Type of auditory cues and apparatus influence how healthy young adults integrate sounds for dynamic balance.

It is unclear whether the brain handles auditory cues similarly to visual cues for balance. We investigated the influence of headphones and loudspeaker reproduction of sounds on dynamic balance performance when an individual is facing a cognitive challenge. Twenty participants (16 females, aged 19-36) were asked to avoid a ball according to a specific visual rule. Visuals were projected from the HTC Vive head-mounted display in an acoustically controlled space. We varied the environment by adding congruent sounds (sounds coincide with the visual rule) or incongruent sounds (sounds may or may not coincide with the visual rule) as well as creating a multimodal (visual and congruent sounds) vs. unimodal (visual or congruent sounds only) display of stimuli. Sounds were played over headphones or loudspeakers. We quantified reaction time (RT) and accuracy (choosing the correct direction to move) by capturing the head movement. We found that in the absence of sounds, RT was slower with headphones compared to loudspeakers, but the introduction of either congruent or incongruent sounds resulted in faster movements with headphones such that RT was no longer different between apparatus. Participants used congruent sounds to improve accuracy but disregarded incongruent sounds. This suggests that selective attention may explain how sounds are incorporated into dynamic balance performance in healthy young adults. Participants leveraged sounds played over loudspeakers, but not over headphones, to enhance accuracy in a unimodal dark environment. This may be explained by the natural listening conditions created by loudspeakers where sounds may be perceived as externalized.

Measurement equivalence of the English and French versions of the self-efficacy to manage chronic disease scale: a Scleroderma Patient-Centered Intervention Network (SPIN) study.

PURPOSE: The Self-Efficacy to Manage Chronic Disease (SEMCD) scale is widely used, including in systemic sclerosis (SSc). The SEMCD has been validated in SSc, but the metric equivalence of the English and French versions has not been assessed (i.e., whether psychometric properties are equivalent across English and French). METHODS: Participants were adults from the Scleroderma Patient-Centered Intervention Network (SPIN) Cohort (N = 2159) who completed baseline measures in English (n = 1473) or French (n = 686) between May 2014 to July 2020. Analyses assessed internal consistency reliability via Cronbach's alpha and McDonald's omega, convergent validity via Pearson's correlations, structural validity via confirmatory factor analysis (CFA), and differential item functioning via the Multiple-Indicator Multiple-Cause (MIMIC) model. RESULTS: Internal consistency reliability was high in English (α = .93, ω = .93) and French (α = .92, ω = .93). All correlations between the SEMCD and measures of health outcomes were moderate to large, statistically significant, and in the hypothesized direction in both languages. The CFA demonstrated that the one-factor model of self-efficacy, overall, fit reasonably well (CFI = .96, TLI = .93, SRMR = .03, RMSEA = .14). Standardized factor loadings were large (.76 to .88). Three items displayed statistically significant uniform DIF and all six displayed nonuniform DIF; all DIF was of minimal magnitude. Comparison of unadjusted and DIF-adjusted models indicated that DIF did not meaningfully impact total score (ICC = 0.999, r = 0.999). CONCLUSION: Scores from English- and French-speaking adults with SSc can be combined for analysis or compared.

External validation of a shortened screening tool using individual participant data meta-analysis: A case study of the Patient Health Questionnaire-Dep-4.

Shortened versions of self-reported questionnaires may be used to reduce respondent burden. When shortened screening tools are used, it is desirable to maintain equivalent diagnostic accuracy to full-length forms. This manuscript presents a case study that illustrates how external data and individual participant data meta-analysis can be used to assess the equivalence in diagnostic accuracy between a shortened and full-length form. This case study compares the Patient Health Questionnaire-9 (PHQ-9) and a 4-item shortened version (PHQ-Dep-4) that was previously developed using optimal test assembly methods. Using a large database of 75 primary studies (34,698 participants, 3,392 major depression cases), we evaluated whether the PHQ-Dep-4 cutoff of ≥ 4 maintained equivalent diagnostic accuracy to a PHQ-9 cutoff of ≥ 10. Using this external validation dataset, a PHQ-Dep-4 cutoff of ≥ 4 maximized the sum of sensitivity and specificity, with a sensitivity of 0.88 (95% CI 0.81, 0.93), 0.68 (95% CI 0.56, 0.78), and 0.80 (95% CI 0.73, 0.85) for the semi-structured, fully structured, and MINI reference standard categories, respectively, and a specificity of 0.79 (95% CI 0.74, 0.83), 0.85 (95% CI 0.78, 0.90), and 0.83 (95% CI 0.80, 0.86) for the semi-structured, fully structured, and MINI reference standard categories, respectively. While equivalence with a PHQ-9 cutoff of ≥ 10 was not established, we found the sensitivity of the PHQ-Dep-4 to be non-inferior to that of the PHQ-9, and the specificity of the PHQ-Dep-4 to be marginally smaller than the PHQ-9.

Differing postural control patterns in individuals with bilateral and unilateral hearing loss.

OBJECTIVES: Hearing loss (HL) is associated with imbalance and increased fall risk. The mechanism underlying this relationship and differences across types of hearing loss remains unclear. Head mounted displays (HMD) can shed light on postural control mechanisms via an analysis of head sway. PURPOSE: The purpose of this study was to evaluate head sway in response to sensory perturbations in individuals with bilateral (BHL) or unilateral hearing loss (UHL) and compare them to controls. MATERIALS AND METHODS: We recruited 36 controls, 23 individuals with UHL and 14 with BHL. An HMD (HTC Vive) measured head sway while participants stood on the floor, hips-width apart. Stimuli included two levels of visuals and sound. Root Mean Square Velocity (RMSV) and Power Spectral Density (PSD) were used to quantify head sway. RESULTS: Adjusting for age, individuals with BHL had significantly higher anterior-posterior and medio-lateral RMSV than controls and individuals with UHL. Individuals with UHL demonstrated significantly lower response to visual perturbations in RMSV AP and in all 3 frequency segments of PSD compared to controls. Individuals with UHL showed significantly lower movements at high frequencies compared to controls. Sounds or severity of HL did not impact head sway. CONCLUSIONS: Individuals with BHL demonstrated increased sway with visual perturbations and should be clinically assessed for balance performance and fall risk. Individuals with UHL exhibited reduced responses to visual stimuli compared with controls, which may reflect conscious movement processing. Additional studies are needed to further understand the mechanistic relationship between hearing loss and imbalance.

Contextual sensory integration training vs. traditional vestibular rehabilitation: a pilot randomized controlled trial.

BACKGROUND: We created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (e.g., turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation. METHODS: Thirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic + home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the covid-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis. RESULTS: Following intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference - 18.703, 95% CI [-28.235, -9.172], p = 0.0002), ABC (8.556, [0.938, 16.174], p = 0.028), VVAS, (-13.603, [-25.634, -1.573], p = 0.027) and the FGA (6.405, [4.474, 8.335], p < 0.0001). No changes were observed for TUG and FSST. CONCLUSION: Patients' symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation. TRIAL REGISTRATION: This study (NCT04268745) was registered on clincaltrials.gov and can be found at https://clinicaltrials.gov/ct2/show/NCT04268745 .

Identifiability and Estimation Under the Test-negative Design With Population Controls With the Goal of Identifying Risk and Preventive Factors for SARS-CoV-2 Infection.

Owing to the rapidly evolving coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, quick public health investigations of the relationships between behaviors and infection risk are essential. Recently the test-negative design (TND) was proposed to recruit and survey participants who are symptomatic and being tested for SARS-CoV-2 infection with the goal of evaluating associations between the survey responses (including behaviors and environment) and testing positive on the test. It was also proposed to recruit additional controls who are part of the general population as a baseline comparison group to evaluate risk factors specific to SARS-CoV-2 infection. In this study, we consider an alternative design where we recruit among all individuals, symptomatic and asymptomatic, being tested for the virus in addition to population controls. We define a regression parameter related to a prospective risk factor analysis and investigate its identifiability under the two study designs. We review the difference between the prospective risk factor parameter and the parameter targeted in the typical TND where only symptomatic and tested people are recruited. Using missing data directed acyclic graphs, we provide conditions and required data collection under which identifiability of the prospective risk factor parameter is possible and compare the benefits and limitations of the alternative study designs and target parameters. We propose a novel inverse probability weighting estimator and demonstrate the performance of this estimator through simulation study.

Shortening the Edinburgh postnatal depression scale using optimal test assembly methods: Development of the EPDS-Dep-5.

AIMS: This study used a large database to develop a reliable and valid shortened form of the Edinburgh Postnatal Depression Scale (EPDS), a self-report questionnaire used for depression screening in pregnancy and postpartum, based on objective criteria. METHODS: Item responses from the 10-item EPDS were obtained from 5157 participants (765 major depression cases) from 22 primary screening accuracy studies that compared the EPDS to the Structured Clinical Interview for DSM (SCID). Unidimensionality of the EPDS latent construct was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally informative shortened form for each possible scale length between 1 and 9 items. The final shortened form was selected based on pre-specified validity and reliability criteria and non-inferiority of screening accuracy of the EPDS as compared to the SCID. RESULTS: A 5-item short form of the EPDS (EPDS-Dep-5) was selected. The EPDS-Dep-5 had a Cronbach's alpha of 0.82. Sensitivity and specificity of the EPDS-Dep-5 for a cutoff of 4 or greater were 0.83 (95% CI, 0.73, 0.89) and 0.86 (95% CI, 0.80, 0.90) and were statistically non-inferior to the EPDS. The correlation of total scores with the full EPDS was high (r = 0.91). CONCLUSION: The EPDS-Dep-5 is a valid short form with minimal loss of information when compared to the full-length EPDS. The EPDS-Dep-5 was developed with OTA methods using objective, pre-specified criteria, but the approach is data-driven and exploratory. Thus, there is a need to replicate results of this study in different populations.

Cross-cultural adaptation of the Perceived Risk of HIV Scale in Brazilian Portuguese.

BACKGROUND: Valid and reliable instruments are needed to measure the multiple dimensions of perceived risk. The Perceived Risk of HIV Scale is an 8-item measure that assesses how people think and feel about their risk of infection. We set out to perform a cross-cultural adaptation of the scale to Brazilian Portuguese among key populations (gay, bisexual and other men who have sex with men and transgender/non-binary) and other populations (cisgender heterosexual men and cisgender women). METHODS: Methodological study with cross-sectional design conducted online during October/2019 (key populations [sample 1] and other populations) and February-March/2020 (key populations not on pre-exposure prophylaxis [sample 2]). Cross-cultural adaptation of the Perceived Risk of HIV Scale followed Beaton et al. 2000 guidelines and included confirmatory factor analysis, differential item functioning (DIF) using the Multiple-Indicator Multiple-Cause model, and concurrent validity to verify if younger individuals, those ever testing for HIV, and engaging in high-risk behaviors had higher scores on the scale. RESULTS: 4342 participants from key populations (sample 1 = 235; sample 2 = 4107) and 155 participants from other populations completed the measure. We confirmed the single-factor structure of the original measure (fit indices for sample 1 plus other populations: CFI = 0.98, TLI = 0.98, RMSEA = 0.07; sample 2 plus other populations: CFI = 0.97, TLI = 0.95, RMSEA = 0.09). For the comparisons between key populations and other populations, three items (item 2: "I worry about getting infected with HIV", item 4: "I am sure I will not get infected with HIV", and item 8: "Getting HIV is something I have") exhibited statistically significant DIF. Items 2 and 8 were endorsed at higher levels by key populations and item 4 by other populations. However, the effect of DIF on overall scores was negligible (0.10 and 0.02 standard deviations for the models with other populations plus sample 1 and 2, respectively). Those ever testing for HIV scored higher than those who never tested (p < .001); among key populations, those engaging in high-risk behaviors scored higher than those reporting low-risk. CONCLUSION: The Perceived Risk of HIV Scale can be used among key populations and other populations from Brazil.

Translation and validation in Brazilian Portuguese of the reactions to homosexuality scale.

Internalized homonegativity results from the acceptance of negative attitudes about one's same-sex orientation, which has negative consequences for the health of gay, bisexual and other men who have sex with men (GBM). We translated the 7-item Reactions to Homosexuality Scale (RHS) to Brazilian Portuguese and assessed its factor structure, validity and reliability. The first step included the translation, back-translation, evaluation, peer review, and pre-testing of the scale. Then, we piloted the scale in two convenience samples of adult Brazilians recruited online during October 2019 and February to March 2020 through advertisements on Grindr and Hornet, respectively. The largest sample was randomly split into two groups for exploratory factor analysis (EFA) then confirmatory factor analysis (CFA). Criterion and construct validity were assessed via correlations between scale scores and study variables. A total of 5573 GBM (sample 1: 218; sample 2: 5355) completed the RHS. EFA (N = 2652) yielded two eigenvalues greater than one (Factor 1: 3.5 and Factor 2: 1.1). A one-factor solution provided the most interpretable model based on examination of scree plot and item factor loadings (χ2(14) = 1373.1, p < 0.001; CFI = 0.89; TLI = 0.84; RMSEA = 0.19; SRMS = 0.09). Though one-factor CFA showed moderate fit, freeing errors terms to covary, based on item content and interpretation, significantly improved model fit (χ2(12) = 309.1, p < .001; CFI = 0.97; TLI = 0.96; RMSEA = 0.09; SRMR = 0.02). As hypothesized, men who did not self-identify as gay (mean score 17.9 compared to those self-identifying as gay: 11.8) and men who reported no sex with men in the past 6 months (mean score 12.6 compared to those who reported sex with men: 10.6) scored higher reflecting higher internalized homonegativity. The RHS was effectively translated and validated in Brazilian Portuguese and can be used to evaluate the role of internalized homonegativity on GBM's health, as well as its impact on the uptake of HIV prevention technologies.

Effects of Practice Variability on Second-Language Speech Production Training.

BACKGROUND: Mastering the phonetics of a second language (L2) involves a component of speech-motor skill, and it has been suggested that L2 learners aiming to achieve a more native-like pronunciation could benefit from practice structured in accordance with the principles of motor learning. PARTICIPANTS AND METHODS: This study investigated the influence one such principle, high versus low variability in practice, has on speech-motor learning for Korean adults seeking to acquire native-like production of English rhotics. Practice incorporated a commercially available intraoral placement device ("R Buddy," Speech Buddies Inc.). In a single-subject across-behaviors design, 8 participants were pseudorandomly assigned to practice rhotic targets in a low-variability (single word) or high-variability (multiple words) practice condition. RESULTS: The hypothesized advantage for high-variability over low-variability practice was observed in the short-term time frame. However, long-term learning was limited in nature for both conditions. CONCLUSION: These results suggest that future research should incorporate high-variability practice while identifying additional manipulations to maximize the magnitude of long-term generalization learning.

Translation and validation of the Short HIV Stigma scale in Brazilian Portuguese.

BACKGROUND: HIV-related stigma, or the degree to which people living with HIV endorse negative stereotypes associated with HIV, is associated with poor continuum of care outcomes. We translated the 12-item Short HIV Stigma scale and evaluated its psychometric properties in a Brazilian context with regard to construct validity and reliability. METHODS: The first step included translation, back-translation, evaluation, peer review, and pre-testing of the Short HIV Sigma scale developed by Reinius et al. (Health Qual Life Outcomes 15(1):115, 2017). The second step involved piloting the scale in three convenience samples of adults recruited online through advertisements on different platforms: Grindr (October/2019) and Hornet (February-March/2020), geospatial network apps for sexual encounters for gay, bisexuals and other men who have sex with men, and social media apps (Facebook and WhatsApp, October/2019). The psychometric evaluation included confirmatory factor analysis, differential item functioning using the Multiple-Indicator Multiple-Cause model, and correlations between subscale scores and antiretroviral treatment use and adherence. Reliability was assessed using Cronbach's alpha, and ordinal alpha and omega from the polychoric correlation matrix. RESULTS: In total, 114, 164, and 1824 participants completed the measure items through Grindr, social media, and Hornet, respectively. We confirmed a 4-factor structure with factors for personalized stigma (3 items), disclosure concerns (3 items), concerns with public attitudes (3 items), and negative self-image (3 items). Small differential item functioning with respect to sample was found for one item ("I feel guilty because I have HIV"), which did not substantively influence estimates of latent factor scores. Grindr and Hornet's participants scored significantly higher than social media participants on all factors except personalized stigma. Higher subscale scores correlated with antiretroviral treatment use among participants from Hornet and with lower treatment adherence in participants from Grindr and Hornet. Reliability as measured by Cronbach's alpha, ordinal alpha and omega were 0.83, 0.88 and 0.93 for the entire scale. DISCUSSION: The Brazilian Portuguese version of the Short HIV Stigma scale had satisfactory psychometric properties with present results suggesting that scores from different samples may be compared without concern that measurement differences substantively influence results though further studies with greater representation of women and heterosexual men are warranted.

Shortening self-report mental health symptom measures through optimal test assembly methods: Development and validation of the Patient Health Questionnaire-Depression-4.

BACKGROUND: The objective of this study was to develop and validate a short form of the Patient Health Questionnaire-9 (PHQ-9), a self-report questionnaire for assessing depressive symptomatology, using objective criteria. METHODS: Responses on the PHQ-9 were obtained from 7,850 English-speaking participants enrolled in 20 primary diagnostic test accuracy studies. PHQ unidimensionality was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally precise short form for each possible length between one and eight items, including and excluding the ninth item. The final short form was selected based on prespecified validity, reliability, and diagnostic accuracy criteria. RESULTS: A four-item short form of the PHQ (PHQ-Dep-4) was selected. The PHQ-Dep-4 had a Cronbach's alpha of 0.805. Sensitivity and specificity of the PHQ-Dep-4 were 0.788 and 0.837, respectively, and were statistically equivalent to the PHQ-9 (sensitivity = 0.761, specificity = 0.866). The correlation of total scores with the full PHQ-9 was high (r = 0.919). CONCLUSION: The PHQ-Dep-4 is a valid short form with minimal loss of information of scores when compared to the full-length PHQ-9. Although OTA methods have been used to shorten patient-reported outcome measures based on objective, prespecified criteria, further studies are required to validate this general procedure for broader use in health research. Furthermore, due to unexamined heterogeneity, there is a need to replicate the results of this study in different patient populations.

Individual predictors of response to biofeedback training for second-language production.

While recent research suggests that visual biofeedback can facilitate speech production training in clinical populations and second language (L2) learners, individual learners' responsiveness to biofeedback is highly variable. This study investigated the hypothesis that the type of biofeedback provided, visual-acoustic versus ultrasound, could interact with individuals' acuity in auditory and somatosensory domains. Specifically, it was hypothesized that learners with lower acuity in a sensory domain would show greater learning in response to biofeedback targeting that domain. Production variability and phonological awareness were also investigated as predictors. Sixty female native speakers of English received 30 min of training, randomly assigned to feature visual-acoustic or ultrasound biofeedback, for each of two Mandarin vowels. On average, participants showed a moderate magnitude of improvement (decrease in Euclidean distance from a native-speaker target) across both vowels and biofeedback conditions. The hypothesis of an interaction between sensory acuity and biofeedback type was not supported, but phonological awareness and production variability were predictive of learning gains, consistent with previous research. Specifically, high phonological awareness and low production variability post-training were associated with better outcomes, although these effects were mediated by vowel target. This line of research could have implications for personalized learning in both L2 pedagogy and clinical practice.

Finding the experts in the crowd: Validity and reliability of crowdsourced measures of children's gradient speech contrasts.

Perceptual ratings aggregated across multiple nonexpert listeners can be used to measure covert contrast in child speech. Online crowdsourcing provides access to a large pool of raters, but for practical purposes, researchers may wish to use smaller samples. The ratings obtained from these smaller samples may not maintain the high levels of validity seen in larger samples. This study aims to measure the validity and reliability of crowdsourced continuous ratings of child speech, obtained through Visual Analog Scaling, and to identify ways to improve these measurements. We first assess overall validity and interrater reliability for measurements obtained from a large set of raters. Second, we investigate two rater-level measures of quality, individual validity and intrarater reliability, and examine the relationship between them. Third, we show that these estimates may be used to establish guidelines for the inclusion of raters, thus impacting the quality of results obtained when smaller samples are used.

Social, Emotional, and Academic Impact of Residual Speech Errors in School-Aged Children: A Survey Study.

Children with residual speech errors face an increased risk of social, emotional, and/or academic challenges relative to their peers with typical speech. Previous research has shown that the effects of speech sound disorder may persist into adulthood and span multiple domains of activity limitations and/or participation restrictions, as defined by the World Health Organization's International Classification of Functioning, Disability and Health model. However, the nature and extent of these influences varies widely across children. This study aimed to expand the evidence base on the social, emotional, and academic impact of residual speech errors by collecting survey data from parents of children receiving treatment for /r/ misarticulation. By examining the relationship between an overall measure of impact (weighted summed score) and responses to 11 survey items, the present study offers preliminary suggestions for factors that could be considered when making decisions pertaining to treatment allocation in this population.

Portable technology for postural control measurement: Comparing head position with center of pressure data.

BACKGROUND: Standing is a basic human function that healthy adults take for granted, yet it is a complex perceptual-motor process that requires sensation of position and motion from the sensory systems. OBJECTIVE: We assessed agreement between center of pressure data from a laboratory force-platform and head position data from an HTC Vive head-mounted display (HMD) for the evaluation of standing postural control. We investigated the impact of different statistical choices when assessing the relationship between two measurements. Specifically: 1) How does correlation and agreement statistics relate before and after logarithmic transformation? 2) Is there systemic or proportional bias between the force-platform and HMD measurements? METHODS: We tested 37 adults (26 controls, 11 with unilateral vestibular hypofunction) standing on foam, observing a static or dynamic visual scene projected from the HMD. We quantified anterior-posterior and medio-lateral sway via Directional Path, Root Mean Square Velocity, Variance, and Power Spectral Density (PSD) from a force-platform and the HMD. RESULTS: Intra-class correlations (ICCs) were moderate-to-good for the non-transformed data and good-to-excellent after logarithmic transformation for all outcomes except for PSD above 1 Hz. Correlations were higher than ICCs. Bland-Altman plots indicated proportional bias but not after logarithmic transformation. CONCLUSIONS: Both devices correlated linearly, and measure people's postural responses but cannot be used interchangeably, mostly because they appear to diverge with larger sway as evident on Bland-Altman plots of non-transformed data. Agreement between devices was excellent for low frequency movement but poor for high frequency small corrective movements.

A Picture May Be Worth 1,000 Words, but Is It Worth a Letter? Examining Whether the Choice of Label Affects the Perception of Speech Sounds.

PURPOSE: Researchers often use identification or goodness rating tasks to assess speech perception for different populations. These tasks provide useful information about a listener's willingness to accept a range of acoustically variable stimuli as belonging to the same category and also about assessing how stimuli that are labeled the same may not be perceived as equally good versions of a particular speech sound. Many methodological aspects of these simple tasks have been tested, but one aspect that has not is the choice of label. In this study, we examine response patterns to images versus letters, as studies with different populations (children vs. adults) or different methods (typical behavioral study vs. visual world paradigm) may vary in the type of label used. METHOD: Eighty-one adult listeners completed phoneme identification and goodness ratings tasks with either images of response options (a picture of a bear and a picture of a pear) or with letter labels (a capital B and P). RESULTS: The results suggest that choice of label does not alter performance within the tasks studied here. In addition, the results did show the expected finding that the slope of the response curve is steeper in an identification task than in a goodness rating task. CONCLUSION: These results suggest that it is possible to compare across studies that use different response options, a benefit to research and practice because letter labels can be used for nonimageable words and nonwords, whereas images may be best used for participants who are younger or have poorer reading skills.

Examining the Relationship Between Multiple Tests of Receptive Vocabulary.

PURPOSE: Numerous tasks have been developed to measure receptive vocabulary, many of which were designed to be administered in person with a trained researcher or clinician. The purpose of the current study is to compare a common, in-person test of vocabulary with other vocabulary assessments that can be self-administered. METHOD: Fifty-three participants completed the Peabody Picture Vocabulary Test (PPVT) via online video call to mimic in-person administration, as well as four additional fully automated, self-administered measures of receptive vocabulary. Participants also completed three control tasks that do not measure receptive vocabulary. RESULTS: Pearson correlations indicated moderate correlations among most of the receptive vocabulary measures (approximately r = .50-.70). As expected, the control tasks revealed only weak correlations to the vocabulary measures. However, subsets of items of the four self-administered measures of receptive vocabulary achieved high correlations with the PPVT (r > .80). These subsets were found through a repeated resampling approach. CONCLUSIONS: Measures of receptive vocabulary differ in which items are included and in the assessment task (e.g., lexical decision, picture matching, synonym matching). The results of the current study suggest that several self-administered tasks are able to achieve high correlations with the PPVT when a subset of items are scored, rather than the full set of items. These data provide evidence that subsets of items on one behavioral assessment can more highly correlate to another measure. In practical terms, these data demonstrate that self-administered, automated measures of receptive vocabulary can be used as reasonable substitutes of at least one test (PPVT) that requires human interaction. That several of the fully automated measures resulted in high correlations with the PPVT suggests that different tasks could be selected depending on the needs of the researcher. It is important to note the aim was not to establish clinical relevance of these measures, but establish whether researchers could use an experimental task of receptive vocabulary that probes a similar construct to what is captured by the PPVT, and use these measures of individual differences.

Word and Gender Identification in the Speech of Transgender Individuals.

Listeners use speech to identify both linguistic information, such as the word being produced, and indexical attributes, such as the gender of the speaker. Previous research has shown that these two aspects of speech perception are interrelated. It is important to understand this relationship in the context of gender-affirming voice training (GAVT), where changes in speech production as part of a speaker's gender-affirming care could potentially influence listeners' recognition of the intended utterance. This study conducted a secondary analysis of data from an experiment in which trans women matched shifted targets for the second formant frequency using visual-acoustic biofeedback. Utterances were synthetically altered to feature a gender-ambiguous fundamental frequency and were presented to blinded listeners for rating on a visual analog scale representing the gender spectrum, as well as word identification in a forced-choice task. We found a statistically significant association between the accuracy of word identification and the gender rating of utterances. However, there was no statistically significant difference in word identification accuracy for the formant-shifted conditions relative to an unshifted condition. Overall, these results support previous research in finding that word identification and speaker gender identification are interrelated processes; however, the findings also suggest that a small magnitude of shift in formant frequencies (of the type that might be pursued in a GAVT context) does not have a significant negative impact on the perceptual recoverability of isolated words.

Incidence, Complications, and Long-term Outcomes of Gender-affirming Phalloplasty: Analysis of a Large Statewide Population-based Dataset.

OBJECTIVE: To evaluate the incidence of gender-affirming phalloplasty and postoperative complications in a large population-based dataset. METHODS: Retrospective cohort study was done using the California Department of Health Care Access and Information datasets which include patient-level data from all licensed hospitals, emergency departments, and ambulatory surgery facilities in California. Adult patients 18 years or older undergoing gender-affirming phalloplasty in California from January 1, 2009 to December 31, 2019 were included. We examined phalloplasty-related complications using International Classification of Disease diagnosis and procedure codes and Current Procedural Terminology codes. Unique record linkage number identifiers were used to follow patients longitudinally. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS: We identified 766 patients who underwent gender-affirming phalloplasty in 23 facilities. Of 475 patients with record linkage numbers, 253 (55.3%) had subsequent re-presentations to the inpatient, emergency department, and ambulatory surgery settings related to phalloplasty complications. Survival analysis indicated that 50% of patients re-presented by 1year post-phalloplasty. Asian/Pacific Islander patients had lower risk of complications, and California residents had higher risk of complications. CONCLUSION: This population-based study confirms that gender-affirming phalloplasty has a high complication rate, and demonstrates for the first time an association with high rates of return to hospitals, emergency departments, and ambulatory surgery centers. These findings provide additional higher-level evidence that may aid patient counseling, shared surgical decision-making, and institutional and government policy.