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Purpose: Caregiver-implemented interventions are frequently used to support the early communication of young children with language impairment. Although there are numerous studies and meta-analyses supporting their use, there is a need to better understand the intervention approaches and identify potential gaps in the research base. With that premise, we conducted a scoping review to synthesize existing data with an end goal of informing future research directions., Method: We identified relevant studies by comprehensively searching four databases. After deduplication, we screened 5,703 studies. We required included studies ( N = 59) to evaluate caregiver-implemented communication interventions and include at least one caregiver communication outcome measure. We extracted information related to the (a) study, child, and caregiver characteristics; (b) intervention components (e.g., strategies taught, delivery method and format, and dosage); and (c) caregiver and child outcome measures (e.g., type, quality, and level of evidence)., Results: We synthesized results by age group of the child participants. There were no studies with children in the prenatal through 11-month-old age range identified in our review that yielded a caregiver language outcome measure with promising or compelling evidence. For the 12- through 23-month group, there were seven studies, which included eight communication intervention groups; for the 24- through 35-month group, there were 21 studies, which included 26 intervention groups; and for the 36- through 48-month group, there were 21 studies, which included 23 intervention groups. Across studies and age groups, there was considerable variability in the reporting of study characteristics, intervention approaches, and outcome measures., Conclusion: Our scoping review highlights important research gaps and inconsistencies in study reporting that should be addressed in future investigations., Supplemental Material: https://doi.org/10.23641/asha.20289195.

The circumgalactic medium (CGM) is fed by galaxy outflows and accretion of intergalactic gas, but its mass, heavy element enrichment, and relation to galaxy properties are poorly constrained by observations. In a survey of the outskirts of 42 galaxies with the Cosmic Origins Spectrograph onboard the Hubble Space Telescope, we detected ubiquitous, large (150-kiloparsec) halos of ionized oxygen surrounding star-forming galaxies; we found much less ionized oxygen around galaxies with little or no star formation. This ionized CGM contains a substantial mass of heavy elements and gas, perhaps far exceeding the reservoirs of gas in the galaxies themselves. Our data indicate that it is a basic component of nearly all star-forming galaxies that is removed or transformed during the quenching of star formation and the transition to passive evolution.

Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period?, Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years., Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes "favors family or self over agency assistance" and "does not expect filial obligation" were also independently associated., Discussion: The results are consistent with previous studies of successful aging and show that attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years.

A serological study to determine the frequency of Bordetella pertussis infection in 100 adults aged >/=65 years was carried out over a 3-year period. Ten serum samples (collected every 4 months) from each subject were examined for IgA and IgG antibodies to the following B. pertussis antigens: pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin, and fimbriae-2. A >/=2-fold titer increase in ELISA units from one time period to the next was considered serological evidence of infection. The rate of serologically defined infection (i.e., in which there was an increase in titer against any antigen) was 19.7 per 100 person-years. With the use of more specific criteria that indicate definite B. pertussis infection (>/=2-fold increase in titer to PT) and probable B. pertussis infection (>/=2-fold increase in titer to PT or >/=2-fold increase to fimbriae-2), the rates were 3.3 and 8.0 per 100 person-years, respectively. Fifty percent of individuals with definite B. pertussis infections had time-associated symptomatology. Antibody patterns over time suggest that antibody to FHA and perhaps to pertactin is stimulated by infections with other organisms, as well as B. pertussis infections. Our data suggest that symptomatic pertussis occurs in elderly individuals. Consideration should be given to immunization of the elderly with acellular pertussis vaccines.

Objective: To test the hypothesis that there is an inverse relationship between smoking and cognitive impairment by examining the prevalence and incidence of such impairment in a representative cohort of older urban residents., Design: Survey follow-up with three interviews over a 4-year period., Setting: City of Cleveland, Ohio., Participants: Six hundred forty-seven survivors of a population-based, multi-stage probability sample of urban residents, aged 74 years and older in 1984., Measurements: Past and present cigarette smoking was measured in 1984 by direct questioning. Cognitive impairment was measured in 1984, 1987, and 1988 by the 10-item Short Portable Mental Status Questionnaire. Mortality was determined at each interview date, and death certificates were obtained. Data were analyzed by univariate analysis, stratified analysis, and multivariate logistic regression., Results: There were 99 cases of cognitive impairment at baseline among 628 individuals for whom complete data were available. Crude data suggest that the prevalence of cognitive impairment was lower among smokers than among non-smokers, but logistic regression, adjusted for age, income, and gender, showed this difference to be non-significant, OR 0.73; 95% CI (0.42, 1.29). Fifty-one new cases of cognitive impairment occurred during the 4-year observation period. Neither the crude data nor logistic regression showed any significant relationship between smoking and the incidence of cognitive impairment, OR 1.03; 95% CI (0.54, 1.99). Four-year mortality did not differ significantly between these older smokers and non-smokers, but smokers died at a relatively younger age and were more likely to die of diseases associated with smoking.

To assess acute-phase proteins in relation to ageing, we measured serum concentrations of C-reactive protein of AGP in 131 healthy elderly individuals (aged >/= 65 years) living independently in the community, and 47 healthy younger individuals. Concentrations of CRP in the older persons (median = 3.0 microg/ml) were significantly greater than in the younger group (median = 0.9 microg/ml, p = 0. 0003). Concentrations of SAA and AGP were similar in the two groups, but AGP glycosylation forms with reduced binding affinity for concanavalin-A (changes that have been observed in chronic inflammatory states) were increased in the elderly sample (p<0.0001). These findings suggest that both quantitative and qualitative alterations of acute-phase proteins occur with physiological ageing in humans.

Objective: To describe the 3-year incidence of acute respiratory illness in a population of noninstitutionalized elderly persons., Design: Cohort analytic study with an observation period of 3 years., Setting: Large midwestern urban community., Subjects: 574 noninstitutionalized persons aged 65 years and older, of whom 349 were living independently, 110 were in congregate settings, and 115 were living independently and regularly caring for small children., Methods: Subjects were interviewed and examined by nurse practitioners at intake and every 4 months. Acute illness and convalescent visits were made when illnesses were reported by participants., Main Outcome Measures: The incidence of acute respiratory illness was used to test the hypothesis that elderly persons taking care of children have the highest incidence, congregate-dwellers intermediate incidence, and those living independently the lowest incidence., Results: The average incidence of acute respiratory illness was 2.5 per 100 person months, comparable to rates reported in the National Health Survey. The incidence of respiratory illness was significantly greater in subjects living in congregate settings or regularly caring for young children. Similarly, greater proportions of persons in the congregate and child-care groups reported at least one episode of illness (P < .05). A more detailed analysis of exposure shows that acute respiratory illness was significantly more common in subjects who had contact with children (P < .05). This risk was definitely present during the months November through February, and probably also during July through October, but was not observed for March through June., Conclusions: Elderly persons living in the community experience low rates of acute upper respiratory illness. Contact with children increases their risk of developing such illnesses during certain seasons of the year.

Recent social and economic trends suggest that the health and welfare of elderly persons living in urban areas may have deteriorated during the past two decades. Two representative samples of noninstitutionalized urban persons aged 65 and over were interviewed, one in 1975 (n = 1598) and the other in 1987 (n = 1491). Cohorts of "young-old" (ages 65-76), "old-old" (ages 77-88), and "oldest-old" (ages 89-100) urban residents were compared at the two time points by multivariate analysis. Over the 12 years studied, the proportion of Blacks and poor persons rose, while the educational level improved. The young-old cohort of 1987, in particular, reported more chronic illness, more psychological distress, more need for help with activities of daily living, more visits to physicians, and more need for additional medical care. We conclude that, between 1975 and 1987, a new cohort of urban residents who were more impaired, disabled, and disadvantaged than their predecessors entered the young-old age group.

A nine-year representative, longitudinal study of 1,598 urban elderly shows that two to eight times as many impaired or disabled are cared for in the community as in institutions. Younger age, male gender, better income, and living with others, especially children, favor continuing care in the home.

A population-based cohort of 1,598 urban residents, aged 65 years and over, was studied in 1975, and 645 survivors were re-interviewed in their places of residence in 1984. Since 25.6 percent of the subjects were Black, it was possible to examine race-related changes in health, function, and socioeconomic status over nine years, as well as differences in rates of institutionalization and mortality. Aging urban Blacks continue to experience major social disadvantages, especially in education and income. After age 74, although Blacks probably experience more favorable mortality rates and less institutionalization, they consider themselves less healthy and are more likely to develop diabetes, hypertension, and glaucoma. Although Blacks rate their own mental health lower, this difference is not supported by other measures. Functionally, elderly Whites are more likely to be dependent in certain activities of daily living. The findings are consistent with the previously observed mortality crossover; predictors of mortality are identified but do not differ by race. Lower institutionalization rates among older Blacks may be partly explained by different living patterns, poverty, and a higher proportion of males among surviving Blacks.

The usefulness of household composition in characterizing the functional status of the elderly was examined in a random sample of 1,598 noninstitutionalized urban persons aged 65 years and older. Subjects were interviewed twice, one year apart. Five areas of well-being were assessed, including: physical and mental health, social and economic functioning, and ability to perform daily tasks. Living arrangements were categorized as follows: living alone, never married; living alone, ever married; living with spouse; living with spouse and children; living with children, but without spouse; and living with others, not spouse or children. Profiles for those living with children but without spouses and those living with spouses provided the most extreme contrasts. Persons living alone and never married consistently had better outcomes than those living alone but ever married. After one year, changes in living arrangements were most likely to occur for those living with spouse/children and those living with others. For the elderly, "Who lives with you?", is an important question.

To increase the competence of physicians to practice and teach geriatric medicine, the Office of Geriatric Medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, offered an 11-week course to interested physicians on the faculty. This course, "Medical Management of the Aged--A State of the Art Symposium for Medical Faculty," was conducted as part of an overall plan of the Office to enhance faculty and curriculum development in geriatrics within the School. The weekly sessions consisted of clinical and research information presented by recognized experts in the field of geriatric medicine. Of the 52 formal registrants, 79 per cent were physicians and were from such fields of specialization as internal medicine, family medicine, and psychiatry. The mean attendance was 37. An overview and evaluation of the geriatric faculty development program is given.

This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self-reported illness and disability. One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician-nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self-report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self-report and by physician-nurse assessment, using established measures of mobility and activities of daily living. Results indicate that interview self-report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self-report alone is not a sufficiently sensitive measure to be used for case-finding or diagnosis. When functional disabilities are matched against the specific medical conditions that cause them and disease-specific mortality is also taken into account, a three-dimensional classification results that has implications for future clinical and survey work with the elderly.

A study of accidental firearm fatalities in Cuyahoga Count, Ohio, (Metropolitan Cleveland) from 1958-1973, inclusive, has shown a threefold increase in the rate of such deaths since1967. They are more frequent in the central city than in the suburbs, show a male preponderance, are more common in nonwhites, have a peak prevalence in the 25-34-year age range and usually happen in the home. Approximately half of the adult victims had been drinking alcoholic beverages when shot. It is hypothesized that the frequency of accidental firearm fatalities is primarily related to the number of guns, particulary handguns, in civilian possession. The data indicate that a loaded firearm in the home is more likely to cause an accidental death than to be used as a lethal weapon against and intruder.

Etiological theories of suicide are reviewed from epidemiological, individual (both biological and psychological), and psychosocial perspectives. Cohort and population-model approaches as explanations for the two- to three-fold increase in completed suicide rates observed in adolescents and young adults over the past 25 years are presented. The results of the authors' study of suicides in adolescents and young adults in Cuyahoga County, Ohio, to test these hypotheses are summarized. This study revealed marked cohort differences in suicide rates and provided partial support for the "population-model" approach. Differences between suicide rates in adolescents and other age groups are discussed, as are data from some minority groups. The role of depression in adolescents and various studies of diagnostic approaches (e.g., structured diagnostic assessments, biological markers, clues during intensive psychotherapy or psychoanalysis, studies of high-risk diagnostic groups) are reviewed. Lastly, treatment employing individual, family, and group approaches to classical psychoanalytic or cognitive psychotherapy as well as the role of pharmacological treatments are considered.

Suicide rates in Cuyahoga County (metropolitan Cleveland) rose from 10.2 in 1958 to 12.5 per 100,000 populations in 1974 (23 per cent increase) with the greatest rise among nonwhite males (from 5.9 to 13.1, or 122 per cent). Increased rates were observed in both the city (19 per cent increase) and suburbs (35 per cent increase). Rates increased among young non-white and white adults of both sexes aged 15--34 years, but decreased slightly among adults aged 65 years and older. These findings are consistent with national trends. Alcohol was present in the blood of one-fourth of the individuals who were "dead on arrival," and at intoxicating levels in 20 per cent. There were increasing percentages of victims with positive blood alcohol and with intoxicating levels during the study period. White male victims in the city had significantly higher frequencies of such findings than their counterparts in the suburbs. The rates of suicide committed by firearms rose among all race-sex groups, with the greatest increase among city nonwhite males (2.1 to 7.7, or 267 per cent). Suicide by chemical agents (roughly one-half being barbiturates) increased in all groups except city nonwhite males, with the greatest increase among white males and suburban white females. Firearms among males and poisoning among females displaced asphyxia as the leading modes of suicide.

Access to medical care of 492 black urban respondents 60 years of age and older was measured in a house-to-house survey in a large midwestern city. Of those in this study, 93 percent indicated that they had a regular source of medical care, and 88 percent reported a visit to a physician or clinic within the past year. These percentages are higher than those reported for the general population of elderly people in the United States. Physical limitation, general health, and mental health were related to access to medical care. Respondents who reported poorer physical and mental health were more likely to have a regular source of care and to have seen a physician in the past year.

Distance is the major factor determining the frequency of social interaction with family and friends for elderly whites. Age, sex, marital status, length of residence, and income also affect the number of social contacts. These relationships have not been studied for elderly blacks. Utilizing data from a survey of 655 black urban residents 60 years old and older, this study investigated contacts with family and friends. The major finding was that the neighborhood is an important place for socializing with both family and friends for this population as is the case for working-class white elderly adults. A surprising finding is that, whereas social contacts increase with higher income for working-class elderly whites, for these black elderly adults who are of the working class and poor, social contacts decrease with higher income.

Examinations of 427 prisoners at the time of the admission to a large urban county jail showed that more than a quarter were, or had been, users of potentially addictive drugs. Except for their drug problems, the drug users did not present any more of different health problems than the nonusers. The treatment for drug abuse recommended by the examining physicians was, for the most part, not available in the facility. Evidence of continued drug use in the jail by less than 10 per cent of the prisoners was obtained at 4-week and 8-week followup examinations. Detection of drug use by means of questionnaires and urine testing was shown to be feasible among persons admitted to such a jail.

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Age adjusted mortality rates for the 1969-1971 adult population in the United States reveal a consistent pattern of 13% excess cancer mortality in the metropolitan counties with central cities compared to non-metropolitan counties. Only 14% of all cancer death exhibit a different pattern. A detailed analysis of cancer mortality in Cuyahoga County, (Cleveland), Ohio, during the years 1969-1971, shows that apart from cancer mortality of the respiratory tract, general air pollution characteristics correlate secondarily with mortality, compared with socioeconomic factors.

Cordierite-bearing, hyper-sthene-quartz monzonite porphyry, the most widespread rock unit, is intruded by biotite granite and porphyritic biotite granite. Sedimentary and metasedimentary rocks, mainly quartzites and argillites, have been metamorphosed locally to hornfels and have been involved in high-angle faulting. Shear zones are common in the plutonic rocks.