Doctor of Philosophy

dissertationThe current study evaluated the use of a manualized social skills program, Superheroes Social Skills, to increase the use of prosocial behaviors and decrease the use of aggressive behaviors for children with externalizing behaviors. The training was implemented by a school psychologist in a pullout group with four children with highincidence disabilities and four typically developing peers at a public elementary school. The program implemented was a multimedia, high interest program that incorporates the use of animation to teach the lessons. This program also uses evidence-based practices (e.g., video-modeling, peer mediation, social stories, and self-management) to help increase the effectiveness of the intervention. There were eleven skills taught during one 30-minute session. Two sessions were taught per week. Children were videotaped during free play and recess observations for baseline, treatment, and follow-up. Their behaviors were then coded using a partial interval recording system. The behaviors observed were verbal aggression, physical aggression, neutral behavior, positive initiations, and positive responses. The observation codes were used to calculate effect sizes, percentage of nonoverlapping data points, and percentage of all nonoverlapping data points. The Social Skills Improvement System (SSIS) was used as a pre- and postmeasure of treatment effectiveness. Measures were also used to determine social validity, consumer satisfaction, and treatment integrity. These measures were analyzed using descriptive statistics. Results indicated that this intervention was effective for decreasing aggressive behaviors, decreasing neutral play, and increasing positive responses in both the treatment setting and the generalized recess setting. Results were also maintained at a 2-week follow-up. Parents and participants indicated the program was effective and favorable. The results of the SSIS indicated minimal treatment effect, although teachers rated a significant increase in social skills. The treatment was implemented with high treatment fidelity. Overall, this study found that the Superheroes Social Skills Program was an effective intervention for children with high-incidence disabilities and externalizing behaviors

Master of Science

thesisThe current study assessed the Superhero Social Skills program as an evidencebased practice for teaching social skills to elementary children with Autism Spectrum Disorder (ASD) in a clinical out-patient setting. The program consists of many research validated components, including peer mediation, video-modeling, and social stories. There were 4 participants with ASD and 4 "peer buddies," all between the ages of 5 and 10. Intervention sessions took place at an outpatient clinical setting over 8 weeks. One lesson was taught per week and incorporated components from the program's typical two lesson per week format. After each session, analog free play observations were conducted and coded by the researcher and another graduate student to achieve interrater reliability. Parents reported the number of spontaneous uses of skills at home to measure generalization. Effect size and percentage of nonoverlapping data points were calculated to determine changes in social engagement and generalization. There were also pre- and postmeasures of social behaviors completed by parents and consumer satisfaction measures completed after the intervention by parents and children. The results of this study indicate increased levels of social initiations, social responses, and social engagement during free play observations. For most participants, there was also an increase in generalized use of the skills. Parents and children reported high levels of satisfaction with the program. Overall, results suggest that the "superhero social skills" program is effective for children with ASD

Solar stormwatch: tracking solar eruptions

The Solar Stormwatch team reviews progress and prospects for this highly effective citizen-science project focused on the Sun

Health professionals’ perspectives on delivering home and hospital management at diagnosis for children with type 1 diabetes: a qualitative study from the Delivering Early Care in Diabetes Evaluation (DECIDE) trial

Objective: To explore the delivery of home and hospital management at diagnosis of Type 1 diabetes in childhood and any impact this had on health professionals delivering care. Methods: This qualitative study was undertaken as part of the DECIDE randomised controlled trial where participants were individually randomised to receive initiation of management at diagnosis, to home or hospital. Semi-structured telephone interviews were planned with a purposive sample of health professionals involved with the delivery of home and hospital management, to include consultants, diabetes and research nurses, and dietitians from the eight UK centres taking part. The interview schedule focused on their experiences of delivering the two models of care; preferences, impact and future plans. Data were subject to Thematic Analysis. Results: Twenty two health professionals participated, represented by consultants, diabetes and research nurses, and dietitians. Overall, nurses preferred home management and perceived it to be beneficial in terms of facilitating a unique opportunity to understand family life and provide education to extended family members. Nurses described a special bond and lasting relationship that they developed with the home managed children and families. Consultants expressed concern that it jeopardised their relationship with families. Dietitians reported being unable to deliver short bursts of education to families in the home managed arm. All health professionals were equally divided over which was logistically easier to deliver. Conclusions: A hybrid approach, of a brief stay in hospital and early home management, offers a pragmatic solution to the advantages and challenges presented by both systems

Optimal error bounds for two-grid schemes applied to the Navier-Stokes equations

We consider two-grid mixed-finite element schemes for the spatial discretization of the incompressible Navier-Stokes equations. A standard mixed-finite element method is applied over the coarse grid to approximate the nonlinear Navier-Stokes equations while a linear evolutionary problem is solved over the fine grid. The previously computed Galerkin approximation to the velocity is used to linearize the convective term. For the analysis we take into account the lack of regularity of the solutions of the Navier-Stokes equations at the initial time in the absence of nonlocal compatibility conditions of the data. Optimal error bounds are obtained

Physical activity self-management and coaching compared to social interaction in huntington disease: results from the ENGAGE-HD randomized, controlled, pilot feasibility trial.

Abstract Background: Self-management and self-efficacy for physical activity is not routinely considered in neurologic rehabilitation. Objective: We assessed feasibility and outcomes of a 14 week physical activity self-management and coaching intervention compared with social contact in Huntington's disease (HD) to inform the design of a future full-scale trial. Design: Assessor blind, multi-site, randomized pilot feasibility trial. Setting: Participants were recruited and assessed at baseline, 16 weeks following randomisation, and then again at 26 weeks in HD specialist clinics with intervention delivery by trained coaches in the participants’ homes. Patients and Intervention: People with HD were allocated to the ENGAGE-HD physical activity coaching intervention or a social interaction intervention. Measurements: Eligibility, recruitment, retention and intervention adherence were determined at 16 weeks. Other outcomes of interest included measures of functional, home and community mobility, self-efficacy, physical activity and disease-specific measures of motor and cognition. Fidelity and costs for both the physical activity and social comparator interventions were established. Results: Forty % (n=46) of eligible patients were enrolled and 22 randomised to the physical intervention and 24 to social intervention. Retention rates in the physical intervention and social intervention were 77% and 92% respectively. Minimum adherence criteria were achieved by 82% of participants in the physical intervention and 100% in the social intervention. There was no indication of between group treatment effects on function, however increases in self-efficacy for exercise and self-reported levels of physical activity in the physical intervention lends support to our pre-defined intervention logic model. Limitations: The use of self-report measures may have introduced bias. Conclusions: An HD physical activity self-management and coaching intervention is feasible and worthy of further investigation.Health and Care Research Wale

Development and Delivery of a Physical Activity Intervention for People With Huntington Disease:Facilitating Translation to Clinical Practice

Background and Purpose: We studied the development and delivery of a 14-week complex physical activity intervention for people with Huntington disease, where detailed information about the intervention was fully embedded in the trial design process. Methods: Intervention Development: The intervention was developed through a series of focus groups. The findings from the focus groups informed the development of a logic model for the physical activity intervention that was broadly consistent with the framework of self-determination theory. Intervention Delivery: Key components underpinning the delivery of the intervention were implemented including a defined coach training program and intervention fidelity assessment methods. Training of coaches (physical therapists, occupational therapists, research nurses, and exercise trainers) was delivered via group and 1:1 training sessions using a detailed coach's manual, and with ongoing support via video calls, and e-mail communication as needed. Detailed documentation was provided to determine costs of intervention development and coach training. Results: Intervention delivery coaches at 8 sites across the United Kingdom participated in the face-to-face training. Self-report checklists completed by each of the coaches indicated that all components of the intervention were delivered in accordance with the protocol. Mean (standard deviation) intervention fidelity scores (n = 15), as measured using a purpose-developed rating scale, was 11 (2.4) (out of 16 possible points). Coaches' perceptions of intervention fidelity were similarly high. The total cost of developing the intervention and providing training was [pounds]30,773 ($47,042 USD). Discussion and Conclusions: An important consideration in promoting translation of clinical research into practice is the ability to convey the detailed components of how the intervention was delivered to facilitate replication if the results are favorable. This report presents an illustrative example of a physical activity intervention, including the development and the training required to deliver it. This approach has the potential to facilitate reproducibility, evidence synthesis, and implementation in clinical practice

Assessing the efficacy, safety and utility of closed-loop insulin delivery compared with sensor-augmented pump therapy in very young children with type 1 diabetes (KidsAP02 study): an open-label, multicentre, multinational, randomised cross-over study protocol

Introduction: Diabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group. Methods and analysis: The study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1-7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1-4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants' and caregivers' experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed. Ethics and dissemination: Ethics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d'Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations

What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting

Objectives We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services. Design Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits. Setting 18 partnerships of local authority and healthcare organisations in England. Outcomes Descriptive framework of services. Rates of service usage reported by trial participants. Results 161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30–63 universal services per site and 22–67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor. Conclusions The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential