Facilitating transfer and maintenance in school-aged children who stutter : a guidebook for clinicians

textThis report was developed to: a) enhance the clinician’s understanding of transfer and maintenance as it relates to stuttering, b) explore the unique challenges that face the school-aged population, c) examine research outside of the field that may be of benefit for school-aged stuttering clients, and d) provide the clinician with examples and activities that will facilitate the transfer and maintenance of stuttering treatment. The report will include a brief discussion of transfer and maintenance. The remainder of the report will focus on facilitating transfer and maintenance by increasing motivation, self-efficacy, realistic goal setting, and self-regulation.Communication Sciences and Disorder

Prolonged dexamethasone exposure enhances zebrafish lateral-line regeneration but disrupts mitochondrial homeostasis and hair cell function

The synthetic glucocorticoid dexamethasone is commonly used to treat inner ear disorders. Previous work in larval zebrafish has shown that dexamethasone treatment enhances hair cell regeneration, yet dexamethasone has also been shown to inhibit regeneration of peripheral nerves after lesion. We therefore used the zebrafish model to determine the impact of dexamethasone treatment on lateral-line hair cells and primary afferents. To explore dexamethasone in the context of regeneration, we used copper sulfate (CuS

First Detection of HCO+^+ Absorption in the Magellanic System

We present the first detection of HCO$^+$ absorption in the Magellanic System. Using the Australia Telescope Compact Array (ATCA), we observed 9 extragalactic radio continuum sources behind the Magellanic System and detected HCO$^+$ absorption towards one source located behind the leading edge of the Magellanic Bridge. The detection is located at LSR velocity of $v=214.0 \pm 0.4\rm\,km\,s^{-1}$, with a full width at half maximum of $\Delta v=4.5\pm 1.0\rm\,km\,s^{-1}$ and optical depth of $\tau(\rm HCO^+)=0.10\pm 0.02$. Although there is abundant neutral hydrogen (HI) surrounding the sightline in position-velocity space, at the exact location of the absorber the HI column density is low, $<10^{20}\rm\,cm^{-2}$, and there is little evidence for dust or CO emission from Planck observations. While the origin and survival of molecules in such a diffuse environment remains unclear, dynamical events such as HI flows and cloud collisions in this interacting system likely play an important role.Comment: Accepted for publication in ApJ. 6 pages, 2 figures, 2 table

Health behavior modification after electron beam computed tomography and physician consultation

This study aimed to determine whether participants reported altering health behaviors (physical activity, diet, and alcohol consumption) after seeing results from an electron-beam computed tomography (EBCT) scan for coronary artery calcium and reviewing these results with a physician. Clinicians attempt to motivate patients to control cardiovascular risk factors by adopting healthy behaviors and reducing harmful actions. Asymptomatic patients (N = 510) were evaluated by EBCT for the extent of coronary artery calcium. Information pertaining to demographics, health history, and lifestyle/health behaviors was obtained from each participant at the time of the EBCT scan. Patients were given their numerical calcium score, shown images of their coronary arteries, and counseled by a physician for lifestyle and medical risk modification based on their coronary artery calcium score. Approximately 6 years after the scan, participants completed a follow-up questionnaire related to lifestyle modifications. In multivariable analysis, the presence and extent of coronary artery calcium was significantly associated with beneficial health behavior modifications. Specifically, the greater a patient’s coronary artery calcium score, the more likely they were to report increasing exercise (odds ratio = 1.34, P = 0.02), changing diet (odds ratio = 1.40, P < 0.01), and changing alcohol intake (odds ratio = 1.46, P = 0.05). This study suggests that seeing and being counseled on the presence and extent of coronary artery calcium is significantly associated with behavior change

Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities

<div><h3>Background</h3><p>Deceased donor kidneys for transplantation are in most countries allocated preferentially to recipients who have limited co-morbidities. Little is known about the incremental health and economic gain from transplanting those with co-morbidities compared to remaining on dialysis. The aim of our study is to estimate the average and incremental survival benefits and health care costs of listing and transplantation compared to dialysis among individuals with varying co-morbidities.</p> <h3>Methods</h3><p>A probabilistic Markov model was constructed, using current outcomes for patients with defined co-morbidities treated with either dialysis or transplantation, to compare the health and economic benefits of listing and transplantation with dialysis.</p> <h3>Findings</h3><p>Using the current waiting time for deceased donor transplantation, transplanting a potential recipient, with or without co-morbidities achieves survival gains of between 6 months and more than three life years compared to remaining on dialysis, with an average incremental cost-effectiveness ratio (ICER) of less than $50,000/LYS, even among those with advanced age. Age at listing and the waiting time for transplantation are the most influential variables within the model. If there were an unlimited supply of organs and no waiting time, transplanting the younger and healthier individuals saves the most number of life years and is cost-saving, whereas transplanting the middle-age to older patients still achieves substantial incremental gains in life expectancy compared to being on dialysis.</p> <h3>Conclusions</h3><p>Our modelled analyses suggest transplanting the younger and healthier individuals with end-stage kidney disease maximises survival gains and saves money. Listing and transplanting those with considerable co-morbidities is also cost-effective and achieves substantial survival gains compared with the dialysis alternative. Preferentially excluding the older and sicker individuals cannot be justified on utilitarian grounds.</p> </div