A systematic review on experimental studies about patient adherence to treatment.

A better understanding of patients' adherence to treatment is a prerequisite to maximize the benefit of healthcare provision for patients, reduce treatment costs, and is a key factor in a variety of subsequent health outcomes. We aim to understand the state of the art of scientific evidence about which factors influence patients' adherence to treatment. A systematic literature review was conducted using PRISMA guidelines in five separate electronic databases of scientific publications: PubMed, PsycINFO (ProQuest), Cochrane library (Ovid), Google Scholar, and Web of Science. The search focused on literature reporting the significance of factors in adherence to treatment between 2011 and 2021, including only experimental studies (e.g., randomized controlled trials [RCT], clinical trials, etc.). We included 47 experimental studies. The results of the systematic review (SR) are grouped according to predetermined categories of the World Health Organization (WHO): socioeconomic, treatment, condition, personal, and healthcare-related factors. This review gives an actual overview of evidence-based studies on adherence and analyzed the significance of factors defined by the WHO classification. By showing the strength of certain factors in several independent studies and concomitantly uncovering gaps in research, these insights could serve as a basis for the design of future adherence studies and models.

The Assessment of Chinese Children's English Vocabulary-A Culturally Appropriate Receptive Vocabulary Test for Young Chinese Learners of English.

Millions of Chinese children learn English at increasingly younger ages. Yet when it comes to measuring proficiency, educators, and researchers rely on assessments that have been developed for L1 learners and/or for different cultural contexts, or on non-validated, individually designed tests. We developed the Assessment of Chinese Children's English Vocabulary test (ACCE-V) to address the need for a validated, culturally appropriate receptive vocabulary test, designed specifically for young Chinese learners. The items are drawn from current teaching materials used in China, and the depictions of people and objects are culturally appropriate. We evaluated the instrument's reliability and validity in two field tests with a combined sample size of 1,092 children (181 children for the first field test and 911 children for the second field test, age range from 3.1 to 7.7, mean age: 5.2. Item Response Theory (IRT) analyses show that the ACCE-V is sufficiently sensitive to capture different proficiency levels and that it has good psychometric properties. ACCE-V scores were correlated with Peabody Picture Vocabulary Test scores, indicating concurrent validity. We found that children's age and English learning experience can significantly predict the scores of ACCE-V, but the effect of English learning experience is greater. The ACCE-V thus offers an alternative to existing vocabulary tests. We argue that culturally appropriate assessments like the ACCE-V are fairer to learners and help promote an English learning and teaching environment that is less dominated by Western cultures and native speaker norms.

Input effects in the acquisition of verb inflection: Evidence from Emirati Arabic.

This study investigates the acquisition of the Imperfective verb inflection paradigm in Emirati Arabic (EA), to determine whether the learning process is sensitive to the phonological and typological properties of the input. We collected data from 48 participants aged 2;7 to 5;9 years, using an elicited production paradigm. Input frequencies of inflectional contexts, verb types and tokens were obtained from corpora of child-directed and adult EA. Children's accuracy was inversely related to the input frequency of inflectional contexts, but not related to type and token frequency or phonological neighborhood density. Token frequency interacted with age, such that younger children performed considerably worse on low-frequency tokens, but older children performed equally well on high- and low-frequency tokens. We conclude that learning is input-driven, but that a sufficiently regular paradigm allows children to eventually generalise across all items earlier than in previously studied European languages.

Structural and interactional aspects of adverbial sentences in English mother-child interactions: an analysis of two dense corpora.

We analysed both structural and functional aspects of sentences containing the four adverbials "after", "before", "because", and "if" in two dense corpora of parent-child interactions from two British English-acquiring children (2;00-4;07). In comparing mothers' and children's usage we separate out the effects of frequency, cognitive complexity and pragmatics in explaining the course of acquisition of adverbial sentences. We also compare these usage patterns to stimuli used in a range of experimental studies and show how differences may account for some of the difficulties that children have shown in experiments. In addition, we report descriptive data on various aspects of adverbial sentences that have not yet been studied as a resource for future investigations.

Which second trimester placenta previa remains a placenta previa in the third trimester: A prospective cohort study.

OBJECTIVE: The far majority of women with a placenta previa in the second trimester will no longer have a placenta that overlies the internal os in the third trimester. Women with a placenta previa in the third trimester are at risk for complication such as preterm birth and blood loss. Four counselling purposes we aim to identify which women with a second trimester placenta previa have a low-risk and a high-risk for persistence of the placenta previa. STUDY DESIGN: A prospective cohort study of women with a placenta previa in the second trimester between 2014 and 2019. The odds for having a placenta previa in the third trimester were calculated for different baseline characteristics. Multilevel likelihood ratios for ranges of the placenta overlying the internal os in the second trimester and the corresponding ROC curve were calculated to identify the optimal cut-off values. RESULTS: We included 313 women with a placenta previa in the second trimester. The placenta was more frequently located on the posterior wall (62 %) than on the anterior wall (38 %). At evaluation in the third trimester, 37 women (14 %) still had a placenta previa. Women with a larger distance of the placenta overlying the internal os, women having a previous cesarean delivery and women after a conception with assisted reproductive technique had a significant higher risk of placenta previa persistence (p-values <0.001). Women with a placenta overlying less than 14 mm can be considered as low-risk, indicated by a likelihood ratio of 0. Women with a placenta with more than 55 mm overlap can be considered as high-risk, indicated a the likelihood ratio of ∞. CONCLUSION: The majority of the second trimester placenta previa will no longer overly the internal os in the third trimester. Placenta previa persistence is associated with the distance overlying the internal os, a previous cesarean delivery and assisted reproductive techniques. In the second trimester, women can be identified as low-risk and high-risk for persistence of placenta previa. This can be used for risk stratification, counselling and individualized care for women with a second trimester placenta previa.

Interactions between givenness and clause order in children's processing of complex sentences.

Understanding complex sentences that contain multiple clauses referring to events in the world and the relations between them is an important development in children's language learning. A number of theoretical positions have suggested that factors like syntactic structure (clause order), iconicity (whether the order of clauses reflects the order of events), and givenness (whether information is shared between speakers) affect ease of comprehension. We tested these accounts by investigating how these factors interact in British English-speaking children's comprehension of complex sentences with adverbial clauses (after, before, because, if), while controlling for language level, working memory and inhibitory control. 92 children in three age groups (4, 5 and 8 years) and 17 adults completed a picture selection task. Participants heard an initial context sentence, followed by a two-clause sentence which varied in: (1) the order of the main and subordinate clause; (2) the order of given and new information; and (3) whether the given information occurred in the main or subordinate clause. Accuracy and response times were measured. Our results showed that given-before-new improves comprehension for four- and five-year-olds, but only when the given information is in the initial subordinate clause (e.g., "Sue crawls on the floor. Before she crawls on the floor, she hops up and down"). Temporal adverbials (after, before) were processed faster than causal adverbials (because, if). These effects were not found for the eight-year-olds, whose performance was more similar to that of the adults. Providing a context sentence also improved performance compared to presenting the test sentences in isolation. We conclude that existing accounts based on either ease of processing or information structure cannot fully account for these findings, and suggest a more integrated explanation which reflects children's developing language and literacy skills.

Final outcome of a second trimester low-positioned placenta: A systematic review and meta-analysis.

Low-positioned placentas which are located in the lower uterine segment (LUS), either a low-lying placenta or a placenta previa, are associated with increased obstetric risks. However, most second trimester low-positioned placentas resolve during pregnancy and have a higher position in the third trimester, without posing any risks. We performed a systematic review and meta-analysis to evaluate the proportion of second trimester low-positioned placentas that have a position towards the fundus in the third trimester. Our aim was to find a cut-off value that included all women in whom the placenta will remain low in the third trimester, thus who are at increased risk of obstetric complications. Subsequently, we assessed whether an anterior or posterior placental location influenced this proportion. We searched MEDLINE and EMBASE and clinicaltrials.gov up to April 2019 for studies on the sonographic follow-up of second trimester low-positioned placentas, with a distance between the placenta and the internal os of the cervix of 20 mm or less at a gestational age of above 15 week and a follow up after 28 weeks. Studies were scored on methodological quality using the Newcastle-Ottowa Scale (NOS). A meta-analysis was conducted to summarize the proportion of second trimester low-positioned placentas with a position towards the fundus in the third trimester. We calculated the proportion at different cut-off values of the distance from the placental edge to the internal os of the cervix (0 mm, 10 mm and 20 mm). Also, anteriorly and posteriorly located placentas and women with and without a prior cesarean delivery were compared. We included 11 eligible studies which reported on 3586 women with a low-positioned placenta in the second trimester. Proportions of placentas with a position towards the fundus in the third trimester ranged between 0.63 and 1.0. Pooled proportions were 0.90 (95% CI 0.87-0.93) for IOD <10 mm and 0.80 (95% CI 0.74-0.85) for IOD < 0 mm. Due to heterogeneity between studies, the subgroup of <20 mm could not be pooled. Overall, anteriorly located placentas more often had a position towards the fundus in the third trimester, but studies did report conflicting results. Prior cesarean section had no influence except for an IOD of <0 mm, in which women without a prior cesarean delivery more often had a placenta towards the fundus. The majority of second trimester low-positioned placentas will be located towards the fundus at the time of follow-up. However, we could not determine a cut-off value for anterior and posterior placentas that included all women at high risk. The cut-off value, placental side and prior cesarean section should be assessed in a large prospective observational study.

Incidence and recurrence rate of postpartum hemorrhage and manual removal of the placenta: A longitudinal linked national cohort study in The Netherlands.

OBJECTIVE: We studied the incidence of postpartum hemorrhage and manual removal of the placenta and their recurrence rate in a subsequent pregnancy. We hypothesized that the risk of recurrence was dependent on the gestational age at first birth and whether or not a manual removal of the placenta was necessary. Knowledge on this subject can potentially improve counselling, prevention and management in obstetric care for women at risk for PPH or identify women at low risk for recurrence. STUDY DESIGN: This was a retrospective national cohort study consisting of women with two consecutive singleton deliveries between 1999 and 2009 in the Netherlands. A longitudinal linked national cohort with information on subsequent singleton deliveries in the Netherlands was used. Main outcome measures were: postpartum hemorrhage (defined as ≥1000 mL after vaginal delivery or Caesarean section) and manual removal of the placenta. We calculated incidence and recurrence rates of postpartum hemorrhage and manual removal of the placenta for all women and stratified by gestational age. RESULTS: After application of in- and exclusion criteria 359 737 women were studied. A total of 5.4% women experienced postpartum hemorrhage in the first pregnancy and 2.7% of women had a manual removal of the placenta. The risk of postpartum hemorrhage in a subsequent pregnancy was significantly higher in women with a history of postpartum hemorrhage compared to women without a previous postpartum hemorrhage (18% vs 3.9%, adjusted odds ratio 4.5; 95% confidence interval 4.3-4.7). The risk of manual removal of the placenta in the second pregnancy was only 1.4% in women without a previous manual removal compared to 17% of women with a previous manual removal of the placenta. Women with a manual removal of the placenta in the first pregnancy between 32 and 37 weeks were most at risk for recurrence (adjusted odds ratio 8.9; 95% confidence interval 7.2-11). CONCLUSION: Women with a previous delivery complicated by postpartum hemorrhage or manual removal of the placenta are at increased risk for recurrence. The magnitude of this risk is highest in women with deliveries beyond 32 weeks in the first pregnancy.

Iconicity affects children's comprehension of complex sentences: The role of semantics, clause order, input and individual differences.

Complex sentences involving adverbial clauses appear in children's speech at about three years of age yet children have difficulty comprehending these sentences well into the school years. To date, the reasons for these difficulties are unclear, largely because previous studies have tended to focus on only sub-types of adverbial clauses, or have tested only limited theoretical models. In this paper, we provide the most comprehensive experimental study to date. We tested four-year-olds, five-year-olds and adults on four different adverbial clauses (before, after, because, if) to evaluate four different theoretical models (semantic, syntactic, frequency-based and capacity-constrained). 71 children and 10 adults (as controls) completed a forced-choice, picture-selection comprehension test, providing accuracy and response time data. Children also completed a battery of tests to assess their linguistic and general cognitive abilities. We found that children's comprehension was strongly influenced by semantic factors - the iconicity of the event-to-language mappings - and that their response times were influenced by the type of relation expressed by the connective (temporal vs. causal). Neither input frequency (frequency-based account), nor clause order (syntax account) or working memory (capacity-constrained account) provided a good fit to the data. Our findings thus contribute to the development of more sophisticated models of sentence processing. We conclude that such models must also take into account how children's emerging linguistic understanding interacts with developments in other cognitive domains such as their ability to construct mental models and reason flexibly about them.

Don't shoot the giant whose shoulders we are standing on.

Structural priming is a sufficient but not a necessary condition for proving the existence of representations. Absence of evidence is not evidence of absence. Cognitive science relies on the legitimacy of positing representations and processes without "proving" every component. Also, psycholinguistics relies on other methods, including acceptability judgments, to find the materials for priming experiments in the first place.

Predictors for Emergency Cesarean Delivery in Women with Placenta Previa.

Objective The objective of this study was to identify the predictors of emergency delivery in women with placenta previa. Methods This is a retrospective study of pregnancies complicated by placenta previa, scheduled for a cesarean delivery between 2001 and 2011. Using univariable and multivariable regression predictors for emergency delivery in these women were determined. Predictive performance was assessed using receiver operating characteristic analysis and calibration plot. Internal validation was performed by bootstrap analysis. Results Of 214 women with singleton pregnancies, 93 (43%) had an emergency cesarean delivery, and 43 (20%) were preterm. Independent predictors for emergency delivery were history of cesarean section (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.2-12), antepartum bleeding with one (OR, 7.5; 95% CI, 2.5-23), two (OR, 14; 95% CI, 4.3-47), and three or more episodes (OR, 27; 95% CI, 8.3-90) as well as need for blood transfusion (OR, 6.4; 95% CI, 1.7-23). For emergency preterm delivery, covariates were comparable. The area under the curve was 0.832 on the original data and 0.821 on the bootstrap samples. Conclusion Predictors for emergency delivery in women with placenta previa can be used for individualized antenatal care concerning timing of delivery and corticosteroid cover. Potentially, careful selection in women with placenta previa can result in more conservative treatment in an outpatient setting and reduction of iatrogenic preterm delivery.

Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands.

OBJECTIVE: Women who have experienced a placental abruption have a risk of recurrence, but exact information to quantify this risk is currently not available. We studied the incidence and recurrence rate of placental abruption in a subsequent pregnancy and the influence of hypertensive disorders. STUDY DESIGN: We conducted a retrospective national cohort study of all singleton pregnancies that ended from 1999-2007 in the Netherlands. A longitudinal linked national cohort of these women with information on a subsequent singleton delivery was used. We calculated and compared incidence and recurrence rates of placental abruption for women in total, stratified by gestational age of first placental abruption and by the presence of a hypertensive disorder in their first pregnancy. RESULTS: We studied 1,570,635 women of which 3496 (0.22%) experienced a placental abruption. Information was available on a subsequent singleton delivery for 264,424 deliveries. Of these, 521 women (0.20%) had a placental abruption in the first pregnancy vs 214 women (0.08%) in the second pregnancy. The risk of placental abruption in a subsequent pregnancy was significantly higher in women with a previous placental abruption compared with women without (5.8% vs 0.06%; adjusted odds ratio [aOR], 93; 95% confidence interval [CI], 62-139). Women with a placental abruption that occurred at term in their first pregnancy were more at risk for recurrence (aOR, 188; 95% CI, 116-306) than women with a preterm (aOR, 52; 95% CI, 25-111) or early preterm (<32 weeks of gestation) placental abruption in their first pregnancy (aOR, 39; 95% CI, 13-116). Placental abruption was more frequent among women with a hypertensive disorder compared with normotensive women (0.44% vs 0.16%; odds ratio, 2.7; 95% CI, 2.3-3.3). Women with a hypertensive disorder were less at risk for recurrence than were normotensive women (aOR, 0.68; 95% CI, 0.27-1.6). No interaction between a hypertensive disorder in the first pregnancy and the recurrence risk was found. CONCLUSION: Women with a placental abruption in their first pregnancy have a greatly increased risk of placental abruption in a subsequent pregnancy. Hypertensive disorders increase the risk of placental abruption but do not increase the recurrence rate in a subsequent pregnancy. We suggest elective induction from 37 weeks of gestation for women with a history of placental abruption at term in a previous pregnancy.

How German children use intonation to signal information status in narrative discourse.

Recent research on adult German suggests that speakers use particular pitch accent types to signal the information status of discourse referents. This study investigates to what extent German five- and seven-year-olds have acquired this mapping. Semi-natural speech data was obtained from a picture-elicited narration task in which the information status was systematically varied. Surprisingly, data from an adult control group were inconsistent with the claim of a clear status-accent mapping, and demonstrated that adult scripted speech cannot be taken as a target model. However, compared with adults' unscripted speech productions, children were indeed adult-like in their information status marking. Both child groups accented new referents, but tended to deaccent given referents. Accessible referents (whose first mentions were less recent) were mostly realized like new referents. Differences between adults and children emerged in the use of intonation to structure narrations, suggesting that some functions of intonation may be acquired only later.

Polynomial modeling of child and adult intonation in German spontaneous speech.

In a data set of 291 spontaneous utterances from German 5-year-olds, 7-year-olds and adults, nuclear pitch contours were labeled manually using the GToBI annotation system.Ten different contour types were identified.The fundamental frequency (F0) of these contours was modeled using third-order orthogonal polynomials, following an approach similar to the one Grabe, Kochanski, and Coleman (2007) used for English. Statistical analyses showed that all but one contour pair differed significantly from each other in at least one of the four coefficients.This demonstrates that polynomial modeling can provide quantitative empirical support for phonological labels in unscripted speech, and for languages other than English. Furthermore, polynomial expressions can be used to derive the alignment of tonal targets relative to the syllable structure, making polynomial modeling more accessible to the phonological research community. Finally, within-contour comparisons of the three age groups showed that for children, the magnitude of the higher coefficients is lower, suggesting that they are not yet able to modulate their pitch as fast as adults.