Webcam Delivery of the Lidcombe Program for Preschool Children Who Stutter: A Randomised Controlled Trial

Early intervention provides children who stutter with the best opportunity to avoid the lifelong complications associated with stuttering. Access to effective treatment, in particular, the Lidcombe Program, provides preschool children with the best chance to overcome their stuttering. Currently many children are unable to access such efficacious treatment due to distance and lifestyle factors. One solution to this problem is to deliver the treatment via webcam over the internet. This service delivery model was designed to increase access to timely, best-practice intervention for those who are currently unable to access treatment. That model was thought to be able to produce efficiency rates similar to those of traditional clinic treatment. Further, it provides a method of service delivery that: (1) improves access to evidence-based best-practice stuttering treatment for children, (2) improves access to specialist speech pathologists and quality services, (3) reduces costs and resources involved with outreach service provision, (4) provides more convenient home-based treatment for young children, and (5) ensures more equitable service delivery for rural and remote preschool children and their families. A Phase I study showed that webcam delivery of the Lidcombe Program was a viable treatment delivery model (O’Brian, Smith & Onslow, 2012). This thesis further investigates delivery of the Lidcombe Program for preschool children using the internet and a webcam. The modification in this project, compared to previous, low-tech telehealth (phone and mail) trials of the Lidcombe Program, allowed the principles of standard delivery of the Lidcombe Program to remain relatively unchanged. This was due primarily to the use of a webcam and live videoconferencing. The speech pathologist-parent-child triad was preserved, with all parties having clinic contact. Real-time measurements, observation and education for parent implementation of the program were also achieved through this medium. Thus, treatment could be delivered mostly in accordance with the program treatment guide (Packman et al., 2011, p. 1). The design for this project was a parallel, open plan, Phase III noninferiority randomised controlled trial (RCT). The control group received standard delivery of the Lidcombe Program (Packman, et al., 2011) in a traditional clinic setting. The experimental group received the Lidcombe Program within their homes using a computer, a webcam, the internet and a live video calling program (Skype). The primary outcome measures – the number of consultations and speech pathologist hours to attain entry into Stage 2 – evaluated treatment efficiency. The secondary outcomes – stuttering reduction as measured by parent evaluated severity ratings, investigated treatment efficacy, as did quantitative and qualitative data obtained from parent questionnaires. The number of weeks to attain Stage 2 entry was also measured. Initially, 66 children were assessed for this trial. Eleven were ineligible and six withdrew during the assessment process, with 49 participants being randomised. Of these, 24 were assigned to the control arm and 25 to the experimental arm. Due to time restrictions associated with the student’s candidature, not all 18-month data were collected in time for inclusion in this thesis. Pretreatment data are reported for all 49 participants. Data for all 43 participants active in the trial 9 months postrandomisation are also reported. Stage 2 entry data are available for the 35 participants (71% of the total cohort) who reached Stage 2 by December 31st 2012. Results for both groups showed no significant difference between the number of consultations and the number of weeks to Stage 2. Efficacy measures showed no significant difference between the groups in stuttering reduction. A further secondary outcome measure was parent responses to a questionnaire at entry into Stage 2. Similarly, there was no significant difference between the two groups when asked about speech pathologist-child rapport, speech pathologist-parent rapport, ease of learning treatment, severity ratings and ability to adapt treatment. Further, two-thirds of clinic families said they would choose webcam treatment in the future. Webcam parents reported no difficulty in seeking out their own resources and did not feel treatment within their home was invasive. Webcam families listed convenience and comfort as the main advantages of webcam treatment, with technical difficulties as the main disadvantage. All webcam families would choose this same method for future stuttering treatment. The thesis concludes with a discussion of the speech pathologist’s role, consultation logistics and additional qualitative observations from the webcam group. These include convenience, treatment readiness, defining clinical space, trends in clinical transfer, clinical application, limitations and future directions. Overall, this thesis demonstrates that the findings from a Phase III RCT investigating the efficiency and efficacy of stuttering treatment for preschool support the use of webcam and internet to increase access to timely and appropriate stuttering intervention. The potential for community translation of these findings is considerable; children as young as 3 years of age can receive the same stuttering treatment within their homes as they would within a clinic; they can expect no difference in outcomes or experience. This is significant given that children as young as 2 years of age can be negatively affected by their stuttering. No longer do children who stutter need to be disadvantaged by where they live or by the skills of the closest speech pathologist. They can now access evidence-based treatment within their homes

The completeness of electronic medical record data for patients with type 2 diabetes in primary care and its implications for computer modelling of predicted clinical outcomes.

Computer models predicting outcomes among patients with Type 2 Diabetes (T2D) can be used as disease management program evaluation tools. The clinical data required as inputs for these models include annually updated measurements such as blood pressure and glycated haemoglobin (HbA1c). These data can be extracted from primary care physician office systems but there are concerns about their completeness. This paper reports on the completeness of general practice records.Background: Computer models predicting outcomes among patients with Type 2 Diabetes (T2D) can be used as disease management program evaluation tools. The clinical data required as inputs for these models can include annually updated measurements such as blood pressure and glycated haemoglobin (HbA1c). These data can be extracted from primary care physician office systems but there are concerns about their completeness. Objectives/methods: This study addressed the completeness of routinely collected data extracted from 12 primary care practices in Australia. Data on annual availability of blood pressure, weight, total cholesterol, HDL-cholesterol and HbA1c values for regular patients were extracted in 2103 and analysed for temporal trends over the period 2000 to 2012. An ordinal logistic regression model was used to evaluate associations between patient characteristics and completeness of their records. Primary care practitioners were surveyed to identify barriers to recording data and strategies to improve its completeness. Results: Over the study period completeness of data improved substantially from less than 20% for some parameters up to a level of approximately 80% complete, except for the recording of weight. T2D patients with Ischaemic Heart Disease were more likely to have their blood pressure recorded (OR 1.6, p=0.02). Practitioners’ responses suggest they were not experiencing any major barriers to using their electronic medical record system but did agree with some suggested strategies to improve record completeness. Conclusion: The completeness of routinely collected data suitable for input into computerised predictive models is improving although other dimensions of data quality need to be addressed

Understanding the origin of the magnetic field morphology in the wide-binary protostellar system BHR 71

We present 1.3 mm Atacama Large Millimeter/submillimeter Array observations of polarized dust emission toward the wide-binary protostellar system BHR 71 IRS1 and IRS2. IRS1 features what appears to be a natal, hourglass-shaped magnetic field. In contrast, IRS2 exhibits a magnetic field that has been affected by its bipolar outflow. Toward IRS2, the polarization is confined mainly to the outflow cavity walls. Along the northern edge of the redshifted outflow cavity of IRS2, the polarized emission is sandwiched between the outflow and a filament of cold, dense gas traced by N2D+, toward which no dust polarization is detected. This suggests that the origin of the enhanced polarization in IRS2 is the irradiation of the outflow cavity walls, which enables the alignment of dust grains with respect to the magnetic field—but only to a depth of ~300 au, beyond which the dust is cold and unpolarized. However, in order to align grains deep enough in the cavity walls, and to produce the high polarization fraction seen in IRS2, the aligning photons are likely to be in the mid- to far-infrared range, which suggests a degree of grain growth beyond what is typically expected in very young, Class 0 sources. Finally, toward IRS1 we see a narrow, linear feature with a high (10%–20%) polarization fraction and a well-ordered magnetic field that is not associated with the bipolar outflow cavity. We speculate that this feature may be a magnetized accretion streamer; however, this has yet to be confirmed by kinematic observations of dense-gas tracers.Stars and planetary system

Coupling Of Ribosome And tRNA Dynamics During Translation

Interstellar matter and star formatio

Chemical telemetry of OH observed to measure interstellar magnetic fields

We present models for the chemistry in gas moving towards the ionization front of an HII region. When it is far from the ionization front, the gas is highly depleted of elements more massive than helium. However, as it approaches the ionization front, ices are destroyed and species formed on the grain surfaces are injected into the gas phase. Photodissociation removes gas phase molecular species as the gas flows towards the ionization front. We identify models for which the OH column densities are comparable to those measured in observations undertaken to study the magnetic fields in star forming regions and give results for the column densities of other species that should be abundant if the observed OH arises through a combination of the liberation of H2O from surfaces and photodissociation. They include CH3OH, H2CO, and H2S. Observations of these other species may help establish the nature of the OH spatial distribution in the clouds, which is important for the interpretation of the magnetic field results.Comment: 11 pages, 2 figures, accepted by Astrophysics and Space Scienc

Protostellar accretion traced with chemistry. High-resolution C18O and continuum observations towards deeply embedded protostars in Perseus

Interstellar matter and star formatio

Star and Planet Formation with ALMA: an Overview

Submillimeter observations with ALMA will be the essential next step in our understanding of how stars and planets form. Key projects range from detailed imaging of the collapse of pre-stellar cores and measuring the accretion rate of matter onto deeply embedded protostars, to unravelling the chemistry and dynamics of high-mass star-forming clusters and high-spatial resolution studies of protoplanetary disks down to the 1 AU scale.Comment: Invited review, 8 pages, 5 figures; to appear in the proceedings of "Science with ALMA: a New Era for Astrophysics". Astrophysics & Space Science, in pres

Studies of Dense Cores with ALMA

Dense cores are the simplest star-forming sites that we know, but despite their simplicity, they still hold a number of mysteries that limit our understanding of how solar-type stars form. ALMA promises to revolutionize our knowledge of every stage in the life of a core, from the pre-stellar phase to the final disruption by the newly born star. This contribution presents a brief review of the evolution of dense cores and illustrates particular questions that will greatly benefit from the increase in resolution and sensitivity expected from ALMAComment: 6 pages, 2 figures, to appear in Astrophysics and Space Science, special issue of "Science with ALMA: a new era for Astrophysics" conference, ed. Dr. Bachille