An explainable machine learning model to predict early and late acute kidney injury after major hepatectomy.

BACKGROUND: Risk assessment models for acute kidney injury (AKI) after major hepatectomy that differentiate between early and late AKI are lacking. This retrospective study aimed to create a model predicting AKI through machine learning and identify features that contribute to the development of early and late AKI. METHODS: Patients that underwent major hepatectomy were categorized into the No-AKI, Early-AKI (within 48 h) or Late-AKI group (between 48 h and 7 days). Modeling was done with 20 perioperative features and the performance of prediction models were measured by the area under the receiver operating characteristic curve (AUROCC). Shapley Additive Explanation (SHAP) values were utilized to explain the outcome of the prediction model. RESULTS: Of the 1383 patients included in this study, 1229, 110 and 44 patients were categorized into the No-AKI, Early-AKI and Late-AKI group, respectively. The CatBoost classifier exhibited the greatest AUROCC of 0.758 (95% CI: 0.671-0.847) and was found to differentiate well between Early and Late-AKI. We identified different perioperative features for predicting each outcome and found 1-year mortality to be greater for Early-AKI. CONCLUSIONS: Our results suggest that risk factors are different for Early and Late-AKI after major hepatectomy, and 1-year mortality is greater for Early-AKI.

The Role of Gesture in Language Development for Neurotypical Children and Children With or at Increased Likelihood of Autism.

For young children, gesture is found to precede and predict language development. However, we are still building a knowledge base about the specific nature of the relationship between gesture and speech. While much of the research on this topic has been conducted with neurotypical children, there is a growing body of work with children who have or are at increased likelihood of autism spectrum disorder (ASD). Here, we summarize the literature on relations between gesture and speech, including the role of child gesture production as well as that of gesture exposure (caregiver gesture). We include literature on both neurotypical children and children with or at likelihood of ASD, highlight the similarities and differences across populations, and offer implications for research as well as early identification and intervention.

Here's the Story: Narrative Ability and Executive Function in Autism Spectrum Disorder.

Background: Difficulties with narrative have been reported in individuals diagnosed with autism spectrum disorder (ASD), but the role of executive function on narrative ability has not been examined in ASD. In this study, we aimed to (1) examine whether narrative abilities of ASD children differed from neurotypical (NT) children who did not differ in age, sex, and IQ; and (2) investigate relations between executive function and narrative ability in ASD children. Method: Narratives were elicited from 64 ASD children and 26 NT children using a wordless picture book and coded to derive several aspects of narrative ability such as propositions, evaluative devices, and self-repairs. Executive functions (specifically, inhibition and working memory) were measured using both experimenter-administered assessment and parent-report measures. Results: Compared to NT children, ASD children produced fewer propositions but did not differ in their use of evaluative devices and self-repairs during narrative production. Greater inhibitory challenges related to more self-repairs involving repetition of story elements, whereas working memory did not relate to any of the measures of narrative ability among ASD children. Conclusions: This study revealed that narratives by verbally fluent ASD children were shorter and less complex than those by NT children but did not differ in the specific features of narratives. Furthermore, although ASD children did not make more self-repairs than NT children, difficulty with inhibition was related to more self-repairs, indicating more dysfluent narrative production in ASD children, which has implications for intervention.

Neural correlates of face processing associated with development of social communication in 12-month infants with familial risk of autism spectrum disorder.

BACKGROUND: Differences in face processing in individuals with ASD is hypothesized to impact the development of social communication skills. This study aimed to characterize the neural correlates of face processing in 12-month-old infants at familial risk of developing ASD by (1) comparing face-sensitive event-related potentials (ERP) (Nc, N290, P400) between high-familial-risk infants who develop ASD (HR-ASD), high-familial-risk infants without ASD (HR-NoASD), and low-familial-risk infants (LR), and (2) evaluating how face-sensitive ERP components are associated with development of social communication skills. METHODS: 12-month-old infants participated in a study in which they were presented with alternating images of their mother's face and the face of a stranger (LR = 45, HR-NoASD = 41, HR-ASD = 24) as EEG data were collected. Parent-reported and laboratory-observed social communication measures were obtained at 12 and 18 months. Group differences in ERP responses were evaluated using ANOVA, and multiple linear regressions were conducted with maternal education and outcome groups as covariates to assess relationships between ERP and behavioral measures. RESULTS: For each of the ERP components (Nc [negative-central], N290, and P400), the amplitude difference between mother and stranger (Mother-Stranger) trials was not statistically different between the three outcome groups (Nc p = 0.72, N290 p = 0.88, P400 p = 0.91). Marginal effects analyses found that within the LR group, a greater Nc Mother-Stranger response was associated with better expressive language skills on the Mullen Scales of Early Learning, controlling for maternal education and outcome group effects (marginal effects dy/dx = 1.15; p < 0.01). No significant associations were observed between the Nc and language or social measures in HR-NoASD or HR-ASD groups. In contrast, specific to the HR-ASD group, amplitude difference between the Mother versus Stranger P400 response was positively associated with expressive (dy/dx = 2.1, p < 0.001) and receptive language skills at 12 months (dy/dx = 1.68, p < 0.005), and negatively associated with social affect scores on the Autism Diagnostic Observation Schedule (dy/dx = - 1.22, p < 0.001) at 18 months. CONCLUSIONS: In 12-month-old infant siblings with subsequent ASD, increased P400 response to Mother over Stranger faces is positively associated with concurrent language and future social skills.

Parental Language Input Predicts Neuroscillatory Patterns Associated with Language Development in Toddlers at Risk of Autism.

In this study we investigated the impact of parental language input on language development and associated neuroscillatory patterns in toddlers at risk of Autism Spectrum Disorder (ASD). Forty-six mother-toddler dyads at either high (n = 22) or low (n = 24) familial risk of ASD completed a longitudinal, prospective study including free-play, resting electroencephalography, and standardized language assessments. Input quantity/quality at 18 months positively predicted expressive language at 24 months, and relationships were stronger for high-risk toddlers. Moderated mediations revealed that input-language relationships were explained by 24-month frontal and temporal gamma power (30-50 Hz) for high-risk toddlers who would later develop ASD. Results suggest that high-risk toddlers may be cognitively and neurally more sensitive to their language environments, which has implications for early intervention.

Brief Report: Parents' Declarative Use of Deictic Gestures Predict Vocabulary Development in Infants at High and Low Risk for Autism Spectrum Disorder.

We examined the communicative intentions behind parents' deictic gesture use with high-risk infants later diagnosed with autism spectrum disorder (ASD; n = 17), high-risk infants who were not diagnosed with ASD (n = 25), and low-risk infants (n = 28) at 12 months and assessed the extent to which the parental deictic gesture intentions predicted infants' later vocabulary development. We found that parents in the three groups produced similar numbers of declarative and imperative gestures during a 10-minute parent-child interaction in the lab at 12 months and that 12-month parental declarative gesture use was significantly, positively associated with children's 36-month vocabulary scores. Encouraging parental use of declarative gestures with infants could have important implications for language development.

Show, give, and point gestures across infancy differentially predict language development.

It is well established that deictic gestures, especially pointing, play an important role in children's language development. However, recent evidence suggests that other types of deictic gestures, specifically show and give gestures, emerge before pointing and are associated with later pointing. In the present study, we examined the development of show, give, and point gestures in a sample of 47 infants followed longitudinally from 10 to 16 months of age and asked whether there are certain ages during which different gestures are more or less predictive of language skills at 18 months. We also explored whether parents' responses vary as a function of child gesture types. Child gestures and parent responses were reliably coded from videotaped sessions of parent-child interactions. Language skills were measured at 18 months using standardized (Mullen Scales of Early Learning) and parent report (MacArthur-Bates Communicative Development Inventory) measures. We found that at 10 months, show+give gestures were a better predictor of 18-month language skills than pointing gestures were, yet at 14 months, pointing gestures were a better predictor of 18-month language skills than show+give gestures. By 16 months, children's use of speech in the interaction, not gesture, best predicted 18-month language skills. Parents responded to a higher proportion of shows+gives than to points at 10 months. These results demonstrate that different types of deictic gestures provide a window into language development at different points across infancy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A parent gesture intervention as a means to increase parent declarative pointing and child vocabulary.

This study examined whether a brief parent gesture training resulted in a change in the communicative intent of pointing gestures used by parents of infants from age 10-12 months and whether specific types of points (declarative vs. imperative) were more or less likely to predict later child language skill at 18 months. Compared to parents who were randomized to the control group, parents in the intervention group produced significantly more declarative pointing gestures as a result of the intervention. Moreover, parents' use of declarative points at 12 months was predictive of later child vocabulary comprehension at 18 months. These findings suggest that a short-term parent training can have important effects on the communicative intentions conveyed through gesture which predict vocabulary development.

A Longitudinal Study of Parent Gestures, Infant Responsiveness, and Vocabulary Development in Infants at Risk for Autism Spectrum Disorder.

We investigated gestures that parents used with 12-, 18-, and 24-month-old infants at high or low risk for autism spectrum disorder (ASD; high-risk diagnosed with ASD: n = 21; high-risk classified as no ASD: n = 34; low-risk classified as no ASD: n = 34). We also examined infant responses to parent gestures and assessed the extent to which parent gesture relates to vocabulary development. Parents of three groups gestured in similar frequencies and proportions. Infants, in turn, responded similarly to parent gestures regardless of the infant's ASD risk and later diagnosis. Finally, parents who gestured more at 12 months had children with better vocabulary at 36 months than parents who gestured less. These findings highlight the importance of examining parent gestures when predicting language development.

Reciprocal Influences Between Parent Input and Child Language Skills in Dyads Involving High- and Low-Risk Infants for Autism Spectrum Disorder.

We examined the language input of parents of infants at high and low familial risk for autism spectrum disorder (ASD) and investigated reciprocal associations between parent input and child language skills in the first 2 years of life. Parent-infant dyads (high-risk: n = 53; low-risk: n = 33), 19 of whom included an infant later diagnosed with ASD, were videotaped during free play interactions at 12, 18, and 24 months. Measures of parent input were derived from parent-child interactions. Children's language skills were assessed using the Mullen Scales of Early Learning at 12, 18, and 24 months. Results suggested that (a) parents of high- and low-risk infants produced similar word tokens, word types, and proportions of contingent verbal responses, but parents of high-risk infants used shorter mean length of utterances (MLU) than parents of low-risk infants at 18 and 24 months; (b) parents' MLU at 18 months was positively associated with their infants' language at the subsequent visit after 6 months, regardless of group; and (c) infants' language at 18 months was positively associated with parents' MLU at the subsequent visit after 6 months in the high-risk group only. These findings contribute to our understanding of the mechanisms underlying early language learning of high-risk infants who have an increased risk for language delays and deficits. Autism Res 2020, 13: 1168-1183. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Parents provide an important source of language input to their children. In this study, we looked at parent input to infants at high- and low-risk for autism spectrum disorder and relations between parent input and child language in the first 2 years of life. We found that parents of high- and low-risk infants provided similar quantity and quality of input, except shorter average length of utterances at 18 and 24 months in the high-risk group. Also, there were bidirectional relations between parent input and child language at 18 and 24 months in high-risk pairs, suggesting that parents and children collectively shape the early language environment.

Gesture Development, Caregiver Responsiveness, and Language and Diagnostic Outcomes in Infants at High and Low Risk for Autism.

We investigated gesture production in infants at high and low risk for autism spectrum disorder (ASD) and caregiver responsiveness between 12 and 24 months of age and assessed the extent to which early gesture predicts later language and ASD outcomes. Participants included 55 high-risk infants, 21 of whom later met criteria for ASD, 34 low-risk infants, and their caregivers. Results indicated that (a) infants with ASD outcomes used fewer gestures and a lower proportion of developmentally advanced gesture-speech combinations; (b) caregivers of all the infants provided similar rates of contingent responses to their infants' gestures; and (c) gesture production at 12 months predicted subsequent receptive language and ASD outcomes within the high-risk group.

Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder.

BACKGROUND: A growing body of research suggests that fine motor abilities are associated with skills in a variety of domains in both typical and atypical development. In this study, we investigated developmental trajectories of fine motor skills between 6 and 24 months in relation to expressive language outcomes at 36 months in infants at high and low familial risk for autism spectrum disorder (ASD). METHODS: Participants included 71 high-risk infants without ASD diagnoses, 30 high-risk infants later diagnosed with ASD, and 69 low-risk infants without ASD diagnoses. As part of a prospective, longitudinal study, fine motor skills were assessed at 6, 12, 18, and 24 months of age and expressive language outcomes at 36 months using the Mullen Scales of Early Learning. Diagnosis of ASD was determined at the infant's last visit to the lab (18, 24, or 36 months) using the Autism Diagnostic Observation Schedule. RESULTS: Hierarchical linear modeling revealed that high-risk infants who later developed ASD showed significantly slower growth in fine motor skills between 6 and 24 months, compared to their typically developing peers. In contrast to group differences in growth from age 6 months, cross-sectional group differences emerged only in the second year of life. Also, fine motor skills at 6 months predicted expressive language outcomes at 3 years of age. CONCLUSIONS: These results highlight the importance of utilizing longitudinal approaches in measuring early fine motor skills to reveal subtle group differences in infancy between ASD high-risk and low-risk infant populations and to predict their subsequent language outcomes.