Preschool children generate quantity inferences from both words and pictures.

As children learn to communicate with others, they must develop an understanding of the principles that underlie human communication. Recent evidence suggests that adults expect communicative principles to govern all forms of communication, not just language, but evidence about children's ability to do so is sparse. This study investigated whether preschool children expect both pictures and words to adhere to the communicative principle of quantity using a simple matched paradigm. Children (N = 293) aged of 3 to 5 years (52.5% male and 47.5% female; majority White with college-educated mothers) participated. Results show that children as young as 3.5 years can use the communicative principle of quantity to infer meaning across verbal and pictorial alternatives.

Representing agents, patients, goals and instruments in causative events: A cross-linguistic investigation of early language and cognition.

Although it is widely assumed that the linguistic description of events is based on a structured representation of event components at the perceptual/conceptual level, little empirical work has tested this assumption directly. Here, we test the connection between language and perception/cognition cross-linguistically, focusing on the relative salience of causative event components in language and cognition. We draw on evidence from preschoolers speaking English or Turkish. In a picture description task, Turkish-speaking 3-5-year-olds mentioned Agents less than their English-speaking peers (Turkish allows subject drop); furthermore, both language groups mentioned Patients more frequently than Goals, and Instruments less frequently than either Patients or Goals. In a change blindness task, both language groups were equally accurate at detecting changes to Agents (despite surface differences in Agent mentions). The remaining components also behaved similarly: both language groups were less accurate in detecting changes to Instruments than either Patients or Goals (even though Turkish-speaking preschoolers were less accurate overall than their English-speaking peers). To our knowledge, this is the first study offering evidence for a strong-even though not strict-homology between linguistic and conceptual event roles in young learners cross-linguistically.

Motion verbs and memory for motion events.

Language is assumed to affect memory by offering an additional medium of encoding visual stimuli. Given that natural languages differ, cross-linguistic differences might impact memory processes. We investigate the role of motion verbs on memory for motion events in speakers of English, which preferentially encodes manner in motion verbs (e.g., driving), and Greek, which tends to encode path of motion in verbs (e.g., entering). Participants viewed a series of motion events and we later assessed their memory of the path and manner of the original events. There were no effects of language-specific biases on memory when participants watched events in silence; both English and Greek speakers remembered paths better than manners of motion. Moreover, even when motion verbs were available (either produced by or heard by the participants), they affected memory similarly regardless of the participants' language: path verbs attenuated memory for manners of motion, but the reverse did not occur. We conclude that overt language affects motion memory, but these effects interact with underlying, shared biases in how viewers represent motion events.

Certified Child Life Specialists Lessen Emotional Distress of Children Undergoing Laceration Repair in the Emergency Department.

OBJECTIVE: The objective of this study is to evaluate the impact of certified child life specialists (CCLSs) on the emotional responses of children undergoing laceration repair in the emergency department (ED). METHODS: Patients 4 to 12 years of age who required laceration repair by suturing were prospectively enrolled at an urban tertiary pediatric ED. Certified child life specialists are not available at all times in our institution, allowing for a priori categorization of subjects into 2 comparison groups, those with and those without CCLS involvement. Subjects requiring anxiolysis, pharmacologic sedation, narcotics, or physical restraint were excluded. The Children's Emotional Manifestation Scale, a previously validated Likert-like tool, was used to quantify the patients' distress, with a higher score reflecting a more emotional child. Just before placement of the first suture, subjects were scored by trained independent observers. Baseline data included age, sex, race, type of local anesthetic, length and location of laceration, and analgesics administered. The primary endpoint of emotional score was compared with a 2-tailed Mann-Whitney U test, with a P < 0.05 considered statistically significant. RESULTS: Two hundred one patients constituted the final study cohort, with 103 (51%) having CCLS involvement. Study groups did not differ in regards to any baseline demographic or clinical characteristics. The median emotional score for patients with child life services was 7 (interquartile range, 6-9) versus 9 (interquartile range, 7.5-12) for those without (P < 0.0005). CONCLUSIONS: Certified child life specialist involvement is associated with less emotional distress for children undergoing laceration repair in the ED.

Quality and Outcomes of Treatment of Hypercalcemia of Malignancy.

Using a nationwide database, 4,874 patients with hypercalcemia of malignancy were identified. The in-hospital mortality rate was 6.8%. Overall, 1,971 (40.4%) patients received pamidronate and 1,399 (28.7%) received zoledronic acid during hospitalization. Calcitonin was utilized in 1,337 (27.4%) patients while glucocorticoids were administered to 1,311 (26.9%). Use of contraindicated medications was noted in 136 (2.8%) patients who received thiazide diuretics and 12 (0.2%) who received lithium. Tumor site, presence of bone metastases, and severity of illness were predictors of treatment. There was no association between treatment with bisphosphonates, calcitonin, or glucocorticoids and morbidity or mortality.

Variability in outcome after elective cerebral aneurysm repair in high-volume academic medical centers.

BACKGROUND AND PURPOSE: Unruptured intracranial aneurysm repair is the most commonly performed procedure for the prevention of hemorrhagic stroke. Despite efforts to regionalize care in high-volume centers, overall results have improved little. This study aims to determine the effectiveness in improving outcomes of previous efforts to regionalize unruptured intracranial aneurysm repair to high-volume centers and to recommend future steps toward that goal. METHODS: Using data obtained via the New York Statewide Planning and Research Cooperative System, this study included all patients admitted to any of the 10 highest volume centers in New York state between 2005 and 2010 with a principal diagnosis of unruptured intracranial aneurysm who were treated either by microsurgical or endovascular repair. Mixed-effects logistic regression was used to determine the degree to which hospital-level and patient-level variables contributed to observed variation in good outcome, defined as discharge to home, between hospitals. RESULTS: Of 3499 patients treated during the study period, 2692 (76.9%) were treated at the 10 highest volume centers, with 2198 (81.6%) experiencing a good outcome. Good outcomes varied widely between centers, with 44.6% to 91.1% of clipped patients and 75.4% to 92.1% of coiled patients discharged home. Mixed-effects logistic regression revealed that procedural volume accounts for 85.8% of the between-hospital variation in outcome. CONCLUSIONS: There is notable interhospital heterogeneity in outcomes among even the largest volume unruptured intracranial aneurysm referral centers. Although further regionalization may be needed, mandatory participation in prospective, adjudicated registries will be necessary to reliably identify factors associated with superior outcomes.

There goes the neighborhood effect: bias owing to nondifferential measurement error in the construction of neighborhood contextual measures.

BACKGROUND: Multilevel studies of neighborhood effects on health frequently aggregate individual-level data to create contextual measures. For example, percent of residents living in poverty and median household income are both aggregations of Census data on individual-level household income. Because household income is sensitive and complex, it is likely to be reported with error. METHODS: To assess the impact of such error on effect estimates for neighborhood contextual factors, we conducted simulation studies to relate neighborhood measures derived from Census data to individual body mass index, varying the extent of nondifferential misclassification/measurement error in the underlying Census data. We then explored the impact on the magnitude of bias owing to the form of variables chosen for neighborhood measure and outcome, modeling technique used, size and number of neighborhoods, and categorization of neighborhoods. RESULTS: For neighborhood contextual variables expressed as percentages (eg, percent of residents living in poverty), nondifferential misclassification in the underlying individual-level Census data always biases the parameter estimate for the neighborhood variable away from the null. However, estimates of differences between quantiles of neighborhoods using such contextual variables are unbiased. Aggregation of the same underlying individual-level Census income data into a continuous variable, such as median household income, also introduces bias into the regression parameter. Such bias is non-negligible if the sampled groups are small. CONCLUSIONS: Decisions regarding the construction and analysis of neighborhood contextual measures substantially alter the impact on study validity of measurement error in the data used to construct the contextual measure.

A gut microbiota rheostat forecasts responsiveness to PD-L1 and VEGF blockade in mesothelioma.

Malignant mesothelioma is a rare tumour caused by asbestos exposure that originates mainly from the pleural lining or the peritoneum. Treatment options are limited, and the prognosis is dismal. Although immune checkpoint blockade (ICB) can improve survival outcomes, the determinants of responsiveness remain elusive. Here, we report the outcomes of a multi-centre phase II clinical trial (MiST4, NCT03654833) evaluating atezolizumab and bevacizumab (AtzBev) in patients with relapsed mesothelioma. We also use tumour tissue and gut microbiome sequencing, as well as tumour spatial immunophenotyping to identify factors associated with treatment response. MIST4 met its primary endpoint with 50% 12-week disease control, and the treatment was tolerable. Aneuploidy, notably uniparental disomy (UPD), homologous recombination deficiency (HRD), epithelial-mesenchymal transition and inflammation with CD68+ monocytes were identified as tumour-intrinsic resistance factors. The log-ratio of gut-resident microbial genera positively correlated with radiological response to AtzBev and CD8+ T cell infiltration, but was inversely correlated with UPD, HRD and tumour infiltration by CD68+ monocytes. In summary, a model is proposed in which both intrinsic and extrinsic determinants in mesothelioma cooperate to modify the tumour microenvironment and confer clinical sensitivity to AtzBev. Gut microbiota represent a potentially modifiable factor with potential to improve immunotherapy outcomes for individuals with this cancer of unmet need.

Neighborhood walkability and active travel (walking and cycling) in New York City.

Urban planners have suggested that built environment characteristics can support active travel (walking and cycling) and reduce sedentary behavior. This study assessed whether engagement in active travel is associated with neighborhood walkability measured for zip codes in New York City. Data were analyzed on engagement in active travel and the frequency of walking or biking ten blocks or more in the past month, from 8,064 respondents to the New York City 2003 Community Health Survey (CHS). A neighborhood walkability scale that measures: residential, intersection, and subway stop density; land use mix; and the ratio of retail building floor area to retail land area was calculated for each zip code. Data were analyzed using zero-inflated negative binomial regression incorporating survey sample weights and adjusting for respondents' sociodemographic characteristics. Overall, 44 % of respondents reported no episodes of active travel and among those who reported any episode, the mean number was 43.2 episodes per month. Comparing the 75th to the 25th percentile of zip code walkability, the odds ratio for reporting zero episodes of active travel was 0.71 (95 % CI 0.61, 0.83) and the exponentiated beta coefficient for the count of episodes of active travel was 1.13 (95 % CI 1.06, 1.21). Associations between lower walkability and reporting zero episodes of active travel were significantly stronger for non-Hispanic Whites as compared to non-Hispanic Blacks and to Hispanics and for those living in higher income zip codes. The results suggest that neighborhood walkability is associated with higher engagement in active travel.

Socio-economic status, neighbourhood food environments and consumption of fruits and vegetables in New York City.

OBJECTIVE: Recommendations for fruit and vegetable consumption are largely unmet. Lower socio-economic status (SES), neighbourhood poverty and poor access to retail outlets selling healthy foods are thought to predict lower consumption. The objective of the present study was to assess the interrelationships between these risk factors as predictors of fruit and vegetable consumption. DESIGN: Cross-sectional multilevel analyses of data on fruit and vegetable consumption, socio-demographic characteristics, neighbourhood poverty and access to healthy retail food outlets. SETTING: Survey data from the 2002 and 2004 New York City Community Health Survey, linked by residential zip code to neighbourhood data. SUBJECTS: Adult survey respondents (n 15 634). RESULTS: Overall 9?9% of respondents reported eating $5 servings of fruits or vegetables in the day prior to the survey. The odds of eating $5 servings increased with higher income among women and with higher educational attainment among men and women. Compared with women having less than a high-school education, the OR was 1?12 (95% CI 0?82, 1?55) for high-school graduates, 1?95 (95% CI 1?43, 2?66) for those with some college education and 2?13 (95% CI 1?56, 2?91) for college graduates. The association between education and fruit and vegetable consumption was significantly stronger for women living in lower- v. higher-poverty zip codes (P for interaction,0?05). The density of healthy food outlets did not predict consumption of fruits or vegetables. CONCLUSIONS: Higher SES is associated with higher consumption of produce, an association that, in women, is stronger for those residing in lower-poverty neighbourhoods.

Individual- and school-level sociodemographic predictors of obesity among New York City public school children.

To identify student- and school-level sociodemographic characteristics associated with overweight and obesity, the authors conducted cross-sectional analyses of data from 624,204 public school children (kindergarten through 12th grade) who took part in the 2007-2008 New York City Fitnessgram Program. The overall prevalence of obesity was 20.3%, and the prevalence of overweight was 17.6%. In multivariate models, the odds of being obese as compared with normal weight were higher for boys versus girls (odds ratio (OR) = 1.39, 95% confidence interval (CI): 1.36, 1.42), for black (OR = 1.11, 95% CI: 1.07, 1.15) and Hispanic (OR = 1.48, 95% CI: 1.43, 1.53) children as compared with white children, for children receiving reduced-price (OR = 1.17, 95% CI: 1.13, 1.21) or free (OR = 1.12, 95% CI: 1.09, 1.15) school lunches as compared with those paying full price, and for US-born students (OR = 1.54, 95% CI: 1.50, 1.58) as compared with foreign-born students. After adjustment for individual-level factors, obesity was associated with the percentage of students who were US-born (across interquartile range (75th percentile vs. 25th), OR = 1.10, 95% CI: 1.07, 1.14) and the percentage of students who received free or reduced-price lunches (across interquartile range, OR = 1.13, 95% CI: 1.10, 1.18). The authors conclude that individual sociodemographic characteristics and school-level sociodemographic composition are associated with obesity among New York City public school students.

Commentary on ethical dilemmas in the management of infants with necrotizing enterocolitis totalis.

This is a commentary on the manuscript titled "Ethical Dilemmas in the Management of Infants with Necrotizing Enterocolitis Totalis".

The Potential Role of Iceland in Northern Europe's Protein Self-Sufficiency: Feasibility Study of Large-Scale Production of Spirulina in a Novel Energy-Food System.

Europe is dependent on protein-rich crop imports to meet domestic food demand. This has moved the topic of sustainable protein self-sufficiency up the policy agenda. The current study assesses the feasibility of protein self-sufficiency in Iceland, and its capacity to meet Northern Europe's demand, based on industrial-scale cultivation of Spirulina in novel production units. Production units currently operating in Iceland, and laboratory-derived nutritional profile for the Spirulina cultivated, provide the basis for a theoretical protein self-sufficiency model. Integrating installed and potentially installed energy generation data, the model elaborates six production scale-up scenarios. Annual biomass produced is compared with recommended dietary allowance figures for protein and essential amino acids to determine whether Northern Europe's population demands can be met in 2030. Results show that Iceland could be protein self-sufficient under the most conservative scenario, with 20,925 tonnes of Spirulina produced using 15% of currently installed capacity. In a greater allocation of energy capacity used by heavy industry, Iceland could additionally meet the needs of Lithuania, or Latvia, Estonia, Jersey, Isle of Man, Guernsey, and Faroe Islands. Under the most ambitious scenario utilizing planned energy projects, Iceland could support itself plus Denmark, or Finland, or Norway, or Ireland with up to 242,366 tonnes of biomass. On a protein-per-protein basis, each kilogram of Spirulina consumed instead of beef could save 0.315 tonnes CO2-eq. Under the most ambitious scenario, this yields annual savings of 75.1 million tonnes CO2-eq or 7.3% of quarterly European greenhouse gas emissions. Finally, practicalities of production scale-up are discussed.

Acute respiratory distress syndrome driven by severe hypercalcemia and acute kidney injury: A case report and literature review of a rare, life-threatening complication.

Acute respiratory distress syndrome (ARDS) is a rare and under-reported complication of hypercalcemia, which often presents in conjunction with acute kidney injury (AKI). Unfamiliarity with the condition inevitably leads to management uncertainty, resulting in fatal outcomes. Early identification, however, confers a good prognosis. We report a case of a 40-year-old male who presented with severe hypercalcemia and AKI and rapidly deteriorated due to ARDS, with no evidence of cardiogenic pulmonary edema or fluid overload. Infection screens were negative. He died despite invasive ventilation and continuous venous-venous hemofiltration. His autopsy revealed extensive metastatic pulmonary calcifications and alveolar edema. We found only 10 other cases of hypercalcemia-induced ARDS in the literature, with only 2 patients surviving. We provide the first literature review on the subject to guide the management of this rare but fatal complication, which can be managed with good outcomes if considered early.

Increased screening colonoscopy rates and reduced racial disparities in the New York Citywide campaign: an urban model.

OBJECTIVES: In 2003, in response to low colonoscopy screening rates and significant sociodemographic disparities in colonoscopy screening in New York City (NYC), the NYC Department of Health and Mental Hygiene, together with the Citywide Colon Cancer Control Coalition, launched a multifaceted campaign to increase screening. We evaluated colonoscopy trends among adult New Yorkers aged 50 years and older between 2003 and 2007, the first five years of this campaign. METHODS: Data were analyzed from the NYC Community Health Survey, an annual, population-based surveillance of New Yorkers. Annual prevalence estimates of adults who reported a timely colonoscopy, one within the past 10 years, were calculated. Multivariate models were used to analyze changes over time in associations between colonoscopy screening and sociodemographic characteristics. RESULTS: Overall, from 2003 to 2007 the proportion of New Yorkers aged 50 years and older who reported timely colonoscopy screening increased from 41.7% to 61.7%. Racial/ethnic and sex disparities observed in 2003 were eliminated by 2007: prevalence of timely colonoscopy was similar among non-Hispanic whites, non-Hispanic blacks, Hispanics, men, and women. However, Asians, the uninsured, and those with lower education and income continued to lag in receipt of timely colonoscopies. CONCLUSIONS: The increased screening colonoscopy rate and reduction of racial/ethnic disparities observed in NYC suggest that multifaceted, coordinated urban campaigns can improve low utilization of clinical preventive health services and reduce public-health disparities.

Future foods for risk-resilient diets.

Future foods, such as microalgae, mycoprotein and mealworm, have been suggested as nutritious and sustainable dietary options. Here we consider one of the most profound, yet neglected, benefits of future foods farming systems-their potential to provide essential nutrition in the face of systemic disturbances-and discuss major barriers to realizing this prospect.

Postfundoplication retching: Strategies for management.

BACKGROUND: Retching is a common symptom in children following antireflux surgery, particularly in those with neurodisability. There is now a strong body of evidence that implicates retching as a major cause of wrap breakdown. Retching is not a symptom of gastroesophageal reflux disease; it is a component of the emetic reflex. In addition to causing wrap breakdown, it is indicative of the presence of nausea. It is a highly aversive experience and warrants treatment in its own right. METHODS: A framework was constructed for the management of postoperative retching, with strategies targeting different components of the emetic reflex. The impact of differing antireflux procedures upon retching was also considered. CONCLUSIONS: Once treatable underlying causes have been excluded, the approach includes modifications to feeds and feeding regimens, antiemetics and motility agents. Neuromodulation and other, novel, therapies may prove beneficial in future. Children at risk of postoperative retching may be identified before any antireflux surgery is performed. Fundoplication is inappropriate in these children because it does not treat their symptoms, which are not because of gastroesophageal reflux, and may make them worse. They are also at risk of wrap disruption. Alternative strategies for symptom management should be employed, and fundoplication should be avoided. LEVEL OF EVIDENCE: II-V.

Body composition, abdominal fat distribution, and prostate-specific antigen test results.

BACKGROUND: There are competing theories explaining the observed inverse association between obesity and screening prostate-specific antigen (PSA) levels: (a) endocrine disturbances related to abdominal obesity influence PSA production and (b) increased plasma volume associated with obesity dilutes PSA. Under the endocrine disturbance hypothesis, fat mass, but not lean mass, and an abdominal distribution of fat are expected to be inversely associated with PSA levels. Under plasma volume dilution theory, PSA levels are inversely associated with both lean and fat mass and are independent of body fat distribution patterns. METHODS: Data on weight, percent body fat measured by bioimpedance, and waist circumference from approximately 8,000 men undergoing routine PSA screening were evaluated. Multivariate linear regression analyses controlling for age and race/ethnicity were used to determine whether fat, lean mass, or waist circumference were associated with PSA. RESULTS: PSA levels were significantly inversely associated with both lean and fat mass. In separate models, a 5-pound difference in lean mass and fat mass was associated, respectively with a -0.9% (P < 0.001) and -0.7% (P = 0.001) difference in PSA test results. In a model that simultaneously considered lean and fat mass, a 5-pound difference in lean mass and fat mass was associated, respectively, with a -0.6% (P = 0.03) and -0.4% (P = 0.08) difference in PSA test results. Controlling for body mass index, a 1-inch difference in waist circumference was associated with a +0.9% (P = 0.01) difference in PSA levels. CONCLUSION: The results are more consistent with predictions arising from the volume dilution theory than the hormone disturbance theory.