OBJECTIVES/GOALS: Missed appointments (MAs) negatively impact the health outcomes of adults living with type 2 diabetes mellitus (T2DM), causing disruptions in clinic operation and added financial cost to healthcare providers and systems. This study aimed to identify risk factors for MAs in both in-person and telehealth settings among adults living with T2DM. METHODS/STUDY POPULATION: Using a sequential multi-method design guided by the modified Quality-Caring Model, the quantitative phase of this study used electronic health records (EHR) data in Calendar Years 2019 and 2020 with 7,276 encounters made by 2,235 patients with T2DM from four diabetes clinics within a tertiary academic medical center in Baltimore, MD. Multivariable random effect logistic regression were used to examine the association between MAs and included predictors (i.e., patient characteristics [e.g., age, race, health status], health provider factors [e.g., types of provider], and health system factors [e.g., scheduling lag]). Based on the results of the quantitative phase, a purposive sample of 23 adults with T2DM and 10 providers were then interviewed individually via phone or zoom. RESULTS/ANTICIPATED RESULTS: The EHR data found that the following variables decreased the odds of MAs: having an activated patient portal account, patients with age over 46 or with white race. Telehealth was associated with 50% decreased odds of MAs during COVID (after 3/23/2020). On the other hand, longer scheduling lag increased the odds of MAs. Qualitative interviews revealed that MAs were often related to social needs, such as lack of/limited health-related transportation and its associated financial burden. Telehealth helped break these barriers for some adults with T2DM, but technical challenges in telehealth persisted for those with low digital health literacy and people who did not have a digital device and/or with unstable internet connection. Providers worried that these challenges might undermine the quality of diabetes care. DISCUSSION/SIGNIFICANCE: Disparities in MAs by age and race were noted, which might reflect the impact of unmeasured social needs in EHR. Perceived convenient telehealth may reduce MAs in T2DM care. However, the persistent technical challenges of telehealth should be addressed to optimize the quality of diabetes care and to promote care continuity for underserved populations.

The conclusions reached by Leibovich et al. urge the field to regroup and consider new ways of conceptualizing quantitative development. We suggest three potential directions for new research that follow from the authors' extensive review, as well as building on the common ground we can take from decades of research in this area.

We designed a parent-directed home-visiting intervention targeting socioeconomic status (SES) disparities in children's early language environments. A randomized controlled trial was used to evaluate whether the intervention improved parents' knowledge of child language development and increased the amount and diversity of parent talk. Twenty-three mother–child dyads (12 experimental, 11 control, aged 1;5–3;0) participated in eight weekly hour-long home-visits. In the experimental group, but not the control group, parent knowledge of language development increased significantly one week and four months after the intervention. In lab-based observations, parent word types and tokens and child word types increased significantly one week, but not four months, post-intervention. In home-based observations, adult word tokens, conversational turn counts, and child vocalization counts increased significantly during the intervention, but not post-intervention. The results demonstrate the malleability of child-directed language behaviors and knowledge of child language development among low-SES parents.

Speakers of all ages spontaneously gesture as they talk. These gestures predict children's milestones in vocabulary and sentence structure. We ask whether gesture serves a similar role in the development of narrative skill. Children were asked to retell a story conveyed in a wordless cartoon at age five and then again at six, seven, and eight. Children's narrative structure in speech improved across these ages. At age five, many of the children expressed a character's viewpoint in gesture, and these children were more likely to tell better-structured stories at the later ages than children who did not produce character-viewpoint gestures at age five. In contrast, framing narratives from a character's perspective in speech at age five did not predict later narrative structure in speech. Gesture thus continues to act as a harbinger of change even as it assumes new roles in relation to discourse.

The aim of this paper is to compare speech and co-speech gestures observed during a narrative retelling task in five- and ten-year-old children from three different linguistic groups, French, American, and Italian, in order to better understand the role of age and language in the development of multimodal monologue discourse abilities. We asked 98 five- and ten-year-old children to narrate a short, wordless cartoon. Results showed a common developmental trend as well as linguistic and gesture differences between the three language groups. In all three languages, older children were found to give more detailed narratives, to insert more comments, and to gesture more and use different gestures – specifically gestures that contribute to the narrative structure – than their younger counterparts. Taken together, these findings allow a tentative model of multimodal narrative development in which major changes in later language acquisition occur despite language and culture differences.

Children with pre/perinatal unilateral brain lesions (PL) show remarkable plasticity for language development. Is this plasticity characterized by the same developmental trajectory that characterizes typically developing (TD) children, with gesture leading the way into speech? We explored this question, comparing eleven children with PL – matched to thirty TD children on expressive vocabulary – in the second year of life. Children with PL showed similarities to TD children for simple but not complex sentence types. Children with PL produced simple sentences across gesture and speech several months before producing them entirely in speech, exhibiting parallel delays in both gesture + speech and speech-alone. However, unlike TD children, children with PL produced complex sentence types first in speech-alone. Overall, the gesture–speech system appears to be a robust feature of language learning for simple – but not complex – sentence constructions, acting as a harbinger of change in language development even when that language is developing in an injured brain.

The talk children hear from their primary caregivers predicts the size of their vocabularies. But children who spend time with multiple individuals also hear talk that others direct to them, as well as talk not directed to them at all. We investigated the effect of linguistic input on vocabulary acquisition in children who routinely spent time with one vs. multiple individuals. For all children, the number of words primary caregivers directed to them at age 2 ; 6 predicted vocabulary size at age 3 ; 6. For children who spent time with multiple individuals, child-directed words from all household members also predicted later vocabulary and accounted for more variance in vocabulary than words from primary caregivers alone. Interestingly, overheard words added no predictive value to the model. These findings suggest that speech directed to children is important for early word learning, even in households where a sizable proportion of input comes from overheard speech.

This study examined the relation between young English language learners’ (ELL) native oral language skills and their language input in transitional bilingual education kindergarten classrooms. Spanish-speaking ELLs’ (n = 101) Spanish expressive language skills were assessed using the memory for sentences and picture vocabulary subtests of the Woodcock Language Proficiency Battery—Revised. Samples of transitional bilingual education teachers’ (n = 21) speech were recorded and coded for syntactic complexity and vocabulary usage. Results revealed considerable variation in ELLs’ language scores, with overall performance below the normative sample. There was also wide variation in teachers’ speech across classrooms. Hierarchical linear modeling revealed that gains in ELLs’ expressive language skills were positively related to the diversity of teachers’ vocabulary and teachers’ syntactic complexity. These findings suggest that the quality of teachers’ language input, not just the quantity of their input, plays a significant role in the language learning trajectories of ELLs.