scholarly journals A Vocabulary Acquisition and Usage for Late Talkers Treatment Efficacy Study: The Effect of Input Utterance Length and Identification of Responder Profiles

2021 ◽  
Vol 64 (4) ◽  
pp. 1235-1255
Author(s):  
Mary Alt ◽  
Cecilia R. Figueroa ◽  
Heidi M. Mettler ◽  
Nora Evans-Reitz ◽  
Jessie A. Erikson
Keyword(s):  
Decision Tree ◽  
Treatment Effect ◽  
Vocabulary Acquisition ◽  
Treatment Plan ◽  
Treatment Protocol ◽  
Classification And Regression Tree ◽  
Significant Treatment ◽  
Cart Analysis ◽  
Late Talkers ◽  
Utterance Length

Purpose This study examined the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment in a version that manipulated the length of clinician utterance in which a target word was presented (dose length). The study also explored ways to characterize treatment responders versus nonresponders. Method Nineteen primarily English-speaking late-talking toddlers (aged 24–34 months at treatment onset) received VAULT and were quasirandomly assigned to have target words presented in grammatical utterances matching one of two lengths: brief (four words or fewer) or extended (five words or more). Children were measured on their pre- and posttreatment production of (a) target and control words specific to treatment and (b) words not specific to treatment. Classification and Regression Tree (CART) analysis was used to classify responders versus nonresponders. Results VAULT was successful as a whole (i.e., treatment effect sizes of greater than 0), with no difference between the brief and extended conditions. Despite the overall significant treatment effect, the treatment was not successful for all participants. CART results (using participants from the current study and a previous iteration of VAULT) provided a dual-node decision tree for classifying treatment responders versus nonresponders. Conclusions The input-based VAULT treatment protocol is efficacious and offers some flexibility in terms of utterance length. When VAULT works, it works well. The CART decision tree uses pretreatment vocabulary levels and performance in the first two treatment sessions to provide clinicians with promising guidelines for who is likely to be a nonresponder and thus might need a modified treatment plan. Supplemental Material https://doi.org/10.23641/asha.14226641

scholarly journals Exploring Input Parameters in an Expressive Vocabulary Treatment With Late Talkers

2020 ◽  
Vol 63 (1) ◽  
pp. 216-233 ◽  
Author(s):  
Mary Alt ◽  
Heidi M. Mettler ◽  
Jessie A. Erikson ◽  
Cecilia R. Figueroa ◽  
Sarah E. Etters-Thomas ◽  
...  
Keyword(s):  
Treatment Effect ◽  
Repeated Measures ◽  
Vocabulary Acquisition ◽  
Treatment Protocol ◽  
Average Treatment Effect ◽  
Effect Sizes ◽  
Expressive Vocabulary ◽  
Control Effect ◽  
Late Talkers ◽  
Target Words

Purpose The aims of this study were (a) to assess the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment and (b) to compare treatment outcomes for expressive vocabulary acquisition in late talkers in 2 conditions: 3 target words/90 doses per word per session versus 6 target words/45 doses per word per session. Method We ran the treatment protocol for 16 sessions with 24 primarily monolingual English-speaking late talkers. We calculated a d score for each child, compared treatment to control effect sizes, and assessed the number of words per week children acquired outside treatment. We compared treatment effect sizes of children in the condition of 3 target words/90 doses per word to those in the condition of 6 target words/45 doses per word. We used Bayesian repeated-measures analysis of variance and Bayesian t tests to answer our condition-level questions. Results With an average treatment effect size of almost 1.0, VAULT was effective relative to the no-treatment condition. There were no differences between the different dose conditions. Discussion The VAULT protocol was an efficacious treatment that has the potential to increase the spoken vocabulary of late-talking toddlers and provides clinicians some flexibility in terms of number of words targeted and dose number, keeping in mind the interconnectedness of treatment parameters. Supplemental Material https://doi.org/10.23641/asha.11593323

scholarly journals A diagnostic strategy for Parkinsonian syndromes using quantitative indices of DAT SPECT and MIBG scintigraphy: an investigation using the classification and regression tree analysis

2021 ◽  
Author(s):  
Yu Iwabuchi ◽  
Masashi Kameyama ◽  
Yohji Matsusaka ◽  
Hidetoshi Narimatsu ◽  
Masahiro Hashimoto ◽  
...  
Keyword(s):  
Decision Tree ◽  
Regression Tree ◽  
Classification And Regression Tree ◽  
Mibg Scintigraphy ◽  
Tree Model ◽  
Quantitative Indices ◽  
Cart Analysis ◽  
Parkinsonian Syndromes ◽  
Dat Spect ◽  
Classification And Regression

Abstract Purpose We aimed to evaluate the diagnostic performances of quantitative indices obtained from dopamine transporter (DAT) single-photon emission computed tomography (SPECT) and 123I-metaiodobenzylguanidine (MIBG) scintigraphy for Parkinsonian syndromes (PS) using the classification and regression tree (CART) analysis. Methods We retrospectively enrolled 216 patients with or without PS, including 80 without PS (NPS) and 136 with PS [90 Parkinson’s disease (PD), 21 dementia with Lewy bodies (DLB), 16 progressive supranuclear palsy (PSP), and 9 multiple system atrophy (MSA). The striatal binding ratio (SBR), putamen-to-caudate ratio (PCR), and asymmetry index (AI) were calculated using DAT SPECT. The heart-to-mediastinum uptake ratio (H/M) based on the early (H/M [Early]) and delayed (H/M [Delay]) images and cardiac washout rate (WR) were calculated from MIBG scintigraphy. The CART analysis was used to establish a diagnostic decision tree model for differentiating PS based on these quantitative indices. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.5, 96.3, 93.3, 92.9, and 93.1 for NPS; 91.1, 78.6, 75.2, 92.5, and 83.8 for PD; 57.1, 95.9, 60.0, 95.4, and 92.1 for DLB; and 50.0, 98.0, 66.7, 96.1, and 94.4 for PSP, respectively. The PCR, WR, H/M (Delay), and SBR indices played important roles in the optimal decision tree model, and their feature importance was 0.61, 0.22, 0.11, and 0.05, respectively. Conclusion The quantitative indices showed high diagnostic performances in differentiating NPS, PD, DLB, and PSP, but not MSA. Our findings provide useful guidance on how to apply these quantitative indices in clinical practice.

Classification and regression tree (CART) analysis for indicator bacterial concentration prediction for a Californian coastal area

2010 ◽  
Vol 61 (2) ◽  
pp. 545-553 ◽  
Author(s):  
Hun-Kyun Bae ◽  
Betty H. Olson ◽  
Kuo-Lin Hsu ◽  
Soroosh Sorooshian
Keyword(s):  
Decision Tree ◽  
Fecal Coliform ◽  
Mean Squared Error ◽  
Regression Tree ◽  
Total Coliform ◽  
Classification And Regression Tree ◽  
Good Representation ◽  
Tree Structures ◽  
Cart Analysis ◽  
Classification And Regression

The study used existing indicator bacterial data and a number of physicochemical parameters that can be measured instantaneously to determine if a decision tree approach, especially classification and regression tree, could be used to predict bacterial concentrations in timely manner for beach closure management. Each indicator bacteria showed different tree structures and each had its own significant variables; Dissolved oxygen played an important role for both total coliform and fecal coliform and turbidity was the most important factor to predict concentrations of enterococci for decision tree approaches. Root mean squared error stayed between 5 and 6.5% of the average values of observations; RMSEs from each simulation, 0.25 for total coliform, 0.31 for fecal coliform, and 0.29 for enterococci. Estimations from tree structures would be regarded as a good representation of the actual data. In addition to results of the objective function, RMSE, 77.5% of actual value fell into the 95% of confidence interval of estimations for total coliform concentrations, 60% for fecal coliform concentrations, and 62.5% for enterococci concentrations. The approach showed reliable estimations for the majority of the data processed, although the method did not portray low concentrations of bacteria as well.

scholarly journals Validation and verification of predictive salivary biomarkers for oral health

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nagihan Bostanci ◽  
Konstantinos Mitsakakis ◽  
Beral Afacan ◽  
Kai Bao ◽  
Benita Johannsen ◽  
...  
Keyword(s):  
Oral Health ◽  
Predictive Accuracy ◽  
Statistical Tests ◽  
Area Under The Curve ◽  
Regression Tree ◽  
High Sensitivity ◽  
Oral Health Status ◽  
Classification And Regression Tree ◽  
Cart Analysis ◽  
Salivary Biomarkers

AbstractOral health is important not only due to the diseases emerging in the oral cavity but also due to the direct relation to systemic health. Thus, early and accurate characterization of the oral health status is of utmost importance. There are several salivary biomarkers as candidates for gingivitis and periodontitis, which are major oral health threats, affecting the gums. These need to be verified and validated for their potential use as differentiators of health, gingivitis and periodontitis status, before they are translated to chair-side for diagnostics and personalized monitoring. We aimed to measure 10 candidates using high sensitivity ELISAs in a well-controlled cohort of 127 individuals from three groups: periodontitis (60), gingivitis (31) and healthy (36). The statistical approaches included univariate statistical tests, receiver operating characteristic curves (ROC) with the corresponding Area Under the Curve (AUC) and Classification and Regression Tree (CART) analysis. The main outcomes were that the combination of multiple biomarker assays, rather than the use of single ones, can offer a predictive accuracy of > 90% for gingivitis versus health groups; and 100% for periodontitis versus health and periodontitis versus gingivitis groups. Furthermore, ratios of biomarkers MMP-8, MMP-9 and TIMP-1 were also proven to be powerful differentiating values compared to the single biomarkers.

scholarly journals Effects of Vitamin D Supplementation on Surrogate Markers of Fertility in PCOS Women: A Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 547
Author(s):  
Elisabeth Lerchbaum ◽  
Verena Theiler-Schwetz ◽  
Martina Kollmann ◽  
Monika Wölfler ◽  
Stefan Pilz ◽  
...  
Keyword(s):  
Vitamin D ◽  
Treatment Effect ◽  
Polycystic Ovary ◽  
Controlled Trial ◽  
Dehydroepiandrosterone Sulfate ◽  
Vitamin D Supplementation ◽  
Double Blind ◽  
Significant Treatment ◽  
Hydroxyvitamin D ◽  
Randomized Controlled

Vitamin D (VD) might play an important role in polycystic ovary syndrome (PCOS) and female fertility. However, evidence from randomized controlled trials (RCT) is sparse. We examined VD effects on anti-Müllerian hormone (AMH) and other endocrine markers in PCOS and non-PCOS women. This is a post hoc analysis of a single-center, double-blind RCT conducted between December 2011 and October 2017 at the endocrine outpatient clinic at the Medical University of Graz, Austria. We included 180 PCOS women and 150 non-PCOS women with serum 25-hydroxyvitamin D (25(OH)D) concentrations <75 nmol/L in the trial. We randomized subjects to receive 20,000 IU of VD3/week (119 PCOS, 99 non-PCOS women) or placebo (61 PCOS, 51 non-PCOS women) for 24 weeks. Outcome measures were AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, dehydroepiandrosterone sulfate, and androstenedione. In PCOS women, we observed a significant treatment effect on FSH (mean treatment effect 0.94, 95% confidence interval [CI] 0.087 to 1.799, p = 0.031) and LH/FSH ratio (mean treatment effect −0.335, 95% CI −0.621 to 0.050, p = 0.022), whereas no significant effect was observed in non-PCOS women. In PCOS women, VD treatment for 24 weeks had a significant effect on FSH and LH/FSH ratio but no effect on AMH levels.

scholarly journals Population Pharmacokinetics and Pharmacodynamics of Levofloxacin in Acutely Hospitalized Older Patients with Various Degrees of Renal Function

2016 ◽  
Vol 61 (3) ◽  
Author(s):  
Pier Giorgio Cojutti ◽  
Virginia Ramos-Martin ◽  
Isabella Schiavon ◽  
Paolo Rossi ◽  
Massimo Baraldo ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Outcome ◽  
Creatinine Clearance ◽  
Population Pharmacokinetics ◽  
Older Patients ◽  
Classification And Regression Tree ◽  
Therapeutic Drug ◽  
Time Curve ◽  
Content Type ◽  
Cart Analysis

ABSTRACT A retrospective study was conducted in a large sample of acutely hospitalized older patients who underwent therapeutic drug monitoring during levofloxacin treatment. The aim was to assess the population pharmacokinetics (popPK) and pharmacodynamics of levofloxacin among older patients. PopPK and Monte Carlo simulation were performed to define the permissible doses in older patients according to various degrees of renal function. Classification and regression tree (CART) analysis was used to detect the cutoff 24-hour area under the concentration-time curve (AUC24)/MIC ratio that best correlated with the clinical outcome. The probability of target attainment (PTA) of this value was calculated against different pathogens. A total of 168 patients were included, and 330 trough and 239 peak concentrations were used for the popPK analysis. Creatinine clearance (CrCL) was the only covariate that improved the model fit (levofloxacin CL = 0.399 + 0.051 × CrCLCKD-EPI [creatinine clearance estimated by means of the chronic kidney disease epidemiology]). Drug doses ranged between 500 mg every 48 h and 500 mg every 12 h in relation to different renal functions. The identified cutoff AUC24/MIC ratio (≥95.7) was the only covariate that correlated with a favorable clinical outcome in multivariate regression analysis (odds ratio [OR], 20.85; 95% confidence interval [CI], 1.56 to 186.73). PTAs were optimal (>80%) against Escherichia coli and Haemophilus influenzae, borderline against Staphylococcus aureus, and suboptimal against Pseudomonas aeruginosa. The levofloxacin doses defined in our study may be effective for the treatment of infections due to bacterial pathogens, with an MIC of ≤0.5 mg/liter in older patients with various degrees of renal function, while minimizing the toxicity risk. Conversely, the addition of another active antimicrobial should be considered whenever treating infections caused by less susceptible pathogens.

In Support of Initial Parenteral Medical Management of Intrathecal Baclofen Withdrawal in Spasticity Patients

2021 ◽  
pp. 875512252110392
Author(s):  
Brian L. LaRowe ◽  
Vicki M. Nussbaum
Keyword(s):  
Case Reports ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Patient Characteristics ◽  
Clinical Problem ◽  
Clinical Situation ◽  
Intrathecal Baclofen ◽  
Wide Range ◽  
Baclofen Withdrawal

Background: Spasticity may present as a wide range of symptoms and conditions. With this protean presentation, a consensus regarding the best course of treatment does not exist. Those patients most severely affected may receive significant benefit from intrathecal baclofen delivery. However, this therapy may itself lead to patient injury in the event of withdrawal. Objective: Withdrawal from intrathecal baclofen may devolve rapidly into a situation in which the patient may incur significant morbidity and even death. A focused, prompt treatment plan would afford the patient the best possible outcome. Methods: The medical literature was reviewed for reports of plans of treatment of baclofen withdrawal and the results obtained. The nature of this problem does not lend itself to a typical study design, depending on case reports and basic pharmacological science application. The paucity of such reports severely limits categorical comparison of patient characteristics and clinical circumstances. Clinical situations, patient characteristics, and therapies were considered and compared. Outcomes of the varied treatments were evaluated for efficacy. Results: Inaccurate diagnoses, delayed correct diagnoses, and the absence of a consistent, treatment plan contributed to widely disparate outcomes. Prompt, correct diagnosis and intensive care unit–based continuous benzodiazepine infusion with titration led to a controlled clinical situation and maximized patient outcomes. Conclusions: Patients going through withdrawal from intrathecal baclofen achieved best outcomes when treated with a continuous infusion and titration of an intravenous benzodiazepine. A well-defined treatment protocol employing this management, reporting serial outcomes, would enable further refinement of the treatment of this clinical problem.

scholarly journals Statistical Primer for Athletic Trainers: Understanding the Role of Statistical Power in Comparative Athletic Training Research

2018 ◽  
Vol 53 (7) ◽  
pp. 716-719
Author(s):  
Monica R. Lininger ◽  
Bryan L. Riemann
Keyword(s):  
Sample Size ◽  
Athletic Training ◽  
Treatment Effect ◽  
Statistical Power ◽  
Athletic Trainers ◽  
A Priori ◽  
Significant Treatment ◽  
Training Research ◽  
Α Level

Objective: To describe the concept of statistical power as related to comparative interventions and how various factors, including sample size, affect statistical power.Background: Having a sufficiently sized sample for a study is necessary for an investigation to demonstrate that an effective treatment is statistically superior. Many researchers fail to conduct and report a priori sample-size estimates, which then makes it difficult to interpret nonsignificant results and causes the clinician to question the planning of the research design.Description: Statistical power is the probability of statistically detecting a treatment effect when one truly exists. The α level, a measure of differences between groups, the variability of the data, and the sample size all affect statistical power.Recommendations: Authors should conduct and provide the results of a priori sample-size estimations in the literature. This will assist clinicians in determining whether the lack of a statistically significant treatment effect is due to an underpowered study or to a treatment's actually having no effect.

scholarly journals Early indications of drought impacts on forests in the southeastern United States

2015 ◽  
Vol 91 (04) ◽  
pp. 376-383 ◽  
Author(s):  
Michael K. Crosby ◽  
Zhaofei Fan ◽  
Martin A. Spetich ◽  
Theodor D. Leininger ◽  
Xingang Fan
Keyword(s):  
United States ◽  
Forest Type ◽  
Southeastern United States ◽  
Forest Health ◽  
Classification And Regression Tree ◽  
Future Research ◽  
Red Oak ◽  
White Oak ◽  
Cart Analysis ◽  
Crown Dieback

In the southeastern United States, drought can pose a significant threat to forests by reducing the amount of available water, thereby stressing trees. Destructive changes in crown conditions provide the first visible indication of a problem in a forested area, making it a useful indicator for problems within an ecosystem. Forest Health and Monitoring (FHM) and Palmer's Drought Severity Index (PDSI) data from 11 states in the southeastern United States were obtained in an effort to determine the role that drought, forest type, and ecoregion have in indicating differences in crown dieback. Analyses were conducted by species groups using classification and regression tree (CART) analysis. The greatest amount of total relative crown dieback occurred in red oak (18%), followed by other hardwoods (14%), and white oak (11%). Relative crown dieback varied by forest type and ecoregion with a relationship to drought in both red oak and white oak. This information will be useful for focusing future research and modeling efforts to predict forest health conditions affected by changing climate variables.

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