RESUMO
The influence of genetic variants related to opioid use disorder (OUD) was evaluated using multiple logistic regression analysis in self-reported assigned African American/Afro-Caribbean and European biogeographical ancestry groups (BGAGs) and by sex. From a sample size of 1301 adult patients (>18 years of age) seen in emergency departments of three medical centers in Ohio, six variants were found to be associated with OUD. Two of the variants, rs2740574 (CYP3A4) and rs324029 (DRD3), were included in the analysis having met criteria of at least five subjects for each BGAG, variant carrier status, and OUD status combinations. Variant carriers in the African/Afro-Caribbean BGAG had slightly lower predicted probabilities of OUD. Variant carriers in the European BGAG had slightly higher predicted probabilities of OUD. Relative to sex, all the six variants met evaluation criteria (five subjects for all sex, variant, and OUD status combinations). No statistically significant interactions were found between a given variant, BGAGs and sex. Findings suggest variant testing relative to OUD risk can be applied across BGAGs and sex, however, studies in larger populations are needed.
Assuntos
Alelos , Negro ou Afro-Americano , Transtornos Relacionados ao Uso de Opioides , População Branca , Humanos , Masculino , Feminino , Transtornos Relacionados ao Uso de Opioides/genética , Adulto , Negro ou Afro-Americano/genética , População Branca/genética , Autorrelato , Pessoa de Meia-Idade , Região do Caribe , Predisposição Genética para Doença/genética , Citocromo P-450 CYP3A/genética , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , População Negra/genéticaRESUMO
Habitat specialists have been largely overlooked in old-growth pinyon-juniper woodlands, despite specialists exhibiting heightened sensitivity to anthropogenic habitat loss. Furthermore, small mammal relationships within pinyon-juniper woodlands have most commonly been investigated via species abundance or habitat use, rather than habitat selection, thereby providing limited management metrics. We used the Oscura Mountains Colorado Chipmunk (Neotamias quadrivittatus oscuraensis) as a model organism to evaluate whether old-growth conditions drive resource selection by small mammals associated with pinyon-juniper woodlands. The goal of our study was to determine resources important to the chipmunk to inform management decisions. We evaluated microhabitat selection by testing a priori predictions based on natural history characteristics of the chipmunk and the woodlands. We grouped predictions into habitat characteristics affiliated with or not affiliated with old growth. We tested predictions under a multistage modeling framework using generalized linear mixed models with a binomial response variable of use versus availability. Probability of selection by chipmunks increased with increasing mean juniper diameter and increasing variation of pinyon diameter and decreased with increased distance to rocky escape terrain and increased mean percent grass cover. Our findings support the classification of the Oscura Mountains Colorado chipmunk as an old-growth pinyon-juniper specialist, as the chipmunk displayed disproportionate preference for old-growth microhabitat conditions. We recommend management policies that conserve old-growth multiage stands of pinyons and junipers. Old-growth conditions near outcroppings, escarpments, and large boulders are of particular conservation concern. Further, thinning resulting in increased grass cover may be detrimental to this old-growth pinyon-juniper specialist.
RESUMO
CONTEXT: New approaches to emergency response are a national focus due to evolving needs and growing demands on the system, but perspectives of first responders and potential partners have not been evaluated. OBJECTIVE: This project aimed to inform the development and implementation of alternative emergency response models, including interdisciplinary partnerships, by identifying the perspectives of the frontline workforce regarding their evolving roles. DESIGN: An electronic survey was sent, querying respondents about their perceived roles in emergency response, interdisciplinary partnerships, and resources needed. SETTING: This study took place in a metropolitan, midwestern county with participants from 2 public health agencies and 1 emergency medical services (EMS) agency. PARTICIPANTS: The survey was completed by 945 EMS clinicians and 58 public health workers. MAIN OUTCOME MEASURES: The main outcome measures were agreement levels on each group's roles in prevention, response, and recovery after emergencies, as well as general feedback on new models. RESULTS: Overall, 97% of EMS clinicians and 42% of public health workers agreed that they have a role in immediate response to 9-1-1 emergencies. In mental health emergencies, 87% of EMS clinicians and 52% of public health workers agreed that they have a role, compared to 87% and 30%, respectively, in violent emergencies. Also, 84% of respondents felt multidisciplinary models are a needed change. However, 35% of respondents felt their agency has the resources necessary for changes. CONCLUSIONS: We observed differences between EMS clinicians and public health workers in their perceived roles during emergency response and beliefs about the types of emergencies within their scope. There is strong support for alternative approaches and a perception that this model may improve personal well-being and job satisfaction, but a need for additional resources to develop and implement.
Assuntos
Serviços Médicos de Emergência , Saúde Pública , Humanos , Serviços Médicos de Emergência/estatística & dados numéricos , Saúde Pública/métodos , Inquéritos e Questionários , Masculino , Feminino , AdultoRESUMO
Epigenetic clocks are emerging as tools for assessing acceleration and deceleration of biological age during childhood. Maternal depression during pregnancy may affect the biological aging of offspring and related development. In a low-income cohort of mother-child dyads, we investigated the relationship between prenatal maternal depressive symptoms and infant epigenetic age residuals, which represent the deviation (acceleration or deceleration) that exists between predicted biological age and chronological age. The epigenetic age residuals were derived from a pediatric-specific buccal epithelial clock. We hypothesized that maternal depressive symptoms, both sub-clinical and elevated (clinical level), would be associated with estimated biological age deceleration in offspring during early infancy. We analyzed data from 94 mother-child dyads using the Edinburgh Postnatal Depression Scale (EPDS) and DNA methylation derived from offspring buccal cells collected at 3-5 weeks of age. There was a significant non-linear association between the EPDS score and epigenetic age residual (ß = -0.017, 95% confidence interval: -0.03,-0.01, P = <0.01). The results indicated that infants of mothers with sub-clinical depressive symptoms had the lowest infant epigenetic age residuals while infants of mothers with no-to-low depressive symptoms had the highest and experienced biological age acceleration. Maternal depressive symptoms may influence the biological aging of offspring living in poverty.
Assuntos
Depressão , Mucosa Bucal , Feminino , Lactente , Gravidez , Humanos , Criança , Depressão/epidemiologia , Depressão/genética , Mães , Envelhecimento/genética , Epigênese GenéticaRESUMO
Study objective: Earlier intervention for opioid use disorder (OUD) may reduce long-term health implications. Emergency departments (EDs) in the United States treat millions with OUD annually who may not seek care elsewhere. Our objectives were (1) to compare two screening measures for OUD characterization in the ED and (2) to determine the proportion of ED patients screening positive for OUD and those who endorse other substance use to guide future screening programs. Methods: A cross-sectional study of randomly selected adult patients presenting to three Midwestern US EDs were enrolled, with duplicate patients excluded. Surveys were administered via research assistant and documented on tablet devices. Demographics were self-reported, and OUD positivity was assessed by the DSM 5 checklist and the WHO ASSIST 3.1. The primary outcome was the concordance between two screening measures for OUD. Our secondary outcome was the proportion of ED patients meeting OUD criteria and endorsed co-occurring substance use disorder (SUD) criteria. Results: We enrolled 1305 participants; median age of participants was 46 years (range 18-84), with 639 (49.0%) Non-Hispanic, White, and 693 (53.1%) female. Current OUD positivity was identified in 17% (222 out of 1305) of the participants via either DSM-5 (two or more criteria) or ASSIST (score of 4 or greater). We found moderate agreement between the measures (kappa = 0.56; Phi coefficient = 0.57). Of individuals screening positive for OUD, 182 (82%) endorsed criteria for co-occurring SUD. Conclusions: OUD is remarkably prevalent in ED populations, with one in six ED patients screening positive. We found a high prevalence of persons identified with OUD and co-occurring SUD, with moderate agreement between measures. Developing and implementing clinically feasible OUD screening in the ED is essential to enable intervention.
RESUMO
A qualitative, community-engaged assessment was conducted to identify needs and priorities for infant obesity prevention programs among mothers participating in home visiting programs. Thirty-two stakeholders (i.e., community partners, mothers, home visitors) affiliated with a home visiting program serving low-income families during the prenatal to age three period participated in group level assessment sessions or individual qualitative interviews. Results indicated families face many challenges to obesity prevention particularly in terms of healthy eating. An obesity prevention program can address these challenges by offering realistic feeding options and non-judgmental peer support, improving access to resources, and tailoring program content to individual family needs and preferences. Informational needs, family factors in healthy eating outcomes, and the importance of access and awareness of programs were also noted. To ensure the cultural- and contextual-relevance of infant obesity prevention programs for underserved populations, needs and preferences among community stakeholders and the focal population should be used as a roadmap for intervention development.
Assuntos
Obesidade Infantil , Lactente , Feminino , Gravidez , Humanos , Obesidade Infantil/prevenção & controle , Avaliação das Necessidades , Mães , Pobreza , AconselhamentoRESUMO
INTRODUCTION: In-flight medical emergencies occur in an estimated one out of 604 flights. Responding in this environment poses a unique set of challenges unfamiliar to most emergency medicine (EM) providers, including physical space and resource limitations. We developed a novel high-fidelity in-situ training curriculum focused on frequent or high-risk in-flight medical scenarios while replicating this austere environment. METHODS: Our residency program coordinated with our local airport's chief of security and an airline-specific station manager to arrange the use of a grounded Boeing 737 commercial airliner during late evening/early morning hours. Eight stations reviewing in-flight medical emergency topics were reviewed, five of which were simulation scenarios. We created medical and first-aid kits that reflect equipment used by commercial airlines. Residents' self-assessed competency and medical knowledge were assessed both initially and post-curriculum using a standardized questionnaire. RESULTS: Forty residents attended the educational event as learners. Self-assessed competency and medical knowledge increased after curriculum participation. All tested aspects of self-assessed competency had a statistically significant increase from a mean of 15.04 to 29.20 out of a maximum score of forty. The mean medical knowledge score increased from 4.65 to 6.93 out of 10 maximum points. CONCLUSION: A five-hour in-situ curriculum for reviewing in-flight medical emergencies increased self-assessed competency and medical knowledge for EM and EM-internal medicine residents. The curriculum was overwhelmingly well-received by learners.
RESUMO
Genetics are presumed to contribute 30-40% to opioid use disorder (OUD), allowing for the possibility that genetic markers could be used to identify personal risk for developing OUD. We aimed to test the potential association among 180 candidate single nucleotide polymorphisms (SNPs), 120 of which were related to the dopamine reward pathway and 60 related to pharmacokinetics. Participants were randomly recruited in 2020-2021 in a cross-sectional genetic association study. Self-reported health history including Diagnostic and Statistical Manual of Mental Disorders (DSM-5) OUD criteria and buccal swabs were collected. A total of 1,301 participants were included in the analyses for this study. Of included participants, 250 met the DSM-5 criteria for ever having OUD. Logistic regression, adjusting for age and biologic sex, was used to characterize the association between each SNP and DSM-5 criteria consistent with OUD. Six SNPs found in four genes were associated with OUD: increased odds with CYP3A5 (rs15524 and rs776746) and DRD3 (rs324029 and rs2654754), and decreased odds with CYP3A4 (rs2740574) and CYP1A2 (rs2069514). Homozygotic CYP3A5 (rs15524 and rs776746) had the highest adjusted odds ratio of 2.812 (95% confidence interval (CI) 1.737, 4.798) and 2.495 (95% CI 1.670, 3.835), respectively. Variants within the dopamine reward and opioid metabolism pathways have significant positive (DRD3 and CYP3A5) and negative (CYP3A4 and CYP1A2) associations with OUD. Identification of these variants provides promising possibilities for genetic prognostic and therapeutic targets for future investigation.
Assuntos
Citocromo P-450 CYP3A , Transtornos Relacionados ao Uso de Opioides , Humanos , Citocromo P-450 CYP3A/genética , Citocromo P-450 CYP1A2 , Dopamina , Estudos Transversais , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/genética , Analgésicos OpioidesRESUMO
Background: Clinical use of biomarkers requires the development of standardized assays and establishment of cutoffs. Urinary C-C motif chemokine ligand 14 (CCL14) has been validated to predict persistent severe AKI in critically ill patients with established AKI. We now report on the performance of standardized cutoffs using a clinical assay. Methods: A second aim of the multicenter RUBY Study was to establish two cutoffs for the prediction of persistent severe AKI (defined as KDIGO stage 3 AKI for at least 72 consecutive hours). Patients who received renal replacement therapy (RRT) or died before achieving 72 hours in stage 3 AKI were also considered to have reached the end point. Results: A cutoff value for urinary CCL14 of 1.3 ng/ml was determined to achieve high sensitivity (91%; 95% CI, 84% to 96%), and 13 ng/ml achieved high specificity (93%; 95% CI, 89% to 96%). The cutoff of 1.3 ng/ml identifies the majority (91%) of patients who developed persistent severe AKI with a negative predictive value of 92%. The cutoff at 13 ng/ml had a positive predictive value of 72% (with a negative predictive value of 75%). In multivariable adjusted analyses, a CCL14 concentration between 1.3 and 13 ng/ml had an adjusted odds ratio (aOR) of 3.82 (95% CI, 1.73 to 9.12; P=0.001) for the development of persistent severe AKI compared with those with a CCL14 ≤1.3 ng/ml, whereas a CCL14 >13 ng/ml had an aOR of 10.4 (95% CI, 3.89 to 29.9; P<0.001). Conclusions: Using a clinical assay, these standardized cutoffs (1.3 and 13 ng/ml) allow for the identification of patients at high risk for the development of persistent severe AKI. These results have immediate utility in helping to guide AKI patient care and may facilitate future clinical trials.Clinical Trial registry name and registration number: Identification and Validation of Biomarkers of Acute Kidney Injury Recovery, NCT01868724.
Assuntos
Injúria Renal Aguda , Bioensaio , Quimiocinas CC , Injúria Renal Aguda/diagnóstico , Bioensaio/normas , Quimiocinas CC/análise , Humanos , Ligantes , Terapia de Substituição RenalRESUMO
(1) Background: COVID-19 vaccination status varies widely among law enforcement and emergency medical services professionals. Though at high risk of exposure, these first responders have demonstrated significant vaccine hesitancy, with only 70% reportedly vaccinated. We sought to understand whether similar vaccine hesitancy exists for first responders and their household contacts around COVID-19 boosters. (2) Methods: In a prospective longitudinal cohort of first responders and their household contacts, survey data was collected, including demographics, medical history, COVID-19 exposure risks, and vaccination and/or booster status. The statistical analysis focused on primary vaccination and booster rates of both the first responders and their household contacts. (3) Results: Across 119 study participants, 73% reported having received some combination of vaccine and/or booster, and 26% were unvaccinated. Vaccinated individuals were older, reported less prior exposure to COVID-19 and had more comorbidities. Only 23% reported having received a COVID-19 booster. Pairing of the data for household contacts demonstrated a 60% agreement to receive primary vaccination but only a 20% agreement for boosters within households. (4) Conclusions: This study provides insight into the vaccination and booster rates of first responders and household contacts. Focused efforts to enhance vaccinations is essential for the protection and maintenance of this critical workforce.
RESUMO
There is a high prevalence of opioid use disorder in the United States, and emergency departments (EDs) play multiple vital roles in providing care to help these patients with achieving sobriety, one of which is the application of peer recovery services. This technical report discusses the utilization of peer recovery supporters in the ED and associated barriers. They include but are not limited to the difficult hiring process, referral process challenges for certain populations, difficulty with follow-up data collection, retention of peer recovery supporters, and a lack of ED provider awareness. This article also discussed strategies to address these barriers. Examples include simplifying hospital onboarding processes for peer recovery supporters, obtaining grants to utilize peer recovery services, and using managed care organizations to facilitate follow-up data collection, ED provider education, and discharge planning.
RESUMO
OBJECTIVES: National data reveal that 60% of the 4.5 million annual emergency department (ED) visits by patients with cancer result in admission. Many of these visits are due to a febrile illness. Current literature provides limited guidance on how to treat non-neutropenic febrile ED patients. This study characterizes clinical outcomes of non-neutropenic febrile patients with cancer presenting to an academic, Comprehensive Cancer Center affiliated ED. METHODS: Retrospective chart review of 101 randomly selected adult patients with active cancer presenting with a chief complaint of fever or a documented fever in the ED and an absolute neutrophil count above 1000 between October 2015 and September 2016. Descriptive statistics were calculated. RESULTS: The primary malignancies represented were hematologic (24%), gastrointestinal (13%), head and neck (13%), and genitourinary (8%). Sixty-two percent were on chemotherapy, 15% on radiation therapy, and 12% were on targeted therapy. Severe illness outcomes occurred in 39% and 83% were admitted with a median length of stay of 4 days. Among admitted patients, 24% experienced a length of stay ≤2 days. A return visit to the ED or an in-system hospitalization within 7 days of the index visit occurred in 10% and death occurred within 7 days of the index visit in 4%. CONCLUSION: A majority of patients presenting to the ED with non-neutropenic fever are admitted (83%), of whom nearly a quarter experience a length of stay of ≤2 days with infrequent serious illness outcomes. Future efforts should focus on the development of risk stratification tools in this population to avoid potentially unnecessary hospitalizations.
RESUMO
Habitat information for small mammals typically consists of anecdotal descriptions or infrequent analyses of habitat use, which often are reported erroneously as signifying habitat preference, requirements, or quality. Habitat preferences can be determined only by analysis of habitat selection, a behavioral process that results in the disproportionate use of one resource over other available resources and occurs in a hierarchical manner across different environmental scales. North American chipmunks (Neotamias and Tamias) are a prime example of the lack of studies on habitat selection for small mammal species. We used the Organ Mountains Colorado chipmunk (N. quadrivittatus australis) as a case study to determine whether previous descriptions of habitat in the literature were upheld in a multiscale habitat selection context. We tracked VHF radiocollared chipmunks and collected habitat information at used and available locations to analyze habitat selection at three scales: second order (i.e., home range), third order (i.e., within home range), and microhabitat scales. Mean home range was 2.55 ha ± 1.55 SD and did not differ between sexes. At the second and third order, N. q. australis avoided a coniferous forest land cover type and favored particular areas of arroyos (gullies) that were relatively steep-sided and greener and contained montane scrub land cover type. At the microhabitat scale, chipmunks selected areas that had greater woody plant diversity, rock ground cover, and ground cover of coarse woody debris. We concluded that habitat selection by N. q. australis fundamentally was different from descriptions of habitat in the literature that described N. quadrivittatus as primarily associated with coniferous forests. We suggest that arroyos, which are unique and rare on the landscape, function as climate refugia for these chipmunks because they create a cool, wet microclimate. Our findings demonstrate the importance of conducting multiscale habitat selection studies for small mammals to ensure that defensible and enduring habitat information is available to support appropriate conservation and management actions.
RESUMO
Remote cameras are a common method for surveying wildlife and recently have been promoted for implementing large-scale regional biodiversity monitoring programs. The use of camera-trap data depends on the correct identification of animals captured in the photographs, yet misidentification rates can be high, especially when morphologically similar species co-occur, and this can lead to faulty inferences and hinder conservation efforts. Correct identification is dependent on diagnosable taxonomic characters, photograph quality, and the experience and training of the observer. However, keys rooted in taxonomy are rarely used for the identification of camera-trap images and error rates are rarely assessed, even when morphologically similar species are present in the study area. We tested a method for ensuring high identification accuracy using two sympatric and morphologically similar chipmunk (Neotamias) species as a case study. We hypothesized that the identification accuracy would improve with use of the identification key and with observer training, resulting in higher levels of observer confidence and higher levels of agreement among observers. We developed an identification key and tested identification accuracy based on photographs of verified museum specimens. Our results supported predictions for each of these hypotheses. In addition, we validated the method in the field by comparing remote-camera data with live-trapping data. We recommend use of these methods to evaluate error rates and to exclude ambiguous records in camera-trap datasets. We urge that ensuring correct and scientifically defensible species identifications is incumbent on researchers and should be incorporated into the camera-trap workflow.
RESUMO
Older individuals who smoke are at increased risk of having severe outcomes from COVID-19, due to their long-term smoking and underlying health conditions. In this qualitative study, we explored the impact of COVID-19 on attitudes toward smoking and motivation to quit. Participants (N = 30) were enrolled in a larger ongoing randomized controlled smoking cessation trial conducted in the lung cancer screening setting. From March to May 2020, we assessed quantitative and qualitative responses to participants' overall concern about COVID-19, changes in amount smoked, and motivation to reduce/quit smoking. Responses to the quantitative questions indicated that 64.3% of participants were extremely concerned with COVID-19, 20.7% reported reductions in amount smoked, and 37.9% reported increased motivation to quit. The qualitative responses, which were transcribed and coded using Consensual Qualitative Research guidelines, expanded upon these findings by providing the content of participants' concerns, which included perceived risk of contracting COVID-19, the added stressors caused by COVID-19, and a variable impact on the amount smoked and motivation to quit. Although half of participants expressed extreme concern regarding COVID-19, fewer indicated increased motivation or reduced smoking. Qualitative themes suggested that the initial two months of the pandemic prompted some smokers to reduce or quit, but it exacerbated smoking triggers for others. Understanding how the pandemic continues to affect this vulnerable group will aid in adapting methods to support their efforts to stop smoking and remain abstinent.
RESUMO
Species distribution models (SDMs) use presence records to determine the relationship between species occurrence and various environmental variables to create predictive maps describing the species' distribution. The Oscura Mountains Colorado chipmunk (Neotamias quadrivittatus oscuraensis) occurs in central New Mexico and is of conservation concern due to its relict distribution and threats to habitat. We previously created an occupancy model for this taxon, but were concerned that the model may not have adequately captured the ecological factors influencing the chipmunk's distribution because of the data hungry nature of occupancy modeling. MaxEnt is another SDM method that is particularly effective at testing large numbers of variables and handling small sample sizes. Our goal was to create a MaxEnt model for the Oscura Mountains Colorado chipmunk and to compare it with our previous occupancy model for this taxon, either to strengthen our original assessment of the relevant ecological factors or identify additional factors that were not captured by our occupancy model. We created MaxEnt models using occurrence records from baited camera traps and opportunistic surveys. We adjusted model complexity using a novel method for tuning both the regularization multiplier and feature class parameters while also performing variable selection. We compared the distribution maps and variables selected by MaxEnt to the results of our occupancy model for this taxon. The MaxEnt and occupancy models selected similar environmental variables and the overall spatial pattern of occurrence was similar for each model. Likelihood of occurrence was positively related to elevation, piñon woodland vegetation type, and topographic variables associated with escarpments. The overall similarities between the MaxEnt and occupancy models increased our confidence of the ecological factors influencing the distribution of the chipmunk. We conclude that MaxEnt offers advantages for predicting the distribution of rare species, which can help inform conservation actions.
RESUMO
With the increasing capabilities of non-invasive prenatal testing (NIPT), detection of sub-chromosomal deletions and duplications are possible. This case series of deletion rescues resulting in segmental homozygosity helps provide a biological explanation for NIPT discrepancies and adds to the dearth of existing literature surrounding segmental UPD cases and their underlying mechanisms. In the three cases presented here, NIPT reported a sub-chromosomal deletion (in isolation or as part of a complex finding). Diagnostic testing, however, revealed segmental homozygosity or UPD for the region reported deleted on NIPT. Postnatal placental testing was pursued in two cases and confirmed the NIPT findings. This discordance between the screening and diagnostic testing is suggestive of a corrective post-zygotic event, such as telomere capture and/or deletion rescue, ultimately resulting in segmental homozygosity and fetoplacental mosaicism. Imprinted chromosomes and autosomal recessive disease genes make homozygosity an important clinical consideration. Amniocentesis with SNP microarray is particularly useful in determining both copy number and UPD issues alike.
Assuntos
Amniocentese/métodos , Deleção Cromossômica , Homozigoto , Mosaicismo , Placenta/metabolismo , Diagnóstico Pré-Natal/métodos , Dissomia Uniparental/diagnóstico , Adulto , Cromossomos Humanos Par 13/genética , Cromossomos Humanos Par 20/genética , Cromossomos Humanos Par 8/genética , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Dissomia Uniparental/genética , Adulto JovemRESUMO
Purpose: The purpose of this study was to investigate the extent to which a naturalistic communication intervention, Enhanced Milieu Teaching with Phonological Emphasis (EMT + PE) improved the speech outcomes of toddlers with cleft palate with or without cleft lip (CP ± L)Method: This study was a stratified randomised controlled trial.Setting: Treatment was delivered in a university clinic by a trained speech-language pathologist.Thirty children aged between 15 and 36 months (M = 25) with nonsyndromic CP ± CL and typical cognitive development were randomly assigned to a treatment (EMT + PE) or business as usual comparison condition.Participants in the EMT + PE treatment group received 48, 30-min sessions, over a 6-month period. Fidelity of treatment was high across participants.The primary outcome measures were percent consonants correct (PCC), consonant inventory, compensatory articulation errors, and nasal emission.Result: Regression analyses controlling for pre-intervention child characteristics were conducted for PCC and consonant inventory. Intervention was not a significant predictor of post-intervention outcome. Words per minute differentiated the children who benefitted from the intervention from those who did not. Reduction in compensatory errors and nasal emission occurred in both groups but to a greater degree in the EMT + PE group.Conclusion: EMT + PE is a promising early speech intervention for young children with CP ± L, especially for children with higher rates of word use.