Checklist of parent Lidcombe Program administration

This article outlines the development of a checklist to document parent and child behaviours when implementing Lidcombe Program treatment during structured conversations. We present item development and reliability testing and instructions for use by speech pathologists. Finally, we present two case studies to demonstrate use of the checklist to aid clinical decision-making during Lidcombe Program treatment

Oral Inflammatory Myofibroblastic Tumor: Case Report and Review of Literature

Inflammatory myofibroblastic tumor (IMT) is a rarely described tumor of unknown etiology and pathogenesis. It occurs primarily in the lungs, but has occurred in other extra-pulmonary sites. Histologically these lesions appear as an inflammatory infiltrate within a variably myofibrotic background. Current evidence shows that inflammatory myofibroblastic tumors are neoplastic processes resulting from chromosomal translocations that often cause an overexpression of ALK kinase, which is often assessed using immunohistochemical studies. Currently, the biological behavior of oral inflammatory myofibroblastic tumor is still uncertain. This article describes the clinical, histological, and operative features of a case of IMT of the oral cavity

A three-arm randomized controlled trial of Lidcombe Program and Westmead Program early stuttering interventions

Purpose: To compare two experimental Westmead Program treatments with a control Lidcombe Program treatment for early stuttering. Method: The design was a three-arm randomized controlled trial with blinded outcome assessments 9 months post-randomization. Participants were 91 pre-school children. Results: There was no evidence of difference in percentage syllables stuttered at 9 months among groups. Dropout rates were substantive and may have been connected with novel aspects of the trial design: the use of community clinicians, no exclusion criteria, and randomization of children younger than 3 years of age. Conclusion: The substantive dropout rate for all three arms in this trial means that any conclusions about the 9-month stuttering outcomes must be regarded as tentative. However, continued development of the Westmead Program is warranted, and we are currently constructing an internet version

Natural History of Stuttering to 4 Years of Age: A Prospective Community-Based Study

These findings from a community-ascertained cohort refute long-held views suggesting that developmental stuttering is associated with a range of poorer outcomes. If anything, the reverse was true, with stuttering predicting subsequently better language,nonverbal skills, and psychosocial health-related quality of life at 4 years of age.Future research with this cohort will support a more complete longitudinal understanding of when and in whom recovery occurs. Current best practice recommends waiting for 12 monthsbefore commencing treatment, unlessthe child is distressed, there is parental concern, or the child becomes reluctant to communicate. It may be that for many children treatment could be deferred even longer. Treatment is efficacious15 but is both intensive (median of 15.4o ne-hour clinical sessions followedby 10 one-hour clinical maintenance sessions) and expensive; this "watchful waiting" recommendation would therefore help target allocation of scarce resources to the small number of children who do not resolve and experience adverse outcomes, secure in the knowledge that delaying treatment by a year or more has been shown not to compromise treatment efficac

Tracing acid mine drainage and estuarine Zn attenuation using Cd and Zn isotopes

It has been estimated that the acid mine drainage (AMD) impacted Odiel river basin in southern Spain supplies 0.37% and 15% of the global riverine fluxes of Cd and Zn to the oceans, respectively (Sarmiento et al., 2009). However, the behaviour of Cd and Zn in the Ria of Huelva estuary, which connects the Odiel and Tinto watersheds with the Gulf of Cadiz, has yet to be fully investigated. Furthermore, very few studies have investigated Cd and Zn isotope behaviour in estuaries worldwide. This study presents Cd and Zn concentrations and isotopic compositions for the Ria of Huelva estuary and surrounding watersheds, sampled in 2017 and 2019. Sulfide-rich rock samples extracted from three mines yield Cd and Zn isotope compositions that range from –0.14‰ to +0.07‰ (n = 4) for δ114Cd and –0.01‰ to +0.29‰ (n = 4) for δ66Zn. However, a uniform riverine signal of about +0.02‰ for Cd and +0.17‰ for Zn indicates that tracing of individual mining regions using Cd and Zn isotopes is challenging. Limited variability was observed in dissolved δ114Cd values throughout the watershed, including AMD, the estuary, and the Gulf of Cadiz, with a mean value of ±0.00 ± 0.13‰ (n = 25, 2 SD; excludes one AMD outlier, at +0.48‰), including both 2017 and 2019 data. By contrast, δ66Zn values ranged from –0.12‰ to +0.35‰ (n = 28) for the same geographical and temporal scope. In May 2017, a large spill from an abandoned mine, La Zarza, resulted in a drastic increase in the concentrations of trace metals reaching the estuary compared to 2019, but no impact of this mine spill on Cd or Zn isotope compositions is observed. In 2019, an increase in δ66Zn values in the estuary coincided with high pH values (up to pH = 8.8) and chloride concentrations (2.73%), which may reflect an alkaline anthropogenic input from the active neighbouring industrial complex. Overall, Cd concentrations and isotope compositions in the estuary are largely consistent with conservative mixing behaviour. By contrast, Zn behaviour is non-conservative, with removal of 49 to 97% of dissolved riverine Zn in the estuary during the period 2017 to 2019, associated with a relatively small isotopic shift to lighter Zn isotope compositions. Removal of Zn to the particulate phase in the Ria of Huelva estuary therefore largely attenuates high riverine Zn fluxes from AMD, indicating that previously estimated Odiel river basin Zn fluxes were overestimated. Nevertheless, the variable but generally light AMD Cd and Zn isotope compositions, coupled with high dissolved metal concentrations, suggest that Cd and Zn isotopes may be useful tracers of regionally averaged AMD inputs to the Gulf of Cadiz and beyond

The pervasive role of biological cohesion in bedform development

Sediment fluxes in aquatic environments are crucially dependent on bedform dynamics. However, sediment-flux predictions rely almost completely on clean-sand studies, despite most environments being composed of mixtures of non-cohesive sands, physically cohesive muds and biologically cohesive extracellular polymeric substances (EPS) generated by microorganisms. EPS associated with surficial biofilms are known to stabilize sediment and increase erosion thresholds. Here we present experimental data showing that the pervasive distribution of low levels of EPS throughout the sediment, rather than the high surficial levels of EPS in biofilms, is the key control on bedform dynamics. The development time for bedforms increases by up to two orders of magnitude for extremely small quantities of pervasively distributed EPS. This effect is far stronger than for physical cohesion, because EPS inhibit sand grains from moving independently. The results highlight that present bedform predictors are overly simplistic, and the associated sediment transport processes require re-assessment for the influence of EPS

Enhanced hyporheic exchange flow around woody debris does not increase nitrate reduction in a sandy streambed

Anthropogenic nitrogen pollution is a critical problem in freshwaters. Although riverbeds are known to attenuate nitrate, it is not known if large woody debris (LWD) can increase this ecosystem service through enhanced hyporheic exchange and streambed residence time. Over a year, we monitored the surface water and pore water chemistry at 200 points along a ~50m reach of a lowland sandy stream with three natural LWD structures. We directly injected 15N-nitrate at 108 locations within the top 1.5m of the streambed to quantify in situ denitrification, anammox and dissimilatory nitrate reduction to ammonia, which, on average, contributed 85%, 10% and 5% of total nitrate reduction, respectively. Total nitrate reducing activity ranged from 0-16µM h-1 and was highest in the top 30cm of the stream bed. Depth, ambient nitrate and water residence time explained 44% of the observed variation in nitrate reduction; fastest rates were associated with slow flow and shallow depths. In autumn, when the river was in spate, nitrate reduction (in situ and laboratory measures) was enhanced around the LWD compared with non-woody areas, but this was not seen in the spring and summer. Overall, there was no significant effect of LWD on nitrate reduction rates in surrounding streambed sediments, but higher pore water nitrate concentrations and shorter residence times, close to LWD, indicated enhanced delivery of surface water into the streambed under high flow. When hyporheic exchange is too strong, overall nitrate reduction is inhibited due to short flow-paths and associated high oxygen concentrations