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Cochlear-implant (CI) users have previously demonstrated perceptual restoration, or successful repair of noise-interrupted speech, using the interrupted sentences paradigm [Bhargava, Gaudrain, and Başkent (2014). “Top-down restoration of speech in cochlear-implant users,” Hear. Res. 309, 113–123]. The perceptual restoration effect was defined experimentally as higher speech understanding scores with noise-burst interrupted sentences compared to silent-gap interrupted sentences. For the perceptual restoration illusion to occur, it is often necessary for the masking or interrupting noise bursts to have a higher intensity than the adjacent speech signal to be perceived as a plausible masker. Thus, signal processing factors like noise reduction algorithms and automatic gain control could have a negative impact on speech repair in this population. Surprisingly, evidence that participants with cochlear implants experienced the perceptual restoration illusion was not observed across the two planned experiments. A separate experiment, which aimed to provide a close replication of previous work on perceptual restoration in CI users, also found no consistent evidence of perceptual restoration, contrasting the original study's previously reported findings. Typical speech repair of interrupted sentences was not observed in the present work's sample of CI users, and signal-processing factors did not appear to affect speech repair.

Consultation is a key competency area for school psychologists, though much is unknown about how school psychologists develop the competency to consult. Deliberate practice (DP) is a promising approach to enhance use of communication skills, thereby supporting consultation competence. DP training included multiple opportunities for video-recorded consultation practice in response to a consultee's request for assistance, self-reflection on skill application, and corrective supervisory feedback. In this randomized controlled trial, 109 school psychology graduate students across 45 training programs received either consultation training as usual delivered through their first consultation course (control group

We evaluated clinical and socioeconomic burdens of respiratory disease in banana farm workers in Guatemala. We offered all eligible workers enrollment during June 15-December 30, 2020, and annually, then tracked them for influenza-like illnesses (ILI) through self-reporting to study nurses, sentinel surveillance at health posts, and absenteeism. Workers who had ILI submitted nasopharyngeal swab specimens for testing for influenza virus, respiratory syncytial virus, and SARS-CoV-2, then completed surveys at days 0, 7, and 28. Through October 10, 2021, a total of 1,833 workers reported 169 ILIs (12.0 cases/100 person-years), and 43 (25.4%) were laboratory-confirmed infections with SARS-CoV-2 (3.1 cases/100 person-years). Workers who had SARS-CoV-2‒positive ILIs reported more frequent anosmia, dysgeusia, difficulty concentrating, and irritability and worse clinical and well-being severity scores than workers who had test result‒negative ILIs. Workers who had positive results also had greater absenteeism and lost income. These results support prioritization of farm workers in Guatemala for COVID-19 vaccination.

Cochlear-implant (CI) listeners experience signal degradation, which leads to poorer speech perception than normal-hearing (NH) listeners. In the present study, difficulty with word segmentation, the process of perceptually parsing the speech stream into separate words, is considered as a possible contributor to this decrease in performance. CI listeners were compared to a group of NH listeners (presented with unprocessed speech and eight-channel noise-vocoded speech) in their ability to segment phrases with word segmentation ambiguities (e.g., "an iceman" vs "a nice man"). The results showed that CI listeners and NH listeners were worse at segmenting words when hearing processed speech than NH listeners were when presented with unprocessed speech. When viewed at a broad level, all of the groups used cues to word segmentation in similar ways. Detailed analyses, however, indicated that the two processed speech groups weighted top-down knowledge cues to word boundaries more and weighted acoustic cues to word boundaries less relative to NH listeners presented with unprocessed speech.

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)’s Total Worker Health® concept and the World Health Organization (WHO)’s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.

BACKGROUND There is little longitudinal research on whether changes to Total Worker Health® (TWH) policies and programs are associated with changes in health climate and safety climate. We hypothesize that as TWH policies and programs change, employees will report changes in safety climate and health climate from baseline to 1 year. METHODS Twenty-five diverse small businesses and their employees participated in assessments completed approximately 1 year apart. The exposures of interest, TWH policies and programs, were measured using the business-level Healthy Workplace Assessment™ which collects information on six benchmarks. The outcomes of interest, employee perceptions of safety climate and health climate, were measured via an employee survey. We employed paired t-tests and simple linear regression to assess change over a 1-year period. RESULTS The mean Healthy Workplace Assessment overall score changed by 11.3 points (SD = 11.8) from baseline to Year 1. From baseline to Year 1, the mean scores of each benchmark changed in a positive direction within this sample. The mean safety climate score and health climate score changed by +0.1 points (SD = 0.2) and +0.1 points (SD = 6.4) from baseline to Year 1, respectively. The associations between changes in the overall Healthy Workplace Assessment score and health climate and safety climate scores were negligible [β = 0.01 (95% confidence interval [CI]: 0.002, 0.02), and β = 0.01 (95% CI: 0.002, 0.02), respectively]. CONCLUSION Our study suggests that when small businesses improve upon their TWH policies and programs they experience marginal measurable improvements in employee perceptions of their workplace safety climate and health climate.

Storytelling has well-documented therapeutic benefits for survivors of trauma. However, little is known about intimate partner violence (IPV) survivors’ perspectives on sharing their stories. This article presents findings based on the analysis of 26 qualitative interviews with individuals who had experienced IPV regarding first-person story sharing. Participants described telling their stories as an act of healing and empowerment. They also named ways that storytelling can challenge societal views and structures that perpetuate IPV. Based on our findings, we offer suggestions for supporting survivor expertise and storytelling as part of a survivor-centered approach to IPV advocacy and social change.

Retained surgical items, particularly surgical sponges, are a considered a "never event." Unfortunately, they continued to be reported despite significant efforts to reduce them. Our goal was to identify some of the earliest reports of surgical items, particularly surgical sponges, to see how it was presented in the literature as well as any insights into contributing factors and processes to mitigate the event. We progress forward in time to look at how this issue has been addresses or changed as we enter the 21st century. After this review, it appears that our advances are not as significant as those efforts proposed over 100 years ago. We view this as a call to action for significant change in our operative safety processes and to incorporate available technology.

Management of trapped lung with an underlying lung lesion and hydropneumothorax remains controversial. Furthermore, Aspergillus empyema and aspergilloma are rare pathologies for which uniportal video-assisted thoracoscopic (VATS) surgical management remains controversial. We present a young patient referred to our service after recent hospitalization for pneumonia. The patient was found to have a chronic effusion with a right lower lobe cystic parenchymal lesion and was taken to the operating room. The patient underwent right uniportal VATS surgery with evacuation of empyema, total pulmonary decortication, and right lower lobectomy. His postoperative course was unremarkable, and he was discharged home. Postoperative workup demonstrated lymphocyte variant hypereosinophilia. He continues to follow with thoracic surgery at the time of this report and remains asymptomatic. We conclude that uniportal VATS is a most minimally invasive, safe, and efficient approach for management of complex intrathoracic pathology including total pulmonary decortication and lobectomy.

Background Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health (“TWH”) leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later. Methods The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest. Results Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes. Conclusions This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business. Trial registration The trial was retrospectively registered with ClinicalTrials.gov (ID U19OH011227).

Consonants and vowels play different roles in speech perception: listeners rely more heavily on consonant information rather than vowel information when distinguishing between words. This reliance on consonants for word identification is the consonant bias Nespor et al. (Ling 2:203–230, 2003). Several factors modulate infants’ development of the consonant bias, including fine-grained temporal processing ability and native language exposure [for review, see Nazzi et al. (Curr Direct Psychol Sci 25:291–296, 2016)]. A rat model demonstrated that mature fine-grained temporal processing alone cannot account for consonant bias emergence; linguistic exposure is also necessary Bouchon and Toro (An Cog 22:839–850, 2019). This study tested domestic dogs, who have similarly fine-grained temporal processing but more language exposure than rats, to assess whether a minimal lexicon and small degree of regular linguistic exposure can allow for consonant bias development. Dogs demonstrated a vowel bias rather than a consonant bias, preferring their own name over a vowel-mispronounced version of their name, but not in comparison to a consonant-mispronounced version. This is the pattern seen in young infants Bouchon et al. (Dev Sci 18:587–598, 2015) and rats Bouchon et al. (An Cog 22:839–850, 2019). In a follow-up study, dogs treated a consonant-mispronounced version of their name similarly to their actual name, further suggesting that dogs do not treat consonant differences as meaningful for word identity. These results support the findings from Bouchon and Toro (An Cog 2:839–850, 2019), suggesting that there may be a default preference for vowel information over consonant information when identifying word forms, and that the consonant bias may be a human-exclusive tool for language learning.

Supplemental Digital Content is available in the text, Objectives: To evaluate impact of electrolyte supplementation on hydration status and health outcomes in Guatemalan agricultural workers performing heavy work under hot climatic conditions. Methods: A 3-week pragmatic trial was conducted with a group of 50 workers during the 2017 to 2018 sugarcane harvest. Workers received an electrolyte hydration intervention during 2 of the 3 weeks. Blood and urine samples were collected each week. Results: Increased electrolyte intake resulted in less muscle injury. Kidney function was maintained across the intervention period. Workers were adequately hydrated and average electrolyte levels remained in normal ranges. Mild indications of hyponatremia occurred at higher levels of fluid intake. Conclusions: This trial demonstrates the feasibility of maintaining workers’ electrolyte levels under extremely hot and humid conditions while mitigating muscle injury. Electrolyte supplementation should be added to standard workplace water, rest, and shade interventions to protect workers.

Primary lateral sclerosis (PLS) is a neurodegenerative disease characterized by progressive upper motor neuron dysfunction. Because PLS patients represent only 1 to 4% of patients with adult motor neuron diseases, there is limited information about the disease's natural history. The objective of this study was to establish a large multicenter retrospective longitudinal registry of PLS patients seen at Northeast ALS Consortium (NEALS) sites to better characterize the natural progression of PLS.

Problem: Conferences are the most common form of continuing medical education (CME), but their effect on clinician practice is inconsistent. Reflection is a critical step in the process of practice...

The ability to recognize speech that is degraded spectrally is a critical skill for successfully using a cochlear implant (CI). Previous research has shown that toddlers with normal hearing can successfully recognize noise-vocoded words as long as the signal contains at least eight spectral channels [Newman and Chatterjee. (2013). J. Acoust. Soc. Am. 133(1), 483–494; Newman, Chatterjee, Morini, and Remez. (2015). J. Acoust. Soc. Am. 138(3), EL311–EL317], although they have difficulty with signals that only contain four channels of information. Young children with CIs not only need to match a degraded speech signal to a stored representation (word recognition), but they also need to create new representations (word learning), a task that is likely to be more cognitively demanding. Normal-hearing toddlers aged 34 months were tested on their ability to initially learn (fast-map) new words in noise-vocoded stimuli. While children were successful at fast-mapping new words from 16-channel noise-vocoded stimuli, they failed to do so from 8-channel noise-vocoded speech. The level of degradation imposed by 8-channel vocoding appears sufficient to disrupt fast-mapping in young children. Recent results indicate that only CI patients with high spectral resolution can benefit from more than eight active electrodes. This suggests that for many children with CIs, reduced spectral resolution may limit their acquisition of novel words.

Purpose Previous research shows that shared storybook reading interactions can function as effective speech and language interventions for young children, helping to improve a variety of skills—including word-learning. This study sought to investigate the potential benefits of elaboration of new words during a single storybook reading with preschoolers. Method Thirty-three typically developing children ages 35–37 months listened to a storybook containing novel words that were either repeated with a definition, repeated with no additional information, or only said once. Their receptive word-learning for these novel words was then evaluated via a preferential looking task. We analyzed children's correct looks to target pictures and compared looking behavior across the three levels of presentation. Results Results showed that preschoolers demonstrated successful receptive word-learning after a single storybook reading interaction with an adult when target words were repeated, either with or without elaboration. Within this context, elaboration was not required for preschoolers' receptive word-learning. Conclusions These results support the use of storybook reading with young children as a way to foster early receptive word-learning and highlight the importance of repeated exposure to novel material either with or without additional semantic information.

Aims: Although IDS is typically described as slower than adult-directed speech (ADS), potential impacts of slower speech on language development have not been examined. We explored whether IDS speech rates in 42 mother–infant dyads at four time periods predicted children's language outcomes at two years. Method: We correlated IDS speech rate with child language outcomes at two years, and contrasted outcomes in dyads displaying high/low rate profiles. Outcomes: Slower IDS rate at 7 months significantly correlated with vocabulary knowledge at two years. Slowed IDS may benefit child language learning even before children first speak.

Purpose The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs). Methods In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined. Results In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04). Conclusion Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.

This research examined whether the auditory short-term memory (STM) capacity for speech sounds differs from that for nonlinguistic sounds in 11-month-old infants. Infants were presented with streams composed of repeating sequences of either 2 or 4 syllables, akin to prior work by Ross-Sheehy and Newman (2015) using non-linguistic musical instruments. These syllable sequences either stayed the same for every repetition (constant) or changed by one syllable each time it repeated (varying). Using the head-turn preference procedure, we measured infant listening time to each type of stream (constant vs varying and 2 vs 4 syllables). Longer listening to the varying stream was taken as evidence for STM because this required remembering all syllables in the sequence. We found that infants listened longer to the varying streams for 2-syllable sequences but not for 4-syllable sequences. This capacity limitation is comparable to that found previously for nonlinguistic instrument tones, suggesting that young infants have similar STM limitations for speech and nonspeech stimuli.

Transdermal estradiol gel is a commonly used menopausal hormone therapy. In research studies investigating the pharmacokinetics and clinical utility of transdermal estradiol gels, serum is often used to measure estradiol levels. Serum results only represent a moment in time during phlebotomy and thus provide little information and allow for limited inference unless serial measurements are performed. In contrast, dried urine may provide a representation of serum estradiol levels over a longer period of time, while also being non-invasive and easier to collect. The primary aim of this study was to evaluate a dried urine method to determine if it may be a viable option for evaluating estrogen exposure resulting from transdermal estradiol gel use. A secondary aim was to explore differences in the urinary estrogen profiles of premenopausal women on no therapy and postmenopausal women who were either on transdermal estradiol gel therapy or no therapy at all. The results of this study demonstrated that the expected dose-proportional changes in estrogen exposure can be observed in the urinary estrogen profile using a GC-MS/MS dried urine assay. The GC-MS/MS assay also showed the differences in the urinary estrogen profiles of premenopausal women, postmenopausal women on estrogen replacement therapy, and postmenopausal women on no therapy.

Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin &lt, 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2–5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson’s r = −0.32, p &lt, 0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR &lt, 90 mL/min/1.73 m2. On average, the eGFR was 18 mL/min per 1.73 m2 lower [(95% CI:−24, −12), p &lt, 0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m2 lower among those with elevated HbA1c [(95% CI: −13, −2), p &lt, 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.

The role of dissemination and implementation (DI) science is critical to the translation of

Previous work has found that preschoolers with greater phonological awareness and larger lexicons, who speak more throughout the day, exhibit less intra-syllabic coarticulation in controlled speech production tasks. These findings suggest that both linguistic experience and speech-motor control are important predictors of spoken phonetic development. Still, it remains unclear how preschoolers' speech practice when they talk drives the development of coarticulation because children who talk more are likely to have both increased fine motor control and increased auditory feedback experience. Here, the potential effect of auditory feedback is studied by examining a population—children with cochlear implants (CIs)—which is naturally differing in auditory experience. The results show that (1) developmentally appropriate coarticulation improves with an increased hearing age but not chronological age; (2) children with CIs pattern coarticulatorily closer to their younger, hearing age-matched peers than chronological age-matched peers; and (3) the effects of speech practice on coarticulation, measured using naturalistic, at-home recordings of the children's speech production, only appear in the children with CIs after several years of hearing experience. Together, these results indicate a strong role of auditory feedback experience on coarticulation and suggest that parent-child communicative exchanges could stimulate children's own vocal output, which drives speech development.

ObjectivesThere is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu).DesignWe evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points.SettingGuatemala.Participants283 sugarcane workers.Primary outcome measuresCompared self-reported smoking status and urinary cotinine levels in two agricultural worker studies.ResultsSelf-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population.ConclusionsAccording to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.

Meniscal surgery is one of the most common orthopaedic surgical interventions. Total meniscus replacements have been proposed as a solution for patients with irreparable meniscal injuries. Reliable fixation is crucial for the success and functionality of such implants. The aim of this study was to characterise an interference screw fixation system developed for a novel fibre-matrix-reinforced synthetic total meniscus replacement in an ovine cadaveric model.Textile straps were tested in tension to failure (n = 15) and in cyclic tension (70-220 N) for 1000 cycles (n = 5). The textile strap-interference screw fixation system was tested in 4.5 mm-diameter single anterior and double posterior tunnels in North of England Mule ovine tibias aged 2 years using titanium alloy (Ti6Al4Va) and polyether-ether-ketone (PEEK) screws (n ≥ 5). Straps were preconditioned, dynamically loaded for 1000 cycles in tension (70-220 N), the fixation slippage under cyclic loading was measured, and then pulled to failure.Strap stiffness was at least 12 times that recorded for human meniscal roots. Strap creep strain at the maximum load (220 N) was 0.005 following 1000 cycles. For all tunnels, pull-out failure resulted from textile strap slippage or bone fracture rather than strap rupture, which demonstrated that the textile strap was comparatively stronger than the interference screw fixation system. Pull-out load (anterior 544 ± 119 N; posterior 889 ± 157 N) was comparable to human meniscal root strength. Fixation slippage was within the acceptable range for anterior cruciate ligament graft reconstruction (anterior 1.9 ± 0.7 mm; posterior 1.9 ± 0.5 mm).These findings show that the textile attachment-interference screw fixation system provides reliable fixation for a novel ovine meniscus implant, supporting progression to in vivo testing. This research provides a baseline for future development of novel human meniscus replacements, in relation to attachment design and fixation methods. The data suggest that surgical techniques familiar from ligament reconstruction may be used for the fixation of clinical meniscal prostheses.

Purpose The purpose of this research is to determine whether individuals with a history of concussion retain enduring differences in narrative writing tasks, which necessitate rapid and complex integration of both cognitive and linguistic faculties. Method Participants aged 12–40 years old, who did or did not have a remote history of concussion, were recruited to take an online survey that included writing both a familiar and a novel narrative. They also were asked to complete multiple tasks targeting word-level and domain general cognitive skills, so that their performance could be interpreted across these dimensions. Results Participants with a concussion history were largely similar to participants with no history of brain injury across tasks that targeted a single skill in isolation. However, participants with prior concussions demonstrated difficulty in providing both key content and details when presented with a novel video and asked to provide a summary of what they had just seen. Number of lifetime concussions predicted the inclusion of key content when summarizing the video. Thus, differences in cognitive and linguistic skills required for written narrative language may continue to be present far after concussion, despite average normative levels of performance on tasks targeting these skills in isolation. Conclusions These findings suggest that individuals with a concussion history, particularly a history of multiple concussions, may continue to experience difficulties for a long period after injury and are likely to benefit from more complex and ecologically valid assessment prior to discharge. Individuals with a concussion history who return to full participation in work, school, and recreational activities may continue to benefit from assistance when asked to rapidly acquire and distill novel information, as is often required in academic and professional environments.

Purpose: Several studies have explored relationships between children’s early phonological development and later language performance. This literature has included a more recent focus on the potential for early phonological profiles to predict later language outcomes. Methods: The present study longitudinally examined the nature of phonetic inventories and syllable structure patterns of 48 typically developing children at 7, 11, and 18 months, and related them to expressive language outcomes at 2 years of age. Results: Findings provide evidence that as early as 11 months, phonetic inventory and mean syllable structure level are related to 24-month expressive language outcomes, including mean length of utterance and vocabulary diversity in spontaneous language samples, and parent-reported vocabulary scores. Consonant inventories in particular differed at 11 and 18 months for 2-year-olds with lower versus higher language skills. Conclusion: Limited inventories and syllable repertoires may add to risk profiles for later language delays.

Hearing words in sentences facilitates word recognition in monolingual children. Many children grow up receiving input in multiple languages – including exposure to sentences that ‘mix’ the languages. We explored Spanish–English bilingual toddlers’ (n = 24) ability to identify familiar words in three conditions: (i) single word (ball!); (ii) same-language sentence (Where's the ball?); or (iii) mixed-language sentence (Dónde está la ball?). Children successfully identified words across conditions; however, the advantage linked to hearing words in sentences was present only in the same-language condition. This work hence suggests that language mixing plays an important role on bilingual children's ability to recognize spoken words.

Objective The aim of this study was to conduct a cross-sectional assessment of the adoption of Total Worker Health (TWH) policies and practices by business size and evaluate extent and alignment of their safety and health. Methods We conducted an analysis of 382 businesses that completed the Health Links Assessment. We measured organizational adoption of TWH across six benchmarks: organizational supports, workplace assessments, health policies and programs, safety, engagement, and evaluation. Results Benchmark scores were significantly associated with business size. Larger businesses were more likely to score higher across each benchmark. Conclusion Small businesses are implementing TWH in a variety of ways and the level of implementation differs by business size. Practical interventions as well as dissemination and implementation research should take business size into account to ensure that TWH is both effective and sustainable in meeting the needs of employees.

International audience; Phonetic categories must be learned, but the processes that allow that learning to unfold are still under debate. The current study investigates constraints on the structure of categories that can be learned and whether these constraints are speech-specific. Category structure constraints are a key difference between theories of category learning, which can roughly be divided into instance-based learning (i.e., exemplar only) and abstractionist learning (i.e., at least partly rule-based or prototype-based) theories. Abstractionist theories can relatively easily accommodate constraints on the structure of categories that can be learned, whereas instance-based theories cannot easily include such constraints. The current study included three groups to investigate these possible constraints as well as their speech specificity English speakers learning German speech categories, German speakers learning German speech categories, and English speakers learning musical instrument categories, with each group including participants who learned different sets of categories. Both speech groups had greater difficulty learning disjunctive categories (ones that require an or statement) than nondisjunctive categories, which suggests that instance-based learning alone is insufficient to explain the learning of the participants learning phonetic categories. This fact was true for both novices (English speakers) and experts (German speakers), which implies that expertise with the materials used cannot explain the patterns observed. However, the same was not true for the musical instrument categories, suggesting a degree of domain-specificity in these constraints that cannot be explained through recourse to expertise alone.

Supplemental Digital Content is available in the text, Objective: Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu). Methods: We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker. Results: The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function. Conclusions: Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.

In the United States, citizens opposed to stricter gun control laws as a response to mass shootings frequently reframe the problem of gun violence as a mental health issue. As a result, it has been suggested that pro-gun attitudes (i.e., pro-gun rights attitudes and favorable attitudes toward the National Rifle Association) might be associated with stigmatizing attitudes toward people with mental illness. In three studies (total N = 756), we assessed gun attitudes as predictors of mental illness stigma among college students in the United States (data collected in 2018 and 2019). While zero-order correlations revealed that pro-gun attitudes predict more negative attitudes toward people with mental illness, they were not unique predictors after adjusting for political affiliation. These findings replicate previous research on the relationship between conservatism and mental illness stigma and provide a starting point for future research assessing relationships between gun attitudes, political affiliation, and mental illness stigma. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Purpose Children with cochlear implants (CIs) are more likely to struggle with spoken language than their age-matched peers with normal hearing (NH), and new language processing literature suggests that these challenges may be linked to delays in spoken word recognition. The purpose of this study was to investigate whether children with CIs use language knowledge via semantic prediction to facilitate recognition of upcoming words and help compensate for uncertainties in the acoustic signal. Method Five- to 10-year-old children with CIs heard sentences with an informative verb ( draws ) or a neutral verb ( gets ) preceding a target word ( picture ). The target referent was presented on a screen, along with a phonologically similar competitor ( pickle ). Children's eye gaze was recorded to quantify efficiency of access of the target word and suppression of phonological competition. Performance was compared to both an age-matched group and vocabulary-matched group of children with NH. Results Children with CIs, like their peers with NH, demonstrated use of informative verbs to look more quickly to the target word and look less to the phonological competitor. However, children with CIs demonstrated less efficient use of semantic cues relative to their peers with NH, even when matched for vocabulary ability. Conclusions Children with CIs use semantic prediction to facilitate spoken word recognition but do so to a lesser extent than children with NH. Children with CIs experience challenges in predictive spoken language processing above and beyond limitations from delayed vocabulary development. Children with CIs with better vocabulary ability demonstrate more efficient use of lexical-semantic cues. Clinical interventions focusing on building knowledge of words and their associations may support efficiency of spoken language processing for children with CIs. Supplemental Material https://doi.org/10.23641/asha.14417627

Objective Little is understood about the mechanisms for improving the adoption and implementation of Total Worker Health® (TWH) in workplace settings. The primary objective of this study was to identify whether the delivery of TWH advising is associated with subsequent changes in TWH in small-to-medium sized businesses. Methods We conducted a longitudinal study of a TWH intervention in 200 organizations completing Health Links Healthy Workplace Assessments™ between October 2016 and December 2019. Organizations were offered consultation via telephonic and live web-based advising sessions. Results Organizations exhibited non-significant albeit positive change in assessment scores from baseline to assessment 2. Businesses receiving advising showed significant score improvements from assessment 2 to 3, versus those without advising. Conclusions TWH consultation may enhance adoption of organizational behaviors that promote worker health, safety, and well-being over time.

This manuscript introduces BITTSy, the Behavioral InfantToddler Testing System. This software system is capable of running the headturn preference procedure, preferential looking, conditioned headturn, and visual fixation/habituation procedures. It uses only commercial-off-theshelf (COTS) hardware to implement the procedures in an affordable and space-efficient setup. The software package, example protocols and data sets, and manual are freely available and downloadable from go.umd.edu/BITTSy, making this entire set of procedures available to resource-limited labs. Researchers can easily use BITTSy at multiple sites in a uniform manner, resulting in a standardized, powerful research tool that can enhance cross-site research collaborations.

Rapidly progressive idiopathic arthritis of the hip (RPIA) is defined by progressive joint space narrowing of 2 mm or 50% within 1 year. Our aims were to assess (a) the occurrence of RPIA after intra-articular steroid injection, and (b) possible risk factors for RPIA including: patient age, BMI, joint space narrowing, anesthetic and steroid selections, bone mineral density, and pain reduction after injection.A retrospective search of our imaging database identified 1471 patients who had undergone fluoroscopically guided hip injection of triamcinolone acetonide (Kenalog) and anesthetic within a 10-year period. Patient data, including hip DXA results and patient-reported pain scores, were recorded. Pre-injection and follow-up radiographs were assessed for joint space narrowing, femoral head deformity, and markers of osteoarthritis. Osteoarthritis was graded by Croft score. Associations between patient characteristics and outcome variables were analyzed.One hundred six of 1471 injected subjects (7.2%) met the criteria for RPIA. A control group of 161 subjects was randomly selected from subjects who underwent hip injections without developing RPIA. Compared to controls, patients with RPIA were older, had narrower hip joint spaces, and higher Croft scores before injection (p 0.05). Patients who developed RPIA did not differ from controls in sex, BMI, hip DXA T-score, anesthetic and steroid injectates, or pain improvement after injection.We found that approximately 7% of patients undergoing steroid hip injection developed RPIA. More advanced patient age, greater joint space narrowing, and more severe osteoarthritis are risk factors for the development of RPIA after intra-articular steroid injection.

Background Adults and adolescents with autism spectrum disorders show greater difficulties comprehending speech in the presence of noise. Moreover, while neurotypical adults use visual cues on the mouth to help them understand speech in background noise, differences in attention to human faces in autism may affect use of these visual cues. No work has yet examined these skills in toddlers with ASD, despite the fact that they are frequently faced with noisy, multitalker environments. Methods Children aged 2-5 years, both with and without autism spectrum disorder (ASD), saw pairs of images in a preferential looking study and were instructed to look at one of the two objects. Sentences were presented in the presence of quiet or another background talker (noise). On half of the trials, the face of the target person speaking was presented, while half had no face present. Growth-curve modeling was used to examine the time course of children’s looking to the appropriate vs. opposite image. Results Noise impaired performance for both children with ASD and their age- and language-matched peers. When there was no face present on the screen, the effect of noise was generally similar across groups with and without ASD. But when the face was present, the noise had a more detrimental effect on children with ASD than their language-matched peers, suggesting neurotypical children were better able to use visual cues on the speaker’s face to aid performance. Moreover, those children with ASD who attended more to the speaker’s face showed better listening performance in the presence of noise. Conclusions Young children both with and without ASD show poorer performance comprehending speech in the presence of another talker than in quiet. However, results suggest that neurotypical children may be better able to make use of face cues to partially counteract the effects of noise. Children with ASD varied in their use of face cues, but those children who spent more time attending to the face of the target speaker appeared less disadvantaged by the presence of background noise, indicating a potential path for future interventions.

The purpose of this study was to assess the validity of a practical diabetes risk score amongst two heterogenous populations, a working population and a non-working population. Study population 1 (n = 2,089) participated in a large-scale screening program offered to retired workers to discover previously undetected/incipient chronic illness. Study population 2 (n = 3,293) was part of a Colorado worksite wellness program health risk assessment. We assessed the relationship between a continuous diabetes risk score at baseline and development of diabetes in the future using logistic regression. Receiver operating curves and sensitivity/specificity of the models were calculated. Across both study populations, we observed that participants with diabetes at follow-up had higher diabetes risk scores at baseline than participants who did not have diabetes at follow-up. On average, the odds ratio of developing diabetes in the future was 1.38 (95% CI: 1.26–1.50, p < 0.0001) for study population 1 and 1.68 (95% CI: 1.45–1.95, p-value < 0.0001) for study population 2. These findings indicate that the diabetes risk score may be generalizable to diverse individuals, and thus potentially a population level diabetes screening tool. Minimally-invasive diabetes risk scores can aid in the identification of sub-populations of individuals at risk for diabetes.

Background The Total Worker Health® (TWH) approach is a best practice method to protect and promote worker safety, health, and well-being. Central to this approach is leadership support and health and safety climates that support day-to-day use of health and safety policies and programs. There is some research that supports these relationships, but there is limited research amongst small businesses. Furthermore, it remains to be shown what role TWH business strategies, as reflected by organizational policies and programs, play in this process. The purpose of this study is to characterize small businesses by their organizations’ TWH approach and assess the relationship of these approaches to employee health and safety behaviors. Methods We utilized cross-sectional data from 97 businesses participating in the Small+Safe+Well study. We collected data using a business assessment tool, Healthy Workplace Assessment™, and an employee assessment tool, Employee Health and Safety Culture Survey. We used latent profile analysis at the business level to identify subgroups of businesses based on a set of characteristics from these assessments. Linear regression analysis at the employee level was used to determine profile association with employee safety and health behaviors. Results There were two profiles characterized by the lowest (33% of all businesses) and highest (9%) levels of the indicators. There were also two profiles with higher scores on two of the different foci on either TWH business strategies (27%) or leadership and climate (31%). Employees working for a business with a profile that focused on leadership and climate, in addition to having a business strategy, reported the best safety and health behaviors. Conclusions Our study demonstrates that employee engagement in TWH will be highest when businesses have a strategy for how they implement a TWH approach and when they demonstrate leadership commitment to these strategies and foster positive safety and health climates. Our results offer suggestions on how to use TWH assessments to develop interventions for small businesses. More research is needed to understand whether small businesses can improve upon their profile overtime, whether these changes depend on contextual factors, and whether TWH interventions can help them improve their profile.

OBJECTIVE: This study examines employee perceptions of safety and health climates for well-being during the COVID-19 pandemic in a sample of small businesses. METHODS: We evaluated changes to employees' work and home life resulting from COVID-19 and perceptions of safety and health climates. Cross-sectional relationships were assessed using multivariable linear regression models for a sample of 491 employees from 30 small businesses in Colorado in May 2020. RESULTS: Employee perceptions of safety and health climates were significantly related to their self-reported well-being during the first wave of COVID-19, even when there were changes to childcare, the ability to work, and limited social contacts. CONCLUSION: Safety and health climates may influence employee well-being even when other disruptions occur, suggesting that during emergencies, small businesses with strong climates may be better prepared to maintain employee well-being.

Background Dyad learning has been shown to be an effective tool for teaching procedural skills, but little is known about how dyad learning may impact the stress, anxiety, and cognitive load that a student experiences when learning in this manner. In this pilot study, we investigate the relationship between dyad training on stress, anxiety, cognitive load, and performance in a simulated bradycardia scenario. Methods Forty-one fourth-year medical school trainees were randomized as dyads (n = 24) or individuals (n = 17) for an education session on day 1. Reassessment occurred on day 4 and was completed as individuals for all trainees. Primary outcomes were cognitive load (Paas scale), stress (Cognitive Appraisal Ratio), and anxiety levels (abbreviated State-Trait Anxiety Inventory). Secondary outcomes were time-based performance metrics. Results On day 1 we observed significant differences for change in anxiety and stress measured before and after the training scenario between groups. Individuals compared to dyads had larger mean increases in anxiety, (19.6 versus 7.6 on 80-point scale, p = 0.02) and stress ratio (1.8 versus 0.9, p = 0.045). On the day 4 post-intervention assessment, no significant differences were observed between groups. Secondary outcomes were significant for shorter time to diagnosis of bradycardia (p = 0.01) and time to initiation of pacing (p = 0.04) in the dyad group on day 1. On day 4, only time to recognizing the indication for pacing was significantly shorter for individual training (hazard ratio [HR] = 2.26, p = 0.02). Conclusions Dyad training results in lower stress and anxiety levels with similar performance compared to individual training.

As global temperatures continue to rise it is imperative to understand the adverse effects this will pose to workers laboring outdoors. The purpose of this study was to investigate the relationship between increases in wet bulb globe temperature (WBGT) and risk of occupational injury or dehydration among agricultural workers. We used data collected by an agribusiness in Southwest Guatemala over the course of four harvest seasons and Poisson generalized linear modelling for this analysis. Our analyses suggest a 3% increase in recorded injury risk with each degree increase in daily average WBGT above 30 &deg, C (95% CI: &minus, 6%, 14%). Additionally, these data suggest that the relationship between WBGT and injury risk is non-linear with an additional 4% acceleration in risk for every degree increase in WBGT above 30 &deg, C (95% CI: 0%, 8%). No relationship was found between daily average WBGT and risk of dehydration. Our results indicate that agricultural workers are at an increased risk of occupational injury in humid and hot environments and that businesses need to plan and adapt to increasing global temperatures by implementing and evaluating effective occupational safety and health programs to protect the health, safety, and well-being of their workers.

An epidemic of chronic kidney disease of unknown origin (CKDu) has emerged in the past two decades in agricultural communities, characterized by progressive renal failure with a dearth of early clinical symptoms. The aim of this study is to improve understanding of the natural history of this disease and to evaluate the impact of an educational and behavioral intervention on the trajectories of renal decline among a cohort of Guatemalan sugarcane workers. We identified groups of workers based on their kidney function during a longitudinal parent study conducted among sugarcane workers during the 2016&ndash, 2017 harvest season. At the study&rsquo, s first time point in February 2017, workers who developed abnormal kidney function (AKF) (estimated glomerular filtration rate, eGFR, &lt, 60 mL/min per 1.73 m2) were placed in the AKF group, workers with reduced kidney function (RKF) (eGFR 60&ndash, 89) were placed in the RKF group, and workers who maintained normal kidney function (NKF) (eGFR &ge, 90) were placed in the NKF group. As part of the study, a health promotion, behavioral and educational intervention centered on water, electrolytes, rest, and shade (WERS) was provided to all study participants. We then prospectively analyzed renal function at the three study time points in February, March, and April. Additional data collected from previous harvests allowed for retrospective analysis and we compared the rate of change in eGFR over the previous five years (2012 to 2016) for each identified group. Mixed effects linear regression with random intercepts for the workers was used to investigate the difference in rates of change for the three groups and to assess the impact of the intervention study on rate of change of kidney function during the study compared to each group&rsquo, s prior trajectory, utilizing the retrospective data collected during the five years prior to the study intervention. Between 2012 and 2016, eGFR declined at a rate of 0.18 mL/min per 1.73 m2 per year for the NKF group (95% CI: &minus, 0.66, 0.29, p = 0.45), 2.02 per year for the RKF group (95% CI: 1.00, 3.03, p = 0.0001) and 7.52 per year for the AKF group (95% CI: 6.01, 9.04, p &lt, 0.0001). All study groups stabilized or improved their trajectory of decline during the intervention. This study supports the need to institute WERS interventions and to include mid-harvest screening protocols and longitudinal tracking of kidney function among sugarcane workers at high risk of CKDu. Early detection of rapid kidney function decline combined with appropriate interventions hold promise for stopping or slowing progression of renal insufficiency among these workers.

Viewers’ perception of actions is coloured by the context in which those actions are found. An action that seems uncomfortably sudden in one context might seem expeditious in another. In this study, we examined the influence of one type of context: the rate at which an action is being performed. Based on parallel findings in other modalities, we anticipated that viewers would adapt to the rate at which actions were displayed at. Viewers watched a series of actions performed on a touchscreen that could end in actions that were ambiguous to their number (e.g., two separate “tap” actions versus a single “double tap” action) or identity (e.g., a “swipe” action versus a slower “drag”). In Experiment 1, the rate of actions themselves was manipulated; participants used the rate of the actions to distinguish between two similar, related actions. In Experiment 2, the rate of the actions that preceded the ambiguous one was sped up or slowed down. In line with our hypotheses, viewers perceived the identity of those final actions with reference to the rate of the preceding actions. This was true even in Experiment 3, when the action immediately before the ambiguous one was left unmodified. Ambiguous actions embedded in a fast context were seen as relatively long, while ambiguous actions embedded in a slow context were seen as relatively short. This shows that viewers adapt to the rate of actions when perceiving visual events.

Background: Sugarcane workers in Central America experience a heavy burden of chronic kidney disease of unknown origin. We conducted a pilot study among worker proxies in Guatemala to characterize exposures to particulate matter, silica, heavy metals, and glyphosate, as well as to examine potential nephrotoxic exposures. Methods: Air, soil, and ash samples were collected and analyzed using scanning electron microscopy, X-ray diffraction, inductively coupled plasma mass spectrometry, and an enzyme-linked immunosorbent assay. Results: The average mass concentration for particulate matter (PM)2.5 and PM100 exposures were 360 &micro, g/m3 (range: 32 to 1500 &micro, g/m3) and 555 &micro, g/m3 (range: 229 to 1170 &micro, g/m3), respectively. The elemental composition of particles was largely silicon. The amount of crystalline silica was below 5 &mu, g, yet the percentage of total silica was ~17% by weight. Putatively, the silica was in the amorphous form. Concentrations of aluminum and calcium ranged from 2&ndash, 7 &mu, g/m3. Glyphosate was not detectable in analyzed air samples but was detectable at concentrations ranging from 81&ndash, 165 ppb in soil samples. Conclusion: Sugarcane workers are exposed to high concentrations of particulate matter. Future studies should investigate the potential role of silica, heavy metals, and agrochemicals in the etiology of chronic kidney disease in this population.

To identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values.Consecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed.Of 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these "missed" patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction.There were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non-ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.