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BACKGROUND: Smokers manifest varied phenotypes of pulmonary impairment. RESEARCH QUESTION: Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers? STUDY DESIGN AND METHODS: We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV(1) to FVC ratio, < 0.70). RESULTS: Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV(1) and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts. INTERPRETATION: Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV(1) and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.

Purpose We report on a study that replicates previous treatment studies using Abstract Semantic Associative Network Training (AbSANT), which was developed to help persons with aphasia improve their ability to retrieve abstract words, as well as thematically related concrete words. We hypothesized that previous results would be replicated; that is, when abstract words are trained using this protocol, improvement would be observed for both abstract and concrete words in the same context-category, but when concrete words are trained, no improvement for abstract words would be observed. We then frame the results of this study with the results of previous studies that used AbSANT to provide better evidence for the utility of this therapeutic technique. We also discuss proposed mechanisms of AbSANT. Method Four persons with aphasia completed one phase of concrete word training and one phase of abstract word training using the AbSANT protocol. Effect sizes were calculated for each word type for each phase. Effect sizes for this study are compared with the effect sizes from previous studies. Results As predicted, training abstract words resulted in both direct training and generalization effects, whereas training concrete words resulted in only direct training effects. The reported results are consistent across studies. Furthermore, when the data are compared across studies, there is a distinct pattern of the added benefit of training abstract words using AbSANT. Conclusion Treatment for word retrieval in aphasia is most often aimed at concrete words, despite the usefulness and pervasiveness of abstract words in everyday conversation. We show the utility of AbSANT as a means of improving not only abstract word retrieval but also concrete word retrieval and hope this evidence will help foster its application in clinical practice.

This article describes a 12-year collaboration between a special collections librarian and history faculty for an undergraduate history writing course at Vanderbilt University. Originally taught as...

Purpose The purpose of this ongoing project was to provide speech-language pathologists who serve culturally and linguistically diverse populations with a freely available online tool for naming therapy in a variety of languages. The purpose of this clinical focus article was to report on this resource in an effort to make known its existence, its instructions for use, and the evidence-based practices from which it was developed. Method The website, http://bilingualnamingtherapy.psu.edu/ , was created by the research team in collaboration with a web programmer using Amazon Web Services. The treatment protocol for the website was adapted from an evidence-based naming intervention in which clients select and verify appropriate semantic features for the target words. This protocol comes from the work of Kiran and colleagues ( Edmonds & Kiran, 2006 ; Kiran & Iakupova, 2011 ; Kiran & Lo, 2013 ; Kiran & Roberts, 2010 ; Kiran, Sandberg, Gray, Ascenso, & Kester, 2013 ; Krishnan, Tiwari, Kiran, & Chengappa, 2014 ), who showed positive benefits of this therapy within and across languages in bilingual persons with aphasia. The stimuli for the online therapy were developed in a variety of languages. First, words and semantic features were translated from English to 10 different languages. Next, surveys were created using Qualtrics software and posted on Amazon Mechanical Turk to verify picture labels and semantic features for each word in each language. The results of these surveys guided the stimuli used for each language on the website. An interactive website was developed to allow clinicians to select a set of words and progress through a series of steps. A step-by-step tutorial on how to use this website is also included in this article. Conclusions The interactive online naming therapy described in this article is currently available in English and Spanish, with Chinese under construction. Several more languages are in various stages of preparation for use on the website, and suggestions for additional languages are being actively sought. http://bilingualnamingtherapy.psu.edu/ promises to be a useful tool for speech-language pathologists who work with culturally and linguistically diverse clients. This website provides naming therapy materials, adapted from an evidence-based protocol, in a variety of languages, that have been developed based on feedback from speakers of each language to maximize cultural and linguistic appropriateness.

Genome-wide association studies (GWAS) have identified multiple associations with emphysema apicobasal distribution (EABD), but the biological functions of these variants are unknown. To characterize the functions of EABD-associated variants, we integrated GWAS results with 1) expression quantitative trait loci (eQTL) from the Genotype Tissue Expression (GTEx) project and subjects in the COPDGene (Genetic Epidemiology of COPD) study and 2) cell type epigenomic marks from the Roadmap Epigenomics project. On the basis of these analyses, we selected a variant near ACVR1B (activin A receptor type 1B) for functional validation. SNPs from 168 loci with P values less than 5 × 10(−5) in the largest GWAS meta-analysis of EABD were analyzed. Eighty-four loci overlapped eQTL, with 12 of these loci showing greater than 80% likelihood of harboring a single, shared GWAS and eQTL causal variant. Seventeen cell types were enriched for overlap between EABD loci and Roadmap Epigenomics marks (permutation P

Rationale: Increasing awareness of the prevalence and significance of Preserved Ratio Impaired Spirometry (PRISm), alternatively known as restrictive or Global Initiative for Chronic Obstructive Lu...

Background: Bilinguals with post-stroke aphasia (BWA) require treatment options that are sensitive to their particular bilingual background and deficits across languages. However, they may experience limited access to bilingual clinical resources due to reduced availability of bilingual practitioners, geographical constraints, and other difficulties. Telerehabilitation can improve access to bilingual clinical services for BWA and facilitate the delivery of specific language treatments at distance, but more evidence on its effectiveness and reliability is needed. This study aimed to determine the equivalence of effectiveness and reliability of a semantic treatment for word retrieval deficits in BWA delivered via telerehabilitation relative to in-person therapy.Methods: We examined the retrospective data of 16 BWA who received 20 sessions of therapy based on semantic feature analysis for word retrieval deficits in person (n = 8) or via telerehabilitation (n = 8). The two groups were comparable on age, years of education, time of post-stroke onset, aphasia severity, and naming ability in both languages. Treatment effectiveness (i.e., effect sizes in the treated and the untreated language, and change on secondary outcome measures) and reliability (i.e., clinician adherence to treatment protocol) were computed for each delivery modality and compared across groups.Results: Significant improvements were observed in most patients, with no significant differences in treatment effect sizes or secondary outcomes in the treated and the untreated language between the teletherapy group and the in-person therapy group. Also, the average percentage of correctly delivered treatment steps by clinicians was high for both therapy delivery methods with no significant differences between the telerehabilitation vs. the in-person modality.Discussion: This study provides evidence of the equivalence of treatment gains between teletherapy and in-person therapy in BWA and the high reliability with which treatment for word retrieval deficits can be delivered via telerehabilitation, suggesting that the essential treatment components of the intervention can be conducted in a comparable manner in both delivery modalities. We further discuss the benefits and potential challenges of the implementation of telerehabilitation for BWA. In the future, telerehabilitation may increase access to therapy for BWA with varying linguistic and cultural backgrounds, thus, offering a more inclusive treatment approach to this population.

Contains fulltext : 220761.pdf (Publisher’s version ) (Open Access) Rationale: The decades-long progression of chronic obstructive pulmonary disease (COPD) renders identifying different trajectories of disease progression challenging.Objectives: To identify subtypes of patients with COPD with distinct longitudinal progression patterns using a novel machine-learning tool called "Subtype and Stage Inference" (SuStaIn) and to evaluate the utility of SuStaIn for patient stratification in COPD.Methods: We applied SuStaIn to cross-sectional computed tomography imaging markers in 3,698 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-4 patients and 3,479 controls from the COPDGene (COPD Genetic Epidemiology) study to identify subtypes of patients with COPD. We confirmed the identified subtypes and progression patterns using ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) data. We assessed the utility of SuStaIn for patient stratification by comparing SuStaIn subtypes and stages at baseline with longitudinal follow-up data.Measurements and Main Results: We identified two trajectories of disease progression in COPD: a "Tissue-->Airway" subtype (n = 2,354, 70.4%), in which small airway dysfunction and emphysema precede large airway wall abnormalities, and an "Airway-->Tissue" subtype (n = 988, 29.6%), in which large airway wall abnormalities precede emphysema and small airway dysfunction. Subtypes were reproducible in ECLIPSE. Baseline stage in both subtypes correlated with future FEV1/FVC decline (r = -0.16 [P < 0.001] in the Tissue-->Airway group; r = -0.14 [P = 0.011] in the Airway-->Tissue group). SuStaIn placed 30% of smokers with normal lung function at elevated stages, suggesting imaging changes consistent with early COPD. Individuals with early changes were 2.5 times more likely to meet COPD diagnostic criteria at follow-up.Conclusions: We demonstrate two distinct patterns of disease progression in COPD using SuStaIn, likely representing different endotypes. One third of healthy smokers have detectable imaging changes, suggesting a new biomarker of "early COPD."

Meconium is the first neonatal feces and is often chosen over other maternal and/or neonatal matrices to identify neonatal drug exposure. Meconium is primarily composed of mucopolysaccharides, water, bile salts, bile acids, epithelial cells, and other lipids. Meconium is usually excreted within the first 1–3 days of life, and specimens are easily and non-invasively collected from soiled diapers. Contamination by neonatal urine is possible if urine collection devices are not employed. Drugs, metabolites, and other exogenous agents are theorized to deposit in meconium through biliary excretion following fetal hepatic metabolism and by swallowing contaminated amniotic fluid. Because accumulation begins around the 12th week of gestation, meconium is assumed to reflect drug exposure in the second and trimesters, representing the longest window of drug detection among neonatal matrices. Meconium testing is performed in a common forensic manner, involving screening and confirmation (if the screening results are above a pre-determined cutoff). However, due to the nature of the matrix, more expensive specimen preparation is required before analysis.

Background Previous investigations in adult smokers from the COPDGene Study have shown that early-life respiratory disease is associated with reduced lung function, COPD, and airway thickening. Using 5-year follow-up data, we assessed disease progression in subjects who had experienced early-life respiratory disease. We hypothesized that there are alternative pathways to reaching reduced FEV 1 and that subjects who had childhood pneumonia, childhood asthma, or asthma-COPD overlap (ACO) would have less lung function decline than subjects without these conditions. Methods Subjects returning for 5-year follow-up were assessed. Childhood pneumonia was defined by self-reported pneumonia at Results Follow-up data from 4,915 subjects were examined, including 407 subjects who had childhood pneumonia, 323 subjects who had childhood asthma, and 242 subjects with ACO. History of childhood asthma or ACO was associated with an increased exacerbation frequency (childhood asthma, P P = .006) and odds of severe exacerbations (childhood asthma, OR, 1.41; ACO, OR, 1.42). History of childhood pneumonia was associated with increased exacerbations in subjects with COPD (absolute difference [β], 0.17; P = .04). None of these early-life respiratory diseases were associated with an increased rate of lung function decline or progression on CT scans. Conclusions Subjects who had early-life asthma are at increased risk of developing COPD and of having more active disease with more frequent and severe respiratory exacerbations without an increased rate of lung function decline over a 5-year period. Trial Registry ClinicalTrials.gov; No. NCT00608764; https://clinicaltrials.gov.

In this study we examined linguistic and non-linguistic control mechanisms in 20 Spanish–English neurologically healthy bilingual adults and 13 Spanish–English bilingual adults with aphasia. Participants completed two linguistic and two non-linguistic control tasks accounting for low and high complexity. Healthy bilingual results were indicative of domain general cognitive control, whereas patient results were indicative of domain specific cognitive control. The magnitude of conflict required to complete the tasks was also examined. Healthy bilinguals exhibited significant amounts of conflict on all tasks and linguistic and non-linguistic conflict ratios were correlated; whereas patient results revealed significant conflict only on non-linguistic tasks and those conflict ratios were not correlated with linguistic conflict ratios, indicating a dissociation between how patients are controlling information in these two domains. Finally, a relationship between language impairment and language control was identified and brain damage was associated with linguistic and non-linguistic task performance.

Contains fulltext : 194255.pdf (Publisher’s version ) (Open Access) BACKGROUND: Emphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized. METHODS: We sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared. RESULTS: Three clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted. CONCLUSIONS: Subgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD.

Introduction: This article presents a novel approach to anomia therapy (i.e., BAbSANT: Bilingual Abstract Semantic Associative Network Training) for bilingual persons with aphasia (B-PWA) that capitalizes both on lexico-semantic theories in bilingualism and general theories of semantic organization and learning. Based on previous work, we hypothesized that training abstract words in either language would promote within-language generalization, while training in the nondominant language would promote both within- and cross-language generalization. Methods: This case study used a single-subject A1BA2CA3 design. The participant was living with aphasia secondary to stroke and spoke both Polish and English, with Polish being his native and dominant language. Phase B consisted of abstract word training in Polish and phase C consisted of abstract word training in English. Prior to initiating therapy, in addition to a comprehensive language battery, we administered a cognitive control task to explore the relationship between cognitive control and treatment outcome. Results: We found within-language generalization regardless of the trained language, replicating previous work in monolingual persons with aphasia, further supporting the utility of training abstract words. However, contrary to our second hypothesis, cross-language generalization only occurred when the stronger language was trained. Conclusions: The discussion of the results of this case study is framed within previous work and theories of bilingualism. The lack of cross-language generalization when the weaker language was trained is discussed, taking into account nonverbal cognitive control deficits. In addition to showing the efficacy of BAbSANT, these results highlight the importance of considering cognitive control as a factor influencing therapeutic outcomes in anomia treatment in bilingual PWA.

This article discusses key issues that relate to bilingual aphasia and intervention techniques. The primary topics include: (a) an intervention roadmap that outlines diagnostic procedures and the importance of obtaining a comprehensive language profile for a bilingual person with aphasia, and (b) the theoretical underpinnings of bilingual language control, lexical access impairment, and bilingual control impairment.

Rationale: The American Thoracic Society (ATS)/European Respiratory Society defines a positive bronchodilator response (BDR) by a composite of BDR in either forced expiratory volume in 1 second (FEV(1)) and/or forced vital capacity (FVC) greater than or equal to 12% and 200 ml (ATS-BDR). We hypothesized that ATS-BDR components would be differentially associated with important chronic obstructive pulmonary disease (COPD) outcomes. Objectives: To examine whether ATS-BDR components are differentially associated with clinical, functional, and radiographic features in COPD. Methods: We included subjects with COPD enrolled in the COPDGene study. In the main analysis, we excluded subjects with self-reported asthma. We categorized BDR into the following: 1) No-BDR, no BDR in either FEV(1) or FVC; 2) FEV(1)-BDR, BDR in FEV(1) but no BDR in FVC; 3) FVC-BDR, BDR in FVC but no BDR in FEV(1); and 4) Combined-BDR, BDR in both FEV(1) and FVC. We constructed multivariable logistic, linear, zero-inflated negative binomial, and Cox hazards models to examine the association of BDR categories with symptoms, computed tomography findings, change in FEV(1) over time, respiratory exacerbations, and mortality. We also created models using the ATS BDR definition (ATS-BDR) as the main independent variable. Results: Of 3,340 COPD subjects included in the analysis, 1,083 (32.43%) had ATS-BDR, 182 (5.45%) had FEV(1)-BDR, 522 (15.63%) had FVC-BDR, and 379 (11.34%) had Combined-BDR. All BDR categories were associated with FEV(1) decline compared with No-BDR. Compared with No-BDR, both ATS-BDR and Combined-BDR were associated with higher functional residual capacity %predicted, greater internal perimeter of 10 mm, and greater 6-minute-walk distance. In contrast to ATS-BDR, Combined-BDR was independently associated with less emphysema (adjusted beta regression coefficient, −1.67; 95% confidence interval [CI], −2.68 to −0.65; P = 0.001), more frequent respiratory exacerbations (incidence rate ratio, 1.25; 95% CI, 1.03–1.50; P = 0.02) and severe exacerbations (incidence rate ratio, 1.34; 95% CI, 1.05–1.71; P = 0.02), and lower mortality (adjusted hazards ratio, 0.76; 95% CI, 0.58–0.99; P = 0.046). Sensitivity analysis that included subjects with self-reported history of asthma showed similar findings. Conclusions: BDR in both FEV(1) and FVC indicates a COPD phenotype with asthma-like characteristics, and provides clinically more meaningful information than current definitions of BDR.

The bilingual advantage proposes that bilingual individuals have enhanced cognitive control compared to their monolingual counterparts. Bilingualism has also been shown to contribute to cognitive reserve by offsetting the behavioral presentation of brain injury or neural degeneration. However, this effect has not been closely examined in individuals with post-stroke or post-TBI aphasia. Because bilingualism has been suggested as a factor of cognitive reserve, it may provide protective mechanisms for adults with aphasia. In the current study, evidence for the bilingual advantage was examined in 13 Spanish-English bilingual healthy adults (BHA) compared to 13 English monolingual healthy adults (MHA). Additionally, evidence for cognitive reserve as defined by a bilingual advantage was examined in 18 Spanish-English bilingual adults with aphasia (BAA) compared to 18 English monolingual adults with aphasia (MAA) who were otherwise matched on their age, education, language impairment, and non-verbal executive functions. All participants completed a non-linguistic cognitive control task that included congruent and incongruent conditions. Results indicated no bilingual cognitive control advantage on reaction times in healthy adult groups; however, BAA were faster than MAA, suggesting that bilingualism may contribute to cognitive reserve in adults with aphasia. Thus, manipulating multiple languages throughout the lifetime may be protective after an acquired brain injury.

Spirometric Volumes and Breathlessness Across Levels of Airflow Limitation : The COPDGene Study.

BACKGROUND:Eosinophilic airway inflammation in patients with chronic obstructive pulmonary disease (COPD) is associated with exacerbations and responsivity to steroids, suggesting potential shared mechanisms with eosinophilic asthma. However, there is no consistent blood eosinophil count that has been used to define the increased exacerbation risk. OBJECTIVE:We sought to investigate blood eosinophil counts associated with exacerbation risk in patients with COPD. METHODS:Blood eosinophil counts and exacerbation risk were analyzed in patients with moderate-to-severe COPD by using 2 independent studies of former and current smokers with longitudinal data. The Genetic Epidemiology of COPD (COPDGene) study was analyzed for discovery (n=1,553), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was analyzed for validation (n=1,895). Asubset of the ECLIPSE study subjects were used to assess the stability of blood eosinophil counts over time. RESULTS:COPD exacerbation risk increased with higher eosinophil counts. An eosinophil count threshold of 300cells/μL or greater showed adjusted incidence rate ratios for exacerbations of 1.32 in the COPDGene study (95% CI, 1.10-1.63). The cutoff of 300cells/μL or greater was validated for prospective risk of exacerbation in the ECLIPSE study, with adjusted incidence rate ratios of 1.22 (95% CI, 1.06-1.41) using 3-year follow-up data. Stratified analysis confirmed that the increased exacerbation risk associated with an eosinophil count of 300cells/μL or greater was driven by subjects with a history of frequent exacerbations in both the COPDGene and ECLIPSE studies. CONCLUSIONS:Patients with moderate-to-severe COPD and blood eosinophil counts of 300cells/μL or greater had an increased risk exacerbations in the COPDGene study, which was prospectively validated in the ECLIPSE study.

This study examines language control deficits in bilingual aphasia in terms of domain specific cognitive control and domain general cognitive control. Thirty Spanish–English controls and ten Spanish–English adults with aphasia completed the flanker task and a word-pair relatedness judgment task. All participants exhibited congruency effects on the flanker task. On the linguistic task, controls did not show the congruency effect on the first level analysis. However, conflict ratios revealed that the control group exhibited significant effects of language control. Additionally, individual patient analysis revealed overall positive and negative effects of language control impairment and a benefit from semantically related word-pairs. Patient data suggest a dissociation between the mechanisms of language control and cognitive control, thus providing evidence for domain specific cognitive control. The influence of language proficiency on speed of translation was also examined. Generally, controls were faster when translating into their dominant language, whereas the patients did not show the same trends.

The heritability of chronic obstructive pulmonary disease (COPD) cannot be fully explained by recognized genetic risk factors identified as achieving genome-wide significance. In addition, the combined contribution of genetic variation to COPD risk has not been fully explored. We sought to determine: (1) whether studies of variants from previous studies of COPD or lung function in a larger sample could identify additional associated variants, particularly for severe COPD; and (2) the impact of genetic risk scores on COPD. We genotyped 3,346 single-nucleotide polymorphisms (SNPs) in 2,588 cases (1,803 severe COPD) and 1,782 control subjects from four cohorts, and performed association testing with COPD, combining these results with existing genotyping data from 6,633 cases (3,497 severe COPD) and 5,704 control subjects. In addition, we developed genetic risk scores from SNPs associated with lung function and COPD and tested their discriminatory power for COPD-related measures. We identified significant associations between SNPs near PPIC (P = 1.28 X 10(-8)) and PPP4R4/SERPINA1 (P = 1.01 X 10(-8)) and severe COPD; the latter association may be driven by recognized variants in SERPINA1. Genetic risk scores based on SNPs previously associated with COPD and lung function had a modest ability to discriminate COPD (area under the curve, similar to 0.6), and accounted for a mean 0.9-1.9% lower forced expiratory volume in 1 second percent predicted for each additional risk allele. In a large genetic association analysis, we identified associations with severe COPD near PPIC and SERPINA1. A risk score based on combining genetic variants had modest, but significant, effects on risk of COPD and lung function.

Purpose The purpose of this study was to examine premorbid language proficiency and lexical and semantic processing deficits in bilingual aphasia and develop a theoretical account of bilingual language processing. Method Nineteen Spanish–English patients with bilingual aphasia completed a language use questionnaire (LUQ) and were administered Spanish and English standardized language assessments. The authors analyzed the data to (a) identify patterns of lexical and semantic processing deficits and conceptualize a theoretical framework that accounts for language deficits, (b) determine LUQ measures that predict poststroke language deficits, and (c) evaluate the relationship between predictive LUQ measures and poststroke language deficits in order to identify impairment patterns. Results On the basis of the results, the authors obtained significant correlations on several measures between language input and output. They identified prestroke language ability rating as the strongest predictor of poststroke outcomes. On the basis of these data, 2 distinct groups were identified: (a) patients who lost the same amount of language in Spanish and English and (b) patients who lost different amounts of Spanish and English. Conclusions These findings suggest that it is possible to identify relationships between language patterns and deficits in patients with bilingual aphasia and that these trends will be instrumental in clinical assessments of this understudied population.

Objective To compare the characteristics of postmenopausal women seen by gynecologists versus family physicians and to determine factors associated with current hormone replacement therapy (HRT) use. Methods We conducted a cross-sectional study of 426 postmenopausal women seen for their annual examination at university clinics. Logistic regression was used to identify predictors of current versus never HRT use. Results Overall, 60% of women recruited in family practice clinics and 69% in gynecology clinics were current HRT users. Significant, positive, multivariable predictors of HRT use were gynecology versus family practice clinic attendance (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.4, 4.6), surgical menopause (OR 2.3, 95% CI 1.2, 4.6), history of depression (OR 2.3, 95% CI 1.2, 4.7), at least two live births (OR 2.1, 95% CI 1.1, 4.0), and current alcohol use (OR 1.8, 95% CI 1.04, 3.2). Significant, negative, multivariable predictors were increasing age (60–70 years versus less than 60 years, OR 0.4, 95% CI 0.2, 0.8; 70 years or older versus less than 60 years, OR 0.4, 95% CI 0.2, 0.9) and history of breast cancer (OR 0.04, 95% CI 0.01, 0.14). Sociodemographic factors, smoking status, number of self-reported medical conditions, number of prescription medications besides HRT, oral contraceptive use, history of hypertension, and exercise level were tested as covariates and did not enter the model. Conclusion Although current HRT use rates between clinics were similar and higher than national averages, we found that the adjusted odds of current HRT use among women receiving care from gynecologists was 2.6 times that among women receiving care from family physicians. This practice variation may reflect physicians’ uncertainty surrounding the preventive value of HRT.

Purpose The goal of this study was to examine if there was a principled way to understand the nature of rehabilitation in bilingual aphasia such that patterns of acquisition and generalization are predictable and logical. Method Seventeen Spanish–English bilingual individuals with aphasia participated in the experiment. For each participant, three sets of stimuli were developed for each language: (a) English Set 1, (b) English Set 2 (semantically related to each item in English Set 1), (c) English Set 3 (unrelated control items), (d) Spanish Set 1 (translations of English Set 1), (e) Spanish Set 2 (translations of English Set 2; semantically related to each item in Spanish Set 1), and (f) Spanish Set 3 (translations of English Set 3; unrelated control items). A single-subject experimental multiple baseline design across participants was implemented. Treatment was conducted in 1 language, but generalization to within- and between-language untrained items was examined. Results Treatment for naming on Set 1 items resulted in significant improvement (i.e., effect size >4.0) on the trained items in 14/17 participants. Of the 14 participants who showed improvement, within-language generalization to semantically related items was observed in 10 participants. Between-language generalization to the translations of trained items was observed in 5 participants, and between-language generalization to the translations of the untrained semantically related items was observed in 6 participants. Conclusion The results of this study demonstrated within- and between-language patterns that were variable across participants. These differences are indicative of the interplay between facilitation (generalization) and inhibition.