Factors affecting consonant production accuracy in children with cochlear implants: Expressive vocabulary and maternal education.

BACKGROUND: Despite the ability of cochlear implants (CIs) to provide children with access to speech, there is considerable variability in spoken language outcomes. Research aimed at identifying factors influencing speech production accuracy is needed. AIMS: To characterize the consonant production accuracy of children with cochlear implants (CWCI) and an age-matched group of children with typical hearing (CWTH) and to explore several factors that potentially affect the ability of both groups to accurately produce consonants. METHODS & PROCEDURES: We administered the Bankson-Bernthal Test of Phonology (BBTOP) to a group of 25 CWCI (mean age = 4;9, SD = 1;6, range = 3;2-8;5) implanted prior to 30 months of age with a mean duration of implant usage of 3;6 and an age-matched group of 25 CWTH (mean age = 5;0, SD = 1;6, range = 3;1-8;6). The recorded results were transcribed, and the accuracy of the target consonants was determined. Expressive vocabulary size estimates were obtained from a language sample using the number of different words (NDW). A parent questionnaire provided information about maternal education, duration of CIs experience and other demographic characteristics of each child. OUTCOMES & RESULTS: The CWCI group demonstrated some similarities to, and some differences from, their hearing peers. The CWCI demonstrated poorer consonant production accuracy overall and in various phonetic categories and word positions. However, both groups produced initial consonants more accurately than final consonants. Whilst CWCI had poorer production accuracy than CWTH for all phonetic categories (stops, nasals, fricatives, affricates, liquids and glides and consonant clusters), both groups exhibited similar error patterns across categories. For CWCI, the factors most related to consonant production accuracy when considered individually were expressive vocabulary size, followed by duration of CI experience, chronological age, maternal education and gender. The combination of maternal education and vocabulary size resulted in the best model of consonant production accuracy for this group. For the CWTH, chronological age followed by vocabulary size were most related to consonant production accuracy. No combination of factors yielded an improved model for the CWTH. CONCLUSIONS & IMPLICATIONS: Whilst group differences in production accuracy between the CWCI and CWTH were found, the pattern of errors was similar for the two groups of children, suggesting that the children are at earlier stages of overall consonant production development. Although duration of CI experience was a significant covariate in a single-variable model of consonant production accuracy for CWCI, the best multivariate model of consonant production accuracy for these children was based on the combination of expressive vocabulary size and maternal education. WHAT THIS PAPER ADDS: What is already known on the subject Research has shown that a range of factors is associated with consonant production accuracy by CWCIs, including factors such as the age at implant, duration of implant use, gender, other language skills and maternal education. Despite numerous studies that have examined speech sound production in these children, most have explored a limited number of factors that might explain the variability in scores obtained. Research that examines the potential role of a range of child-related and environmental factors in the same children is needed to determine the predictive role of these factors in speech production outcomes. What this paper adds to the existing knowledge Whilst the consonant production accuracy was lower for the CWCIs than for their typically hearing peers, there were some similarities suggesting that these children are experiencing similar, but delayed, acquisition of consonant production skills to that of their hearing peers. Whilst several factors are predictive of consonant production accuracy in children with implants, vocabulary diversity and maternal education, an indirect measure of socio-economic status, were the best combined predictors of consonant production accuracy. What are the potential or actual clinical implications of this work? Understanding the factors that shape individual differences in CWCI speech production is important for effective clinical decision-making and intervention planning. The present findings point to two potentially important factors related to speech sound production beyond the duration of robust hearing in CWCI, namely, a lexical diversity and maternal education. This suggests that intervention is likely most efficient that addresses both vocabulary development and speech sound development together. The current findings further suggest the importance of parental involvement and commitment to spoken language development and the importance of receiving early and consistent intervention aimed both at skill development and parental efficacy.

Antibiotic treatment of bacterial vaginosis to prevent preterm delivery: Systematic review and individual participant data meta-analysis.

BACKGROUND: Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD. OBJECTIVES: Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time-to-delivery. DATA SOURCES: Cochrane Systematic Review (2013), MEDLINE, EMBASE, journal searches, and searches (January 2013-September 2022) ("bacterial vaginosis AND pregnancy") of (i) clinicaltrials.gov; (ii) Cochrane Central Register of Controlled Trials; (iii) World Health Organization International Clinical Trials Registry Platform Portal; and (iv) Web of Science ("bacterial vaginosis"). STUDY SELECTION AND DATA EXTRACTION: Studies randomising asymptomatic pregnant individuals with BV to antibiotics or control, measuring delivery gestation. Extraction was from original data files. Bias risk was assessed using the Cochrane tool. Analysis used "one-step" logistic and Cox random effect models, adjusting gestation at randomisation and PTD history; heterogeneity by I2 . Subgroup analysis tested interactions with treatment. In sensitivity analyses, studies not providing IPD were incorporated by "multiple random-donor hot-deck" imputation, using IPD studies as donors. RESULTS: There were 121 references (96 studies) with 23 eligible trials (11,979 participants); 13 studies (6915 participants) provided IPD; 12 (6115) were incorporated. Results from 9 (4887 participants) not providing IPD were imputed. Odds ratios for PTD for metronidazole and clindamycin versus placebo were 1.00 (95% CI 0.84, 1.17), I2  = 62%, and 0.59 (95% CI 0.42, 0.82), I2  = 0 before; and 0.95 (95% CI 0.81, 1.11), I2  = 59%, and 0.90 (95% CI: 0.72, 1.12), I2  = 0, after imputation. Time-to-delivery did not differ from null with either treatment. Including imputed IPD, there was no evidence that either drug was more effective when administered earlier, or among those with a PTD history. CONCLUSIONS: Clindamycin, but not metronidazole, was beneficial in studies providing IPD, but after imputing data from missing IPD studies, treatment of BV during pregnancy did not reduce PTD, nor prolong pregnancy, in any subgroup or when started earlier in gestation.

Contrastive stress production by children with cochlear implants: Accuracy and acoustic characteristics.

The aim of this study was to examine the abilities of eight early-implanted children with cochlear implants (mean age 7.1 years) to produce contrastive stress and to compare their use of amplitude, duration, and fundamental frequency, to an age-matched group of children with typical hearing (mean age 6.11 years). A set of 16 utterances were elicited in which the child was required to stress either an adjective or noun in a short phrase. Although both groups of children produced similar proportions of utterances with stress patterns perceived by hearing listeners as accurate, they employed different strategies for achieving contrastive stress.

Closed testing using surrogate hypotheses with restricted alternatives.

INTRODUCTION: The closed testing principle provides strong control of the type I error probabilities of tests of a set of hypotheses that are closed under intersection such that a given hypothesis H can only be tested and rejected at level α if all intersection hypotheses containing that hypothesis are also tested and rejected at level α. For the higher order hypotheses, multivariate tests (> 1df) are generally employed. However, such tests are directed to an omnibus alternative hypothesis of a difference in any direction for any component that may be less meaningful than a test directed against a restricted alternative hypothesis of interest. METHODS: Herein we describe applications of this principle using an α-level test of a surrogate hypothesis [Formula: see text] such that the type I error probability is preserved if [Formula: see text] such that rejection of [Formula: see text] implies rejection of H. Applications include the analysis of multiple event times in a Wei-Lachin test against a one-directional alternative, a test of the treatment group difference in the means of K repeated measures using a 1 df test of the difference in the longitudinal LSMEANS, and analyses within subgroups when a test of treatment by subgroup interaction is significant. In such cases the successive higher order surrogate tests can be aimed at detecting parameter values that fall within a more desirable restricted subspace of the global alternative hypothesis parameter space. CONCLUSION: Closed testing using α-level tests of surrogate hypotheses will protect the type I error probability and detect specific alternatives of interest, as opposed to the global alternative hypothesis of any difference in any direction.

Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. METHODS: Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period. RESULTS: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25-30, 16.9% had BMI 30-35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6-2.3) and after 5 years 2.4% (CI 95%: 2.0-2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6-6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0-7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89-3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92-4.09). CONCLUSIONS: We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.

Efficacy of a Prenatal Oral Health Program Follow-up with Mothers and their Children.

Brookdale Hospital and Medical Center's Prenatal Care Assistance Program (PCAP) provides oral health education and treatment to expectant mothers from a minority, impoverished, high-risk population. A chart review examined dental records for 42 children of mothers who took PCAP training versus 49 children of mothers who did not. At age 2, the children of PCAP mothers had fewer dental caries, less severe dental caries and fewer extractions. When combining children at ages 2 and 3, results were statistically significant and clinically important. Evidence strongly suggests the PCAP program can lead to vastly improved oral health of participants' young children.

Auditory Perception and Production of Speech Feature Contrasts by Pediatric Implant Users.

OBJECTIVE: The aim of the present research is to examine the relations between auditory perception and production of specific speech contrasts by children with cochlear implants (CIs) who received their implants before 3 years of age and to examine the hierarchy of abilities for perception and production for consonant and vowel features. The following features were examined: vowel height, vowel place, consonant place of articulation (front and back), continuance, and consonant voicing. DESIGN: Fifteen children (mean age = 4;0 and range 3;2 to 5;11) with a minimum of 18 months of experience with their implants and no additional known disabilities served as participants. Perception of feature contrasts was assessed using a modification of the Online Imitative Speech Pattern Contrast test, which uses imitation to assess speech feature perception. Production was examined by having the children name a series of pictures containing consonant and vowel segments that reflected contrasts of each feature. RESULTS: For five of the six feature contrasts, production accuracy was higher than perception accuracy. There was also a significant and positive correlation between accuracy of production and auditory perception for each consonant feature. This correlation was not found for vowels, owing largely to the overall high perception and production scores attained on the vowel features. The children perceived vowel feature contrasts more accurately than consonant feature contrasts. On average, the children had lower perception scores for Back Place and Continuance feature contrasts than for Anterior Place and Voicing contrasts. For all features, the median production scores were 100%; the majority of the children were able to accurately and consistently produce the feature contrasts. The mean production scores for features reflect greater score variability for consonant feature production than for vowel features. Back Place of articulation for back consonants and Continuance contrasts appeared to be the most difficult features to produce, as reflected in lower mean production scores for these features. CONCLUSIONS: The finding of greater production than auditory perception accuracy for five of the six features examined suggests that the children with CIs were able to produce articulatory contrasts that were not readily perceived through audition alone. Factors that are likely to play a role in the greater production accuracy in addition to audition include the lexical and phonetic properties of the words elicited, a child's phonological representation of the words and motor abilities, and learning through oro-tactile, visual, proprioceptive, and kinesthetic perception. The differences among the features examined, and between perception and production, point to the clinical importance of evaluating these abilities in children with CIs. The present findings further point to the utility of picture naming to establish a child's production accuracy, which in turn is necessary if using imitation as a measure of auditory capacity.

Assessing speech perception in children with cochlear implants using a modified hybrid visual habituation procedure.

OBJECTIVES: The objectives of this research were to determine whether an adapted version of a Hybrid Visual Habituation procedure could be used to assess speech perception of phonetic and prosodic features of speech (vowel height, lexical stress, and intonation) in individual pre-school-age children who use cochlear implants. DESIGN: Nine children ranging in age from 3;4 to 5;5 participated in this study. Children were prelingually deaf and used cochlear implants and had no other known disabilities. Children received two speech feature tests using an adaptation of a Hybrid Visual Habituation procedure. RESULTS: Seven of the nine children demonstrated perception of at least one speech feature using this procedure using results from a Bayesian linear regression analysis. At least one child demonstrated perception of each speech feature using this assessment procedure. CONCLUSIONS: An adapted version of the Hybrid Visual Habituation Procedure with an appropriate statistical analysis provides a way to assess phonetic and prosodicaspects of speech in pre-school-age children who use cochlear implants.

Methods for a longitudinal quantitative outcome with a multivariate Gaussian distribution multi-dimensionally censored by therapeutic intervention.

In longitudinal studies, a quantitative outcome (such as blood pressure) may be altered during follow-up by the administration of a non-randomized, non-trial intervention (such as anti-hypertensive medication) that may seriously bias the study results. Current methods mainly address this issue for cross-sectional studies. For longitudinal data, the current methods are either restricted to a specific longitudinal data structure or are valid only under special circumstances. We propose two new methods for estimation of covariate effects on the underlying (untreated) general longitudinal outcomes: a single imputation method employing a modified expectation-maximization (EM)-type algorithm and a multiple imputation (MI) method utilizing a modified Monte Carlo EM-MI algorithm. Each method can be implemented as one-step, two-step, and full-iteration algorithms. They combine the advantages of the current statistical methods while reducing their restrictive assumptions and generalizing them to realistic scenarios. The proposed methods replace intractable numerical integration of a multi-dimensionally censored MVN posterior distribution with a simplified, sufficiently accurate approximation. It is particularly attractive when outcomes reach a plateau after intervention due to various reasons. Methods are studied via simulation and applied to data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study of treatment for type 1 diabetes. Methods proved to be robust to high dimensions, large amounts of censored data, low within-subject correlation, and when subjects receive non-trial intervention to treat the underlying condition only (with high Y), or for treatment in the majority of subjects (with high Y) in combination with prevention for a small fraction of subjects (with normal Y).

Sequential years of dental outreach to Jamaica. Gains toward improved caries status of children.

In the years 2007 to 2011, faculty, pediatric dental residents and dental students lead by New York University College of Dentistry and Healthcare International Reachout, Inc., traveled to the Hoolebury School, Saint Ann Parish, Jamaica, where they provided treatment to 172 children. The service project focused on dental health promotion, education and prevention. Although not a randomized controlled trial, the statistical evidence from records of treatment received and the presence of decay strongly suggests the positive benefit of repeat dental visits and the placement of sealants on permanent molars in these children.

Synaptogenesis and development of pyramidal neuron dendritic morphology in the chimpanzee neocortex resembles humans.

Neocortical development in humans is characterized by an extended period of synaptic proliferation that peaks in mid-childhood, with subsequent pruning through early adulthood, as well as relatively delayed maturation of neuronal arborization in the prefrontal cortex compared with sensorimotor areas. In macaque monkeys, cortical synaptogenesis peaks during early infancy and developmental changes in synapse density and dendritic spines occur synchronously across cortical regions. Thus, relatively prolonged synapse and neuronal maturation in humans might contribute to enhancement of social learning during development and transmission of cultural practices, including language. However, because macaques, which share a last common ancestor with humans ≈ 25 million years ago, have served as the predominant comparative primate model in neurodevelopmental research, the paucity of data from more closely related great apes leaves unresolved when these evolutionary changes in the timing of cortical development became established in the human lineage. To address this question, we used immunohistochemistry, electron microscopy, and Golgi staining to characterize synaptic density and dendritic morphology of pyramidal neurons in primary somatosensory (area 3b), primary motor (area 4), prestriate visual (area 18), and prefrontal (area 10) cortices of developing chimpanzees (Pan troglodytes). We found that synaptogenesis occurs synchronously across cortical areas, with a peak of synapse density during the juvenile period (3-5 y). Moreover, similar to findings in humans, dendrites of prefrontal pyramidal neurons developed later than sensorimotor areas. These results suggest that evolutionary changes to neocortical development promoting greater neuronal plasticity early in postnatal life preceded the divergence of the human and chimpanzee lineages.

A MiniReview of the use of hospital-based databases in observational inpatient studies of drugs.

The majority of pharmacoepidemiological data resources are based on data generated in primary health care. Although inpatient data resources have existed since the 1960s, inpatient pharmacoepidemiological studies are relatively scarce. The objectives of this MiniReview were to describe pharmacoepidemiological studies in hospital settings and the underlying databases to provide an overview of research questions addressed by such databases. The studies were retrieved by chain searching. We included pharmacoepidemiological studies in hospital settings containing data on inpatient drug use. Twelve inpatient databases in Asia, the United States and Europe were found. Most databases were automatically collected from claims data or generated from electronic medical records. The contents of the databases varied as well as the potential for linkage with other data sources such as laboratory and outpatient data. Twenty studies were selected and discussed to illustrate the diversity of inpatient pharmacoepidemiological studies. Hospital-based databases had mainly been used for drug utilization studies and research in adverse drug reactions. Five studies within comparative effectiveness were found. The number of pharmacoepidemiological studies in inpatient settings was low compared with studies from primary healthcare settings. These resources may be under-utilized.

Bornean orangutans on the brink of protein bankruptcy.

Protein is a limiting resource that is essential to the growth, maintenance and reproduction of tropical frugivores, yet few studies have examined how wild animals maintain protein balance. During chronic periods of fruit scarcity, Bornean orangutans (Pongo pygmaeus) often catabolize their own fat reserves despite unusually low metabolic requirements. Such energy deficits suggest a marginal existence, and raise the possibility that orangutans also endure periods of negative protein balance. To test this hypothesis, we conducted the first study of protein cycling in a wild primate. Our five year analysis of urinary metabolites revealed evidence of protein recycling when fruit was scarce. During these periods, orangutans consumed more leaves and bark, proteinaceous but tough foods that yielded a mean daily intake of 1.4 g protein kg(-1) metabolic mass. Such an amount is inadequate for humans and one-tenth the intake of mountain gorillas, but sufficient to avert, perhaps narrowly, a severe protein deficit. Our findings highlight the functional and adaptive value of traits that maximize protein assimilation during periods of ecological exigency.

Forest fruit production is higher on Sumatra than on Borneo.

BACKGROUND: Various studies have shown that the population densities of a number of forest vertebrates, such as orangutans, are higher on Sumatra than Borneo, and that several species exhibit smaller body sizes on Borneo than Sumatra and mainland Southeast Asia. It has been suggested that differences in forest fruit productivity between the islands can explain these patterns. Here we present a large-scale comparison of forest fruit production between the islands to test this hypothesis. METHODOLOGY/PRINCIPAL FINDINGS: Data on fruit production were collated from Sumatran and Bornean sites. At six sites we assessed fruit production in three forest types: riverine, peat swamp and dryland forests. We compared fruit production using time-series models during different periods of overall fruit production and in different tree size classes. We examined overall island differences and differences specifically for fruiting period and tree size class. The results of these analyses indicate that overall the Sumatran forests are more productive than those on Borneo. This difference remains when each of the three forest types (dryland, riverine, and peat) are examined separately. The difference also holds over most tree sizes and fruiting periods. CONCLUSIONS/SIGNIFICANCE: Our results provide strong support for the hypothesis that forest fruit productivity is higher on Sumatra than Borneo. This difference is most likely the result of the overall younger and more volcanic soils on Sumatra than Borneo. These results contribute to our understanding of the determinants of faunal density and the evolution of body size on both islands.

Missing data assumptions and methods in a smoking cessation study.

AIM: A sizable percentage of subjects do not respond to follow-up attempts in smoking cessation studies. The usual procedure in the smoking cessation literature is to assume that non-respondents have resumed smoking. This study used data from a study with a high follow-up rate to assess the degree of bias that may be caused by different methods of imputing missing data. DESIGN AND METHODS: Based on a large data set with very little missing follow-up information at 12 months, a simulation study was undertaken to compare and contrast missing data imputation methods (assuming smoking, propensity score matching and optimal matching) under various assumptions as to how the missing data arose (randomly generated missing values, increased non-response from smokers and a hybrid of the two). FINDINGS: Missing data imputation methods all resulted in some degree of bias which increased with the amount of missing data. CONCLUSION: None of the missing data imputation methods currently available can compensate for bias when there are substantial amounts of missing data.

A comparison of urban school- and community-based dental clinics.

BACKGROUND: The objective of the study was to quantitatively compare school- and community-based dental clinics in New York City that provide dental services to children in need. It was hypothesized that the school-based clinics would perform better in terms of several measures. METHODS: We reviewed billing and visit data derived from encounter forms and expense reports from 4 school- and 3 community-based clinics during 12 months in 2004-2005. The health clinics, administered by the Children's Aid Society, provided dental services to children regardless of ability to pay. The assessments were based on 8 performance indicators, including some based on relative value units, and profile of service indicators was used for assessment. Descriptive statistics and results from hypothesis tests are reported. RESULTS: Based on significant and large differences on the indicators, the school-based health clinics appear to have definite advantages over community-based dental clinics. Results were consistent across many indicators. CONCLUSIONS: The results support increasing the number of school-based dental clinics in urban areas that serve children in need. Being based in schools, factors such as transportation issues, parent availability, and missed appointments are greatly reduced. This has great public dental health implications for children in underserved areas. Schools provide a natural location to provide preventive and responsive dental care. Similar advantages could be expected in rural areas and other areas of need.

Children's fingernail hygiene and length as predictors of carious teeth.

Two dental residents collected data on 104 randomly selected inner city children (ages 3 to 8 years old) from the Episcopal Hospital Pediatric Dental Clinic in Philadelphia in 2002. The purpose of this study was to produce a preliminary assessment of the plausibility of simple indicators of hygiene as predictors of dental health. Fingernail length was measured as 10 mm to 10 mm beyond the end of the fingertip. The cleanliness of fingernails was the number of nails with foreign matter under the nail. Residents quantified the number of decayed, missing or filled teeth (DMFT) according to ADA guidelines during regular clinic visits. The number of dirty fingernails, fingernail length and absolute value of fingernail length are statistically significant predictors of the number of DMFT. The combination of absolute value of fingernail length and the number of dirty fingernails yielded improved and statistically significant predictions of DMFT. The number of dirty fingernails had the most impact on predicted DMFT. Based on this observational study of a single population, it can be suggested that further study of simple hygiene indicators as predictors of dental health be conducted on children from diverse backgrounds.

Methylenedioxy- and methoxyflavones from Melicope coodeana syn. Euodia simplex.

Three new natural products, 3,8-dimethoxy-5,7-dihydroxy-3',4'-methylenedioxyflavone, 3,6,8-trimethoxy-5,7-dihydroxy-3',4'-methylenedioxyflavone and 3,6,8,3',4'-pentamethoxy-5,7-dihydroxyflavone were isolated from Melicope coodeana syn. Euodia simplex (Rutaceae) along with 3,6,3'-trimethoxy-5,7,4'-trihydroxyflavone and 3,3'-dimethoxy-5,7,4'-trihydroxyflavone. The structural assignments are based on (1)H and (13)C NMR data, including discussion of the chemical shifts of C-2 in 3,5-dihydroxy- and 3-methoxy-5-hydroxyflavones. The presence of highly methoxylated and methylenedioxyflavones is characteristic of the genus Melicope, and the present findings support the recent transfer of Euodia simplex to Melicope.