Clinical Implications of Over- and Under-Triage Using Need for Trauma Intervention and Cribari Indices.

BACKGROUND: Need for Trauma Intervention (NFTI) score was proposed to help identify injured trauma patients while minimizing under (UT) and over triage (OT). Using a national database, we aimed to describe UT and OT of NFTI vs standard Cribari method (CM) and hypothesized triage sensitivity remains poor. METHODS: The 2021 Trauma Quality Improvement Program (TQIP) database was queried. Demographics, mechanism, verification level, interfacility transfer (IF), and level of activation were collected. Patients were stratified by both NFTI [+ vs -] and CM [Injury severity score (ISS) < 15 vs > 15]. UT was defined as NFTI + or ISS >15 without full trauma activation. RESULTS: 1,030,526 patients were identified in TQIP. 84,969 were UT and 97,262 were OT using NFTI while 94,020 were UT and 108,823 were OT using CM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NFTI is 49%, 89%, 45%, and 90%, respectively vs 43%, 87%, 39%, and 89% of CM, respectively. Age was higher in the UT group using both scores (52 vs 42, P < .0001 and 54 vs 42, P < .0001, respectively). Using MLR, level 2 and 3 verification, blunt mechanism, female, IF, and older age were associated with UT in both NFTI and CM. Level 1 verification, penetrating mechanism, male, no IF, and younger age were associated with OT. CONCLUSIONS: Current prehospital triage criteria have poor sensitivity for identifying severely injured trauma patients by both NFTI and CM. UT increases as age of the patient increases. Further studies are needed to improve triage.

Using digital PCR to predict ciliate abundance from ribosomal RNA gene copy numbers.

Ciliates play a key role in most ecosystems. Their abundance in natural samples is crucial for answering many ecological questions. Traditional methods of quantifying individual species, which rely on microscopy, are often labour-intensive, time-consuming and can be highly biassed. As a result, we investigated the potential of digital polymerase chain reaction (dPCR) for quantifying ciliates. A significant challenge in this process is the high variation in the copy number of the taxonomic marker gene (ribosomal RNA [rRNA]). We first quantified the rRNA gene copy numbers (GCN) of the model ciliate, Paramecium tetraurelia, during different stages of the cell cycle and growth phases. The per-cell rRNA GCN varied between approximately 11,000 and 130,000, averaging around 50,000 copies per cell. Despite these variations in per-cell rRNA GCN, we found a highly significant correlation between GCN and cell numbers. This is likely due to the coexistence of different cellular stages in an uncontrolled (environmental) ciliate population. Thanks to the high sensitivity of dPCR, we were able to detect the target gene in a sample that contained only a single cell. The dPCR approach presented here is a valuable addition to the molecular toolbox in protistan ecology. It may guide future studies in quantifying and monitoring the abundance of targeted (even rare) ciliates in natural samples.

Outcomes and Predictors of Delayed Intervention After Renal Trauma.

INTRODUCTION: Historically, a zone II hematoma mandated exploration after penetrating trauma, but this has been challenged given potentially higher nephrectomy rates and the advent of therapeutic endovascular and endoscopic interventions. We hypothesized penetrating mechanism was not a predictor for delayed intervention in the modern era. METHODS: This single-center, retrospective study included renal trauma patients from 3/2019 to 6/2022. Our institutional practice is selective exploration of zone II hematomas for active bleeding and expanding hematoma only, regardless of mechanism. Descriptive statistics and multivariable logistic regression (MLR) were performed. RESULTS: One-hundred and forty-four patients were identified, with median age 32 years (IQR:23,49), 66% blunt mechanism, and injury severity score 17(IQR:11,26). Forty-three (30%) required operative intervention, and of the 20 that had a zone II exploration, 3 (15%) underwent renorrhaphy and 17 (85%) underwent nephrectomy. Penetrating patients more frequently underwent immediate operative intervention (67%vs10%,P < .0001), required nephrectomy (27%vs5%,P = .0003), and were less likely to undergo pre-intervention CT (51%vs96%,P < .0001) compared to blunt patients. Delayed renal interventions were higher in penetrating (33%vs13%,P = .004) with no difference in mortality or length of stay compared to blunt mechanism. Ureteral stent placement and renal embolization were the most common delayed interventions. On MLR, the only independent predictor for delayed intervention was need for initial operative intervention (OR 3.803;95%CI:1.612-8.975,P = .0023). Four (3%) required delayed nephrectomy, of which only one underwent initial operative intervention without zone 2 exploration. CONCLUSIONS: The most common delayed interventions after renal trauma were renal embolization and ureteral stent. Penetrating mechanism was not a predictor of delayed renal intervention in a trauma center that manages zone II retroperitoneal hematomas similarly regardless of mechanism.

Predicting feed intake in confined beef cows.

Six existing equations (three for nonlactating and three for lactating; NRC, 1987, Predicting feed intake of food-producing animals. Washington, DC: The National Academies Press, National Academy of Science; doi: 10.17226/950; NRC, 1996, Nutrient requirements of beef cattle, 7th Revised Edition: Update 1996. Washington, DC: The National Academies Press; doi: 10.17226/9791; Hibberd and Thrift, 1992. Supplementation of forage-based diets. J. Anim. Sci. 70:181. [Abstr]) were evaluated for predicting feed intake in beef cows. Each of the previously published equations are sensitive to cow-shrunk BW and feed energy concentration. Adjustments in feed intake prediction are provided for level of milk yield in NRC (1987. Predicting feed intake of food-producing animals. Washington, DC: The National Academies Press, National Academy of Science; doi: 10.17226/950) and NRC (1996 Nutrient requirements of beef cattle, 7th Revised Edition: Update 1996. Washington, DC: The National Academies Press; doi: 10.17226/9791) equations. The equation published in 1996 used data generated between 1979 and 1993. Our objectives were to validate the accuracy of the published equations using more recent data and to propose alternative prediction models. Criteria for inclusion in the evaluation dataset included projects conducted or published since 2002, direct measurement of feed intake, adequate protein supply, and pen feeding (no metabolism crate data). After removing outliers, the dataset included 53 treatment means for nonlactating cows and 32 treatment means for lactating cows. Means for the nonlactating dataset were dry matter intake (DMI) = 13.2 ±â€…2.9 kg/d, shrunk body weight (SBW) = 578 ±â€…83.9 kg, body condition score = 5.7 ±â€…0.73, and Mcal net energy for maintenance (NEm)/kg of feed = 1.27 ±â€…0.15 Mcal/kg. Means for the lactating dataset were DMI = 14.6 ±â€…2.24 kg/d, SBW = 503 ±â€…73.4 kg, body condition score = 4.7 ±â€…0.58, and Mcal NEm/kg feed = 1.22 ±â€…0.16. Simple linear regression was used to determine slope, intercept, and bias when observed DMI (y) was regressed against predicted DMI (x). The NRC (1996. Nutrient requirements of beef cattle, 7th Revised Edition: Update 1996. Washington, DC: The National Academies Press; doi: 10.17226/9791) nonlactating equation underestimated feed intake in diets moderate to high in energy density with intercept differing from 0 and slope differing from one (P ≤ 0.01). Average deviation from observed values was 2.4 kg/d. Similarly, when the NRC (1996. Nutrient requirements of beef cattle, 7th Revised Edition: Update 1996. Washington, DC: The National Academies Press; doi: 10.17226/9791) equation was used to predict DMI in lactating cows, the slope differed from one (P < 0.01) with average deviation from observed values of 3.0 kg/d. New models were developed by pooling the two datasets and including a categorical variable for stage of production (0 = nonlactating and 1 = lactating). Continuous variables included study-average SBW0.75 and diet NEm, Mcal/kg. The best-fit empirical model accounted for 68% of the variation in daily feed intake with standard error of the estimate Sy root mean squared error = 1.31. The proposed equation needs to be validated with independent data.

Code-Switching During Narratives by Bilingual Children With and Without Developmental Language Disorder.

PURPOSE: This study examined the frequency, direction, and structural characteristics of code-switching (CS) during narratives by Spanish-English bilingual children with and without developmental language disorder (DLD) to determine whether children with DLD exhibit unique features in their CS that may inform clinical decision-making. METHOD: Spanish-English bilingual children, aged 4;0-6;11 (years;months), with DLD (n = 33) and with typical language development (TLD; n = 33) participated in narrative retell and story generation tasks in Spanish and English. Instances of CS were classified as between utterance or within utterance; within-utterance CS was coded for type of grammatical structure. Children completed the morphosyntax subtests of the Bilingual English-Spanish Assessment to assist in identifying DLD and to index Spanish and English morphosyntactic proficiency. RESULTS: In analyses examining the contributions of both DLD status and Spanish and English proficiency, the only significant effect of DLD was on the tendency to engage in between-utterance CS; children with DLD were more likely than TLD peers to produce whole utterances in English during the Spanish narrative task. Within-utterance CS was related to lower morphosyntax scores in the target language, but there was no effect of DLD. Both groups exhibited noun insertions as the most frequent type of within-utterance CS. However, children with DLD tended to exhibit more determiner and verb insertions than TLD peers and increased use of "congruent lexicalization," that is, CS utterances that integrate content and function words from both languages. CONCLUSIONS: These findings reinforce that use of CS, particularly within-utterance CS, is a typical bilingual behavior even during narrative samples collected in a single-language context. However, language difficulties associated with DLD may emerge in how children code-switch, including use of between-utterance CS and unique patterns during within-utterance CS. Therefore, analyzing CS patterns may contribute to a more complete profile of children's dual-language skills during assessment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23479574.

A crosswalk of foundational BSN population health documents and the AACN essentials.

To guide the development of entry-level nursing education, the American Association of Colleges of Nursing (AACN) published the Essentials document in 2021 with a broadened scope of competencies. Community, population, and public health (CPPH) nurse educators use a number of foundational documents to crosswalk for gaps in the AACN principles, highlighting the need of including these contemporary documents within the baccalaureate CPPH nursing curriculum. In this crosswalk, the authors highlight important capabilities and knowledge exclusive to these fundamental documents and tools, as well as the relevance of these competencies and knowledge to CPPH baccalaureate nursing education.

Sugarbaker Versus Keyhole Repair for Parastomal Hernia: a Systematic Review and Meta-analysis of Comparative Studies.

INTRODUCTION: Parastomal hernia is a debilitating complication of stoma creation. Parastomal hernia repair with mesh reduces recurrence rates in open and laparoscopic settings. Recent comparative studies conflict with previously pooled data on optimal mesh repair technique. The objective of this study is to examine parastomal hernia recurrence rates after Sugarbaker and keyhole repairs by performing an updated systematic review and meta-analysis of comparative studies. METHODS: A systematic review of PubMed, MEDLINE, EMBASE, the Cochrane database, SCOPUS, and the PROSPERO registry was performed according to PRISMA 2020 guidelines (PROSPERO ID: CRD42021290483). Studies comparing parastomal hernia recurrences after Sugarbaker and keyhole repairs were included. Studies with overlapping patient cohorts (duplicate data), non-comparative studies, studies that did not report the primary outcome of interest, and studies not in the English language were excluded. Study bias was assessed using the Newcastle-Ottawa scale. Pooled mean differences (MD), odds ratios (OR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I2 statistic. Forest plots and funnel plots were generated. Study quality was analyzed using MINORS. Additional subgroup analysis of modern studies was performed. RESULTS: Ten comparative studies published between 2005 and 2021 from 5 countries were included for analysis comprising 347 Sugarbaker repairs and 246 keyhole repairs. There were no differences in patient age, sex, or BMI between the groups. There was no difference between the groups regarding surgical site infection (OR 0.78; CI 0.31-1.98; P = 0.61) or post-operative bowel obstruction (OR 0.76; CI 0.23-2.56; P = 0.66). Sugarbaker repairs were significantly less often associated with parastomal hernia recurrence when compared to keyhole repairs (OR 0.38; CI 0.18-0.78; P = 0.008). There was no significant heterogeneity among the studies comparing parastomal hernia recurrence (I2 = 32%; P = 0.15). Quality analysis revealed a median MINORS score of 11 (range 6-16). Subgroup analysis of studies performed after the previously published pooled analysis (2015-2021) revealed no significant difference in parastomal hernia recurrence between the two groups (OR 0.58; CI 0.24-1.38; P = 0.22) with a significant subgroup effect (P = 0.05). CONCLUSIONS: Though there were lower rates of parastomal hernia recurrence with Sugarbaker repairs on overall analysis, this phenomenon disappeared on subgroup analysis of modern studies. Randomized controlled trials with contemporary cohorts would help further evaluate these repairs and minimize potential bias.

Retained energy in lactating beef cows; effects on maintenance energy requirement and voluntary feed intake.

The objectives of these experiments were to determine the relationship between maintenance requirements and energy partitioned to maternal tissue or milk production in limit-fed Angus cows and to determine the relationship between retained energy during the lactation period to dry-period voluntary forage intake (VDMI). Twenty-four mature fall-calving Angus cows were used in a 79-d study during late lactation to establish daily metabolizable energy required for maintenance (MEm). Cows were individually fed daily a mixed diet (2.62 Mcal MEl/kg, 18.2% crude protein) to meet energy and protein requirements of 505 kg beef cows producing 8.2 kg milk daily. If cow BW changed by ±9 kg from initial BW, daily feed intake was adjusted to slow BW loss or reduce BW gain. Milk yield and composition were determined on 3 occasions throughout the study. Maintenance was computed as metabolizable energy intake minus retained energy assigned to average daily maternal tissue energy change, average daily milk energy yield, and average daily energy required for pregnancy. After calves were weaned, cows were fed a low-quality grass hay diet (8.2% crude protein, 65% NDF) and VDMI was measured for 21 days. Lactation maintenance energy was 83% the default value recommended by NASEM (2016. Nutrient Requirements of Beef Cattle: Eighth Revised Edition.) for lactating Angus cows. Increasing lactation-period retained energy (decreasing BW loss and increasing milk energy yield) was associated with lower maintenance energy requirements (P < 0.01; R 2 = 0.92). Increased residual daily gain during lactation was associated with lower lactation maintenance energy requirements (P = 0.05; R 2 = 0.17). Post-weaning VDMI was not related to late-lactation milk energy production, although sensitive to lactation period BCS and BW loss. These results contradict previous reports, suggesting that maintenance requirements increase with increasing milk yield.

Effects of diet on feed intake, weight change, and gas emissions in beef cows.

The objective of this study was to examine the effects of diet energy density on ranking for dry matter intake (DMI), residual feed intake (RFI), and greenhouse gas emissions. Forty-two mature, gestating Angus cows (600 ± 69 kg body weight [BW]; body condition score [BCS] 5.3 ± 1.1) with a wide range in DMI expected progeny difference (-1.38 to 2.91) were randomly assigned to two diet sequences; forage then concentrate (FC) or concentrate then forage (CF). The forage diet consisted of long-stem native grass hay plus protein supplement (HAY; 1.96 Mcal ME/kg DM). The concentrate diet consisted of 35% chopped grass hay and 65% concentrate feeds on a dry matter basis (MIX; 2.5 Mcal ME/kg DM). The GreenFeed Emission Monitoring system was used to determine carbon dioxide (CO2), oxygen (O2), and methane (CH4) flux. Cow performance traits, ultrasound back fat and rump fat, feed DMI, and gas flux data were analyzed in a crossover design using a mixed model including diet, period, and sequence as fixed effects and pen and cow within sequence as random effects. For all measured traits excluding DMI, there was a diet × sequence interaction (P < 0.05). The correlation between MIX and HAY DMI was 0.41 (P = 0.067) and 0.47 (P = 0.03) for FC and CF sequences, respectively. There was no relationship (P > 0.66) between HAY and MIX average daily gain (ADG), regardless of sequence. Fifty-seven percent of the variation in DMI was explained by metabolic BW, ADG, and BCS for both diets during the first period. During the second period, the same three explanatory variables accounted for 38% and 37% of the variation in DMI for MIX and HAY diets, respectively. The negative relationship between BCS and DMI was more pronounced when cows consumed the MIX diet. There was no relationship between MIX and HAY RFI, regardless of sequence (P > 0.18). During the first period, correlations for CO2, CH4, and O2 with MIX DMI were 0.69, 0.81, and 0.56 (P ≤ 0.015), respectively, and 0.76, 0.74, and 0.64 (P < 0.01) with HAY DMI. During the second period, correlations for CO2, CH4, and O2 with MIX DMI were 0.62, 0.47, and 0.56 (P ≤ 0.11), respectively. However, HAY DMI during the second period was not related to gas flux (P > 0.47). Results from this experiment indicate that feed intake of two energy-diverse diets is moderately correlated while ADG while consuming the two diets is not related. Further experimentation is necessary to determine if gas flux data can be used to predict feed intake in beef cows.

The beef cow utilizes about 74% of total feed energy required to produce beef. Therefore, a more thorough understanding of feed intake, weight gain, and feed efficiency traits in the beef cow is fundamental to reducing cost and improving the environmental footprint of beef production. In this experiment, feed intake, weight gain, and greenhouse gas emissions were studied using a crossover design (two study periods) and two diets diverse in energy density and physical characteristics; hay or a hay/concentrate mixed diet. Feed intake of the hay diet was moderately, positively correlated to feed intake when cows consumed the mixed diet. However, there was no correlation in weight gain when cows consumed hay compared to weight gain when cows consumed the mixed diet. There was generally a strong correlation between feed intake and greenhouse gas emissions during the first feeding period. However, there was no correlation between greenhouse gas fluxes and feed intake when cows consumed hay after they had first received the mixed diet. Further research is necessary to determine if greenhouse gas flux data can be used as a reliable proxy for feed intake in beef cows.

Language Control and Code-Switching in Bilingual Children With Developmental Language Disorder.

PURPOSE: The current study examined language control and code-switching in bilingual children with developmental language disorder (DLD) compared to bilingual peers with typical language development (TLD). In addition, proficiency in each language and cognitive control skills were examined as predictors of children's tendency to engage in cross-speaker and intrasentential code-switching. METHOD: The participants were 62 Spanish/English bilingual children, ages 4;0-6;11 (years;months), including 15 children with DLD and 47 children with TLD. In a scripted confederate dialogue task to measure language control, children took turns describing picture scenes with video partners who were monolingual speakers of English or Spanish. The Dimensional Change Card Sort indexed cognitive control, the Bilingual English Spanish Assessment assisted in identifying DLD, and parent ratings from the Inventory to Assess Language Knowledge indexed proficiency in Spanish and English. RESULTS: Children with DLD were more likely to engage in cross-speaker code-switching from Spanish to English (i.e., responding in English when addressed in Spanish) than children with TLD, even when controlling for proficiency in each language. Intrasentential code-switching (i.e., integrating both languages within an utterance) did not differ between groups. Cognitive control was more associated with cross-speaker than with intrasentential code-switching. CONCLUSIONS: These findings highlight the need to consider cross-speaker and intrasentential code-switching separately when seeking distinguishing features of code-switching in bilingual children with DLD. The use of increased cross-speaker code-switching by children with DLD especially with Spanish speakers highlights the need for increased support of home language use.

Water and forage intake, diet digestibility, and blood parameters of beef cows and heifers consuming water with varying concentrations of total dissolved salts.

The objective of this study was to investigate the effects of water quality on water intake (WI), forage intake, diet digestibility, and blood constituents in beef cows and growing beef heifers. This was a replicated 5 × 5 Latin square with five drinking water treatments within each square: 1) fresh water (Control); 2) brackish water (100 BRW treatment) with approximately 6,000 mg/kg total dissolved solids (TDS); 3) same TDS level as 100 BRW achieved by addition of NaCl to fresh water (100 SLW); 4) 50% brackish water and 50% fresh water to achieve approximately 3,000 mg/kg TDS (50 BRW); and 5) same TDS level as 50 BRW achieved by addition of NaCl to fresh water (50 SLW). Each of the five 21-d periods consisted of 14 d of adaptation and 5 d of data collection. Animals were housed individually and fed mixed alfalfa (Medicago sativa) grass hay cubes. Feed and WI were recorded daily. Data were analyzed with animal as the experimental unit. Age, treatment, and age × treatment were fixed effects, and animal ID within age was the random variable for intake, digestibility, and blood parameter data. Water and feed intake were greater than expected, regardless of age or water treatment. No treatment × age interactions were identified for WI (P = 0.71), WI expressed as g/kg body weight (BW; P = 0.70), or dry matter intake (DMI; P = 0.21). However, there was an age × treatment tendency for DMI when scaled to BW (P = 0.09) in cows consuming 100 BRW compared with fresh water. No differences were found for the other three treatments. Heifers provided 50 SLW water consumed less (P < 0.05) feed (g/kg BW) compared with heifers provided fresh water and 100 BRW. No differences (P > 0.05) in water, DMI, feed intake, or diet digestibility were found due to water quality treatment. In conclusion, under these conditions, neither absolute WI, absolute DMI, nor diet digestibility was influenced by the natural brackish or saline water used in this experiment. These results suggest that further research is necessary to determine thresholds for TDS or salinity concentration resulting in reduced water and/or feed intake and diet digestibility.

Processing of Code-Switched Sentences in Noise by Bilingual Children.

Purpose The purpose of the current study was to examine the effects of code-switching on bilingual children's online processing and offline comprehension of sentences in the presence of noise. In addition, the study examined individual differences in language ability and cognitive control skills as moderators of children's ability to process code-switched sentences in noise. Method The participants were 50 Spanish-English bilingual children, ages 7;0-11;8 (years;months). Children completed an auditory moving window task to examine whether they processed sentences with code-switching more slowly and less accurately than single-language sentences in the presence of noise. They completed the Dimensional Change Card Sort task to index cognitive control and standardized language measures in English and Spanish to index relative language dominance and overall language ability. Results Children were significantly less accurate in answering offline comprehension questions about code-switched sentences presented in noise compared to single-language sentences, especially for their dominant language. They also tended to exhibit slower processing speed, but costs did not reach significance. Language ability had an overall effect on offline comprehension but did not moderate the effects of code-switching. Cognitive control moderated the extent to which offline comprehension costs were affected by language dominance. Conclusions The findings of the current study suggest that code-switching, especially in the presence of background noise, may place additional demands on children's ability to comprehend sentences. However, it may be the processing of the nondominant language, rather than code-switching per se, that is especially difficult in the presence of noise.

Maternal production of milk for infants in the neonatal intensive care unit.

Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.

The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit.

OBJECTIVE: To assess the cost-effectiveness of mother's own milk supplemented with donor milk vs mother's own milk supplemented with formula for infants of very low birth weight in the neonatal intensive care unit (NICU). STUDY DESIGN: A retrospective analysis of 319 infants with very low birth weight born before (January 2011-December 2012, mother's own milk + formula, n = 150) and after (April 2013-March 2015, mother's own milk + donor milk, n = 169) a donor milk program was implemented in the NICU. Data were retrieved from a prospectively collected research database, the hospital's electronic medical record, and the hospital's cost accounting system. Costs included feedings and other NICU costs incurred by the hospital. A generalized linear regression model was constructed to evaluate the impact of feeding era on NICU total costs, controlling for neonatal and sociodemographic risk factors and morbidities. An incremental cost-effectiveness ratio was calculated for each morbidity that differed significantly between feeding eras. RESULTS: Infants receiving mother's own milk + donor milk had a lower incidence of necrotizing enterocolitis (NEC) than infants receiving mother's own milk + formula (1.8% vs 6.0%, P = .048). Total (hospital + feeding) median costs (2016 USD) were $169 555 for mother's own milk + donor milk and $185 740 for mother's own milk + formula (P = .331), with median feeding costs of $1317 and $936, respectively (P < .001). Mother's own milk + donor milk was associated with $15 555 lower costs per infant (P = .045) and saved $1812 per percentage point decrease in NEC incidence. CONCLUSIONS: The additional cost of a donor milk program was small compared with the cost of a NICU hospitalization. After its introduction, the NEC incidence was significantly lower with small cost savings per case. We speculate that NICUs with greater NEC rates may have greater cost savings.

Cognitive and Linguistic Predictors of Language Control in Bilingual Children.

In order to communicate effectively with a variety of conversation partners and in a variety of settings, bilingual children must develop language control, the ability to control which language is used for production. Past work has focused on linguistic skills as the limiting factor in children's ability to control their language choice, while cognitive control has been the focus of adult models of language control. The current study examined the effects of both language ability and cognitive control on language control in 4-6 year old Spanish/English bilingual children with a broad range of language skills, including those with low skills in both languages. To measure language control, children participated in an interactive scripted confederate dialogue paradigm in which they took turns describing picture scenes with video partners who presented themselves as monolingual speakers of English or monolingual speakers of Spanish. The paradigm had two conditions: a single-language context, in which children interacted with only one partner, and a dual-language context, in which children needed to switch between languages to address different partners. The Dimensional Change Card Sort (DCCS) indexed cognitive control. The findings revealed an overall effect of language ability, such that children with lower language skills were more likely to produce words in the language not understood by their conversation partner. There was also an effect of cognitive control on children's ability to adjust to the dual-language context. Based on these findings, we suggest that a model of language control in children should consider both linguistic and cognitive factors. However, language ability appears to be the main limiting factor, with cognitive control playing a more restricted role in adapting to a dual-language context.

Processing of code-switched sentences by bilingual children: Cognitive and linguistic predictors.

Production studies of language switching have identified costs in the speed and/or accuracy of word production, but it is unclear whether processing costs are experienced by listeners as well. A related question is whether language control during comprehension recruits domain-general cognitive control. The current study examined processing of code-switching in Spanish-English bilingual children (ages 6;0-11;10) using an auditory moving window paradigm. Cognitive control was indexed by the Dimensional Change Card Sort. Children exhibited significant costs in processing speed when listening to code-switched sentences, but no costs in a measure of offline comprehension. The extent to which cognitive control skills moderated processing costs depended on the robustness of the language system: children with higher language skills exhibited a greater moderating effect of cognitive control. Taken together, the findings provide limited support for a role of cognitive control in children's code-switching processing and suggest that the processing costs incurred may be transitory.

The effects of dual language exposure on executive function in Spanish-English bilingual children with different language abilities.

The current study examined the effects of dual language exposure on executive function in 5- to 11-year-old Spanish-English bilingual children with different language skills. Dual language exposure was measured via parent report and was operationalized as the proportion of time spent in an environment where both English and Spanish were present. Executive function was measured via the Dimensional Change Card Sort (DCCS) task. Shifting costs, switching costs, and mixing costs were derived to index executive function performance. A significant interaction between extent of dual language exposure and language skills was observed such that children showed smaller shifting and mixing costs with increased dual language input as their language skills increased. The results suggest a graded effect of dual language exposure on executive function, where a robust language system may be required for dual language exposure to influence executive function.

Contributions of nonlinguistic task-shifting to language control in bilingual children.

Language control, bilinguals' ability to regulate which language is used, has been posited to recruit domain-general cognitive control. However, studies relating language control and cognitive control have yielded mixed results in adults and have not been undertaken in children. The current study examined the contributions of nonlinguistic task-shifting to language control in Spanish-English bilingual children (ages 5-7) during a cued-switch picture-naming task. Language control was assessed at two levels: (1) cross-language errors, which indexed the success of language selection, and (2) naming speed, which indexed the efficiency of lexical selection. Nonlinguistic task-shifting was a robust predictor of children's cross-language errors, reflecting a role for domain-general cognitive control during language selection. However, task-shifting predicted naming speed only in children's non-dominant language, suggesting a more nuanced role for cognitive control in the efficiency of selecting a particular lexical target.

"Mirror, Mirror on the Wall" Pediatric liver transplantation in the case of situs inversus totalis with a disrupted inferior vena cava.

We present the unique case of a 15-month-old male born with biliary atresia and situs inversus totalis and disrupted inferior vena cava who underwent a successful liver transplantation. The patient had previously undergone a failed Kasai procedure and presented with persistent hyperbilirubinemia. The patient was transplanted with a left lateral segment donor having standard arterial anatomy. Technical considerations included identifying completely replaced arterial anatomy in the recipient from the superior mesenteric artery and creating a branch patch between the gastroduodenal artery and HA, anastomosing the donor left hepatic vein to confluences of the donor left, middle, and right hepatic veins, using a "lazy-S" configuration of portal vein anastomosis, and suspending the allograft to the abdominal wall. Post-operatively, his liver function tests and total bilirubin normalized and he progressed to tolerating an oral diet with tube-feed supplementation.

Processing and Comprehension of Accented Speech by Monolingual and Bilingual Children.

This study tested the effect of Spanish-accented speech on sentence comprehension in children with different degrees of Spanish experience. The hypothesis was that earlier acquisition of Spanish would be associated with enhanced comprehension of Spanish-accented speech. Three groups of 5-6 year old children were tested: monolingual English-speaking children, simultaneous Spanish-English bilingual children and early English-Spanish bilingual children. The children completed a semantic judgment task in English on semantically meaningful and nonsensical sentences produced by a native English speaker and a native Spanish speaker characterized by a strong Spanish accent. All children were slower to respond to foreign accented speech, independent of language background. Monolingual and early bilingual children showed reduced comprehension accuracy of accented speech, but only for nonsensical sentences. Simultaneous bilingual children performed similarly to other groups for meaningful contexts, but were not as strongly affected by accent for nonsensical contexts. Together, the findings suggest that children's language background has only a minor influence on processing of accented speech.