Language Use Contributes to Expressive Language Growth: Evidence From Bilingual Children.

The unique relation of language use (i.e., output) to language growth was investigated for forty-seven 30-month-old Spanish-English bilingual children (27 girls, 20 boys) whose choices of which language to speak resulted in their levels of English output differing from their levels of English input. English expressive vocabularies and receptive language skills were assessed at 30, 36, and 42 months. Longitudinal multilevel modeling indicated an effect of output on expressive vocabulary growth only. The finding that output specifically benefits the development of expressive language skill has implications for understanding effects of language use on language skill in monolingual and bilingual development, and potentially, for understanding consequences of cultural differences in how much children are expected to talk in conversation with adults.

Toward spanning the quality chasm: an examination of team functioning measures.

OBJECTIVE: To examine the effect of 5 measures of team functioning on patient outcomes. DESIGN: Observational, exploratory, measurement. Team functioning surveys and patient outcomes collected 1 year apart in a clinical trial were analyzed. The findings are discussed in context of the domains of team functioning, team effectiveness, and quality improvement. SETTING: 27 Veterans Affairs medical centers. PARTICIPANTS: Staff (t1: N=356; t2: N=273) on inpatient teams and patients (t1: N=4266; t2: N=3213) treated by the teams. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Five measures of team functioning (Physician Engagement, Shared Leadership, Supervisor Team Support, Teamness, and Team Effectiveness scales) and 3 measures of patient outcomes (functional improvement, discharge destination, and length of stay) were assessed at 2 time points with hierarchical generalized linear models to evaluate the association between team functioning measures and changes in patient outcomes. RESULTS: Associations (P<.05) between team functioning measures and patient outcomes were found for 3 of the 15 analyses over the study period. Higher Physician Engagement scale score was associated with lower length of stay (P=.017), and increased scores on Teamness and Team Effectiveness scales correlated with higher rates of community discharge (P=.044 and .049, respectively). CONCLUSIONS: This exploratory analysis revealed trends that team functioning corresponds with patient outcomes in clinically relevant patterns. An increase in community discharge and a decrease in length of stay were associated with higher scores of team functioning. Here, we find evidence that modifiable attributes of team functioning have a measurable effect on patient outcomes. Such findings are promising and support the need for further research on team effectiveness.

Expressive Vocabulary Development in Children from Bilingual and Monolingual Homes: A Longitudinal Study from Two to Four Years.

The early course of language development among children from bilingual homes varies in ways that are not well described and as a result of influences that are not well understood. Here, we describe trajectories of relative change in expressive vocabulary from 22 to 48 months and vocabulary achievement at 48 months in two groups of children from bilingual homes (children with one and children with two native Spanish-speaking parents [ns = 15 and 11]) and in an SES-equivalent group of children from monolingual English homes (n = 31). The two groups from bilingual homes differed in their mean levels of English and Spanish skills, in their developmental trajectories during this period, and in the relation between language use at home and their vocabulary development. Children with two native Spanish-speaking parents showed steepest gains in total vocabulary and were more nearly balanced bilinguals at 48 months. Children with one native Spanish- and one native English-speaking parent showed trajectories of relative decline in Spanish vocabulary. At 48 months, mean levels of English skill among the bilingual children were comparable to monolingual norms, but children with two native Spanish-speaking parents had lower English scores than the SES-equivalent monolingual group. Use of English at home was a significant positive predictor of English vocabulary scores only among children with a native English-speaking parent. These findings argue that efforts to optimize school readiness among children from immigrant families should facilitate their access to native speakers of the community language, and efforts to support heritage language maintenance should include encouraging heritage language use by native speakers in the home.

Longitudinal changes in hearing sensitivity among men: the Veterans Affairs Normative Aging Study.

Over 35 years (1962-1996), participants of the Veterans Affairs Normative Aging Study (NAS), a study of healthy aging in men, completed up to eight audiometric assessments. This report describes the age-related hearing trajectories of screened men (n=953) aged 23 to 81 years at enrollment, estimates the typical rate of change per decade in hearing sensitivity, and compares longitudinal and cross-sectional estimates of change in hearing sensitivity. The men were followed 14 years on average. The hearing trajectories, based on a mixed-effects model analytical approach to the data, provide converging evidence that hearing loss in aging is pervasive and progressive even among men initially selected for good physical health. Typically the men accrued early losses (>25 dB HL) in hearing sensitivity at the higher frequencies beginning in the early 40s, but maintained hearing thresholds better than 25 dB HL for lower frequencies into old age. The average rate of change per year across frequencies and age was 0.69 dB. Predicted cross-sectional estimates of change in hearing sensitivity reliably approximated longitudinal trajectories, with slight misestimations in the 8th decade.

Measuring team process for quality improvement.

BACKGROUND: Even though team care is pivotal to stroke rehabilitation, we have few tools to measure team process. Process measures of team functioning would benefit stroke rehabilitation outcomes and quality improvement (QI). OBJECTIVE: To improve measures of team process and evaluate their potential for use in rehabilitation research and QI. METHODS: We use item response theory (IRT) to analyze and revise selected scales from the Team Functioning Survey administrated to rehabilitation staff (n=365 at 31 VA hospitals) as part of a national clinical trial (NCT00237757). Revised scales were evaluated for reliability (Cronbach's alpha) and validity (correlations, predictions of patient outcomes). RESULTS: Eight scales (60 items) were selected from the TFS for analyses based on their specificity to rehabilitation and potential utility in process improvement. Factor analyses supported the dropping of 2 scales and the combining of 2 scales. As indicated by the IRT analyses of scale psychometric properties, poor performing scale items were dropped and item response categories modified needed areas for further development were identified. Cronbach's alpha for the resultant best 5 scales was good. Intercorrelations varied among scales but were mostly in the moderate ranges. Two of the scales predicted patient outcomes of mFIM™ gain or discharge disposition. CONCLUSION: The analyses resulted in measures of 5 central components of team functioning: physician support, shared leadership, supervisor team support, teamness, and team effectiveness. IRT enables the scales to be refined and strengthened for use in outcome research and QI. The scales are proposed as another step toward understanding and enhancing team process.

Team training and stroke rehabilitation outcomes: a cluster randomized trial.

OBJECTIVE: To test whether a team training intervention in stroke rehabilitation is associated with improved patient outcomes. DESIGN: A cluster randomized trial of 31 rehabilitation units comparing stroke outcomes between intervention and control groups. SETTING: Thirty-one Veterans Affairs medical centers. PARTICIPANTS: A total of 237 clinical staff on 16 control teams and 227 staff on 15 intervention teams. Stroke patients (N=487) treated by these teams before and after the intervention. INTERVENTION: The intervention consisted of a multiphase, staff training program delivered over 6 months, including: an off-site workshop emphasizing team dynamics, problem solving, and the use of performance feedback data; and action plans for process improvement; and telephone and videoconference consultations. Control and intervention teams received site-specific team performance profiles with recommendations to use this information to modify team process. MAIN OUTCOME MEASURES: Three patient outcomes: functional improvement as measured by the change in motor items of the FIM instrument, community discharge, and length of stay (LOS). RESULTS: For both the primary (stroke only) and secondary analyses (all patients), there was a significant difference in improvement of functional outcome between the 2 groups, with the percentage of stroke patients gaining more than a median FIM gain of 23 points increasing significantly more in the intervention group (difference in increase, 13.6%; P=.032). There was no significant difference in LOS or rates of community discharge. CONCLUSIONS: Stroke patients treated by staff who participated in a team training program were more likely to make functional gains than those treated by staff receiving information only. Team based clinicians are encouraged to examine their own team. (ClinicalTrials.gov identifier NCT00237757).

Language specificity in the relation of maternal education to bilingual children's vocabulary growth.

The robust relation between maternal education and child language that is observed in monolingual populations has not been reliably replicated among bilingual children from immigrant families in the United States. We hypothesized that a variable that operates in immigrant populations-the language in which mothers achieved their highest level of education, is relevant to the benefits of maternal education to children's language growth. The participants were 92 U.S.-born bilingually developing children (47 boys, 45 girls) with native Spanish-speaking immigrant mothers. The mothers varied both in their level of education and in the language (English or Spanish) in which they had achieved their highest level of education. The children's expressive vocabulary in English and Spanish was assessed at 6-month intervals between 30 and 60 months. Four sets of multilevel models, which included estimates of children's relative amount of input in each language and mothers' age of arrival, found that maternal level of education in English was significantly related to children's English skill, but not their Spanish skill, and that maternal level of education in Spanish was related to children's Spanish skill, but not their English skill. These language specific relations between mothers' levels of education and their children's language development potentially explain previous findings in immigrant populations. These findings further argue that maternal education benefits children's language because education changes mothers' use of the language in which that education was achieved. There was no evidence of a language general benefit of education, as might arise from increased knowledge of child development. (PsycINFO Database Record

The relationship between the action of arginine vasopressin and responsiveness to oral desmopressin in older men: a pilot study.

OBJECTIVES: To identify whether oral desmopressin (ddAVP) reduced nocturnal urine volume (NUV) in older men with nocturia without obvious bladder outlet obstruction and to determine whether deficiencies in arginine vasopressin (AVP) release and action demonstrated using water deprivation testing predicted responsiveness to ddAVP. DESIGN: Participants had a 2-day Clinical Research Center (CRC) evaluation followed by a double-blinded, placebo-controlled, crossover trial of individually titrated oral ddAVP. SETTING: Participants were from a single Department of Veterans Affairs Medical Center. MEASUREMENTS: Maximum urine osmolality and percentage increase in osmolality were measured after subjects received aqueous vasopressin as part of the overnight water deprivation study; these data were used to categorize participants as normal, having partial central AVP deficiency, or having impaired renal responsiveness to AVP. Response to ddAVP was assessed using data from frequency-volume records. RESULTS: Fourteen participants completed the CRC stay and ddAVP trial. Subjects given ddAVP reduced NUV significantly from baseline (P=.02) and had significantly lower NUV than when on placebo (P=.01). The mean net reduction in NUV from ddAVP compared to placebo was 14+/-18%. Using water deprivation testing to categorize participants, 10 were normal, two had partial central AVP deficiency, and two had impaired renal responsiveness. The mean net reduction in NUV for those with abnormal water deprivation tests was 11+/-25%, versus 15+/-16% for those with normal water deprivation testing (P=.70). CONCLUSION: In this small randomized, controlled trial in older men with nocturia, ddAVP reduced NUV. Counter to expectations, participants deemed normal according to water deprivation tests had approximately equivalent responsiveness to ddAVP. Although this study cannot offer definitive conclusions on the lack of prediction of water deprivation testing for ddAVP benefit, these data offer additional information that may help clarify the pathophysiology and optimal treatment of nocturia in older men.

The Center for Epidemiological Studies Depression Scale (CES-D): Measurement equivalence across gender groups in Hispanic college students.

BACKGROUND: This study examined among Hispanic college students the factor structure and gender measurement invariance of the Center for Epidemiologic Studies Depression (CES-D) scale. The CES-D's original 20 item four-factor model was compared to a recently proposed 14 item, three-factor model. METHODS: Participants included 858 Hispanic undergraduates at an ethnically diverse, major research, urban, public university in the Southwest United States (U.S.). Multigroup confirmatory factor analyses (CFAs) and structural equation modeling were used to examine the factor structure, gender invariance, and construct validity of the CES-D scores. RESULTS: Multigroup CFAs provided support for full configural and metric invariance and partial scalar invariance for the three-factor model across gender groups. Two of the 14 items (#3 and #18) demonstrated different thresholds; women scored higher than men in both items. The pattern of latent correlations of the three depression factors to four stress variables (college academic, social, financial and discrimination stress) demonstrated configural, metric and scalar invariance across gender groups. LIMITATIONS: About two thirds of the participants were women and most were of Mexican descent and had been born in the U.S. Therefore, findings may not generalize to more gender balanced samples and students from other Latin American countries or immigration generational status. CONCLUSIONS: Partial scalar invariance in two items may not have a strong impact in the calculation of the overall depression score. Given evidence for functional invariance, results provide support for the use of the14-item, three-factor CES-D scale to assess depression symptoms among Hispanic college students.

Significant differences in pediatric psychotropic side effects: Implications for school performance.

Some side effects (SEs) of increasingly prescribed psychotropic medications can impact student performance in school. SE risk varies, even among drugs from the same class (e.g., antidepressants). Knowing which SEs occur significantly more often than others may enable school psychologists to enhance collaborative risk-benefit analysis, medication monitoring, data-based decision-making, and inform mitigation efforts. SE data from Full Prescribing Information (PI) on the FDA website for ADHD drugs, atypical antipsychotics, and antidepressants with pediatric indications were analyzed. Risk ratios (RR) are reported for each drug within a category compared with placebo. RR tables and graphs inform the reader about SE incidence differences for each drug and provide clear evidence of the wide variability in SE incidence in the FDA data. Breslow-Day and Cochran Mantel-Haenszel methods were used to test for drug-placebo SE differences and to test for significance across drugs within each category based on odds ratios (ORs). Significant drug-placebo differences were found for each drug compared with placebo, when odds were pooled across all drugs in a category compared with placebo, and between some drugs within categories. Unexpectedly, many large RR differences did not reach significance. Potential explanations are offered, including limitations of the FDA data sets and statistical and methodological issues. Future research directions are offered. The potential impact of certain SEs on school performance, mitigation strategies, and the potential role of the school psychologist is discussed, with consideration for ethical and legal limitations.

A single-institution experience with the AneuRx Stent Graft for endovascular repair of abdominal aortic aneurysm.

We report our experience of endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) using the modular AneuRx Stent Graft System. We retrospectively reviewed the outcomes of 113 patients who underwent EVAR with the AneuRx system performed at our institution between October 1999 and August 2003. The mean age of this group was 72.5 years, with 71% (n = 80) over the age of 70 years and 95% (n = 107) males. Aneurysm diameter ranged 4.0-9.0 cm, with 33% (n = 37) >6.0 cm. The average duration of late follow-up was 32.6 +/- 24.8 months (median = 37). Successful deployment of the modular AneuRx system was noted in all patients. There were no immediate operative conversions, deaths within 24 hr of operation, or type I or III endoleaks observed at the completion of the procedure. Thirty-day mortality was 3.5% (n = 4). Acute deployment-related complications occurred in 10% (n = 13) of patients and included misdeployment, operative bleeding, arterial perforation/dissection, and access site complications. Acute systemic complications were present in nine patients, predominantly renal and cardiac complications. An endoleak noted at any time occurred in 25% of patients, with 40% of those requiring a secondary intervention. Two patients suffered late aneurysm rupture due to a type I endoleak and graft infection. Kaplan-Meier analysis revealed 5-year freedom from secondary intervention of 72.4%; freedom from aneurysm-related death of 93.9%; and probability of survival based on all-cause mortality of 60.1%. Endovascular treatment with the modular AneuRx Stent Graft System is safe and effective, producing acceptable rates of disease-free survival and mid-term clinical outcome.