Comorbid Word Reading and Mathematics Computation Difficulty at Start of First Grade.

The purpose of this analysis was to describe cognitive processes associated with comorbid difficulty between word reading (WR) and mathematics computation (MC) at the start of first grade among children selected for WR and MC delays. A sample of 234 children (mean age 6.50 years, SD = 0.31) was assessed on WR, MC, core cognitive processes (phonological processing, rapid automatized naming, verbal counting [VC]), and domain-general cognitive processes (working memory, oral language, nonverbal reasoning, attentive behavior). Structural equation modeling was used to predict a latent Comorbidity factor, which modeled shared variance between WR and MC, and to identify processes associated with that Comorbidity factor. Results identified each of the core cognitive processes, especially VC, and each of the domain-general cognitive processes, especially working memory, as explaining shared variance between WR and MC. Implications for understanding comorbid difficulty at the start of first grade and designing coordinated first-grade interventions are discussed.

Modeling variability in treatment effects for cluster randomized controlled trials using by-variable smooth functions in a generalized additive mixed model.

Variability in treatment effects is common in intervention studies using cluster randomized controlled trial (C-RCT) designs. Such variability is often examined in multilevel modeling (MLM) to understand how treatment effects (TRT) differ based on the level of a covariate (COV), called TRT × COV. In detecting TRT × COV effects using MLM, relationships between covariates and outcomes are assumed to vary across clusters linearly. However, this linearity assumption may not hold in all applications and an incorrect assumption may lead to biased statistical inference about TRT × COV effects. In this study, we present generalized additive mixed model (GAMM) specifications in which cluster-specific functional relationships between covariates and outcomes can be modeled using by-variable smooth functions. In addition, the implementation for GAMM specifications is explained using the mgcv R package (Wood, 2021). The usefulness of the GAMM specifications is illustrated using intervention data from a C-RCT. Results of simulation studies showed that parameters and by-variable smooth functions were recovered well in various multilevel designs and the misspecification of the relationship between covariates and outcomes led to biased estimates of TRT × COV effects. Furthermore, this study evaluated the extent to which the GAMM can be treated as an alternative model to MLM in the presence of a linear relationship.

Antimicrobial Stewardship in Neonates with Necrotizing Enterocolitis: A Quality Improvement Initiative.

BACKGROUND: Antibiotic overutilization in the neonatal intensive care unit (NICU) has many adverse effects, and necrotizing enterocolitis (NEC) is one of the most common indications for antibiotics in premature infants. Evidence for a preferred antibiotic regimen for NEC is lacking. This project aims to reduce piperacillin-tazobactam use and overall antibiotic duration in neonates with NEC through the implementation of an antibiotic stewardship pathway based on the modified Bell stage classification system. METHODS: A multidisciplinary team consisting of neonatology, pharmacy, infectious disease, and surgery developed an antibiotic protocol for the management of NEC based on Bell stage. Recommendations included 48 h of ampicillin/gentamicin (AG) for stage I, 5-10 days of AG for stage II, the addition of metronidazole for stage IIIA, and 7-14 days of piperacillin-tazobactam (PT) for stage IIIB. We evaluated overall antibiotic and PT exposure, progression to surgical NEC, NEC recurrence, antibiotic resistance, bacteremia/fungemia, and mortality 1 year pre- and post-protocol implementation. RESULTS: 27 patients pre-intervention and 44 post-intervention were analyzed. Antibiotic exposure was reduced from a median 119.19 to 80.65 days of therapy (DOT) per 1000 patient days (p = 0.11). PT exposure decreased after protocol implementation (median 68.78 vs. 7.97 DOT per 1000 patient days, p = 0.002). There were no significant differences in morbidity or mortality outcomes. CONCLUSIONS: Antibiotic stewardship strategies can be implemented in the NICU without compromising outcomes in patients with NEC. Bell stage stratification appears to be an effective method for antibiotic selection. Further studies are needed in a larger population to optimize regimens and ensure safety. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.

Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey.

OBJECTIVE: Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States. STUDY DESIGN: A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact. RESULTS: Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation. CONCLUSION: Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use. KEY POINTS: · Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..

Design and Analytic Features for Reducing Biases in Skill-Building Intervention Impact Forecasts.

Despite policy relevance, longer-term evaluations of educational interventions are relatively rare. A common approach to this problem has been to rely on longitudinal research to determine targets for intervention by looking at the correlation between children's early skills (e.g., preschool numeracy) and medium-term outcomes (e.g., first-grade math achievement). However, this approach has sometimes over-or under-predicted the long-term effects (e.g., 5th-grade math achievement) of successfully improving early math skills. Using a within-study comparison design, we assess various approaches to forecasting medium-term impacts of early math skill-building interventions. The most accurate forecasts were obtained when including comprehensive baseline controls and using a combination of conceptually proximal and distal short-term outcomes (in the nonexperimental longitudinal data). Researchers can use our approach to establish a set of designs and analyses to predict the impacts of their interventions up to two years post-treatment. The approach can also be applied to power analyses, model checking, and theory revisions to understand mechanisms contributing to medium-term outcomes.

Severe Pandemic Learning Loss and the Promise of Remotely Delivered Intervention in Students With Comorbid Reading and Mathematics Learning Difficulty.

Analyses were conducted with second graders, drawn from an ongoing multi-cohort randomized controlled trial (RCT), who had been identified for RCT entry based on comorbid reading comprehension and word-problem solving difficulty. To estimate pandemic learning loss, we contrasted fall performance for 3 cohorts: fall of 2019 (pre-pandemic; n = 47), 2020 (early pandemic, when performance was affected by the truncated preceding school year; n = 35), and 2021 (later pandemic, when performance was affected by the truncated 2019 to 2020 school year plus the subsequent year's ongoing interruptions; n = 75). Across the 2 years, declines (standard deviations below expected growth) were approximately 3 times larger than those reported for the general population and for students in high-poverty schools. To estimate the promise of structured remote intervention for addressing such learning loss during extended school closures, we contrasted effects in the RCT's 2018 to 2019 cohort (entirely in-person intervention delivery; n = 66) against the same intervention's effects in the 2020 to 2021 cohort (alternating periods of remote and in-person delivery; n = 29). Large intervention effects were not moderated by pandemic status, suggesting potential for structured remote intervention to address student needs during extended school closures.

Predicting Risk for Comorbid Reading and Mathematics Disability Using Fluency-Based Screening Assessments.

The first purpose of this study was to examine the prevalence of risk for comorbid reading and mathematics disabilities (RMD) at start of first grade, when measured in a representative sample of 3,062 students with first-grade fluency measures (word reading; computation). The second purpose was to examine the utility of these measures for predicting RMD status within a sample of 577 students when RMD status was assessed at the end of second grade in terms of reading and math accuracy. When set at or below the 16th percentile, first-grade risk for RMD was two times more common than chance; at or below the 7th percentile, it was five times more common. Logistic regression showed that the two first-grade fluency measures accurately distinguished students with and without RMD in second grade; however, when cut scores were set to capture 85% of students with RMD, false positives were high. Overall, the results provide support for the use of fluency measures as an initial gating procedure in first grade, but additional gating steps appear necessary in the screening process to reduce false positives.

Gastrostomy Tube Use in Pediatrics: A Systematic Review.

CONTEXT: Despite frequency of gastrostomy placement procedures in children, there remains considerable variability in preoperative work-up and procedural technique of gastrostomy placement and a paucity of literature regarding patient-centric outcomes. OBJECTIVES: This review summarizes existing literature and provides consensus-driven guidelines for patients throughout the enteral access decision-making process. DATA SOURCES: PubMed, Google Scholar, Medline, and Scopus. STUDY SELECTION: Included studies were identified through a combination of the search terms "gastrostomy," "g-tube," and "tube feeding" in children. DATA EXTRACTION: Relevant data, level of evidence, and risk of bias were extracted from included articles to guide formulation of consensus summaries of the evidence. Meta-analysis was conducted when data afforded a quantitative analysis. EVIDENCE REVIEW: Four themes were explored: preoperative nasogastric feeding tube trials, decision-making surrounding enteral access, the role of preoperative imaging, and gastrostomy insertion techniques. Guidelines were generated after evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology. RESULTS: Nearly 900 publications were reviewed, with 58 influencing final recommendations. In total, 17 recommendations are provided, including: (1) tTrial of home nasogastric feeding is safe and should be strongly considered before gastrostomy placement, especially for patients who are likely to learn to eat by mouth; (2) rRoutine contrast studies are not indicated before gastrostomy placement; and (3) lLaparoscopic placement is associated with the best safety profile. LIMITATIONS: Recommendations were generated almost exclusively from observational studies and expert opinion, with few studies describing direct comparisons between GT placement and prolonged nasogastric feeding tube trial. CONCLUSIONS: Additional patient- and family-centric evidence is needed to understand critical aspects of decision-making surrounding surgically placed enteral access devices for children.

The Effects of Language Instruction on Math Development.

How does language shape mathematical development? In this article, we consider this question by reviewing findings from cross-sectional and longitudinal research. In this literature, we find that differences in the structures of languages and individual variation in language ability are associated with mathematical performance in both obvious and unexpected ways. We then consider the causal nature of these relations, with a focus on experimental studies that have tested the effects of language instruction on mathematical outcomes. Findings from this work show that certain forms of language instruction meaningfully improve performance in several mathematical domains, providing strong evidence of a linguistic pathway in mathematical development. However, much additional research is needed to understand how language instruction may be integrated optimally into math education. We conclude with recommendations for research.

Modelling multilevel nonlinear treatment-by-covariate interactions in cluster randomized controlled trials using a generalized additive mixed model.

A cluster randomized controlled trial (C-RCT) is common in educational intervention studies. Multilevel modelling (MLM) is a dominant analytic method to evaluate treatment effects in a C-RCT. In most MLM applications intended to detect an interaction effect, a single interaction effect (called a conflated effect) is considered instead of level-specific interaction effects in a multilevel design (called unconflated multilevel interaction effects), and the linear interaction effect is modelled. In this paper we present a generalized additive mixed model (GAMM) that allows an unconflated multilevel interaction to be estimated without assuming a prespecified form of the interaction. R code is provided to estimate the model parameters using maximum likelihood estimation and to visualize the nonlinear treatment-by-covariate interaction. The usefulness of the model is illustrated using instructional intervention data from a C-RCT. Results of simulation studies showed that the GAMM outperformed an alternative approach to recover an unconflated logistic multilevel interaction. In addition, the parameter recovery of the GAMM was relatively satisfactory in multilevel designs found in educational intervention studies, except when the number of clusters, cluster sizes, and intraclass correlations were small. When modelling a linear multilevel treatment-by-covariate interaction in the presence of a nonlinear effect, biased estimates (such as overestimated standard errors and overestimated random effect variances) and incorrect predictions of the unconflated multilevel interaction were found.

Connections between Mathematics and Reading Development: Numerical Cognition Mediates Relations between Foundational Competencies and Later Academic Outcomes.

We examined longitudinal relations between 1st-grade cognitive predictors (early nonverbal reasoning, processing speed, listening comprehension, working memory, calculation skill, word-problem solving, word-reading fluency, attentive behavior, and numerical cognition) and 2nd-grade academic outcomes (calculations, word-problem solving, and word reading) in 370 children (M age = 6.55 years, SD age = 0.33 years at the start of the study) who were identified as at-risk or not-at-risk for mathematics disability. Path analysis mediation models revealed that numerical cognition, assessed at an intermediary timepoint, mediated the effects of processing speed, working memory, calculation skill, word-problem solving, and attentive behavior on all 3 outcomes. Findings indicate that multiple early domain-general cognitive abilities are related to later mathematics and reading outcomes and that numerical cognition processes, which may track ease of forming symbol-concept associations, predict later performance across both academic domains.

Comorbidity in Reading Comprehension and Word-Problem Solving Difficulties: Exploring Shared Risk Factors and Their Impact on Language Minority Learners.

The purpose of this study was threefold: to examine unique and shared risk factors of comorbidity for reading comprehension and word-problem solving difficulties, to explore whether language minority (LM) learners are at increased risk of what we refer to as higher order comorbidity (reading comprehension and word-problem solving difficulties), and to examine the profiles of at-risk LM learners compared with at-risk non-LM learners. At-risk (LM n = 70; non-LM n = 89) and not-at-risk (LM n = 44; non-LM n = 114) students were evaluated on foundational academic (word reading, calculation), behavioral (behavioral attention), cognitive (working memory, processing speed, nonverbal reasoning), and language (vocabulary, listening comprehension) measures in English. Results indicated listening comprehension was the only shared risk factor for higher order comorbidity. Furthermore, LM learners were 3 times more likely to be identified as at risk compared with non-LM learners. Finally, among at-risk learners, no differences were found on cognitive dimensions by language status, but LM learners had lower reading and listening comprehension skills than non-LM learners, with a relative advantage in behavioral attention. Results have implications for understanding higher order comorbidity and for developing methods to identify and intervene with higher order comorbidity among the growing population of LM learners.

Bringing Data-Based Individualization to Scale: A Call for the Next-Generation Technology of Teacher Supports.

The purpose of this narrative synthesis of the curriculum-based measure (CBM) instructional utility literature is to deepen insight into the supports required to enrich teachers' instructional decision-making within curriculum-based measure-data-based individualization (CBM-DBI) in ways that enhance the learning outcomes of students with intensive intervention needs, including students with learning disabilities. We begin by summarizing a recent meta-analysis of CBM-DBI studies focused on academic outcomes. We then reconsider studies from that meta-analysis to further explore the supports required to enrich teachers' instructional decision-making within CBM-DBI and improve student learning. We next draw conclusions and propose a renewed program of instructional utility CBM-DBI research for capitalizing on technology's potential to enhance productive instructional decision-making for students who require intensive intervention, fulfill DBI's potential, and bring CBM-DBI to scale.

Closing the Word-Problem Achievement Gap in First Grade: Schema-Based Word-Problem Intervention with Embedded Language Comprehension Instruction.

The main purpose of this study was to test the effects of word-problem intervention, with versus without embedded language comprehension instruction, on at-risk 1st graders' word-problem performance. We also isolated the need for a structured approach to word-problem intervention and tested the efficacy of schema-based instruction at 1st grade. Children (n=391; mean age = 6.53, SD = 0.32) were randomly assigned to 4 conditions: schema-based word-problem intervention with embedded language instruction, the same word-problem intervention but without language comprehension instruction, structured number knowledge intervention without a structured word-problem component, and a control group. Each intervention included 45 30-min sessions. Multilevel models, accounting for classroom and school effects, revealed the efficacy of schema-based word-problem intervention at 1st grade, with both word-problem conditions outperforming the number knowledge condition and the control group. Yet, word-problem performance was significantly stronger for the schema-based condition with embedded language comprehension instruction compared to the schema-based condition without language comprehension instruction. Number knowledge intervention conveyed no word-problem advantage over the control group, even though all 3 intervention conditions outperformed the control group on arithmetic. Results demonstrate the importance of a structured approach to word-problem intervention; the efficacy of schema-based instruction at 1st grade; and the added value of language comprehension instruction within word-problem intervention. Results also provide causal evidence on the role of language comprehension in word-problem solving.

Language-Related Longitudinal Predictors of Arithmetic Word Problem Solving: A Structural Equation Modeling Approach.

We investigated the longitudinal relations between cognitive skills, specifically language-related skills, and word-problem solving in 340 children (6.10 to 9.02 years). We used structural equation modeling to examine whether word-problem solving, computation skill, working memory, nonverbal reasoning, oral language, and word reading fluency measured at second grade were associated with performance on measures of word-problem solving in fourth grade. Results indicated that prior word-problem solving, computation skill, nonverbal reasoning, and oral language were significantly associated with children's later word-problem solving. Multi-group modeling suggested that these relations were not significantly different for boys versus girls. Implications of these findings are discussed.

Is "Response/No Response" Too Simple a Notion for RTI Frameworks? Exploring Multiple Response Types With Latent Profile Analysis.

We conducted a secondary analysis of data from a randomized control trial to explore this question: Does "response/no response" best characterize students' reactions to a generally efficacious first-grade reading program, or is a more nuanced characterization necessary? Data were collected on 265 at-risk readers' word reading prior to and immediately following program implementation in first grade and in spring of second grade. Pretreatment data were also obtained on domain-specific skills (letter knowledge, decoding, passage comprehension, language) and domain-general skills (working memory, non-verbal reasoning). Latent profile analysis of word reading across the three time points with controls as a local norm revealed a strongly responsive group (n = 45) with mean word-reading z scores of 0.25, 1.64, and 1.26 at the three time points, respectively; a mildly responsive group (n = 109), z scores = 0.30, 0.47, and 0.55; a mildly non-responsive group (n = 90), z scores = -0.11, -0.15, and -0.55; and a strongly non-responsive group (n = 21), z scores = -1.24, -1.26, and -1.57. The two responsive groups had stronger pretreatment letter knowledge and passage comprehension than the two non-responsive groups. The mildly non-responsive group demonstrated better pretreatment passage comprehension than the strongly non-responsive group. No domain-general skill distinguished the four groups. Findings suggest response to early reading intervention was more complicated than response/no response, and pretreatment reading comprehension was an important predictor of response even with pretreatment word reading controlled.

Do the Processes Engaged During Mathematical Word-Problem Solving Differ Along the Distribution of Word-Problem Competence?

Conventional research methods for understanding sources of individual differences in word-problem solving (WPS) only permit estimation of average relations between component processes and outcomes. The purpose of the present study was instead to examine whether and if so how the component processes engaged in WPS differ along the spectrum of WPS performance. Second graders (N = 1,130) from 126 classrooms in 17 schools were assessed on component processes (reasoning, in-class attentive behavior, working memory, language comprehension, calculation fluency, word reading) and WPS. Multilevel, unconditional quantile multiple regression indicated that 3 component processes, calculation fluency, language comprehension, and working memory, are engaged in WPS differentially depending on students' overall word-problem skill. The role of calculation fluency and language comprehension was stronger with more competent word-problem solving ability. By contrast, the role of working memory was stronger with intermediate-level than for strong problem solving. Results deepen insight into the role of these processes in WPS and provide the basis for hypothesizing how instructional strategies may be differentiated depending on students' overall level of WPS competence.

Improving Language Comprehension to Enhance Word-Problem Solving.

The focus of this article is the role of language comprehension within word-problem solving (WPS). The role of the language comprehension in WPS is explained, and an overview of research illustrating language comprehension's contribution to WPS is described. Next, an innovative intervention that embeds WP-specific language comprehension instruction within a validated form of schema-based WP intervention is described, and the methods and results of a randomized controlled trial assessing the added value of embedding WP-specific language comprehension instruction are outlined. Implications for practice and future research are drawn.

Dynamic Assessment for Identifying Spanish-Speaking English Learners' Risk for Mathematics Disabilities: Does Language of Administration Matter?

We examined dynamic assessment's (DA's) added value over traditional assessments for identifying Spanish-speaking English learners' (ELs) risk for developing mathematics disabilities, as a function of the language of test administration (English vs. Spanish), type of math outcome, and EL's language dominance. At the start of first grade, ELs (N = 368) were randomly assigned to English-DA or Spanish-DA conditions, were assessed on static mathematics measures and domain-general (language, reasoning) measures in English, and completed DA in their assigned language condition. At year's end, they were assessed on calculation and word-problem solving outcomes in English. Results from multigroup path models indicated that Spanish-DA mitigates the impact of ELs' language dominance on DA performance. Moreover, ELs' language dominance moderated DA's predictive validity differentially depending on DA language and type of outcome. Spanish-DA showed higher predictive validity in Spanish-dominant ELs than English-dominant ELs when predicting calculations but not word-problem solving. English-DA was predictive for both outcomes, regardless of ELs' language dominance.