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

Sediment Composition Influences Spatial Variation in the Abundance of Human Pathogen Indicator Bacteria within an Estuarine Environment

Faecal contamination of estuarine and coastal waters can pose a risk to human health, particularly in areas used for shellfish production or recreation. Routine microbiological water quality testing highlights areas of faecal indicator bacteria (FIB) contamination within the water column, but fails to consider the abundance of FIB in sediments, which under certain hydrodynamic conditions can become resuspended. Sediments can enhance the survival of FIB in estuarine environments, but the influence of sediment composition on the ecology and abundance of FIB is poorly understood. To determine the relationship between sediment composition (grain size and organic matter) and the abundance of pathogen indicator bacteria (PIB), sediments were collected from four transverse transects of the Conwy estuary, UK. The abundance of culturable Escherichia coli, total coliforms, enterococci, Campylobacter, Salmonella and Vibrio spp. in sediments was determined in relation to sediment grain size, organic matter content, salinity, depth and temperature. Sediments that contained higher proportions of silt and/or clay and associated organic matter content showed significant positive correlations with the abundance of PIB. Furthermore, the abundance of each bacterial group was positively correlated with the presence of all other groups enumerated. Campylobacter spp. were not isolated from estuarine sediments. Comparisons of the number of culturable E. coli, total coliforms and Vibrio spp. in sediments and the water column revealed that their abundance was 281, 433 and 58-fold greater in sediments (colony forming units (CFU)/100 g) when compared with the water column (CFU/100 ml), respectively. These data provide important insights into sediment compositions that promote the abundance of PIB in estuarine environments, with important implications for the modelling and prediction of public health risk based on sediment resuspension and transport

Decay rates of faecal indicator bacteria from sewage and ovine faeces in brackish and freshwater microcosms with contrasting suspended particulate matter concentrations

AbstractTo safeguard human health, legislative measures require the monitoring of faecal indicator bacteria (FIB) concentrations in recreational and shellfish waters. Consequently, numerous studies have focussed on FIB survival in the water column and more recently in estuarine sediments. However, there is a paucity of information regarding the influence of contrasting suspended particulate matter (SPM) concentrations on the survival of FIB in the water column of estuaries. Here, microcosms containing freshwater or brackish water with low, high and extreme SPM concentrations were inoculated with sewage and ovine faeces and the decay rate of Escherichia coli, coliforms and enterococci were determined by enumeration over five consecutive days. E. coli derived from ovine faeces proliferated and persisted at high levels in both freshwater and brackish microcosms (no decay), whereas ovine enterococci demonstrated a net decay over the duration of the experiment. Furthermore, SPM concentration had a significant effect on the decay rates of both E. coli and enterococci from ovine faeces in brackish microcosms, but decay rate was greater at low SPM concentrations for E. coli, whereas the opposite was observed for enterococci, whose decay rates increased as SPM concentration increased. E. coli, enterococci and coliforms derived from wastewater demonstrated a net decay in both freshwater and brackish microcosms, with contrasting effects of SPM concentration on decay rate. In addition, some FIB groups demonstrated contrasting responses (decay or proliferation) in the first 24h following inoculation into freshwater versus brackish microcosms. Overall, SPM concentrations influenced the proliferation and decay rates of FIB in brackish waters, but had minimal influence in freshwater. These results demonstrate that the survival rates of FIB in aquatic environments are system specific, species and source dependent, and influenced by SPM concentration. This study has important implications for catchment-based risk assessments and source apportionment of FIB pollution in aquatic environments

Using chemical, microbial and fluorescence techniques to understand contaminant sources and pathways to wetlands in a conservation site

Nutrients and faecal contaminants can enter wetland systems in a number of ways, with both biological and potentially human-health implications. In this study we used a combination of inorganic chemistry, dissolved organic matter (DOM) fluorescence and Escherichia coli and total coliform (TC) count techniques to study the sources and multiple pathways of contamination affecting a designated sand dune site of international conservation importance, surrounded by agricultural land. Analysis of stream samples, groundwater and dune slack wetlands revealed multiple input pathways. These included riverbank seepage, runoff events and percolation of nutrients from adjacent pasture into the groundwater, as well as some on-site sources. The combined techniques showed that off-site nutrient inputs into the sand dune system were primarily from fertilisers, revealed by high nitrate concentrations, and relatively low tryptophan-like fulvic-like ratios < 0.4 Raman units (R.U.). The E. coli and TC counts recorded across the site confirm a relatively minor source of bacterial and nutrient inputs from on-site grazers. Attenuation of the nutrient concentrations in streams, in groundwater and in run-off inputs occurs within the site, restoring healthier groundwater nutrient concentrations showing that contaminant filtration by the sand dunes provides a valuable ecosystem service. However, previous studies show that this input of nutrients has a clear adverse ecological impact

Bulk mineralogical characterisation of oilfield reservoir rocks and sandstones using DRIFTS and partial least squares analysis

The feasibility of applying Partial Least Squares (PLS) to the Diffuse Reflectance Infrared Fourier Transform Spectroscopy (DRIFTS) spectra of mineral mixtures, quarry sandstones and oilfield reservoir rocks has been investigated and shown considerable potential for accurate and precise mineralogical analysis. Rapid spectrum acquisition and data processing together with small sample size requirements are key advantages of the PLS–DRIFTS method. A PLS model was created from the DRIFTS spectra of mixtures of seven mineral standards chosen to represent the most frequently encountered minerals in sandstone-type rocks; quartz, dolomite, montmorillonite, illite, kaolinite, chlorite and albite. The PLS–DRIFTS model was able to quantify the mineral components of independent mixtures with an absolute error of 1 wt.% for all the minerals (concentration range 0–30 wt.%) with the exception of quartz which exhibited an absolute error of 3 wt.% (concentration range 50–90 wt.%). The results provided by applying this PLS–DRIFTS model to several sandstone-type quarry rocks and a suite of oilfield reservoir rocks were considerably better than anticipated even though the model did not describe all the mineral components present in the samples nor the entire variance of constituent mineral components (e.g. crystallinity). The model was not able to differentiate between montmorillonite and illite probably due to the similarity of the DRIFTS spectra of these minerals, but it was able to quantify the combined (montmorillonite + illite) concentrations to within 1 wt.%. The model over-predicted the concentration of albite in the quarry rocks due to the presence of K-feldspar, which has a similar DRIFTS spectrum and was not included in the model. However, the model accurately predicted the total (albite and K-feldspar) concentration to within 4 wt.%. A separate PLS–DRIFTS model constructed using the DRIFTS spectra of the oilfield reservoir rocks showed that the carbonate components, calcite and dolomite could be differentiated and quantified to within 5.0 and 3.6 wt.%, respectively. This feasibility study confirmed the strong potential of combining DRIFTS with a multivariate statistical approach such as PLS and it is clear that more sophisticated models, that incorporates and describes a higher percentage of the variance in unknowns, would further improve the predictions

Sugar prevalence in Aedes albopictus differs by habitat, sex and time of day on Masig Island, Torres Strait, Australia

Background: Sugar feeding is a fundamental behaviour of many mosquito species. For Aedes albopictus, an important vector of dengue virus and chikungunya virus, little is known about its sugar-feeding behaviour, and no studies have been conducted on this in the southern hemisphere. This knowledge is pivotal for determining the potential of attractive targeted sugar baits (ATSBs) to control this important vector. Methods: The prevalence of sugar was assessed in 1808 Ae. albopictus from Masig Island, Torres Strait, Australia collected between 13 and 25 March 2020. Fructose presence and content in field-collected Ae. albopictus were quantified using the cold anthrone assay. Results: Significantly more male (35.8%) than female (28.4%) Ae. albopictus were sugar fed. There was a significant interaction between sex and time of day on the probability of capturing sugar-fed Ae. albopictus. For both sexes, fructose prevalence and content were higher in mosquitoes caught in the morning than in the afternoon. Female Ae. albopictus collected in the residential habitat were significantly more likely to be sugar fed than those collected in the woodland habitat. Conclusions: These findings provide baseline information about the sugar-feeding patterns of Ae. albopictus and provide essential information to enable an assessment of the potential of ATSBs for vector suppression and control on Masig Island, with relevance to other locations where this species occurs

Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States

Introduction: Edentulism affects health and quality of life. Objectives: Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model. Methods: The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set (n = 4,288) was split into selection (70%, n = 3,002) and test data (30%, n = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training (n = 1,716) and validation (n = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples. Results: From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate (P = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715?0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.Conclusion:Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.Knowledge Transfer Statement:This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults

The interaction of human microbial pathogens, particulate material and nutrients in estuarine environments and their impacts on recreational and shellfish waters

Anthropogenic activities have increased the load of faecal bacteria, pathogenic viruses and nutrients in rivers, estuaries and coastal areas through point and diffuse sources such as sewage discharges and agricultural runoff. These areas are used by humans for both commercial and recreational activities and are therefore protected by a range of European Directives. If water quality declines in these zones, significant economic losses can occur. Identifying the sources of pollution, however, is notoriously difficult due to the ephemeral nature of discharges, their diffuse source, and uncertainties associated with transport and transformation of the pollutants through the freshwater–marine interface. Further, significant interaction between nutrients, microorganisms and particulates can occur in the water column making prediction of the fate and potential infectivity of human pathogenic organisms difficult to ascertain. This interaction is most prevalent in estuarine environments due to the formation of flocs (suspended sediment) at the marine-freshwater interface. A range of physical, chemical and biological processes can induce the co-flocculation of microorganisms, organic matter and mineral particles resulting in pathogenic organisms becoming potentially protected from a range of biotic (e.g. predation) and abiotic stresses (e.g. UV, salinity). These flocs contain and retain macro- and micro- nutrients allowing the potential survival, growth and transfer of pathogenic organisms to commercially sensitive areas (e.g. beaches, shellfish harvesting waters). The flocs can either be transported directly to the coastal environment or can become deposited in the estuary forming cohesive sediments where pathogens can survive for long periods. Especially in response to storms, these sediments can be subsequently remobilised releasing pulses of potential pathogenic organisms back into the water column leading to contamination of marine waters long after the initial contamination event occurred. Further work, however, is still required to understand and predict the potential human infectivity of pathogenic organisms alongside the better design of early warning systems and surveillance measures for risk assessment purposes

The effect of layer number and substrate on the stability of graphene under MeV proton beam irradiation

The use of graphene electronics in space will depend on the radiation hardness of graphene. The damage threshold of graphene samples, subjected to 2 MeV proton irradiation, was found to increase with layer number and also when the graphene layer was supported by a substrate. The thermal properties of graphene as a function of the number of layers or as influenced by the substrate argue against a thermal model for the production of damage by the ion beam. We propose a model of intense electronically-stimulated surface desorption of the atoms as the most likely process for this damage mechanism.Comment: 20 pages, 5 figure

Development and Testing of the Quality Improvement Self-efficacy Inventory

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses’ ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses’ knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies