Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease

Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and language therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids

The PD COMM trial: A protocol for the process evaluation of a randomised trial assessing the effectiveness of two types of SLT for people with Parkinson's disease

BACKGROUND: The PD COMM trial is a phase III multi-centre randomised controlled trial whose aim is to evaluate the effectiveness and cost-effectiveness of two approaches to speech and language therapy (SLT) compared with no SLT intervention (control) for people with Parkinson's disease who have self-reported or carer-reported problems with their speech or voice. Our protocol describes the process evaluation embedded within the outcome evaluation whose aim is to evaluate what happened at the time of the PD COMM intervention implementation and to provide findings that will assist in the interpretation of the PD COMM trial results. Furthermore, the aim of the PD COMM process evaluation is to investigate intervention complexity within a theoretical model of how the trialled interventions might work best and why. METHODS/DESIGN: Drawing from the Normalization Process Theory and frameworks for implementation fidelity, a mixed method design will be used to address process evaluation research questions. Therapists' and participants' perceptions and experiences will be investigated via in-depth interviews. Critical incident reports, baseline survey data from therapists, treatment record forms and home practice diaries also will be collected at relevant time points throughout the running of the PD COMM trial. Process evaluation data will be analysed independently of the outcome evaluation before the two sets of data are then combined. DISCUSSION: To date, there are a limited number of published process evaluation protocols, and few are linked to trials investigating rehabilitation therapies. Providing a strong theoretical framework underpinning design choices and being tailored to meet the complex characteristics of the trialled interventions, our process evaluation has the potential to provide valuable insight into which components of the interventions being delivered in PD COMM worked best (and what did not), how they worked well and why

Educating International Security Practitioners: Preparing to Face the Demands of the 21st Century International Security Environment

The authors examine the challenges of the 21st century international security environment to which future strategic leaders and policy practitioners will need to respond. More specifically, they offer the reader insights into security studies and leadership development at their respective levels (military undergraduate, civilian undergraduate, traditional and nontraditional graduate, and senior military officer) and institutions (including research centers and professional outreach programs). The goal is to inform a broader audience about what is currently being done in the way of educating strategic practitioners at these various institutions, and what might need to be done differently or better.https://press.armywarcollege.edu/monographs/1835/thumbnail.jp

Terrestrial primary production for the conterminous United States derived from Landsat 30 m and MODIS 250 m

Terrestrial primary production is a fundamental ecological process and a crucial component in understanding the flow of energy through trophic levels. The global MODIS gross primary production (GPP) and net primary production (NPP) products (MOD17) are widely used for monitoring GPP and NPP at coarse resolutions across broad spatial extents. The coarse input datasets and global biome‐level parameters, however, are well‐known limitations to the applicability of the MOD17 product at finer scales. We addressed these limitations and created two improved products for the conterminous United States (CONUS) that capture the spatiotemporal variability in terrestrial production. The MOD17 algorithm was utilized with medium resolution land cover classifications and improved meteorological data specific to CONUS in order to produce: (a) Landsat derived 16‐day GPP and annual NPP at 30 m resolution from 1986 to 2016 (GPPL30 and NPPL30, respectively); and (b) MODIS derived 8‐day GPP and annual NPP at 250 m resolution from 2001 to 2016 (GPPM250 and NPPM250 respectively). Biome‐specific input parameters were optimized based on eddy covariance flux tower‐derived GPP data from the FLUXNET2015 database. We evaluated GPPL30 and GPPM250 products against the standard MODIS GPP product utilizing a select subset of representative flux tower sites, and found improvement across all land cover classes except croplands. We also found consistent interannual variability and trends across NPPL30, NPPM250, and the standard MODIS NPP product. We highlight the application potential of the production products, demonstrating their improved capacity for monitoring terrestrial production at higher levels of spatial detail across broad spatiotemporal scales

The effects of symptom overreporting on PTSD treatment outcome

Background: It is often assumed that individuals with posttraumatic stress disorder (PTSD) who overreport their symptoms should be excluded from trauma-focused treatments. Objective: To investigate the effects of a brief, intensive trauma-focused treatment programme for ndividuals with PTSD who are overreporting symptoms. Methods: Individuals (n = 205) with PTSD participated in an intensive trauma-focused treatment programme consisting of EMDR and prolonged exposure (PE) therapy, physical activity and psycho-education. Assessments took place at pre- and post-treatment (Structured Inventory of Malingered Symptomatology; SIMS, Clinician Administered PTSD Scale for DSM-5; CAPS-5). Results: Using a high SIMS cut-off of 24 or above, 14.1% (n = 29) had elevated SIMS scores (i.e. ‘overreporters’). The group of overreporters showed significant decreases in PTSDsymptoms, and these treatment results did not differ significantly from other patients. Although some patients (35.5%) remained overreporters at post-treatment, SIMS scores decreased significantly during treatment. Conclusion: The results suggest that an intensive trauma-focused treatment not only is a feasible and safe treatment for PTSD in general, but also for individuals who overreport their symptoms

Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren

<STRONG>Background</STRONG> Previous studies have demonstrated an association between preterm delivery and increased risk of special educational need (SEN). The aim of our study was to examine the risk of SEN across the full range of gestation. <STRONG>Methods and Findings</STRONG> We conducted a population-based, retrospective study by linking school census data on the 407,503 eligible school-aged children resident in 19 Scottish Local Authority areas (total population 3.8 million) to their routine birth data. SEN was recorded in 17,784 (4.9%) children; 1,565 (8.4%) of those born preterm and 16,219 (4.7%) of those born at term. The risk of SEN increased across the whole range of gestation from 40 to 24 wk: 37–39 wk adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 1.12–1.20; 33–36 wk adjusted OR 1.53, 95% CI 1.43–1.63; 28–32 wk adjusted OR 2.66, 95% CI 2.38–2.97; 24–27 wk adjusted OR 6.92, 95% CI 5.58–8.58. There was no interaction between elective versus spontaneous delivery. Overall, gestation at delivery accounted for 10% of the adjusted population attributable fraction of SEN. Because of their high frequency, early term deliveries (37–39 wk) accounted for 5.5% of cases of SEN compared with preterm deliveries (<37 wk), which accounted for only 3.6% of cases. <STRONG>Conclusions</STRONG> Gestation at delivery had a strong, dose-dependent relationship with SEN that was apparent across the whole range of gestation. Because early term delivery is more common than preterm delivery, the former accounts for a higher percentage of SEN cases. Our findings have important implications for clinical practice in relation to the timing of elective delivery

Moving black holes via singularity excision

We present a singularity excision algorithm appropriate for numerical simulations of black holes moving throughout the computational domain. The method is an extension of the excision procedure previously used to obtain stable simulations of single, non-moving black holes. The excision procedure also shares elements used in recent work to study the dynamics of a scalarfield in the background of a single, boosted black hole. The robustness of our excision method is tested with single black-hole evolutions using a coordinate system in which the coordinate location of the black hole, and thus the excision boundary, moves throughout the computational domain.Comment: 9 pages and 11 figure

Sequential Decay Distortion of Goldhaber Model Widths for Spectator Fragments

Momentum widths of the primary fragments and observed final fragments have been investigated within the framework of an Antisymmetrized Molecular Dynamics transport model code (AMD-V) with a sequential decay afterburner (GEMINI). It is found that the secondary evaporation effects cause the values of a reduced momentum width, $\sigma_0$, derived from momentum widths of the final fragments to be significantly less than those appropriate to the primary fragment but close to those observed in many experiments. Therefore, a new interpretation for experiemental momentum widths of projectile-like fragments is presented.Comment: 4 pages, 3 figs. Accepted for publication in Phys. Rev. C as a Rapid Communicatio

Sequential Decay Distortion of Goldhaber Model Widths for Spectator Fragments

Momentum widths of the primary fragments and observed final fragments have been investigated within the framework of an Antisymmetrized Molecular Dynamics transport model code (AMD-V) with a sequential decay afterburner (GEMINI). It is found that the secondary evaporation effects cause the values of a reduced momentum width, $\sigma_0$, derived from momentum widths of the final fragments to be significantly less than those appropriate to the primary fragment but close to those observed in many experiments. Therefore, a new interpretation for experiemental momentum widths of projectile-like fragments is presented.Comment: 4 pages, 3 figs. Accepted for publication in Phys. Rev. C as a Rapid Communicatio