How Prior Knowledge, Gesture Instruction, and Interference After Instruction Interact to Influence Learning of Mathematical Equivalence.

Although children learn more when teachers gesture, it is not clear how gesture supports learning. Here, we sought to investigate the nature of the memory processes that underlie the observed benefits of gesture on lasting learning. We hypothesized that instruction with gesture might create memory representations that are particularly resistant to interference. We investigated this possibility in a classroom study with 402 second- and third-grade children. Participants received classroom-level instruction in mathematical equivalence using videos with or without accompanying gesture. After instruction, children solved problems that were either visually similar to the problems that were taught, and consistent with an operational interpretation of the equal sign (interference), or visually distinct from equivalence problems and without an equal sign (control) in order to assess the role of gesture in resisting interference after learning. Gesture facilitated learning, but the effects of gesture and interference varied depending on type of problem being solved and the strategies that children used to solve problems prior to instruction. Some children benefitted from gesture, while others did not. These findings have implications for understanding the mechanisms underlying the beneficial effect of gesture on mathematical learning, revealing that gesture does not work via a general mechanism like enhancing attention or engagement that would apply to children with all forms of prior knowledge.

Emoji as gesture in digital communication: Emoji improve comprehension of indirect speech.

As reliance on digital communication grows, so does the importance of communicating effectively with text. Yet when communicating with text, benefits from other channels, such as hand gesture, are diminished. Hand gestures support comprehension and disambiguate characteristics of the spoken message by providing information in a visual channel supporting speech. Can emoji (pictures used to supplement text communication) perform similar functions? Here, we ask whether emoji improve comprehension of indirect speech. Indirect speech is ambiguous, and appropriate comprehension depends on the receiver decoding context cues, such as hand gesture. We adapted gesture conditions from prior research (Kelly et al., 1999, Experiment 2) to a digital, text-based format, using emoji rather than gestures. Participants interpreted 12 hypothetical text-message exchanges that ended with indirect speech, communicated via text only, text+emoji, or emoji only, in a between-subjects design. Like that previously seen for hand gesture, emoji improved comprehension. Participants were more likely to correctly interpret indirect speech in the emoji-only condition compared with the text+emoji and the text-only conditions, and more likely in the text+emoji condition compared to the text-only condition. Thus, emoji are not mere decoration, but rather are integrated with text to communicate and disambiguate complex messages. Similar to gesture in face-to-face communication, emoji improve comprehension during text-based communication.

Teaching little kids big sentences: A randomized controlled trial showing that children with DLD respond to complex syntax intervention embedded within the context of preschool/kindergarten science instruction.

BACKGROUND: The language of the science curriculum is complex, even in the early grades. To communicate their scientific observations, children must produce complex syntax, particularly complement clauses (e.g., I think it will float; We noticed that it vibrates). Complex syntax is often challenging for children with developmental language disorder (DLD), and thus their learning and communication of science may be compromised. AIMS: We asked whether recast therapy delivered in the context of a science curriculum led to gains in complement clause use and scientific content knowledge. To understand the efficacy of recast therapy, we compared changes in science and language knowledge in children who received treatment for complement clauses embedded in a first-grade science curriculum to two active control conditions (vocabulary + science, phonological awareness + science). METHODS & PROCEDURES: This 2-year single-site three-arm parallel randomized controlled trial was conducted in Delaware, USA. Children with DLD, not yet in first grade and with low accuracy on complement clauses, were eligible. Thirty-three 4-7-year-old children participated in the summers of 2018 and 2019 (2020 was cancelled due to COVID-19). We assigned participants to arms using 1:1:1 pseudo-random allocation (avoiding placing siblings together). The intervention consisted of 39 small-group sessions of recast therapy, robust vocabulary instruction or phonological awareness intervention during eight science units over 4 weeks, followed by two science units (1 week) taught without language intervention. Pre-/post-measures were collected 3 weeks before and after camp by unmasked assessors. OUTCOMES & RESULTS: Primary outcome measures were accuracy on a 20-item probe of complement clause production and performance on ten 10-item unit tests (eight science + language, two science only). Complete data were available for 31 children (10 grammar, 21 active control); two others were lost to follow-up. Both groups made similar gains on science unit tests for science + language content (pre versus post, d = 2.9, p < 0.0001; group, p = 0.24). The grammar group performed significantly better at post-test than the active control group (d = 2.5, p = 0.049) on complement clause probes and marginally better on science-only unit tests (d = 2.5, p = 0.051). CONCLUSIONS & IMPLICATIONS: Children with DLD can benefit from language intervention embedded in curricular content and learn both language and science targets taught simultaneously. Tentative findings suggest that treatment for grammar targets may improve academic outcomes. WHAT THIS PAPER ADDS: What is already known on the subject We know that recast therapy focused on morphology is effective but very time consuming. Treatment for complex syntax in young children has preliminary efficacy data available. Prior research provides mixed evidence as to children's ability to learn language targets in conjunction with other information. What this study adds This study provides additional data supporting the efficacy of intensive complex syntax recast therapy for children ages 4-7 with Developmental Language Disorder. It also provides data that children can learn language targets and science curricular content simultaneously. What are the clinical implications of this work? As SLPs, we have to talk about something to deliver language therapy; we should consider talking about curricular content. Recast therapy focused on syntactic frames is effective with young children.

A pre-registered, multi-lab non-replication of the action-sentence compatibility effect (ACE).

The Action-sentence Compatibility Effect (ACE) is a well-known demonstration of the role of motor activity in the comprehension of language. Participants are asked to make sensibility judgments on sentences by producing movements toward the body or away from the body. The ACE is the finding that movements are faster when the direction of the movement (e.g., toward) matches the direction of the action in the to-be-judged sentence (e.g., Art gave you the pen describes action toward you). We report on a pre-registered, multi-lab replication of one version of the ACE. The results show that none of the 18 labs involved in the study observed a reliable ACE, and that the meta-analytic estimate of the size of the ACE was essentially zero.

SARS-CoV-2 Testing of 11,884 Healthcare Workers at an Acute NHS Hospital Trust in England: A Retrospective Analysis.

Healthcare workers (HCWs) are known to be at increased risk of infection with SARS-CoV-2, although whether these risks are equal across all roles is uncertain. Here we report a retrospective analysis of a large real-world dataset obtained from 10 March to 6 July 2020 in an NHS Foundation Trust in England with 17,126 employees. 3,338 HCWs underwent symptomatic PCR testing (14.4% positive, 2.8% of all staff) and 11,103 HCWs underwent serological testing for SARS-CoV-2 IgG (8.4% positive, 5.5% of all staff). Seropositivity was lower than other hospital settings in England but higher than community estimates. Increased test positivity rates were observed in HCWs from BAME backgrounds and residents in areas of higher social deprivation. A multiple logistic regression model adjusting for ethnicity and social deprivation confirmed statistically significant increases in the odds of testing positive in certain occupational groups, most notably domestic services staff, nurses, and health-care assistants. PCR testing of symptomatic HCWs appeared to underestimate overall infection levels, probably due to asymptomatic seroconversion. Clinical outcomes were reassuring, with only a small minority of HCWs with COVID-19 requiring hospitalization (2.3%) or ICU management (0.7%) and with no deaths. Despite a relatively low level of HCW infection compared to other UK cohorts, there were nevertheless important differences in test positivity rates between occupational groups, robust to adjustment for demographic factors such as ethnic background and social deprivation. Quantitative and qualitative studies are needed to better understand the factors contributing to this risk. Robust informatics solutions for HCW exposure data are essential to inform occupational monitoring.

Parenting and Home Environment in Childhood and Adolescence and Alcohol Use Disorder in Adulthood.

PURPOSE: Parenting is a modifiable factor affecting the development of alcohol use disorder (AUD); however, the persistence of this effect into adulthood remains poorly understood. This study aimed to explore the longitudinal relationship between positive parenting and AUD in adulthood. METHODS: Data were gathered from the Christchurch Health and Development Study (CHDS), a birth cohort of 1,265 children born in Christchurch (New Zealand) in mid-1977. Positive parenting was quantified to age 16, and included the extent to which cohort members self-reported: high scores on measures of maternal and paternal care; low scores on a measure of maternal and paternal overprotection; high scores on a measure of parental attachment; low scores on a measure of parental intimate partner violence; and occasional or no use of physical punishment. Outcome measures were AUD incidence and symptoms at ages 15-35, with potential confounding factors and time-dynamic covariates included. RESULTS: There was a significant association between positive parenting and AUD outcomes, with higher levels of positive parenting associated with a lower incidence of AUD and AUD symptoms. Controlling for confounding factors reduced the association between positive parenting and AUD outcomes, but they remained statistically significant. Adjustment for mental health, life stress, and employment reduced the magnitude of the association between positive parenting and alcohol outcomes to statistical nonsignificance. CONCLUSIONS: Parenting factors in childhood and adolescence are linked to AUD outcomes in adulthood, as well as mental health, substance use, and life stress. Investment in positive parenting in adolescence may reduce AUD and associated harms in adulthood.

The Challenge of Rich Vocabulary Instruction for Children With Developmental Language Disorder.

Purpose The aims of the study were to explore responses of children with developmental language disorder (DLD) to rich vocabulary instruction and to identify potential factors that contribute to outcomes. Method Children with DLD participated in a language intervention embedded within a science camp. Using parent and clinician reports, standardized tests, probes, notes, and video, we derived descriptions of seven of the campers who received a vocabulary intervention that incorporated principles of rich instruction. We present them here as a case series. Results Five cases responded to the intervention with modest gains in Tier 2 science vocabulary and science knowledge. One case demonstrated no response, and another was unable to complete the intervention. The latter two cases presented with triple risks: DLD, executive function deficits, and stressors associated with poverty. In comparison, the best responder also lived in poverty and had DLD, but he had intact executive function, strengths in extant vocabulary, stronger knowledge of science, better engagement in the science and language intervention activities, and was older. Other factors that seemed to contribute to outcomes included the complexity of the word forms and dosage. Conclusions Translating research on rich instruction to clinical practice is challenging. This case series motivated hypotheses about the nature of the challenge and what to do about it, the primary one being that the modest success of rich vocabulary instruction for children with DLD is not a limitation of the approach itself but rather a reflection of the difficulty of delivering the intervention while tailoring the targets, approach, and dosage to the needs of individual children with DLD. Supplemental Material https://doi.org/10.23641/asha.13667699.

Acute Hemolytic Transfusion Reaction Due to Pooled Platelets: A Rare but Serious Adverse Event.

A female patient aged 65 years with blood group A with relapsed lymphoma had thrombocytopenia; leukocyte-reduced group O prestorage pooled platelet concentrates (PPLTs) were transfused without adverse events. She was discharged home, but 1.5 hours later she returned with fever and dark urine. Hypotension and tachycardia developed; she was admitted to the intensive care unit. Post-transfusion blood and urine samples were obtained. Serial dilutions from 5 donor testing tubes and a simulated PLT pool were performed and read at immediate spin and IgG. Testing confirmed an acute hemolytic transfusion reaction (AHTR): elevated lactate dehydrogenase (996 U/L; normal range 135 U/L-225 U/L) and undetectable haptoglobin (<10 mg/dL; normal range 30 mg/dL-200 mg/dL) levels. Urinalysis showed dark amber urine but no significant quantity of red blood cells. At 37ºC the simulated pool and donor number 5 had high-titer anti-A. As a precaution, the donor was permanently deferred. Research has shown that PLT-associated AHTR has occurred with apheresis platelets but is very rare with whole blood-derived PLTs.

Gesture during math instruction specifically benefits learners with high visuospatial working memory capacity.

BACKGROUND: Characteristics of both teachers and learners influence mathematical learning. For example, when teachers use hand gestures to support instruction, students learn more than others who learn the same concept with only speech, and students with higher working memory capacity (WMC) learn more rapidly than those with lower WMC. One hypothesis for the effect of gesture on math learning is that gestures provide a signal to learners that can reduce demand on working memory resources during learning. However, it is not known what sort of working memory resources support learning with gesture. Gestures are motoric; they co-occur with verbal language and they are perceived visually. METHODS: In two studies, we investigated the relationship between mathematical learning with or without gesture and individual variation in verbal, visuospatial, and kinesthetic WMC. Students observed a videotaped lesson in a novel mathematical system that either included instruction with both speech and gesture (Study 1) or instruction with only speech (Study 2). After instruction, students solved novel problems in the instructed system and transfer problems in a related system. Finally, students completed verbal, visuospatial, and kinesthetic working memory assessments. RESULTS: There was a positive relationship between visuospatial WMC and math learning when gesture was present, but no relationship between visuospatial WMC and math learning when gesture was absent. Rather, when gesture was absent, there was a relationship between verbal WMC and math learning. CONCLUSION: Providing gesture during instruction appears to change the cognitive resources recruited when learning a novel math task.

Institution of a Novel Process for N95 Respirator Disinfection with Vaporized Hydrogen Peroxide in the Setting of the COVID-19 Pandemic at a Large Academic Medical Center.

Personal protective equipment (PPE) has been an invaluable yet limited resource when it comes to protecting healthcare workers against infection during the 2019 coronavirus (COVID-19) pandemic. In the US, N95 respirator supply chains are severely strained and conservation strategies are needed. A multidisciplinary team at the Washington University School of Medicine, Barnes Jewish Hospital, and BJC Healthcare was formed to implement a program to disinfect N95 respirators. The process described extends the life of N95 respirators using vaporized hydrogen peroxide (VHP) disinfection and allows healthcare workers to retain their own N95 respirator across a large metropolitan healthcare system.

Trajectories of alcohol use problems based on early adolescent alcohol use: Findings from a 35 year population cohort.

BACKGROUND: Early exposure to alcohol in adolescence is associated with a range of long term harms. Better understanding of trajectories of alcohol use from adolescence to early adulthood would help target prevention strategies to high risk groups. METHODS: Christchurch (New Zealand) general population birth cohort (n = 1265). A latent trajectory model of drinking behaviour at age 14-16 was used to predict drinking outcomes at age 18-35, net of covariate factors known to be associated with substance use outcomes in this cohort. RESULTS: Three classes of adolescent alcohol use were identified. These were: occasional drinkers, emergent binge drinkers and increasing heavy drinkers. CONCLUSIONS: This analysis identifies three groups of adolescent alcohol users with differing patterns of use. Emergent binge drinkers likely require public policy responses to alcohol use whereas increasing heavy drinkers are potentially able to be identified individually on the basis of patterns of alcohol use and social variables. This group may benefit from psychosocial interventions and are unlikely to respond to a broad public health approach.

Comparison of age of first drink and age of first intoxication as predictors of substance use and mental health problems in adulthood.

BACKGROUND: International public policy on age of first alcoholic drink (AFD) has emphasised the long-term benefits of delaying AFD. This study aimed to compare AFD to age of first intoxication (AFI) as predictors of substance use disorder and mental disorder outcomes in adulthood. METHODS: Data were obtained from a longitudinal birth cohort in Christchurch, New Zealand. Participants were born in 1977. Analysis samples ranged from n = 1025 (age 18) to n = 962 (age 35). Measures of AFD and AFI were generated using parental- and self-report data collected from age 11. Outcomes at age 18-35 were alcohol quantity consumed, DSM-IV alcohol use disorder (AUD) and AUD symptoms, major depression, anxiety disorder, and nicotine, cannabis, and other illicit drug dependence. Covariate factors measured during childhood included family socioeconomic status, family functioning, parental alcohol-related attitudes/behaviours, and individual factors. RESULTS: There was a significant unadjusted association between AFD and symptoms of AUD (p < .001) and nicotine dependence (p < .05) but not other outcomes. AFI was significantly (p < .05) associated with all outcomes. After adjustment for covariates, the association between AFD and outcomes was not statistically significant. Conversely, in adjusted models, statistically significant (p < .05) associations remained between AFI and all AUD and substance use disorder outcomes but not alcohol consumption or mental disorder outcomes. CONCLUSIONS: AFI was a more robust predictor of adult substance use disorder outcomes than AFD. Public health and policy interventions aimed at prevention of long term harms from alcohol should therefore focus on AFI rather than AFD.

Patients with hippocampal amnesia successfully integrate gesture and speech.

During conversation, people integrate information from co-speech hand gestures with information in spoken language. For example, after hearing the sentence, "A piece of the log flew up and hit Carl in the face" while viewing a gesture directed at the nose, people tend to later report that the log hit Carl in the nose (information only in gesture) rather than in the face (information in speech). The cognitive and neural mechanisms that support the integration of gesture with speech are unclear. One possibility is that the hippocampus - known for its role in relational memory and information integration - is necessary for integrating gesture and speech. To test this possibility, we examined how patients with hippocampal amnesia and healthy and brain-damaged comparison participants express information from gesture in a narrative retelling task. Participants watched videos of an experimenter telling narratives that included hand gestures that contained supplementary information. Participants were asked to retell the narratives and their spoken retellings were assessed for the presence of information from gesture. For features that had been accompanied by supplementary gesture, patients with amnesia retold fewer of these features overall and fewer retellings that matched the speech from the narrative. Yet their retellings included features that contained information that had been present uniquely in gesture in amounts that were not reliably different from comparison groups. Thus, a functioning hippocampus is not necessary for gesture-speech integration over short timescales. Providing unique information in gesture may enhance communication for individuals with declarative memory impairment, possibly via non-declarative memory mechanisms.

Hand gestures support word learning in patients with hippocampal amnesia.

Co-speech hand gesture facilitates learning and memory, yet the cognitive and neural mechanisms supporting this remain unclear. One possibility is that motor information in gesture may engage procedural memory representations. Alternatively, iconic information from gesture may contribute to declarative memory representations mediated by the hippocampus. To investigate these alternatives, we examined gesture's effects on word learning in patients with hippocampal damage and declarative memory impairment, with intact procedural memory, and in healthy and in brain-damaged comparison groups. Participants learned novel label-object pairings while producing gesture, observing gesture, or observing without gesture. After a delay, recall and object identification were assessed. Unsurprisingly, amnesic patients were unable to recall the labels at test. However, they correctly identified objects at above chance levels, but only if they produced a gesture at encoding. Comparison groups performed well above chance at both recall and object identification regardless of gesture. These findings suggest that gesture production may support word learning by engaging nondeclarative (procedural) memory.

The influence of the hippocampus and declarative memory on word use: Patients with amnesia use less imageable words.

Hippocampal functioning contributes to our ability to generate multifaceted, imagistic event representations. Patients with hippocampal damage produce event narratives that contain fewer details and fewer imagistic features. We hypothesized that impoverished memory representations would influence language at the word level, yielding words lower in imageability and concreteness. We tested this by examining language produced by patients with bilateral hippocampal damage and severe declarative memory impairment, and brain-damaged and healthy comparison groups. Participants described events from the real past, imagined past, imagined present, and imagined future. We analyzed the imageability and concreteness of words used. Patients with amnesia used words that were less imageable than those of comparison groups across time periods, even when accounting for the amount of episodic detail in narratives. Moreover, all participants used words that were relatively more imageable when discussing real past events than other time periods. Taken together, these findings suggest that the memory that we have for an event affects how we talk about that event, and this extends all the way to the individual words that we use.

A novel approach to improving efficiency and cost saving in preoperative blood preparation.

BACKGROUND: Preoperative ordering of blood products has been an area of optimization due to considerable variability among physicians; overpreparation can lead to extra costs and underpreparation of blood can potentially compromise patient safety. STUDY DESIGN AND METHODS: We examined the potential cost savings of extending the storage interval of a presurgical type-and-screen sample from 7 to 14 days, thereby reducing the need for a new specimen on the day of surgery. RESULTS: Sensitivity analysis showed annual cost savings for our institution to be an estimated $38,770 ($22,420-$73,120). CONCLUSION: These results are even more robust when incorporating the additional potential savings from improved operating room efficiency.

Animation Stimuli System for Research on Instructor Gestures in Education.

Education research has shown that instructor gestures can help capture, maintain, and direct the student's attention during a lecture as well as enhance learning and retention. Traditional education research on instructor gestures relies on video stimuli, which are time consuming to produce, especially when gesture precision and consistency across conditions are strictly enforced. The proposed system allows users to efficiently create accurate and effective stimuli for complex studies on gesture, without the need for computer animation expertise or artist talent.

A technique for continuous measurement of body movement from video.

The movements that we make with our body vary continuously along multiple dimensions. However, many of the tools and techniques presently used for coding and analyzing hand gestures and other body movements yield categorical outcome variables. Focusing on categorical variables as the primary quantitative outcomes may mislead researchers or distort conclusions. Moreover, categorical systems may fail to capture the richness present in movement. Variations in body movement may be informative in multiple dimensions. For example, a single hand gesture has a unique size, height of production, trajectory, speed, and handshape. Slight variations in any of these features may alter how both the speaker and the listener are affected by gesture. In this paper, we describe a new method for measuring and visualizing the physical trajectory of movement using video. This method is generally accessible, requiring only video data and freely available computer software. This method allows researchers to examine features of hand gestures, body movement, and other motion, including size, height, curvature, and speed. We offer a detailed account of how to implement this approach, and we also offer some guidelines for situations where this approach may be fruitful in revealing how the body expresses information. Finally, we provide data from a small study on how speakers alter their hand gestures in response to different characteristics of a stimulus to demonstrate the utility of analyzing continuous dimensions of motion. By creating shared methods, we hope to facilitate communication between researchers from varying methodological traditions.

Hand Gesture and Mathematics Learning: Lessons From an Avatar.

A beneficial effect of gesture on learning has been demonstrated in multiple domains, including mathematics, science, and foreign language vocabulary. However, because gesture is known to co-vary with other non-verbal behaviors, including eye gaze and prosody along with face, lip, and body movements, it is possible the beneficial effect of gesture is instead attributable to these other behaviors. We used a computer-generated animated pedagogical agent to control both verbal and non-verbal behavior. Children viewed lessons on mathematical equivalence in which an avatar either gestured or did not gesture, while eye gaze, head position, and lip movements remained identical across gesture conditions. Children who observed the gesturing avatar learned more, and they solved problems more quickly. Moreover, those children who learned were more likely to transfer and generalize their knowledge. These findings provide converging evidence that gesture facilitates math learning, and they reveal the potential for using technology to study non-verbal behavior in controlled experiments.