Validating the Use of Percent Grammatical Utterances for Assessing Mandarin-Speaking Children's Grammatical Skill: Evidence From 3-Year-Olds.

PURPOSE: The study examined the use of percent grammatical utterances (PGUs) for assessing grammatical skills in Mandarin-speaking 3-year-old children. METHOD: Participants were 30 Mandarin-speaking 3-year-olds with typical development. Language samples were collected in two visits for each child using a picture description task. Children were asked to talk about 16 pictures in response to questions and prompts at each visit. Pictures for the language sample collection were identical across the visits. PGUs were computed, and the grammatical errors that children produced in the task were coded and tallied for error types at each visit. Test-retest reliability, split-half reliability, and concurrent criterion validity of PGUs were evaluated. RESULTS: The mean PGU level was approximately 78% at Visit 1 and 81% at Visit 2, both of which were significantly below the mastery level (i.e., 90%). The correlation coefficient for test-retest reliability of PGU was large (r = .70, p < .01); the correlation coefficient for split-half reliability was medium at Visit 1 (r = .47, p < .01) and large (r = .65, p < .01) at Visit 2. In addition, the correlation coefficient for concurrent criterion validity of PGU was medium for both visits (rs ≥ .35, ps ≤ .03). The ranking and proportion of each error type were similar between the visits. CONCLUSION: The initial evidence from psychometric properties suggests that PGU computed from the picture description task is a reliable and valid measure for evaluating grammatical skills in Mandarin-speaking 3-year-old children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25395499.

Impaired motor skills and proprioceptive function in Mandarin-speaking children with developmental language disorder.

This study examined proprioceptive acuity and its relationship with motor function in Mandarin-speaking children with and without developmental language disorder (DLD). Fifteen children aged 9-12 years with DLD and 15 age- and sex-matched typically developing (TD) children participated in this study. Children's motor function was assessed using the second edition of the Movement Assessment Battery for Children (MABC-2). Their proprioceptive acuity was measured based on the absolute error (i.e., proprioceptive bias) and variable error (i.e., proprioceptive precision) when performing joint position matching tasks. Compared with the TD group, the DLD group exhibited impaired motor function and poorer proprioceptive acuity, as evidenced by the lower scores on the MABC-2 and the higher rates of absolute and variable errors in the joint position matching tasks. A significant association between the proprioceptive bias (absolute error) and the MABC-2 total score was also observed in the combined cohort of children with and without DLD. We conclude that DLD is associated with proprioceptive dysfunction.

Nonlinguistic Cognitive Functions of Mandarin Speakers With Poststroke Aphasia.

PURPOSE: The purpose of this study was to examine the cognitive functions of Mandarin speakers with poststroke aphasia and to investigate the relationship between nonlinguistic cognitive deficits and the severity of aphasia. METHOD: Twenty-three adults with aphasia resulting from left-hemispheric stroke and 23 adults matched for age and educational level completed a series of six nonlinguistic cognitive tests measuring nonverbal intelligence, short-term memory, visual selective attention, visual alternating attention, auditory selective attention, and auditory alternating attention. A standardized aphasia assessment (Concise Chinese Aphasia Test [CCAT]) was also conducted to evaluate the severity of aphasia. Data analyses examined cognitive functions by comparing task performance of the two groups and examining the relationship between scores on the cognitive tasks and aphasia severity based on a hierarchical regression analysis. RESULTS: The aphasia group scored significantly lower than the control group on all nonlinguistic cognitive tasks with large effect sizes (d = 0.95 ~ 1.54). Significant associations between different nonlinguistic cognitive tasks and CCAT subtests were observed. Results from the hierarchical regression analysis showed that auditory alternating attention was the only factor that significantly predicted aphasia severity based on CCAT overall scores after age and education level were taken into account. CONCLUSIONS: The findings align with prior research observing deficits in nonlinguistic cognition in individuals with aphasia. Implications for clinical practice and future research are discussed.

Mean residual life cure models for right-censored data with and without length-biased sampling.

We propose a semiparametric mean residual life mixture cure model for right-censored survival data with a cured fraction. The model employs the proportional mean residual life model to describe the effects of covariates on the mean residual time of uncured subjects and the logistic regression model to describe the effects of covariates on the cure rate. We develop estimating equations to estimate the proposed cure model for the right-censored data with and without length-biased sampling, the latter is often found in prevalent cohort studies. In particular, we propose two estimating equations to estimate the effects of covariates in the cure rate and a method to combine them to improve the estimation efficiency. The consistency and asymptotic normality of the proposed estimates are established. The finite sample performance of the estimates is confirmed with simulations. The proposed estimation methods are applied to a clinical trial study on melanoma and a prevalent cohort study on early-onset type 2 diabetes mellitus.

Not only motor skill performance but also haptic function is impaired in children with developmental language disorder.

BACKGROUND: Previous studies have found an association between motor immaturity and developmental language impairment in children. However, systematic investigations of somatosensory dysfunctions that might be linked to motor deficits in children with developmental language disorder (DLD) are lacking. AIMS: Examined haptic perception and motor skills in school-age children with DLD and typically-developing (TD) children. METHODS: Sixteen children with DLD and sixteen age-matched TD children performed a curvature detection task measuring haptic sensitivity and a curvature discrimination task measuring haptic acuity. The Movement Assessment Battery for Children, 2nd edition (MABC-2) was also conducted to evaluate children's motor ability. RESULTS: The results revealed elevated thresholds of both haptic detection (67.5%) and haptic discrimination (67.9%) in the DLD group when compared to the TD group. In addition, the children with DLD performed significantly less well on the manual dexterity of MABC-2. Finally, a lower haptic acuity was associated with poorer manual dexterity scores of MABC-2. CONCLUSIONS: This study demonstrates for the first time that not only motor skills, but also haptic function is altered in children with DLD. The observed association between manual dexterity and haptic acuity suggests a close relationship between haptic and motor skills in school-age children.

Benefits of applying virtual reality in pelvic movement training through a Wii Fit: a randomized controlled trial.

BACKGROUND: Pelvic movement training has become compulsory for part of medical students. An increasing amount of research has focused on the influence of virtual reality (VR) on learning effectiveness. However, its application to pelvic floor muscles or pelvic movement training is still in its infancy. We compared the effectiveness of conventional pelvic movement training with or without VR-assisted pelvic movement training for student learning. METHODS: We recruited 44 university students (16 male and 28 female participants; average age = 19.7 ± 0.31 years) who had not previously received pelvic movement education or training. The participants were randomly assigned into traditional and experimental groups to acquire pelvic movements and relevant knowledge. The traditional group received conventional classes (about 15 min), whereas the experimental group received both conventional classes and VR-assisted teaching (additional VR session took approximately 25-45 min depending on the speed of movement of each participant). The participants were asked to control the trajectory of the centre of pressure on the Wii Fit balance board and build-in games to learn pelvic movements. We conducted evaluations before, immediately after, and 2 weeks after the experiment, based on the scores of written and practical examinations. The experimental group was also asked to complete a questionnaire during the posttest. RESULTS: We carried out two-way repeated measures ANOVA and discovered that the written examination scores indicated a significant Time × Group interaction (p=0.015). In each group, the written and practical examinations in the posttest and follow-up test exhibited significantly improved results compared with the baseline value (p <0.001, except for traditional group of written exam in follow up test vs. baseline p=0.001). The written examination in the follow-up test did not decline significantly compared with those in the posttest, but the practical examination in the follow-up test was decline significantly compared with those in the posttest (p=0.033). The experimental group had superior overall performance in the practical examinations than the traditional group (experimental group: mean = 76.27, 95% confidence level [CI] = 70.84-81.71; traditional group: mean = 64.21, 95% CI = 58.78-69.65). No significant difference in the written examination between two groups. The percentage for agreement ratio on the usefulness, ease of use, users' intention to continue using the VR-assisted teaching is high (95.5-100%). CONCLUSIONS: The results of this study suggested that conventional and conventional + VR teaching were both effective. However, the incorporation of VR stimulated learning motivation and facilitated precise performance of pelvic movements. It is recommended that pelvic floor muscles training could be supplemented with VR or games to increase students' motivation and understanding how to perform pelvic movements.

Maximum likelihood estimation for length-biased and interval-censored data with a nonsusceptible fraction.

Left-truncated data are often encountered in epidemiological cohort studies, where individuals are recruited according to a certain cross-sectional sampling criterion. Length-biased data, a special case of left-truncated data, assume that the incidence of the initial event follows a homogeneous Poisson process. In this article, we consider an analysis of length-biased and interval-censored data with a nonsusceptible fraction. We first point out the importance of a well-defined target population, which depends on the prior knowledge for the support of the failure times of susceptible individuals. Given the target population, we proceed with a length-biased sampling and draw valid inferences from a length-biased sample. When there is no covariate, we show that it suffices to consider a discrete version of the survival function for the susceptible individuals with jump points at the left endpoints of the censoring intervals when maximizing the full likelihood function, and propose an EM algorithm to obtain the nonparametric maximum likelihood estimates of nonsusceptible rate and the survival function of the susceptible individuals. We also develop a novel graphical method for assessing the stationarity assumption. When covariates are present, we consider the Cox proportional hazards model for the survival time of the susceptible individuals and the logistic regression model for the probability of being susceptible. We construct the full likelihood function and obtain the nonparametric maximum likelihood estimates of the regression parameters by employing the EM algorithm. The large sample properties of the estimates are established. The performance of the method is assessed by simulations. The proposed model and method are applied to data from an early-onset diabetes mellitus study.

Household structure and concurrent stunting and overweight among young children in Indonesia.

OBJECTIVE: To examine the association of household type and household composition with concurrent stunting and overweight in young children from urban and rural Indonesia. DESIGN: This study is a secondary data analysis using a nationally representative cross-sectional survey. Household structure was analysed as household type, household size, number of working adults, number of dependent adults and children, and household head's gender. We defined 'concurrent stunting and overweight' as height-for-age Z-score <-2 and weight-for-height Z-score >+2 based on WHO growth standards. Multivariable logistic regression to test the aforementioned association was performed separately for urban and rural areas. SETTING: Data were from Indonesia Basic Heath Research 2013. PARTICIPANTS: Children aged 2-5 years (n 45 050). RESULTS: The prevalence of concurrent stunting and overweight children was 5·6 %. In rural areas, this prevalence differed significantly by household types and the highest prevalence was among children in nuclear two-parent households (6·8 %). In rural areas, children in extended households had lower odds of concurrent stunting and overweight than those from nuclear households (OR = 0·73, 95 % CI 0·59, 0·92). In urban areas, household size and number of working adults were significantly associated with the decreased odds of concurrent stunting and overweight in children. CONCLUSIONS: Household structure was associated with children's concurrent stunting and overweight in urban and rural regions of Indonesia. The patterns of the association might differ between urban and rural regions, but no significant interaction term was found.

Adolescents' Physical Activity and the Association With Perceived Social Support of Parents and Peers in Indonesia.

This study examined the trends of adolescents' physical activity (PA) and its association with parental and peer support, based on the Indonesia Global School-Based Health Survey. Between 2007 and 2015, prevalence of PA in adolescents declined from 24.4% to 16.5%. Prevalence of active transportation (AT) decreased from 47.2% to 32.3%. Prevalence of sedentary leisure behavior (SLB) declined from 33.6% to 27.2%. Girls' SLB was inversely associated with parental supervision SLB in 2007 (odds ratio [OR] = 0.49; 95% CI = 0.30-0.80) and in 2015 (adjusted OR [AOR] = 0.55; 95% CI = 0.43-0.71), and so was boys' SLB in 2015 (OR = 0.75; 95% CI = 0.59-0.95). Boys' AT was inversely associated with peer support in 2015 (OR = 0.73; 95% CI = 0.59-0.91). Parental control was associated with PA in girls (OR = 1.71; 95% CI = 1.23-2.37), in boys (OR = 1.65; 95% CI = 1.07-2.54), and with SLB among girls in 2015 (OR = 1.28; 95% CI = 1.11-1.47). Hence, adolescents' PA was associated with perceived social support.

Dietary knowledge, preferences and behaviors in Ramadan among Muslim patients with type 2 diabetes.

AIMS: To explore the association between dietary knowledge, attitude, and practices during Ramadan among Muslim patients with type 2 diabetes. METHODS: Recruited after Ramadan from public clinics and a hospital in Banda Aceh, Indonesia, 401 outpatients recalled their food consumption frequencies of high-fiber food, deep-fried food, and high-sugar dessert, and relevant knowledge and attitudes. Multivariable logistic regression models were applied to examine the research questions. RESULTS: Vegetable consumption and preference were both high among the patients. However, only 4.5% knew that brown rice is rich in fiber, and 19% agreed that whole-grain foods were accessible. Deep-fried food consumption and its availability at home was common, even though the majority considered it should be avoided. Patients with a lower preference for deep-fried foods were less likely to consume deep-fried foods during Ramadan (OR = 0.239, 95% CI = 0.109-0.523, p = 0.001). Knowledge of the glycemic index's health implication was associated with more high-fiber foods consumption (OR = 2.733, 95% CI = 1.179-6.332, p = 0.019). Yet, knowing the potential risk of added sugar on blood glucose level was associated with high-sugar dessert consumption (OR = 2.997, 95% CI = 1.482-6.060, p = 0.002). CONCLUSION: The patients' low consumption of whole-grain food and common comsumption of deep-fried food during Ramadan would be the first priority to be improved. Along with dietary knowledge and attitude, food environment could be an important factor that influences patients' dietary behaviors.

AimB Is a Small Protein Regulator of Cell Size and MreB Assembly.

The MreB actin-like cytoskeleton assembles into dynamic polymers that coordinate cell shape in many bacteria. In contrast to most other cytoskeleton systems, few MreB-interacting proteins have been well characterized. Here, we identify a small protein from Caulobacter crescentus, an assembly inhibitor of MreB (AimB). AimB overexpression mimics inhibition of MreB polymerization, leading to increased cell width and MreB delocalization. Furthermore, aimB appears to be essential, and its depletion results in decreased cell width and increased resistance to A22, a small-molecule inhibitor of MreB assembly. Molecular dynamics simulations suggest that AimB binds MreB at its monomer-monomer protofilament interaction cleft and that this interaction is favored for C. crescentus MreB over Escherichia coli MreB because of a closer match in the degree of opening with AimB size, suggesting coevolution of AimB with MreB conformational dynamics in C. crescentus. We support this model through functional analysis of point mutants in both AimB and MreB, photo-cross-linking studies with site-specific unnatural amino acids, and species-specific activity of AimB. Together, our findings are consistent with AimB promoting MreB dynamics by inhibiting monomer-monomer assembly interactions, representing a new mechanism for regulating actin-like polymers and the first identification of a non-toxin MreB assembly inhibitor. Because AimB has only 104 amino acids and small proteins are often poorly characterized, our work suggests the possibility of more bacterial cytoskeletal regulators to be found in this class. Thus, like FtsZ and eukaryotic actin, MreB may have a rich repertoire of regulators to tune its precise assembly and dynamics.

Hepatic extravasation complicated by umbilical venous catheterization in neonates: A 5-year, single-center experience.

BACKGROUND: Care of newborns in the neonatal intensive care unit generally involves umbilical venous catheterization (UVC) for central vein access to enable medical needs. The study aimed to evaluate the sonographic appearance, risk factors, and outcomes of UVC-related hepatic extravasation (HE) in neonates. METHODS: A 5-year retrospective study where 33 neonates were enrolled with a diagnosis age ranging from 2 to 25 days. 78.8% of the subjects had UVC malpositioning shown on initial radiography. All neonates sonographically diagnosed with HE, and follow-up ultrasound (US) was performed. RESULTS: The main findings of HE on US were hyperechoic or heterogeneous lesions of a lobulated (51.7%) or wedge shape (48.3%), located mainly in the left lobe (72.7%). The mean time to resolution of HE was 2.25 months. Seven (21.2%) patients showed hepatic vascular thrombosis at follow-up. Two (6%) patients had abnormal liver function, which subsequently normalized. CONCLUSION: Malposition of the UV catheter was the predisposing factor for UVC-related HE in neonates. US facilitates detection of UVC malpositioning and diagnosis of HE, as well as delayed complications. A shorter duration of UVC placement is associated with favorable outcomes of UVC-related HE in neonates.

NASA Mission X Program for Healthy Eating and Active Living among Taiwanese Elementary School Students.

PURPOSE: This study assessed the effects of an intervention program adapted from the NASA Mission X (MX) program on children's Healthy Eating Active Living (HEAL) knowledge and behaviors and anthropometry. METHODS: This clustered randomized control trial recruited 8 elementary schools in remote rural areas of Northern Taiwan. The intervention was the 8-week MX program. All the 3rd and 4th graders were invited to the study (n = 245). Children's weight, height, HEAL knowledge and behaviors were measured pre- and post-intervention. RESULTS: The intervention group had significantly more improvements than control group in physical activity knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). BMI increased from 18.4 to 18.6 (p < 0.05) for the control group but did not change for the intervention group. The changes in BMI between groups did not differ significantly. CONCLUSION AND PRACTICE IMPLICATIONS: This randomized controlled trial showed that the NASA MX program was feasible and acceptable among children in Taiwan, and improved children's HEAL knowledge. (ClinicalTrials.gov registration: NCT03355131).

Age, period and birth cohort effects on the prevalence of overweight and obesity among Taiwanese adolescents: a national population-based study.

BACKGROUND: The age-period-cohort effects on youth overweight and obesity among junior and senior high school students in Taiwan is not clear. METHODS: We utilized the 2006-14 nationally representative School Physical Fitness Dataset. Based on the International Obesity Task Force cut-off criteria, a log-linear age-period-cohort analysis was performed to determine the influence of age, period and cohort on the trend in being overweight, obese and severely obese for both sexes. RESULTS: The final dataset included 1073173 individuals (n = 520 382 boys and 552 791 girls). For girls, the prevalence of overweight and obesity declined with age, and the prevalence of overweight declined over time. For boys, the prevalence of overweight and obesity declined with age and over time from 2006 to 2014. The prevalence of severe obesity declined over time and increased with age for the boys. The younger birth cohorts had greater odds of being overweight, obese and severely obese than the older birth cohorts. CONCLUSIONS: After differentiating the age-period-cohort effects, the data suggested a decreasing temporal trend in overweight and obesity among adolescents in Taiwan from 2006 to 2014. Among the birth cohorts of the 1990s, the younger cohorts had greater odds of being overweight and obese than the older cohorts when they reached adolescence.

Associations of exercise, nutritional status, and smoking with cognitive decline among older adults in Taiwan: Results of a longitudinal population-based study.

This study aimed to explore the long-term effects of exercise, smoking, and nutritional status on cognitive reserve and changes in cognitive function among Taiwanese adults aged ≥65 years. Data were obtained from the Taiwan Longitudinal Study of Aging, a national representative population-based cohort study. Results showed that the average baseline scores on the Short Portable Mental Status Questionnaire (SPMSQ) and Mini-Nutritional Assessment (MNA) were 9.07 and 26.01, respectively. The proportions of smoking and exercising at baseline were 24.12% and 58.67%, respectively. A linear regression analysis indicated that old adults who were current and consistent exercisers had better subsequent 4-year SPMSQ scores than those who were not exercisers (P < 0.05). The MNA score was positively associated with subsequent 4- and 8-year SPMSQ scores for the 65-74-year-old adults (P < 0.05). The logistic regression analysis showed that current and consistent exercise was negatively associated with subsequent 4-year cognitive decline (P < 0.05). Previous exercise experience was positively associated with subsequent 8-year cognitive decline for the ≥75-year-old adults (P < 0.05). The MNA score was negatively correlated with subsequent 4- and 8-year cognitive decline among the 65-74-year-old adults. Among the adults aged ≥75 years, consistent smoking was positively associated with cognitive decline over 4 years (P < 0.05). Therefore, current and consistent exercise and good nutritional status benefit cognitive function and reserve, and have protective effects on cognitive decline among old adults, whereas discontinued exercise, poor nutrition, and cigarette smoking are likely to raise the risk of cognitive decline.

Secular trends and associated factors of age at natural menopause in Taiwanese women.

OBJECTIVE: Age at natural menopause (ANM) is considered an indicator for chronic disease and mortality risk in later life. Research suggests that ANM appears to vary across geographic regions and ethnicities. The aim of this study was to explore the secular trends and factors associated with ANM in Taiwanese women. METHODS: We used data from three cross-sectional phases of the Nutrition and Health Survey in Taiwan. In all, 4,111 women aged 35 years and over were included. Information on ANM and sociodemographics, lifestyle, and health factors were collected using household questionnaires. A Cox proportional-hazards model was used to determine the association of ANM with relevant factors, and a life table method was used to estimate median ANM. RESULTS: Life table method estimated the median ANM to be 50 years. ANM was getting later for women born in younger cohorts (hazard ratio [HR] 0.87 per 10-year difference, 95% confidence interval [CI] 0.81-0.95). ANM was also later among women who achieved higher educational levels (HR 0.91 per one-category difference, 95% CI 0.86-0.96) and who had been married (HR 0.64, 95% CI 0.42-0.96). ANM occurred later for parous than for nulliparous women. Multivariable analysis found no significant associations of ANM with age at menarche, smoking, or alcohol drinking. CONCLUSIONS: The results suggest that women in the younger cohorts, with higher educational levels, and who are parous and married may have later ANM. The trend effect of secular time and educational levels on ANM may reflect the influences of socioeconomic/nutritional status in their childhood or throughout their lifetime.

Gender differences and burden of chronic conditions: impact on quality of life among the elderly in Taiwan.

BACKGROUND: Multiple chronic conditions affect people's health-related quality of life (QoL) and the distributions of the conditions may differ between genders. Our goal was to examine gender differences in chronic conditions and QoL among community-living elderly in Taiwan and to examine whether differences in QoL between genders, if present, were attributable to the distribution of chronic conditions. METHODS: We used data from the Nutrition and Health Survey in Taiwan (NAHSIT, 2005-2008), which interviewed a representative sample of the Taiwanese population. The survey questions included the SF-36 questionnaire to assess participants' QoL and items for participants' medical history. We used multiple linear regressions to examine the difference in QoL between genders. RESULTS: We included 1179 elders for our analysis; men accounted for 52% (612/1179). The mean age was 73; women were slightly younger. The mean (standard deviation) of SF-36 physical and mental health component score (PCS and MCS) was 44.5 (11.1) and 55.6 (9.0), respectively, and women reported a significantly lower PCS than men (difference - 4.85, p < 0.001). Urinary incontinence, arthritis, stroke, and kidney disease were associated with a clinically meaningful decrease in PCS (≤ - 6.5 points). The difference in PCS between genders was not attenuated after we accounted for chronic conditions in regression analysis. CONCLUSIONS: Our findings suggest that women tend to report that their physical health-related QoL is poorer than that of men, and such a difference does not seem to be attributable to the distribution of chronic conditions. Elderly men and women may perceive health-related QoL differently.

FtsZ-Independent Mechanism of Division Inhibition by the Small Molecule PC190723 in Escherichia coli.

While cell division is a critical process in cellular proliferation, very few antibiotics have been identified that target the bacterial cell-division machinery. Recent studies have shown that the small molecule PC190723 inhibits cell division in several Gram-positive bacteria, with a hypothesized mechanism of action involving direct targeting of the tubulin homolog FtsZ, which is essential for division in virtually all bacterial species. Here, it is shown that PC190723 also inhibits cell division in the Gram-negative bacterium Escherichia coli if the outer membrane permeability barrier is compromised genetically or chemically. The results show that the equivalent FtsZ mutations conferring PC190723 resistance in Staphylococcus aureus do not protect E. coli against PC190723, and that suppressors of PC190723 sensitivity in E. coli, which do not generically decrease outer membrane permeability, do not map to FtsZ or other division proteins. These suppressors display a wide range of morphological and growth phenotypes, and one exhibits a death phenotype in the stationary phase similar to that of a mutant with disrupted lipid homeostasis. Finally, a complementing FtsZ-msfGFP fusion is used to show that PC190723 does not affect the Z-ring structure. Taken together, the findings suggest that PC190723 inhibits growth and division in E. coli without targeting FtsZ. This study highlights the importance of utilizing a combination of genetic, chemical, and single-cell approaches to dissect the mechanisms of action of new antibiotics, which are not necessarily conserved across bacterial species.