2/s at 38 weeks; and -12.8 ± 2.8% and -1.1 ± 0.2/s at 40 weeks. CONCLUSIONS: Global ventricular strain values diminish with advancing gestational age. Myocardial deformation imaging is feasible in late gestation and may be useful as an adjunct for the assessment of fetal cardiac function close to birth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Função Ventricular Esquerda , Função Ventricular Direita , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Método Simples-CegoRESUMO
OBJECTIVES: To investigate prospectively the relationship of fetal cardiac function and Doppler ultrasound parameters with intrapartum fetal compromise (IFC) in appropriately grown term fetuses. Secondary aims were to correlate prenatal cardiac function with neonatal acid-base status, intrapartum fetal heart rate (FHR) abnormalities and adverse neonatal outcomes. METHODS: This was a blinded, prospective, observational, cohort study of 270 women with an uncomplicated singleton pregnancy who underwent fortnightly ultrasound assessment from 36 weeks' gestation until delivery at the Mater Mother's Hospital, Brisbane, Australia. Fetal cardiac output and blood flow parameters were assessed and correlated with intrapartum and neonatal outcomes. The primary outcome was need for operative (either Cesarean or instrumental vaginal) delivery for IFC. Secondary outcome measures were acidosis at birth, 5-min Apgar score ≤ 7, suspicious or pathological FHR abnormalities and admission to the neonatal intensive care unit. RESULTS: Two hundred and seventy women were included in the analysis, of whom 51 (18.9%) had an emergency operative delivery for IFC. Fetuses that had emergency delivery for IFC showed lower mean left ventricular cardiac output (LVCO) (560 ± 44 mL/min vs 617 ± 73 mL/min; P < 0.001), lower mean LVCO/right ventricular cardiac output (RVCO) ratio (0.55 ± 0.07 vs 0.64 ± 0.11; P < 0.001), lower mean cerebroplacental ratio (CPR) (1.62 ± 0.3 vs 1.90 ± 0.5; P < 0.001) and higher mean RVCO (1026 ± 105 mL/min vs 978 ± 110 mL/min; P = 0.003) compared with those that did not develop IFC. Additionally, LVCO and CPR were lower in fetuses with adverse neonatal outcome. CONCLUSION: Term fetuses with estimated fetal weight > 10th centile that develop IFC have evidence of lower LVCO and higher RVCO, which are in turn associated with poorer condition of the newborn. Fetal CPR is positively correlated with LVCO. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Sofrimento Fetal/diagnóstico por imagem , Coração Fetal/diagnóstico por imagem , Trabalho de Parto , Ultrassonografia Pré-Natal , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Estudos de Coortes , Método Duplo-Cego , Feminino , Sofrimento Fetal/fisiopatologia , Coração Fetal/fisiopatologia , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
OBJECTIVES: Prediction of intrapartum fetal compromise in uncomplicated, term pregnancies is a global obstetric challenge. Currently, no widely accepted screening test for this condition exists, although the cerebroplacental ratio (CPR) shows promise. We aimed to evaluate prospectively the screening performance of the CPR 10th centile threshold for prediction of Cesarean section for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (ANO) after 36 weeks' gestation in low-risk women, and to compare this with CPR ≤ 1 and < 5th centile thresholds described previously in the literature. METHODS: This was a blinded, prospective, observational, cohort study of 483 women with uncomplicated singleton pregnancy who underwent fortnightly CPR measurements from 36 weeks to delivery, and their intrapartum and neonatal outcomes were recorded. The CPR 10th centile threshold screening performance was calculated for emergency Cesarean section for IFC and composite ANO (defined as acidosis at birth, 5-min Apgar score < 7 and/or admission to the neonatal intensive care unit). Comparison of screening performance of CPR ≤ 1 and < 5th and < 10th centile thresholds was also undertaken for these specified outcomes. RESULTS: In total, 437 women were included in the analysis, of whom 4.1% had an emergency Cesarean section for IFC and 17.8% had a composite ANO. Sensitivity and specificity for CPR < 10th centile were, respectively, 55.6% and 87.9% for prediction of Cesarean section for IFC, and 28.2% and 88.0% for composite ANO. Compared with CPR ≤ 1 and < 5th centile, CPR < 10th centile yielded the best overall test performance for detection of Cesarean section for IFC and composite ANO, although its predictive value was only fair for Cesarean section for IFC (area under the receiver-operating characteristics curve (AUC) = 0.72) and poor for composite ANO (AUC = 0.58). CONCLUSION: The CPR 10th centile threshold may be useful as a component of a risk assessment tool for Cesarean section for IFC in low-risk pregnancies at term. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Cesárea/estatística & dados numéricos , Sofrimento Fetal/diagnóstico , Resultado da Gravidez/epidemiologia , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Recém-Nascido , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/embriologia , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Medição de Risco , Método Simples-Cego , Artérias Umbilicais/diagnóstico por imagemRESUMO
The onset of the verbal behavior developmental cusp of bidirectional naming (BiN) in a second language makes it possible for monolingual English-speaking children to learn names of things in a second language incidentally. We conducted 2 experiments to identify why monolingual English-speaking children cannot demonstrate BiN in another language when they demonstrated BiN in their native language. In Experiment I, using a group design (n = 32 preschoolers), we identified Chinese speech sounds that monolingual English-speaking children with BiN in English for familiar stimuli could not echo. In Experiment II, using a multiple-probe design, we investigated if mastery of echoics with the speech sounds identified in Experiment I would result in BiN in Chinese with 6 participants from Experiment I. The dependent variable was untaught responses to the probe stimuli presented following the naming experience based on the echoic stimuli from Experiment I. The results showed that echoic training was functionally related to the establishment of BiN in the second language. It appeared that the emission of accurate echoics might be the key to second-language BiN and that emergent correspondence between producing and hearing that occurs with the mastery of the echoic responding may be the source of reinforcement.
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OBJECTIVES: To determine the screening performance of low fetal cerebroplacental ratio (CPR), a marker of fetal adaptation to suboptimal growth, and maternal placental growth factor (PlGF) level, both in isolation and in combination, for the prediction of Cesarean section (CS) for intrapartum fetal compromise (IFC) and composite adverse neonatal outcome (CANO). METHODS: This was a prospective cohort study in low-risk women with uncomplicated singleton pregnancy from 36 weeks' gestation to delivery. CPR and PlGF were assessed fortnightly and intrapartum and neonatal outcomes were recorded. CPR and PlGF values from the final assessment for each woman were corrected for gestational age and assessed for screening performance, firstly as continuous variables and then as binary predictors. RESULTS: Of the 264 women who consented to participate in the study, 207 were included in the final analysis. Seven pregnancies required CS for IFC and 38 had CANO. Pregnancies delivered by CS for IFC had lower CPR and PlGF centiles than those in all other pregnancies. Pregnancies with CANO had a lower PlGF centile. The greatest areas under the receiver-operating characteristics curves (AUCs) for the prediction of CS for IFC (0.92; 95% CI, 0.86-0.97) and CANO (0.64; 95% CI, 0.54-0.74) were achieved by a combination of CPR 20th and PlGF 33rd centile thresholds. This produced sensitivities, specificities and positive likelihood ratios for the prediction of CS for IFC of 100%, 86% and 7.14, respectively, and 34.2%, 87.0% and 2.63, respectively, for the prediction of CANO. There was no statistical difference in the AUC for CS for IFC between the combined model and when CPR was used alone, or for CANO between the combined model and CPR or PlGF in isolation. CONCLUSIONS: This pilot proof-of-concept study describes the screening performance of CPR and maternal PlGF level for CS for IFC in low-risk women from 36 weeks' gestation. It was found that CPR and maternal PlGF improved the overall predictive utility for CS for IFC, as well as that for CANO. However, given the lack of significant difference between the combined model and its individual components, it is debatable whether the combined model is a superior screening test. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.