Christopher Holloman

Emergent literacy in kindergartners with cochlear implants

Objective: A key ingredient to academic success is being able to read. Deaf individuals have historically failed to develop literacy skills comparable with those of their normal-hearing (NH) peers, but early identification and cochlear implants (CIs) have improved prospects such that these children can learn to read at the levels of their peers. The goal of this study was to examine early, or emergent, literacy in these children. Method: Twenty-seven deaf children with CIs, who had just completed kindergarten were tested on emergent literacy, and on cognitive and linguistic skills that support emergent literacy, specifically ones involving phonological awareness, executive functioning, and oral language. Seventeen kindergartners with NH and eight with hearing loss, but who used hearing aids served as controls. Outcomes were compared for these three groups of children, regression analyses were performed to see whether predictor variables for emergent literacy differed for children with NH and those with CIs, and factors related to the early treatment of hearing loss and prosthesis configuration were examined for children with CIs. Results: The performance of children with CIs was roughly 1 SD or more below the mean performance of children with NH on all tasks, except for syllable counting, reading fluency, and rapid serial naming. Oral language skills explained more variance in emergent literacy for children with CIs than for children with NH. Age of first implant explained moderate amounts of variance for several measures. Having one or two CIs had no effect, but children who had some amount of bimodal experience outperformed children who had none on several measures. Conclusions: Even deaf children who have benefitted from early identification, intervention, and implantation are still at risk for problems with emergent literacy that could affect their academic success. This finding means that intensive language support needs to continue through at least the early elementary grades. Also, a period of bimodal stimulation during the preschool years can help boost emergent literacy skills to some extent.

Lifetime history of traumatic brain injury among persons with substance use disorders

Objective: Determine (a) if there are sub-groups of individuals with substance use disorders distinguished by their pattern of sustaining traumatic brain injury (TBI) over the lifetime and (b) whether sub-group membership affects current functioning. Design: Secondary analysis. Settings: Outpatient substance abuse treatment programme and state prison. Participants: Two hundred and fifty-seven participants with lifetime histories of both TBI and substance used disorder drawn from two previous studies of (a) persons in substance abuse treatment and (b) prison inmates. Main outcome measures: Ohio State University TBI Identification Method, speed of information processing, working memory, disinhibition, cognitive complaints, sociopathy and substance use disorder severity. Results: Seven clusters of lifetime history of TBI were characterized by the severity of injuries, age at occurrence and presence of a period of time when multiple mild injuries were incurred, often receiving no medical attention. Cluster membership contributed to the prediction of cognitive performance (i.e. processing speed), self-reported cognitive problems and alcohol and other drug severity. Conclusions: In addition to injury severity, age at injury and periods of repeated injury may be distinguishing aspects of a lifetime history of TBI for persons with substance use disorders. Results suggest that clinicians would benefit from knowledge of a persons full history of TBI.

Shared Decision Making and Other Variables as Correlates of Satisfaction with Health Care Decisions in a United States National Survey

OBJECTIVE The purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations. METHODS A randomly selected age-proportionate national sample of adults (aged 21-70 years) stratified on race, ethnicity, and gender (N=488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the shared decision making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD. RESULTS After controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R(2)=.368, p<.001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD. CONCLUSION SDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly. PRACTICE IMPLICATIONS By identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes.

Piloting “sodabriety” – a school-based intervention to impact sugar-sweetened beverage consumption in rural Appalachian high schools

BACKGROUND Sugar-sweetened beverages (SSBs) are the largest source of added sugar in the US diet. In adolescents aged 12-19, these drinks account for 13% to 28% of total daily calories. Compared with other adolescents, those residing in Appalachia have the highest consumption rates of SSBs. METHODS Using a Teen Advisory Council (TAC), a student-designed and student-led intervention was conducted at 2 high schools in a rural Appalachian county. Using repeated-measures models design with Bonferroni correction, data were collected on daily and weekly consumption of SSBs and of water at baseline, immediately post-intervention, and 30 days post-intervention. Vending machine surveys were completed. RESULTS The 186 participants reported purchasing SSBs from school vending machines (41.4%), cafeteria (36.5%), and school stores (7.7%). Daily SSB servings decreased from an average of 2.32 (SD = 2.14) to 1.32 (SD = 1.29) (p < .001). Weekly consumption decreased from an average of 4.30 (SD = 2.40) days/week to 2.64 (SD = 1.91) (p < .001). Water consumption increased 19% from baseline to immediately post-intervention. CONCLUSIONS Student-directed efforts to support behavioral change are feasible and effective at affecting individual lifestyle behaviors. Small and manageable changes may lead to net improvements in lifestyle behaviors.

Comparing the Effects of Teen Mentors to Adult Teachers on Child Lifestyle Behaviors and Health Outcomes in Appalachia.

Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting.

Certified Crop Advisors’ Perceptions of Giant Ragweed (Ambrosia trifida) Distribution, Herbicide Resistance, and Management in the Corn Belt

Abstract Giant ragweed has been increasing as a major weed of row crops in the last 30 yr, but quantitative data regarding its pattern and mechanisms of spread in crop fields are lacking. To address this gap, we conducted a Web-based survey of certified crop advisors in the U.S. Corn Belt and Ontario, Canada. Participants were asked questions regarding giant ragweed and crop production practices for the county of their choice. Responses were mapped and correlation analyses were conducted among the responses to determine factors associated with giant ragweed populations. Respondents rated giant ragweed as the most or one of the most difficult weeds to manage in 45% of 421 U.S. counties responding, and 57% of responding counties reported giant ragweed populations with herbicide resistance to acetolactate synthase inhibitors, glyphosate, or both herbicides. Results suggest that giant ragweed is increasing in crop fields outward from the east-central U.S. Corn Belt in most directions. Crop production practices associated with giant ragweed populations included minimum tillage, continuous soybean, and multiple-application herbicide programs; ecological factors included giant ragweed presence in noncrop edge habitats, early and prolonged emergence, and presence of the seed-burying common earthworm in crop fields. Managing giant ragweed in noncrop areas could reduce giant ragweed migration from noncrop habitats into crop fields and slow its spread. Where giant ragweed is already established in crop fields, including a more diverse combination of crop species, tillage practices, and herbicide sites of action will be critical to reduce populations, disrupt emergence patterns, and select against herbicide-resistant giant ragweed genotypes. Incorporation of a cereal grain into the crop rotation may help suppress early giant ragweed emergence and provide chemical or mechanical control options for late-emerging giant ragweed. Nomenclature: Glyphosate; giant ragweed; Ambrosia trifida L. AMBTR; common earthworm; Lumbricus terrestris L.; corn; Zea mays L.; soybean, Glycine max (L.) Merr.

Workplace bullying in the OR: Results of a descriptive study.

This study describes the incidence of workplace bullying among perioperative RNs, surgical technologists, and unlicensed perioperative personnel in two academic medical centers. The study sought to determine whether the demographic variables of gender, ethnicity, hospital, years of experience on the unit, years in the profession, and job title predict the experience of workplace bullying; whether a relationship exists between workplace bullying and emotional exhaustion; and whether bullying is associated with perceptions of patient safety in the OR. The cross-sectional design included perioperative nurses, surgical technologists, and unlicensed perioperative personnel (N = 167). Fifty-nine percent of the study participants reported witnessing coworker bullying weekly, and 34% reported at least two bullying acts weekly. Having ones opinion ignored is the most common bullying act, with 28% of respondents experiencing being ignored. Differences in the experience of bullying can be found between hospitals and among ethnicities. Emotional exhaustion also was correlated with bullying. The participants did not perceive bullying as affecting patient safety.

Measuring what matters: Effectively predicting language and literacy in children with cochlear implants

OBJECTIVES To evaluate how well various language measures typically used with very young children after they receive cochlear implants predict language and literacy skills as they enter school. METHODS Subjects were 50 children who had just completed kindergarten and were 6 or 7 years of age. All had previously participated in a longitudinal study from 12 to 48 months of age. 27 children had severe-to-profound hearing loss and wore cochlear implants, 8 had moderate hearing loss and wore hearing aids, and 15 had normal hearing. A latent variable of language/literacy skill was constructed from scores on six kinds of measures: (1) language comprehension; (2) expressive vocabulary; (3) phonological awareness; (4) literacy; (5) narrative skill; and (6) processing speed. Five kinds of language measures obtained at six-month intervals from 12 to 48 months of age were used as predictor variables in correlational analyses: (1) language comprehension; (2) expressive vocabulary; (3) syntactic structure of productive speech; (4) form and (5) function of language used in language samples. RESULTS Outcomes quantified how much variance in kindergarten language/literacy performance was explained by each predictor variable, at each earlier age of testing. Comprehension measures consistently predicted roughly 25-50 percent of the variance in kindergarten language/literacy performance, and were the only effective predictors before 24 months of age. Vocabulary and syntactic complexity were strong predictors after roughly 36 months of age. Amount of speech produced in language samples and number of answers to parental queries explained moderate amounts of variance in performance after 24 months of age. Number of manual gestures and nonspeech vocalizations produced in language samples explained little to no variance before 24 months of age, and after that were negatively correlated with kindergarten performance. The number of imitations produced in language samples at 24 months of age explained about 10 percent of variance in kindergarten performance, but was otherwise not correlated or negatively correlated with kindergarten outcomes. CONCLUSIONS Before 24 months of age, the best predictor of later language success is language comprehension. In general, measures that index a childs cognitive processing of language are the most sensitive predictors of school-age language abilities.

Melatonin: Can it Stop the Ringing?:

Objectives: We sought to report the efficacy of oral melatonin as treatment for chronic tinnitus and to determine whether particular subsets of tinnitus patients have greater benefit from melatonin therapy than others. Methods: This was a prospective, randomized, double-blind, crossover clinical trial in an ambulatory tertiary referral otology and neurotology practice. Adults with chronic tinnitus were randomized to 3 mg melatonin or placebo nightly for 30 days followed by a 1-month washout period. Each group then crossed into the opposite treatment arm for 30 days. The tests audiometric tinnitus matching (TM), Tinnitus Severity Index (TSI), Self Rated Tinnitus (SRT), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were administered at the outset and every 30 days thereafter to assess the effects of each intervention. Results: A total of 61 subjects completed the study. A significantly greater decrease in TM and SRT scores (p < 0.05) from baseline was observed after treatment with melatonin relative to the effect observed with placebo. Male gender, bilateral tinnitus, noise exposure, no prior tinnitus treatment, absence of depression and/or anxiety at baseline, and greater pretreatment TSI scores were associated with a positive response to melatonin. Absence of depression and/or anxiety at baseline, greater pretreatment TSI scores, and greater pretreatment SRT scores were found to be positively associated with greater likelihood of improvement in both tinnitus and sleep with use of melatonin (p < 0.05). Conclusions: Melatonin is associated with a statistically significant decrease in tinnitus intensity and improved sleep quality in patients with chronic tinnitus. Melatonin is most effective in men, those without a history of depression, those who have not undergone prior tinnitus treatments, those with more severe and bilateral tinnitus, and those with a history of noise exposure.

Health status and access to health care services: a comparison between Ohio's rural non-Appalachian and Appalachian families.

Comparisons in the health status of rural dwellers and care access have not traditionally considered culturally defined areas such as Appalachia. This study examined differences in parent health status, child health status, and access to care between those living in Ohios 29 Appalachian counties and those living in Ohios 30 rural counties. We analyzed data from the 2008 Ohio Family Health Survey including Bayesian hierarchical modeling. Child health differed by gender and ethnicity. Parent health status differed by region. Parent and child health status were related to care access. Health and access disparities exist within rural and Appalachia Ohio.