The economic impact of childhood developmental language disorder

University of Technology Sydney. Faculty of Business.This thesis examines the economic impact of childhood developmental language disorder (DLD) on individuals, families and society, using a national Australian panel data set of 10,000 children—the Longitudinal Study of Australian Children (LSAC). The thesis comprises four studies. The first study investigates healthcare consumption decisions of families with a child with DLD. This study demonstrates a consistent positive relationship between a child’s language difficulties and their increased medical services utilisation and expenditure. These children seek more general practitioner services, and this is observed in conjunction with higher referral rates to paediatricians, speech pathologists and other specialists. Healthcare utilisation makes up a relatively small portion of the overall costs of language difficulties. However, language difficulties are likely to place an increasingly larger burden on the health and welfare system as these children move through school and after they leave school. The second study examines the effects of DLD on future human capital and economic success. The results provide strong evidence of the impact of language difficulties on future earning potential, as a result of low levels of literacy and numeracy. This effect is greater than the effect socioeconomic disadvantage alone. Although many of these children are behind when they start school, there is some evidence that a school of high academic achievement mitigates the effects of this impairment on academic achievement. The results also demonstrate that early identification and intervention exerts a positive effect on cognitive and non-cognitive skills. In the third study, the labour force decisions of families with a child with DLD are explored by measuring the indirect costs associated with reduced maternal labour force participation. This study highlights that the impact of language difficulties on labour force participation is considerable and represents the largest proportion of overall costs. The results show that carers of children with language difficulties substitute paid for unpaid work by working fewer hours. When their child’s condition is severe or persistent, mothers are less likely to be employed, and when the child is older, mothers receive a wage rate premium to remain in the workforce. For these carers, the substitution, respite and income effect are equally important. The final study uses estimates from the three preceding studies to calculate the societal costs of DLD in Australia. The total cost to society of language difficulties is estimated to be between $1.362 billion per year and$3.308 billion per year (based on a prevalence range 7 to 17 per cent). The annual cost per child with language difficulties is estimated to be $4,353. Productivity losses account for the largest proportion of this cost, with 42While the individual costs associated with DLD are not as high as other childhood conditions such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder, its high prevalence and broad impact has made DLD an important public health concern. The total cost to society of language difficulties could be similar to the cost of asthma ($3.6 billion per year)1 and ASD ($5.5 billion per year). The costs associated with DLD have important implications for intervention of language disorders. This study provides decision makers with a picture of the global burden of DLD and more importantly, of the major cost components and the areas where cost containment policies would have the greatest impact and should therefore be prioritised. These estimates can be used to inform cost-effectiveness models of effective interventions for children with DLD

Valuing EQ-5D health states: A review and analysis, CHERE Working Paper 2007/9

Objective: To identify the key methodological issues in the construction of population-level EQ-5D / Time Trade-Off (TTO) preference elicitation studies. Study Design: This study involves three components. The first was to identify existing population-level EQ-5D TTO studies. The second was to illustrate and discuss the key areas of divergence between studies, including the international comparison of tariffs. The third was to portray the relative merits of each of the approaches, and to compare the results of studies across countries. Results: While most papers report use of the protocol developed in the original UK study, we identified three key areas of divergence in the construction and analysis of surveys. These are the number of health states valued in order to determine the algorithm for estimating all health states, the approach to valuing states worse than immediate death, and the choice of algorithm. Finally, the evidence on international comparisons suggests differences between countries, although it is difficult to disentangle differences in cultural attitudes with random error and differences due to methodological divergence. Conclusion: Differences in methods are likely to obscure true differences in values between countries. However, population-specific valuation sets for countries engaging in economic evaluation would better represent societal attitudes.health state valuation, EQ5-D

Attenuated CSF-1R signalling drives cerebrovascular pathology

Cerebrovascular pathologies occur in up to 80% of cases of Alzheimer's disease; however, the underlying mechanisms that lead to perivascular pathology and accompanying blood-brain barrier (BBB) disruption are still not fully understood. We have identified previously unreported mutations in colony stimulating factor-1 receptor (CSF-1R) in an ultra-rare autosomal dominant condition termed adult-onset leucoencephalopathy with axonal spheroids and pigmented glia (ALSP). Cerebrovascular pathologies such as cerebral amyloid angiopathy (CAA) and perivascular p-Tau were some of the primary neuropathological features of this condition. We have identified two families with different dominant acting alleles with variants located in the kinase region of the CSF-1R gene, which confer a lack of kinase activity and signalling. The protein product of this gene acts as the receptor for 2 cognate ligands, namely colony stimulating factor-1 (CSF-1) and interleukin-34 (IL-34). Here, we show that depletion in CSF-1R signalling induces BBB disruption and decreases the phagocytic capacity of peripheral macrophages but not microglia. CSF-1R signalling appears to be critical for macrophage and microglial activation, and macrophage localisation to amyloid appears reduced following the induction of Csf-1r heterozygosity in macrophages. Finally, we show that endothelial/microglial crosstalk and concomitant attenuation of CSF-1R signalling causes re-modelling of BBB-associated tight junctions and suggest that regulating BBB integrity and systemic macrophage recruitment to the brain may be therapeutically relevant in ALSP and other Alzheimer's-like dementias

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families : the Strong Families Trial

Background: Obesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years. Methods: Eight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention. Discussion: This study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status. Trial Registration: This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001019190). Registered 16 July 2019

Monitoring Guidance for Underwater Noise in European Seas- Part II: Monitoring Guidance Specifications

This document has been prepared by the Technical Subgroup on Underwater Noise and other forms of Energy (TSG Noise), established in 2010 by the Marine Directors, i.e. the representatives of directorates or units in European Union Member States, Acceding Countries, Candidate Countries and EFTA Member States dealing with or responsible for marine issues. In December 2011, the Marine Directors requested the TSG Noise to provide monitoring guidance that could be used by Member States in establishing monitoring schemes to meet the needs of the Marine Strategy Framework Directive indicators for underwater noise in their marine waters. This document presents the recommendations and information needed to commence the monitoring required for underwater noise.JRC.H.1-Water Resource

Monitoring Guidance for Underwater Noise in European Seas - Part I: Executive Summary

This document has been prepared by the Technical Subgroup on Underwater Noise and other forms of Energy (TSG Noise), established in 2010 by the Marine Directors, i.e. the representatives of directorates or units in European Union Member States, Acceding Countries, Candidate Countries and EFTA Member States dealing with or responsible for marine issues. In December 2011, the Marine Directors requested the TSG Noise to provide monitoring guidance that could be used by Member States in establishing monitoring schemes to meet the needs of the Marine Strategy Framework Directive indicators for underwater noise in their marine waters. This document presents the key conclusions and recommendations that support the implementation of the practical guidance to commence the monitoring required for underwater noise.JRC.H.1-Water Resource

Initial investigation of test-retest reliability of home-to-home teleneuropsychological assessment in healthy, English-speaking adults

Prior teleneuropsychological research has assessed the reliability between in-person and remote administration of cognitive assessments. Few, if any, studies have examined the test-retest reliability of cognitive assessments conducted in sequential clinic-to-home or home-to-home teleneuropsychological evaluations - a critical issue given the state of clinical practice during the COVID-19 pandemic. This study examined this key psychometric question for several cognitive tests administered over repeated videoconferencing visits 4-6 months apart in a sample of healthy English-speaking adults. A total of 44 participants (ages 18-75) completed baseline and follow-up cognitive testing 4-6 months apart. Testing was conducted in a home-to-home setting over HIPAA-compliant videoconferencing meetings on participants' audio-visual enabled laptop or desktop computers. The following measures were repeated at both virtual visits: the Controlled Oral Word Association Test (FAS), Category Fluency (Animals), and Digit Span Forward and Backward from the Wechsler Adult Intelligence Scale, Fourth Edition. Intraclass correlation coefficients (ICC), Pearson correlations, root mean square difference (RMSD), and concordance correlation coefficients (CCC) were calculated as test-retest reliability metrics, and practice effects were assessed using paired-samples t-tests. Some tests exhibited small practice effects, and test-retest reliability was marginal or worse for all measures except FAS, which had adequate reliability (based on ICC and r). Reliability estimates with RMSD suggested that change within +/- 1 SD on these measures may reflect typical test-retest variability. The included cognitive measures exhibited questionable reliability over repeated home-to-home videoconferencing evaluations. Future teleneuropsychology test-retest reliability research is needed with larger, more diverse samples and in clinical populations.F31 AG062158 - NIA NIH HHS; R01 AG054671 - NIA NIH HHS; R01 AG066823 - NIA NIH HHSAccepted manuscrip

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO