Speech Development Between 30 and 119 Months in Typical Children III: Interaction Between Speaking Rate and Intelligibility.

Purpose: Earlier work has established developmental benchmarks for intelligibility and articulation rate, but the intersection of these two variables, especially within individual children, has received limited attention. This study examines the interaction between intelligibility and speaking rate in typically developing children between the ages 2;6 and 9;11 (years;months) and evaluates whether children show a speed-accuracy trade-off in their habitual speech production.

Method: Speech samples of varying lengths were collected from 538 typically developing children.

Protocol for a randomized clinical trial of strength at home parents: A trauma informed parenting intervention for veterans.

Background: Post-traumatic stress disorder (PTSD) is highly prevalent in veterans and associated with impairments in family functioning, including parenting. There is a bidirectional relationship between PTSD and familial functioning such that impaired functioning is related to increases in trauma-related symptoms, and vice versa. Despite this known bidirectional association, there is currently no trauma-informed parenting intervention available for veterans within the Department of Veterans Affairs (VA).

Three Open Questions in Polygenic Score Portability.

A major obstacle hindering the broad adoption of polygenic scores (PGS) is their lack of "portability" to people that differ-in genetic ancestry or other characteristics-from the GWAS samples in which genetic effects were estimated. Here, we use the UK Biobank to measure the change in PGS prediction accuracy as a continuous function of individuals' genome-wide genetic dissimilarity to the GWAS sample ("genetic distance"). Our results highlight three gaps in our understanding of PGS portability.

Indoor allergen exposure and its association to upper respiratory infections and pulmonary outcomes among children with asthma.

Background: Certain environmental allergen exposures are more common in disadvantaged communities and may contribute to differences in susceptibility to upper respiratory infections (URIs).

Objectives: We examined associations between indoor allergens and: (1) URI; (2) URI + cold symptoms; (3) URI + cold symptoms + pulmonary eosinophilic inflammation (fraction of exhaled nitric oxide ≥20 ppb); and (4) URI + cold symptoms + reduced lung function (percent predicted forced expiratory volume in 1 second of <80%).

Methods: We used data from the Environmental Control as Add-on Therapy for Childhood Asthma (ECATCh) study.

MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury.

Importance: Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain.

Objectives: To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors.

The role of recurrent trauma on post-traumatic stress disorder symptoms and substance use among trauma exposed youth.

Comorbidity between post-traumatic stress disorder (PTSD) and substance use disorder may be explained by a prospective trauma risk conferred by both conditions. The current study modeled concurrent and prospective associations of trauma, PTSD symptoms, and substance use (SU) behavior among trauma exposed youth (ages 8-20). Clinical interviews assessed trauma exposure, PTSD symptom severity, and SU behavior at baseline and at six- and 12-month follow up study visits (N = 2,069).

Comparing diagnostic criteria for posttraumatic stress disorder in a diverse sample of trauma-exposed youth.

Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..

Comparative effectiveness of dexamethasone in treatment of hospitalized COVID-19 patients in the United States during the first year of the pandemic: Findings from the National COVID Cohort Collaborative (N3C) data repository.

Background: Dexamethasone was approved for use in hospitalized COVID-19 patients early in the pandemic based on the RECOVERY trial, but evidence is still needed to support its real-world effectiveness in heterogeneous populations of patients with a wide range of comorbidities.

Methods: COVID-19 inpatients represented within the National COVID Cohort Collaborative (N3C) Data Enclave, prior to vaccine availability, were studied. Primary outcome was in-hospital death; secondary outcome was combined in-hospital death and severe outcome defined by use of ECMO or mechanical ventilation.

Racial and Ethnic Identity and Vulnerability to Upper Respiratory Viral Infections Among US Children.

Background: It is unclear whether there are racial/ethnic disparities in the risk of upper respiratory viral infection acquisition and/or lower respiratory manifestations.

Methods: We studied all children and children with asthma aged 6 to 17 years in the National Health and Nutrition Examination Survey (2007-2012) to evaluate (1) the association between race/ethnicity and upper respiratory infection (URI) and (2) whether race/ethnicity is a risk factor for URI-associated pulmonary eosinophilic inflammation or decreased lung function.

Results: Children who identified as Black (adjusted odds ratio [aOR], 1.

Evaluating traumatic event scoring schemas for their predictive value to concurrent diagnostic profiles: Texas Childhood Trauma Research Network.

Background: To prospectively chart pathways of risk and resiliency following childhood trauma studies need to address three limitations of prior work: 1) recruit beyond social service/ treatment settings; 2) include broad spectrum of trauma types and 3) cast a broad longitudinal measurement framework of both clinical diagnoses and traumatic exposures. The Texas-Childhood Trauma Research Network (TX-CTRN) is a multi-site collaboration that addresses these limitations. In this baseline-only report, we examined domains of trauma and evaluated the concurrent predictive validity of various traumatic event scoring schemas for clinical diagnoses.

Characterizing patterns of substance use in trauma exposed youth.

Objective: Previous work investigating the impact of childhood trauma on substance use and co-occurring psychiatric disorders has primarily been conducted in adults or on specific trauma types. This limits understanding of traumas impact in childhood and how different types of traumas play a role. We sought to characterize substance use in a sample of trauma-exposed youth in the context of psychiatric comorbidities.

Generalizing the information content for stepped wedge designs: A marginal modeling approach.

Stepped wedge trials are increasingly adopted because practical constraints necessitate staggered roll-out. While a complete design requires clusters to collect data in all periods, resource and patient-centered considerations may call for an incomplete stepped wedge design to minimize data collection burden. To study incomplete designs, we expand the metric of information content to discrete outcomes.

Intelligibility in Context Scale: Growth Curves for Typically Developing English-Speaking Children Between Ages 2;6 and 9;11.

Purpose: The aim of this study was to quantify the clinical utility of the Intelligibility in Context Scale (ICS) English version by characterizing the growth patterns of the ICS composite scores and seven ICS individual item scores of typically developing American English-speaking children.

Method: Parents of 545 typically developing children aged 2;6-9;11 (years;months) completed the ICS. Using a proportional odds model, we regressed ICS composite scores on age and computed for model-estimated mean and lower quantile ICS composite scores.

Coping Behaviors and Incident Kidney Disease.

Key Points: Adaptive coping behaviors are associated with lower odds of incident CKD. Coping behaviors could represent a target to prevent CKD.

Background: How someone copes may alter the trajectory of their kidney function.

ORTH.Ord: An R package for analyzing correlated ordinal outcomes using alternating logistic regressions with orthogonalized residuals.

Background And Objectives: Marginal models with generalized estimating equations (GEE) are usually recommended for analyzing correlated ordinal outcomes which are commonly seen in a longitudinal study or clustered randomized trial (CRT). Within-cluster association is often of interest in longitudinal studies or CRTs, and can be estimated with paired estimating equations. However, the estimators for within-cluster association parameters and variances may be subject to finite-sample biases when the number of clusters is small.

Prenatal Weight Change Trajectories and Perinatal Outcomes among Twin Gestations.

Objective: Despite an increase in twin pregnancies in recent decades, the Institute of Medicine twin weight gain recommendations remain provisional and provide no guidance for the pattern or timing of weight change. We sought to characterize gestational weight change trajectory patterns and examine associations with birth outcomes in a cohort of twin pregnancies.

Study Design: Prenatal and delivery records were examined for 320 twin pregnancies from a maternal-fetal medicine practice in Austin, TX 2011-2019.

Sensor-Controlled Digital Game for Heart Failure Self-management: Protocol for a Randomized Controlled Trial.

Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. There are substantial racial and geographic disparities in HF outcomes, with patients living in southern US states having a mortality rate 69% higher than the national average. Self-management behaviors, particularly daily weight monitoring and physical activity, are extremely important in improving HF outcomes; however, patients typically have particularly low adherence to these behaviors.

power swgee: GEE-based power calculations in stepped wedge cluster randomized trials.

Stepped wedge cluster randomized trials are increasingly being used to evaluate interventions in medical, public health, educational, and social science contexts. With the longitudinal and crossover nature of a SW-CRT, complex analysis techniques are often needed which makes appropriately powering SW-CRTs challenging. In this paper, we introduce a newly-developed SW-CRT power calculator, embedded within the power command in Stata.

Establishing a training plan and estimating inter-rater reliability across the multi-site Texas childhood trauma research network.

Objective: Minimal guidance is available in the literature to develop protocols for training non-clinician raters to administer semi-structured psychiatric interviews in large, multi-site studies. Previous work has not produced standardized methods for maintaining rater quality control or estimating interrater reliability (IRR) in such studies. Our objective is to describe the multi-site Texas Childhood Trauma Research Network (TX-CTRN) rater training protocol and activities used to maintain rater calibration and evaluate protocol effectiveness.

Developmental Cut-Points for Atypical Speech Intelligibility in Children With Cerebral Palsy.

Purpose: Early identification of speech motor involvement (SMI) in children with cerebral palsy (CP) is difficult because of overlapping features with many aspects of typical speech development. Quantitative measures of speech intelligibility have the potential to differentiate between children with SMI and those with no SMI (NSMI). We examined thresholds for speech intelligibility development in children with CP relative to the low end of age-specific typical developmental expectations.

Model misspecification and robust analysis for outcome-dependent sampling designs under generalized linear models.

Outcome-dependent sampling (ODS) is a commonly used class of sampling designs to increase estimation efficiency in settings where response information (and possibly adjuster covariates) is available, but the exposure is expensive and/or cumbersome to collect. We focus on ODS within the context of a two-phase study, where in Phase One the response and adjuster covariate information is collected on a large cohort that is representative of the target population, but the expensive exposure variable is not yet measured. In Phase Two, using response information from Phase One, we selectively oversample a subset of informative subjects in whom we collect expensive exposure information.

GEEMAEE: A SAS macro for the analysis of correlated outcomes based on GEE and finite-sample adjustments with application to cluster randomized trials.

Background And Objectives: Generalized estimating equations (GEE) are used to analyze correlated outcomes in marginal regression models with population-averaged interpretations of exposure effects. Limitations of popular software for GEE include: (i) user choice is restricted to a small set of within-cluster pairwise correlation (intra-class correlation; ICC) structures; and (ii) inference on ICC parameters is usually not possible because the precision of their estimates is not quantified. This is important because ICC values inform the design of cluster randomized trials.

Does a Change in Physician Compensation Lead to Changes in Care Delivery in Family Medicine Clinics?

Background And Objectives: Many highly capitated systems still pay physicians based on relative value units (RVU), which may lead to excessive office visits. We reviewed electronic health records from the family medicine clinic panel members of 97 physicians and 42 residents to determine if a change from RVUs to panel-based compensation influenced care delivery as defined by the number of office visits and telephone contacts per panel member per month.

Methods: A retrospective analysis of the electronic health records of patients seen in 4 residency training clinics, 10 community clinics, and 4 regional clinics was conducted.

Do upper respiratory viruses contribute to racial and ethnic disparities in emergency department visits for asthma?

Background: There are marked disparities in asthma-related emergency department (ED) visit rates among children by race and ethnicity. Following the implementation of coronavirus disease 2019 (COVID-19) prevention measures, asthma-related ED visits rates declined substantially. The decline has been attributed to the reduced circulation of upper respiratory viruses, a common trigger of asthma exacerbations in children.