Syllable onsets II: three-element clusters in phonological treatment.

This study extends the application of the Sonority Sequencing Principle, as reported in J. A. Gierut (1999), to acquisition of word-initial 3-element clusters by children with functional phonological delays (ages in years;months: 3;4 to 6;3). The representational structure of 3-element clusters is complex and unusual because it consists of an s-adjunct plus a branching onset, which respectively violate and conform to the Sonority Sequencing Principle. Given the representational asymmetry, it is unclear how children might learn these clusters in treatment or whether such treatment may even be effective. Results of a single-subject staggered multiple-baseline experiment demonstrated that children learned the treated 3-element cluster in treatment but showed no further generalization to similar types of (asymmetric) onsets. Treatment of 3-element clusters did, however, result in widespread generalization to untreated singletons, including affricates. Moreover, there was differential generalization to untreated 2-element clusters, with individual differences being traced to the composition of children's singleton inventories. Theoretically, the results suggest a segmental-syllabic interface that holds predictive potential for determining the effectiveness and effects of clinical treatment as based on the notion of linguistic complexity.

Cost for inpatient care of venous thrombosis: a trial of enoxaparin vs standard heparin.

BACKGROUND: Enoxaparin, a low-molecular-weight heparin administered to hospitalized patients once or twice daily, has shown efficacy and safety equivalent to unfractionated heparin in the treatment of acute venous thromboembolic disease. Although the cost of either enoxaparin regimen is greater than that of unfractionated heparin, the overall cost of care for each of these 3 treatment strategies is unknown. METHODS: A cost minimization analysis of a 3-month, partially blinded, randomized, controlled efficacy and safety trial of anticoagulant therapy for deep vein thrombosis. Three hundred thirty-nine hospitalized patients with symptomatic lower extremity deep vein thrombosis were randomly assigned to initial therapy with subcutaneous enoxaparin either once (n = 112) or twice (n = 123) daily, or with dose-adjusted intravenous unfractionated heparin (n = 104), followed by long-term oral anticoagulant therapy. Estimated 1997 total cost from a third-party payer perspective for the 3-month episode of care was calculated by assigning standard unit costs to counts of medical resources used by each patient in the clinical trial. RESULTS: Average total cost for the 3-month episode of care was similar across all 3 treatment regimens: once-daily dose of enoxaparin, $12,166 (95% confidence interval [CI], $10,744-$13,588); twice-daily dose of enoxaparin, $11,558 (95% CI, $10,201-$12,915); and unfractionated heparin, $12,146 (95% CI, $10,670-$12,622). Bootstrapped estimates and sensitivity analyses did not significantly change findings. CONCLUSIONS: There was no significant difference in the overall cost for the 3-month episode of care for patients treated with either enoxaparin or unfractionated heparin. Additional acquisition costs for anticoagulant medication among patients treated with enoxaparin were offset by savings associated with lower incidence of hospital readmission and shorter duration of venous thromboembolism-related readmissions.

Lexical constraints in phonological acquisition.

Lexical diffusion, as characterized by interword variation in production, was examined in phonological acquisition. The lexical variables of word frequency and neighbourhood density were hypothesized to facilitate sound change to varying degrees. Twelve children with functional phonological delays, aged 3;0 to 7;4, participated in an alternating treatments experiment to promote sound change. Independent variables were crossed to yield all logically possible combinations of high/low frequency and high/low density in treatment; the dependent measure was generalization accuracy in production. Results indicated word frequency was most facilitative in sound change, whereas, dense neighbourhood structure was least facilitative. The salience of frequency and avoidance of high density are discussed relative to the type of phonological change being induced in children's grammars, either phonetic or phonemic, and to the nature of children's representations. Results are further interpreted with reference to interactive models of language processing and optimality theoretic accounts of linguistic structure.