Publications by authors named "Laura Wagner"

120 Publications

Naturalistic Use of Aspect Morphology in Deaf and Hard-of-Hearing Children.

J Child Lang 2021 Apr 21:1-16. Epub 2021 Apr 21.

The Ohio State University, USA.

Grammatical morphology often links small acoustic forms to abstract semantic domains. Deaf and hard-of-hearing (DHH) children have reduced access to the acoustic signal and frequently have delayed acquisition of grammatical morphology (e.g., Tomblin, Harrison, Ambrose, Walker, Oleson & Moeller, 2015). This study investigated the naturalistic use of aspectual morphology in DHH children to determine if they organize this semantic domain as normal hearing (NH) children have been found to do. Thirty DHH children (M = 6;8) and 29 NH children (M = 5;11) acquiring English participated in a free-play session and their tokens of perfective (simple past) and imperfective (-ing) morphology were coded for the lexical aspect of the predicate they marked. Both groups showed established prototype effects, favoring perfective + telic and imperfective + atelic pairings over perfective + atelic and perfective + atelic ones. Thus, despite reduced access to the acoustic signal, this DHH group was unimpaired for aspectual organization.
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http://dx.doi.org/10.1017/S0305000921000180DOI Listing
April 2021

A Retrospective Comparison of Guidelines to Assess Hospital-diagnosed Urinary Tract Infection in Nursing Home Residents.

Am J Infect Control 2021 Apr 16. Epub 2021 Apr 16.

Senior Associate Dean for Research and Strategic Initiatives, Interim Chair, Department of Physical Therapy, Martha V. and Wickliffe S. Lyne Professor of Health Administration, College of Health Professions, Virginia Commonwealth University, 900 E. Leigh Street, Box 980233, Richmond, VA 23298. Electronic address:

Background: Inappropriate antibiotic treatments for urinary tract infection (UTI) in nursing home (NH) residents are common and contribute to antibiotic resistance. Published guidelines aim to improve accurate assessment, diagnosis, and treatment of UTIs. This study assessed whether records from hospitalized NH residents diagnosed with UTI, while comparing the Cooper Tool and Stone criteria, supported appropriate treatment.

Methods: A retrospective chart review was conducted using electronic medical record (EMR) data from residents of 3 NHs who were diagnosed with UTI when hospitalized over a 3-year period. The Cooper Tool and Stone criteria were used to assess treatment appropriateness.

Results: Of 79 hospitalized residents treated for UTI, 11 (13.9%) were appropriately treated according to the Cooper Tool and 9 (11.4%) according to Stone. The two criteria agreed in 9 of the cases including 100% of those with catheters. Urinalysis was documented in 72% of residents and 24% had documentation of culture and sensitivity.

Conclusions: Appropriate UTI treatment rates using both tools were low but much higher in those with catheters. Future research is necessary to validate the use of these tools in the hospital setting which have the potential to improve treatment accuracy and reduce unnecessary antibiotics use.
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http://dx.doi.org/10.1016/j.ajic.2021.04.001DOI Listing
April 2021

Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial.

PLoS One 2021 11;16(3):e0248339. Epub 2021 Mar 11.

Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States of America.

Background: An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential.

Methods: The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.

Results: At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance.

Conclusions: RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248339PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951877PMC
March 2021

The "when" and "where" of the interplay between attentional capture and response inhibition during a Go/NoGo variant.

Neuroimage 2021 Feb 9;231:117837. Epub 2021 Feb 9.

San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 5500 Campanile Dr., San Diego 92182, CA, United States; Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego 92182, CA, United States; Department of Radiology, University of California, San Diego, 9500 Gilman Dr., La Jolla 92093, CA, United States. Electronic address:

Inhibitory control relies on attention, inhibition, and other functions that are integrated across neural networks in an interactive manner. Functional MRI studies have provided excellent spatial mapping of the involved regions. However, finer temporal resolution is needed to capture the underlying neural dynamics and the pattern of their functional contributions. Here, we used anatomically-constrained magnetoencephalography (aMEG) which combines MEG with structural MRI to examine how the spatial ("where") and temporal ("when") processing stages and interregional co-oscillations unfold in real time to contribute to inhibitory control. Healthy participants completed a modified Go/NoGo paradigm in which a subset of stimuli was modified to be visually salient (SAL). Compared to the non-modified condition, the SAL manipulation facilitated response withholding on NoGo trials and hindered responding to Go stimuli, reflecting attentional capture effectuated by an orienting response to SAL stimuli. aMEG source estimates indicate SAL stimuli elicited the attentional "circuit breaker" effect through early activity within a right-lateralized network centered around the lateral temporal cortex with additional activity in the pre-supplementary motor area (preSMA) and anterior insula (aINS/FO). Activity of the bilateral inferior frontal cortex responded specifically to inhibitory demands and was generally unaffected by the attentional manipulation. In contrast, early aINS/FO activity was sensitive to stimulus salience while subsequent activity was specific to inhibitory control. Activity estimated to the medial prefrontal cortex including the dorsal anterior cingulate cortex and preSMA reflected an integrative role that was sensitive to both inhibitory and attentional stimulus properties. At the level of neurofunctional networks, neural synchrony in the theta band (4-7 Hz) revealed interactions between principal cortical regions subserving attentional and inhibitory processes. Together, these results underscore the dynamic, integrative processing stages underlying inhibitory control.
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http://dx.doi.org/10.1016/j.neuroimage.2021.117837DOI Listing
February 2021

Associations Between Religious/Spiritual Coping and Depression Among Adults with Cystic Fibrosis: A 12-Month Longitudinal Study.

J Relig Health 2021 Feb 11. Epub 2021 Feb 11.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Individuals with cystic fibrosis (CF) face a challenging disease, and depression is a significant concern. Many patients draw on religious/spiritual resources to assist them in managing the demands of chronic illness; however, these coping efforts rarely have been evaluated among adults with CF. This longitudinal study examined relationships between distinct types of positive and negative religious/spiritual coping at baseline (assessed with the RCOPE) and depression screening outcomes 12 month later (assessed with the Hospital Anxiety and Depression Scale). In logistic regression analyses controlling for disease severity (FEV% predicted), lower likelihood of depression caseness at 12 months was predicted by higher general religiousness at baseline, greater use of benevolent religious reappraisal coping, greater use of spiritual connection coping, and lower spiritual discontent. Results suggest that distinct aspects religious/spiritual coping have differential associations with subsequent depression outcomes. Findings extend prior research to an important, understudied medical population, and address a clinically meaningful outcome.
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http://dx.doi.org/10.1007/s10943-021-01185-xDOI Listing
February 2021

Nurse practitioner students as an essential workforce: The lessons of coronavirus disease 2019.

Nurs Outlook 2020 Dec 9. Epub 2020 Dec 9.

UCSF School of Nursing, San Francisco, CA.

Background: The coronavirus disease 2019 (COVID-19) disrupted the education and clinical training of nursing students. Clinical sites shut out students over low equipment supplies, physical distancing requirements, and redeployment of staff.

Purpose And Methods: The purpose of this paper is to highlight a progressive solution to engage nurse practitioner students as part of the COVID-19 response given the disruption of their traditional clinical training environments so that student could continue to matriculate and graduate in a timely manner.

Findings: Nurse practitioner students swiftly responded and were deemed an essential part of the nursing workforce.

Discussion: Policy implications for advanced nursing practice and education for telehealth and simulation research moving forward is also provided.
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http://dx.doi.org/10.1016/j.outlook.2020.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836989PMC
December 2020

Preferences for Accessing Electronic Health Records for Research Purposes: Views of Parents Who Have a Child With a Known or Suspected Genetic Condition.

Value Health 2020 12 26;23(12):1639-1652. Epub 2020 Oct 26.

RTI International, Research Triangle Park, NC, USA.

Objectives: The purpose of this study was to examine parental preferences for researchers accessing their child's electronic health record across 3 groups: those with a child with (1) a known genetic condition (fragile X syndrome FXS), (2) a suspected genetic condition (autism spectrum disorder [ASD]), and (3) no known genetic condition (typically developing).

Methods: After extensive formative work, a discrete choice experiment was designed consisting of 5 attributes, each with 2 or 3 levels, including (1) type of researcher, (2) the use of personally identifiable information, (3) the use of sensitive information, (4) personal importance of research, and (5) return of results. Stratified mixed logit and latent class conditional logit models were examined.

Results: Parents of children with FXS or ASD had relatively higher preferences for research conducted by nonprofits than parents of typically developing children. Parents of children with ASD also preferred research using non-identifiable and nonsensitive information. Parents of children with FXS or ASD also had preferences for research that was personally important and returned either summary or individual results. Although a few child and family characteristics were related to preferences, they did not overall define the subgroups of parents.

Conclusions: Although electronic health record preference research has been conducted with the general public, this is the first study to examine the opinions of parents who have a child with a known or suspected genetic condition. These parents were open to studies using their child's electronic health record because they may have more to gain from this type of research.
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http://dx.doi.org/10.1016/j.jval.2020.06.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701359PMC
December 2020

Clinical and ophthalmologic characteristics of ocular syphilis in a retrospective tertiary hospital cohort.

Sex Transm Dis 2020 Nov 4. Epub 2020 Nov 4.

Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Internal Medicine II, Munich, Germany.

Background: Data on ocular syphilis (OS) and its clinical presentation are currently insufficient. This study aimed to investigate the characteristics of a cohort with a high OS incidence at a university hospital in Germany, focusing on clinical presentation of OS.

Methods: This single-center cohort study retrospectively analyzed data on 90 patients with 109 episodes of syphilis between 2008 and 2018. OS cases were identified and additionally re-evaluated through a study-specific secondary assessment by an ophthalmologist specializing in uveitis.

Results: Twenty-three patients (26%) were diagnosed with OS, 16 (70%) with binocular involvement. Uveitis, especially that of the posterior segment, showed a high prevalence. Lumbar puncture (LP) was performed in 20 OS patients (87%), of whom 17 (85% of those with LP /74% in total) met the 2018 Centers for Disease Control and Prevention criteria for likely neurosyphilis. Five of 23 patients (22%) had human immunodeficiency virus infection, of whom two did not receive antiretroviral therapy. The preferred syphilis treatment regimens were benzylpenicillin and ceftriaxone, which yielded favorable serological, clinical, and ophthalmological outcomes.

Conclusions: A high incidence of OS was identified, and physicians should be aware of uveitis as a manifestation of syphilis. Most patients presented with uveitis and syphilis in an early or late latent stage and showed central nervous system involvement.
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http://dx.doi.org/10.1097/OLQ.0000000000001329DOI Listing
November 2020

Medical Staffing Organization and Quality of Care Outcomes in Post-Acute Care Settings.

Gerontologist 2020 Nov 4. Epub 2020 Nov 4.

Healthforce Center, University of California, San Francisco; San Francisco, CA.

Background And Objectives: Medical providers are significant drivers of care in post-acute long-term care (PALTC) settings, yet little research has examined the medical provider workforce and its role in ensuring quality of care.

Research Design And Methods: This study examined the impact of nursing home medical staffing organization (NHMSO) dimensions on the quality of care in US nursing homes. The principal data source was a survey specifically designed to study medical staff organization for post-acute care. Respondents were medical directors and attending physicians providing PALTC. We linked a number of medical provider and nursing home characteristics to the Centers for Medicaid and Medicare Services Nursing Home Compare quality measures hypothesized to be sensitive to input by medical providers.

Results: From the sample of nursing home medical providers surveyed (n=1,511), 560 responses were received, yielding a 37% response rate; 425 medical provider responses contained sufficient data for analysis. The results of the impact of NHMSO dimensions were mixed, with many domains not having any significance or having negative relationships between provider characteristics and quality measures. Respondents who reported having a formal process for granting privileges and nursing homes with direct employment of physicians reported significantly fewer emergency visits.

Discussion And Implications: Further research is needed regarding what quality measures are sensitive to both medical provider characteristics and NHMSO characteristics.
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http://dx.doi.org/10.1093/geront/gnaa173DOI Listing
November 2020

MEG Theta during Lexico-Semantic and Executive Processing Is Altered in High-Functioning Adolescents with Autism.

Cereb Cortex 2021 Jan;31(2):1116-1130

Department of Psychology, San Diego State University, San Diego, CA 92182, USA.

Neuroimaging studies have revealed atypical activation during language and executive tasks in individuals with autism spectrum disorders (ASD). However, the spatiotemporal stages of processing associated with these dysfunctions remain poorly understood. Using an anatomically constrained magnetoencephalography approach, we examined event-related theta oscillations during a double-duty lexical decision task that combined demands on lexico-semantic processing and executive functions. Relative to typically developing peers, high-functioning adolescents with ASD had lower performance accuracy on trials engaging selective semantic retrieval and cognitive control. They showed an early overall theta increase in the left fusiform cortex followed by greater activity in the left-lateralized temporal (starting at ~250 ms) and frontal cortical areas (after ~450 ms) known to contribute to language processing. During response preparation and execution, the ASD group exhibited elevated theta in the anterior cingulate cortex, indicative of greater engagement of cognitive control. Simultaneously increased activity in the ipsilateral motor cortex may reflect a less lateralized and suboptimally organized motor circuitry. Spanning early sensory-specific and late response selection stages, the higher event-related theta responsivity in ASD may indicate compensatory recruitment to offset inefficient lexico-semantic retrieval under cognitively demanding conditions. Together, these findings provide further support for atypical language and executive functions in high-functioning ASD.
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http://dx.doi.org/10.1093/cercor/bhaa279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786353PMC
January 2021

Admission of first generation to college pre-licensure master's entry and graduate nursing students.

J Prof Nurs 2020 Sep - Oct;36(5):343-347. Epub 2020 Feb 6.

Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94143-0936, United States of America. Electronic address:

Background And Purpose: A growing body of literature is examining the relationships between socio-demographic factors influencing recruitment and retention of students in higher education. The purpose of this study was to explore the characteristics of first generation to college (First-Gen) nursing applicants including socio-demographic variables compared to applicants whose parents received a higher education degree. We also aimed to explore whether acceptance or rejection into the program varied based on an applicant's First-Gen identification.

Method: A total of 3469 applications were analyzed over a six-year admission period from 2012 to 2017 across three programs: Accelerated Registered Nursing; Graduate (Master's degree), and PhD. Data analysis included descriptive and inferential statistics (e.g., chi-square, t-tests) aimed at describing the sample of First-Gen applicants as well as comparing First-Gen applicants to those whose parents received at least a university degree.

Results: Approximately 30% of applicants identified as First-Gen. First-Gen applicants were significantly more likely to be a student of color, older, a Veteran, immigrant or international student. PhD first-gen applicants were significantly more likely to be rejected than those who whose parents had higher education degrees.

Conclusions: This study describes a growing population of nursing student applicant requiring further research and engagement on what supports are most needed. The long-term goal of boosting the diversity of our workforce is to increase recruitment, improve retention, increase graduation rates, and ultimately increase access to and quality of care to the patients we serve.
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http://dx.doi.org/10.1016/j.profnurs.2020.02.001DOI Listing
February 2020

Normal Dual Isotope V/Q SPECT Model for Monte-Carlo Studies.

Front Med (Lausanne) 2020 18;7:461. Epub 2020 Aug 18.

Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France.

There is currently no reliable or validated tool to delineate and quantify functional lung volumes with ventilation/perfusion (V/Q) SPECT/CT. The main challenges encountered include the physiological non-uniformity of lung function, such as the anterior-to-posterior gradient on perfusion images, and the lack of ground truth to assess the accuracy of delineation algorithms. In that respect, Monte-Carlo simulations would be an interesting tool. Thus, the aim of this study was to develop a realistic model of dual-isotope lung V/Q SPECT-CT Monte-Carlo simulations, integrating the anterior to posterior gradient on perfusion. Acquisitions and simulations parameters were set in accordance to nuclear medicine guidelines for V/Q lung SPECT-CT. Projections were acquired and simulated, then the reconstructions [with and without attenuation correction (AC)] were compared. A model was built from a patient's CT scan. To model the anterior to posterior gradient, the lungs were divided into sixteen coronal planes, where a rising radioactivity concentration was set. To assess the realism of simulations, they were compared to a normal co-registered normal cases database in terms of pixelwize Z-score map. For ventilation images, mean (SD) Zscores on Zscore maps were -0.2 (0.7) and -0.2 (0.7) for AC and noAC images, respectively. For perfusion images, mean (SD) Zscores were -0.2 (0.6) and -0.1 (0.6) for AC and noAC images, respectively. We developed a model for dual isotopes lung V/Q SPECT-CT, integrating the anterior-to-posterior gradient on perfusion images. This model could be used to build a catalog of clinical scenarios, in order to test delineation methods of functional lung volumes.
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http://dx.doi.org/10.3389/fmed.2020.00461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461964PMC
August 2020

Medical Care Delivery in US Nursing Homes: Current and Future Practice.

Gerontologist 2020 Sep 22. Epub 2020 Sep 22.

Department of Medicine, University of Rochester, Rochester, New York.

The delivery of medical care services in US nursing homes (NH) is dependent on a workforce comprised of physicians, nurse practitioners (NP), and physician assistants (PA). Each of these disciplines operate under a unique regulatory framework while adhering to common standards of care. NH provider characteristics and their roles in NH care can illuminate potential links to clinical outcomes and overall quality of care with important policy and cost implications. This perspective provides an overview of what is currently known about medical provider practice in NH and organizational models of practice. Links to quality, both conceptual and established, are presented as is a research and policy agenda that addresses the gaps in the evidence base within the context of our ever-changing health care landscape.
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http://dx.doi.org/10.1093/geront/gnaa141DOI Listing
September 2020

Ethical, Legal, and Social Issues Related to the Inclusion of Individuals With Intellectual Disabilities in Electronic Health Record Research: Scoping Review.

J Med Internet Res 2020 05 21;22(5):e16734. Epub 2020 May 21.

RTI International, Research Triangle Park, NC, United States.

Background: Data from electronic health records (EHRs) are increasingly used in the field of genetic research to further precision medicine initiatives. However, many of these efforts exclude individuals with intellectual disabilities, which often stem from genetic conditions. To include this important subpopulation in EHR research, important ethical, legal, and social issues should be considered.

Objective: The goal of this study was to review prior research to better understand what ethical, legal, and social issues may need further investigation when considering the research use of EHRs for individuals with genetic conditions that may result in intellectual disability. This information will be valuable in developing methods and best practices for involving this group in research given they are considered a vulnerable population that may need special research protections.

Methods: We conducted a scoping review to examine issues related to the use of EHRs for research purposes and those more broadly associated with genetic research. The initial search yielded a total of 460 unique citations. We used an evaluative coding process to determine relevancy for inclusion.

Results: This approach resulted in 59 articles in the following areas: informed consent, privacy and security, return of results, and vulnerable populations. The review included several models of garnering informed consent in EHR or genetic research, including tiered or categorical, blanket or general, open, and opt-out models. Second, studies reported on patients' concerns regarding the privacy and security of EHR or genetic data, such as who has access, type of data use in research, identifiability, and risks associated with privacy breach. The literature on return of research results using biospecimens examined the dissension in the field, particularly when sharing individualized genetic results. Finally, work involving vulnerable populations highlighted special considerations when conducting EHR or genetic research.

Conclusions: The results frame important questions for researchers to consider when designing EHR studies, which include individuals with intellectual disabilities, including appropriate safeguards and protections.
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http://dx.doi.org/10.2196/16734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273235PMC
May 2020

Preferences for the research use of electronic health records among young adults with fragile X syndrome or autism spectrum disorder.

Disabil Health J 2020 10 8;13(4):100927. Epub 2020 Apr 8.

RTI International, Research Triangle Park, NC, United States. Electronic address:

Background: Health researchers are increasingly using electronic health records (EHRs) to study the health care needs of people with neurodevelopmental disorders (NDDs). However, little is known about the preferences of people with NDDs for sharing EHRs for research.

Objective: To explore preferences for sharing EHRs for research among young adults ages 18-40 who make their own legal decisions and who have autism spectrum disorder (ASD), fragile X syndrome (FXS), or no NDDs.

Methods: We conducted a qualitative study with seven focus groups: 2 ASD groups, 3 FXS groups, and 2 no-NDD groups. We asked participants about factors that could affect their willingness to share their EHRs for research: type of organization, type of information, study purpose, duration, contact frequency, return of results, benefits, and risks. We analyzed the qualitative data using directed content analysis.

Results: Participants with NDDs valued personally relevant and directly beneficial EHR research. Participants with NDDs expressed willingness to share sensitive data if the study was personally relevant. Most participants wanted to receive results, but only participants with FXS indicated it would affect their willingness to participate. Participants were concerned about privacy risks, discrimination, researcher misconduct, and financial conflicts of interest.

Conclusion: This study provides initial evidence suggesting that young adults with NDDs prefer EHR research that is personally relevant, benefits themselves and their communities, and is conducted in the context of trusting, reciprocal participant-researcher relationships. The findings point to the need for researchers to improve the informed consent process and to better engage individuals with NDDs in research.
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http://dx.doi.org/10.1016/j.dhjo.2020.100927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541430PMC
October 2020

Early Vocabulary Profiles of Young Deaf Children Who Use Cochlear Implants.

J Speech Lang Hear Res 2020 04 17;63(4):1254-1269. Epub 2020 Apr 17.

Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus.

Purpose This study examined vocabulary profiles in young cochlear implant (CI) recipients and in children with normal hearing (NH) matched on receptive vocabulary size to improve our understanding of young CI recipients' acquisition of word categories (e.g., common nouns or closed-class words). Method We compared receptive and expressive vocabulary profiles between young CI recipients ( = 48; mean age at activation = 15.61 months, = 4.20) and children with NH ( = 48). The two groups were matched on receptive vocabulary size as measured by the MacArthur-Bates Communicative Development Inventories (Fenson et al., 2006): Words and Gestures form. The CI group had, on average, 8.98 months of hearing experience. The mean chronological age at completing the MacArthur-Bates Communicative Development Inventories was 23.99 months ( = 5.14) for the CI group and 13.72 months ( = 1.50) for the NH group. Results The CI group had a larger expressive vocabulary size than the receptive vocabulary size-matched NH group. The larger expressive vocabulary size was associated with the group difference in social words but not with common nouns. The analyses for predicate words and closed-class words included only children who produced the target categories. The CI group had a larger proportion of predicate words than the NH group, but no difference was found in closed-class words in expressive vocabulary. Conclusions Differences found in expressive vocabulary profiles may be affected by spoken vocabulary size and their age. A further examination is warranted using language samples to understand the effect of language input on children's vocabulary profiles.
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http://dx.doi.org/10.1044/2020_JSLHR-19-00315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242983PMC
April 2020

"Just tell me what's going on": The views of parents of children with genetic conditions regarding the research use of their child's electronic health record.

J Am Med Inform Assoc 2020 03;27(3):429-436

Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Durham, North Carolina, USA.

Objective: The purpose of this study was to understand the ethical, legal, and social issues described by parents of children with known or suspected genetic conditions that cause intellectual and developmental disabilities regarding research use of their child's electronic health record (EHR).

Materials And Methods: We conducted 4 focus groups with parents of children with a known (n = 12) or suspected (n = 11) genetic condition, as well as 2 comparison groups with parents who had a child with no known genetic condition (n = 15). Focus group transcripts were coded and analyzed using directed content analysis.

Results: After weighing the risks and benefits, parents of children with known or suspected genetic conditions were willing to share their child's EHR for research studies under certain conditions. Preferences were for studies conducted by universities or nonprofits that might benefit their child or others with the same condition. Parents also valued return of research results.

Discussion: Trust, transparency, altruism, and concerns about privacy emerged as factors that affect parents' willingness to allow research use of their child's EHR.

Conclusion: Researchers should consider how to build trust with parents by increasing transparency of the research process and explaining specifically how they will ensure the confidentiality of EHR data.
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http://dx.doi.org/10.1093/jamia/ocz208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025353PMC
March 2020

Director of Nursing Perceptions of Physicians' Roles in US Nursing Homes.

J Am Med Dir Assoc 2019 11 1;20(11):1471-1473. Epub 2019 Jul 1.

University of California, San Francisco, CA.

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http://dx.doi.org/10.1016/j.jamda.2019.05.006DOI Listing
November 2019

Longitudinal associations between gratitude and depression 1 year later among adult cystic fibrosis patients.

J Behav Med 2020 08 28;43(4):596-604. Epub 2019 Jun 28.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Individuals with cystic fibrosis (CF) are confronted by a range of difficult physical and psychosocial sequelae. Gratitude has drawn growing attention as a psychosocial resource, but it has yet to be examined among adults with CF. The current investigation evaluated longitudinal associations between trait gratitude and subsequent outcomes from depression screening 12 months later, adjusting for disease severity (FEV% predicted) and other significant clinical or demographic covariates. Participants were 69 adult CF patients recruited from a regional adult treatment center. They completed a validated measure of gratitude (Gratitude Questionnaire-6) at baseline and a screening measure of depression (Hospital Anxiety and Depression Scale) at 12-month follow-up. In a logistic regression analysis controlling for disease severity, higher levels of baseline gratitude were associated with reduced likelihood of depression caseness at 12 months (OR .83, 95% CI .73-.91, p = .001). Gratitude remained predictive after adjusting for other psychosocial resource variables (i.e., perceived social support and positive reframing coping). Findings offer an initial indication of the potential salutary role of dispositional gratitude in an understudied clinical population.
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http://dx.doi.org/10.1007/s10865-019-00071-yDOI Listing
August 2020

Deleterious Effects of Higher Body Mass Index on Subjective and Objective Measures of Chemotherapy-Induced Peripheral Neuropathy in Cancer Survivors.

J Pain Symptom Manage 2019 08 30;58(2):252-263. Epub 2019 Apr 30.

School of Nursing, University of California, San Francisco, California, USA. Electronic address:

Context: Recent, albeit, limited evidence suggests that body mass index (BMI) may be a modifiable risk factor to reduce the deleterious effects of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors.

Objectives: To evaluate for differences in demographic, clinical, pain, sensation, and balance characteristics among three BMI groups. We hypothesized that as BMI increased, survivors would report higher pain intensity scores and have significant decrements in measures of sensation and balance.

Methods: A total of 416 survivors with CIPN were evaluated using subjective and objective measures of CIPN. Survivors were divided into three BMI groups (i.e., normal weight, overweight, and obese). Differences among the BMI groups were evaluated using parametric and nonparametric statistics.

Results: Of the 416 survivors, 45.4% were normal weight, 32.5% were overweight, and 22.1% were obese. Compared with the normal-weight group, survivors in the other two groups had lower functional status scores, a higher comorbidity burden, higher pain intensity scores, and higher interference scores. In addition, compared with the normal-weight group, survivors in the other two BMI groups had significantly worse balance scores.

Conclusion: Our findings support the hypothesis that as BMI increased, pain sensation and balance characteristics worsened. Our findings suggest that nutritional counseling as well as exercise and weight management programs in survivors with CIPN may improve these clinically important problems.
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http://dx.doi.org/10.1016/j.jpainsymman.2019.04.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679783PMC
August 2019

Persistent Adherence to Airway Clearance Therapy in Adults With Cystic Fibrosis.

Respir Care 2019 Jul 19;64(7):778-785. Epub 2019 Mar 19.

Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Background: Airway clearance therapy (ACT) is a core component of daily treatment for cystic fibrosis (CF). However, surprisingly little is known about sustained or persistent use of ACT over time among adults with CF. This longitudinal study examined persistent adherence to ACT over 12 months and its modifiable predictors, drawing on aspects of Social Cognitive Theory and the Theory of Planned Behavior.

Methods: Subjects were drawn from a regional CF center in the southern United States. Predictor variables evaluated at baseline included self-efficacy for ACT (ie, self-confidence in overcoming barriers), outcome expectations (ie, perceived necessity of ACT and concerns about its disruptive effects), and subjective norms (ie, perceptions of being influenced by others). The Cystic Fibrosis Treatment Questionnaire (CFTQ) was used to assess self-reported adherence to ACT at baseline, at 6 months, and at 12 months.

Results: The mean age of subjects was 27.2 ± 9.1 y, and mean FEV% predicted was 65.5 ± 24.8. Forty-six percent of subjects reported persistent use of ACT (classified as adherent at all assessment periods). In bivariate analyses, all social cognitive predictor variables assessed at baseline were significantly related to persistent adherence (all < .03), except subjective norms. In logistic regression analyses that modeled the effects of these predictors simultaneously while controlling for FEV%, fewer baseline concerns about ACT (odds ratio = 0.82, 95% CI 0.69-0.99) and greater self-efficacy (odds ratio = 1.09, 95% CI 1.01-1.18) remained significant independent predictors.

Conclusions: This longitudinal study addresses an important gap in the literature regarding adherence to ACT over time (12 mo) in a routine clinical setting. Persistent adherence was problematic. As anticipated, social cognitive variables (self-confidence and perceived concerns) predicted self-reported persistence, and these may represent practical targets for intervention.
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http://dx.doi.org/10.4187/respcare.06500DOI Listing
July 2019

Disruption of Frontal Lobe Neural Synchrony During Cognitive Control by Alcohol Intoxication.

J Vis Exp 2019 02 6(144). Epub 2019 Feb 6.

Department of Psychology, San Diego State University.

Decision making relies on dynamic interactions of distributed, primarily frontal brain regions. Extensive evidence from functional magnetic resonance imaging (fMRI) studies indicates that the anterior cingulate (ACC) and the lateral prefrontal cortices (latPFC) are essential nodes subserving cognitive control. However, because of its limited temporal resolution, fMRI cannot accurately reflect the timing and nature of their presumed interplay. The present study combines distributed source modeling of the temporally precise magnetoencephalography (MEG) signal with structural MRI in the form of "brain movies" to: (1) estimate the cortical areas involved in cognitive control ("where"), (2) characterize their temporal sequence ("when"), and (3) quantify the oscillatory dynamics of their neural interactions in real time. Stroop interference was associated with greater event-related theta (4 - 7 Hz) power in the ACC during conflict detection followed by sustained sensitivity to cognitive demands in the ACC and latPFC during integration and response preparation. A phase-locking analysis revealed co-oscillatory interactions between these areas indicating their increased neural synchrony in theta band during conflict-inducing incongruous trials. These results confirm that theta oscillations are fundamental to long-range synchronization needed for integrating top-down influences during cognitive control. MEG reflects neural activity directly, which makes it suitable for pharmacological manipulations in contrast to fMRI that is sensitive to vasoactive confounds. In the present study, healthy social drinkers were given a moderate alcohol dose and placebo in a within-subject design. Acute intoxication attenuated theta power to Stroop conflict and dysregulated co-oscillations between the ACC and latPFC, confirming that alcohol is detrimental to neural synchrony subserving cognitive control. It interferes with goal-directed behavior that may result in deficient self-control, contributing to compulsive drinking. In sum, this method can provide insight into real-time interactions during cognitive processing and can characterize the selective sensitivity to pharmacological challenge across relevant neural networks.
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http://dx.doi.org/10.3791/58839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677147PMC
February 2019

Learning to Lead: Reflections from the Tideswell-AGS-ADGAP Emerging Leaders in Aging Program Scholars.

J Am Geriatr Soc 2019 03 3;67(3):434-436. Epub 2019 Jan 3.

Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.

The Tideswell Emerging Leaders in Aging (ELIA) Program is a 1-year leadership training program focused on developing a sustainable pipeline of leaders in aging who are poised to lead initiatives that will optimize the health of older people. The Tideswell ELIA Program is jointly administered by the American Geriatrics Society, the Association of Directors of Geriatric Academic Programs, and Tideswell at University of California, San Francisco (UCSF), a program within the Division of Geriatrics at UCSF. The ELIA Program prepares early to midcareer healthcare professionals in aging (scholars) for their transition into key leadership roles that involve one or more areas of patient care, education, and research. The program emphasizes the understanding of one's own and others' inherent work strategies and communication styles as integral to leading programs. Approximately 15 ELIA scholars are selected annually to participate in this interactive leadership development program. We conducted a qualitative analysis of program evaluations from 2015 to 2018 scholars (n = 47) to determine effectiveness and impact. All scholars (100%) completed the end-of-training survey. Scholars' satisfaction with the program is high. Scholars reported heightened leadership development and improvements in leadership skills, including communication, team building, and self-awareness. Scholars also reported enhancement of personal leadership attributes that contributed to career advancement. The Tideswell ELIA Program accelerates scholars' personal career development, positively impacts their institutions, and ultimately benefits older people. Sustaining leadership programs such as the Tideswell ELIA Program is vital to ensure a continuous pipeline of leaders skilled in both advocating for and advancing the health of older Americans. J Am Geriatr Soc 67:434-436, 2019.
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http://dx.doi.org/10.1111/jgs.15701DOI Listing
March 2019

Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.

Inquiry 2018 Jan-Dec;55:46958018778902

2 University of California, San Francisco, USA.

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation.
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http://dx.doi.org/10.1177/0046958018778902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050994PMC
December 2018

Factors affecting the communication experiences of newly diagnosed colorectal cancer patients.

Patient Educ Couns 2018 09 27;101(9):1585-1593. Epub 2018 Apr 27.

Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.

Objective: This study assessed patient-centered communication (PCC) among newly diagnosed colorectal cancer patients. PCC, a key part of patient-centered care, contributes directly and indirectly to health-related quality of life, satisfaction with care, and other outcomes.

Methods: We conducted a survey of patients in North Carolina, using a theoretically-based and validated measure that provides an overall PCC score and subscale scores for six PCC functions.

Results: A total of 501 patients participated. The highest scores were for the PCC functions of Fostering Healing Relationships, Exchanging Information, and Making Decisions. The lowest scores were for the functions of Managing Uncertainty and Enabling Self-Management, yet these were functions respondents rated as most important. Respondents who thought about more than one health professional (versus oncologist) reported better communication. PCC also varied by treatment type, mental and physical health status, age, race, and education.

Conclusion: Most patients reported good communication overall, however patients in poor physical health and mental health reported worse communication. The quality of communication varied across the PCC functions.

Practice Implications: Health professionals need to use a PCC approach that builds trust, respects the patient, provides salient information that patients can understand, provides emotional support, and facilitates the patient's engagement in care.
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http://dx.doi.org/10.1016/j.pec.2018.04.016DOI Listing
September 2018

The development of principled connections and kind representations.

Cognition 2018 07 31;176:255-268. Epub 2018 Mar 31.

Hunter College, City University of New York, United States.

Kind representations draw an important distinction between properties that are understood as existing in instances of a kind by virtue of their being the kind of thing they are and properties that are not understood in this manner. For example, the property of barking for the kind dog is understood as being had by dogs by virtue of the fact that they are dogs. These properties are said to have a principled connection to the kind. In contrast, the property of wearing a collar is not understood as existing in instances by virtue of their being dogs, despite the fact that a large percentage of dogs wear collars. Such properties are said to have a statistical connection to the kind. Two experiments tested two signatures of principled connections in 4-7 year olds and adults: (i) that principled connections license normative expectations (e.g., we judge there to be something wrong with a dog that does not bark), and (ii) that principled connections license formal explanations which explain the existence of a property by reference to the kind (e.g., that barks because it is a dog). Experiment 1 showed that both the children and adults have normative expectations for properties that have a principled connection to a kind, but not those that have a mere statistical connection to a kind. Experiment 2 showed that both children and adults are more likely to provide a formal explanation when explaining the existence of properties with a principled connection to a kind than properties with statistical connections to their kinds. Both experiments showed no effect of age (over ages 4, 7, and adulthood) on the extent to which participants differentiated principled and statistical connections. We discuss the implications of the results for theories of conceptual representation and for the structure of explanation.
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http://dx.doi.org/10.1016/j.cognition.2018.02.001DOI Listing
July 2018

Entrustable professional activities for quality and patient safety.

Nurs Outlook 2018 May - Jun;66(3):237-243. Epub 2017 Nov 22.

University of Minnesota Medical School, Minneapolis, MN.

Background: Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs).

Purpose: The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training.

Methods: Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature.

Findings: EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research.

Discussion: Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs.
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http://dx.doi.org/10.1016/j.outlook.2017.11.001DOI Listing
February 2019

Regional dialect perception across the lifespan: Identification and discrimination.

Lang Speech 2019 Mar 30;62(1):115-136. Epub 2017 Nov 30.

Ohio State University, USA.

Although adult listeners can often identify a talker's region of origin based on his or her speech, young children typically fail in dialect perception tasks, and little is known about the development of regional dialect representations from childhood into adulthood. This study explored listeners' understanding of the indexical importance of American English regional dialects across the lifespan. Listeners between 4 and 79 years old in the Midwestern United States heard talkers from the Midland, Northern, Southern, and New England regions in two regional dialect perception tasks: identification and discrimination. The results showed that listeners as young as 4-5 years old understand the identity-marking significance of some regional dialects, although adult-like performance was not achieved until adolescence. Further, the findings suggest that regional dialect perception is simultaneously impacted by the specific dialects involved and the cognitive difficulty of the task.
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http://dx.doi.org/10.1177/0023830917743277DOI Listing
March 2019

Nursing Home Patient Safety Culture Perceptions Among US and Immigrant Nurses.

J Patient Saf 2020 09;16(3):238-244

William Randolph Hearst Foundation Chair in Gerontology & Professor, Hunter-Bellevue School of Nursing, Hunter College of CUNY, New York, New York.

Patient safety is a global concern, yet little is known about how and whether perceptions of patient safety culture (PSC) vary by nurses' countries of origin and preparation. This is particularly important in American nursing homes (NHs), which are increasingly hiring non-US born and prepared nurses to fill staffing needs.

Objectives: This study compared the PSC perceptions of foreign and domestic born and trained nurses working in urban NHs in 5 states to analyze how nurses' PSC perceptions corresponded to their personal and professional characteristics.

Methods: We distributed 3539 surveys to registered nurses and licensed practical/vocational nurses employed in 98 urban NHs across 5 states with higher percentages of internationally prepared nurse workers. Respondents' perceptions of their workplace safety culture were measured with the NH Survey on PSC survey from the Agency for Healthcare Research and Quality (AHRQ) and examined 12 dimensions of PSC. A total of 1629 returned surveys indicated a 46% returned rate.

Results: Results from 1133 analyzed surveys indicated that nurses born and educated abroad exhibited more favorable PSC perceptions in their workplaces, followed by nurses born abroad and educated in the United States. Nurses born and educated in the United States demonstrated the lowest perceptions of workplace PSC overall (P < 0.001).

Conclusions: Although foreign born and trained nurses report higher PSC perceptions than domestically born and educated nurses, further research is needed to understand why these differences occur.
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http://dx.doi.org/10.1097/PTS.0000000000000271DOI Listing
September 2020

The Development of Regional Dialect Locality Judgments and Language Attitudes Across the Life Span.

Child Dev 2019 07 20;90(4):1080-1096. Epub 2017 Oct 20.

Ohio State University.

The development of language attitudes and perception of talker regional background was investigated across the life span (N = 240, age range = 4-75 years). Participants rated 12 talkers on dimensions of geographic locality, status, and solidarity. Children could classify some dialects by locality by age 6-7 years and showed adult-like patterns by age 8 years. Children showed adult-like status ratings for some dialects by age 4-5 years but were not fully adult-like until age 12 years. Solidarity ratings were more variable and did not exhibit a clear developmental trajectory, although some adult-like patterns were in place by age 6-7 years. Locality ratings were a significant but modest predictor of attitude ratings, suggesting that geographic knowledge is one contributor to language attitudes throughout development.
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http://dx.doi.org/10.1111/cdev.12984DOI Listing
July 2019