Speech Telepractice: Installing a Speech Therapy Upgrade for the 21st Century

Much of speech therapy involves the clinician guiding the therapeutic process (e.g., presenting stimuli and eliciting client responses); however, this Brief Communication describes a different approach to speech therapy delivery. Clinicians at Waldo County General Hospital (WCGH) use high definition audio and video to engage clients in telepractice using interactive web-based virtual environments. This technology enables clients and their clinicians to co-create salient treatment activities using authentic materials captured via digital cameras, video and/or curricular materials.  Both therapists and clients manipulate the materials and interact online in real-time. The web-based technology engenders highly personalized and engaging activities, such that clients’ interactions with these high interest tasks often continue well beyond the therapy sessions

Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD): MaineCare (Medicaid) Cost Savings

This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid) directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent) MaineCare patients consecutively referred to Waldo County General Hospital (WCGH) with suspected diagnosis of Vocal Cord Dysfunction (VCD) were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice.  The study suggests that without access to speech therapy telepractice for patients with VCD, the ongoing medical costs to MaineCare will be ongoing and significant

Measuring attitude towards personal data for adaptive cybersecurity

Purpose: This paper presents an initial development of a Personal Data Attitude (PDA) measurement instrument based on established psychometric principles. The aim of the research was to develop a reliable measurement scale for quantifying and comparing attitudes towards personal data that can be incorporated into cybersecurity behavioral research models. Such a scale has become necessary for understanding individuals’ attitudes towards specific sets of data as more technologies are being designed to harvest, collate, share and analyze personal data. Design/methodology/approach: An initial set of 34 five-point Likert style items were developed with 8 sub-scales and administered to participants online. The data collected were subjected to Exploratory and Confirmatory factor analysis and some MANOVA. The results are consistent with multi-dimensionality of attitude theories and suggest the adopted methodology for the study is appropriate for future research with a more representative sample. Findings: Factor analysis of 247 responses identified 6 constructs of individuals’ attitude towards personal data: Protective Behavior, Privacy Concerns, Cost-Benefit, Awareness, Responsibility and Security. This paper illustrates how the PDA scale can be a useful guide for information security research and design by briefly discussing the factor structure of the PDA and related results. Originality/value: This study addresses a genuine gap in the research by taking the first step towards establishing empirical evidence for dimensions underlying personal data attitudes. It also adds a significant benchmark to a growing body of literature on understanding and modelling computer users’ security behaviors

Improving Communicative Competence in Global Aphasia

TB

One-domain-one-input: adaptive random testing by orthogonal recursive bisection with restriction

One goal of software testing may be the identification or generation of a series of test cases that can detect a fault with as few test executions as possible. Motivated by insights from research into failure-causing regions of input domains, the even-spreading (even distribution) of tests across the input domain has been identified as a useful heuristic to more quickly find failures. This finding has encouraged a shift in focus from traditional random testing (RT) to its enhancement, adaptive random testing (ART), which retains the randomness of test input selection, but also attempts to maintain a more evenly distributed spread of test inputs across the input domain. Given that there are different ways to achieve the even distribution, several different ART methods and approaches have been proposed. This paper presents a new ART method, called ART-ORB, which explores the advantages of repeated geometric bisection of the input domain, combined with restriction regions, to evenly spread test inputs. Experimental results show a better performance in terms of fewer test executions than RT to find failures. Compared with other ART methods, ART-ORB has comparable performance (in terms of required test executions), but incurs lower test input selection overheads, especially in higher dimensional input space. It is recommended that ART-ORB be used in testing situations involving expensive test input execution

THE EFFECT OF VANCOMYCIN DOSES GREATER THAN 2 GRAMS ON SERUM CREATININE AND VANCOMYCIN TROUGH LEVELS

Objective: To assess the effect of vancomycin doses greater than 2 grams on renal function and vancomycin trough levels Methods: This is a retrospective, pharmacokinetic study performed in a tertiary care level II trauma center. 3579 electronic charts of patients who received vancomcyin at the medical facility between January 2010 and December 2011 were reviewed. Only 30 patients met the inclusion criteria of the study. Included patients were those who were at least 18 years of age who received doses greater than 2 grams of vancomycin for at least 48 hours. Patients in the intensive care units, pregnant or on hemodialysis and were not included in the study. The mean weight for the participants was 154.67 kg. Results: Patients were dosed based on the institution's vancomycin dosing protocol such as 15-20 mg/kg per dose where the frequency was determined based on the estimated creatinine clearance using cockroft gault equation. A loading dose of 25-30 mg/kg was administered in few cases. Two out of thirty subjects had shown an increase of serum creatinine of ≥ 0.3mg/dL when receiving maintenance doses greater than 2 grams of vancomycin. A Z approximation test was used where a standard error of 0.043 with an α error equal to 0.05 and a 95% confidence interval of (-0.024-0.144) were found. The use of doses greater than 2 grams of IV vancomycin did not show a statistically significance increase in serum creatinine. The two subjects who did have a significant increase in serum creatinine were receiving concomitant nephrotoxins. Conclusion: The use of doses greater than 2 grams of IV vancomycin did not show a statistically significant increase in serum creatinine. Patients whom serum creatinine increased were on other nephrotoxin agents that could have contributed to the acute kidney injury that was seen in these patients

Measuring Communication Competence in Global Aphasia

TB

American Telemedicine Association’s Principles for Delivering Telerehabilitation Services

Telehealth is a broad term used to describe the use of electronic or digital information and communications technologies to support clinical healthcare, patient and professional health related education, and public health and health administration. Telerehabilitation refers to the delivery of rehabilitation and habilitation services via information and communication technologies (ICT), also commonly referred to as” telehealth” technologies. Telerehabilitation services can include evaluation, assessment, monitoring, prevention, intervention, supervision, education, consultation, and coaching. Telerehabilitation services can be deployed across all patient populations and multiple healthcare settings including clinics, homes, schools, or community-based worksites. This document was adapted from the American Telemedicine Association’s (ATA) “A Blueprint for Telerehabilitation Guidelines” (2010) and reflects the current utilization of telerehabilitation services. It was developed collaboratively by members of the ATA Telerehabilitation Special Interest Group, with input and guidance from other practitioners in the field, strategic stakeholders, and ATA staff. Its purpose is to inform and assist practitioners in providing effective and secure services that are based on client needs, current empirical evidence, and available technologies. Rehabilitation professionals, in conjunction with professional associations and other organizations are encouraged to use this document as a resource for developing discipline-specific standards, guidelines, and practice requirements.Keywords: American Telemedicine Association, Habilitation, Rehabilitation, Telehealth, Telepractice

Metamorphic testing: a review of challenges and opportunities

Metamorphic testing is an approach to both test case generation and test result verification. A central element is a set of metamorphic relations, which are necessary properties of the target function or algorithm in relation to multiple inputs and their expected outputs. Since its first publication, we have witnessed a rapidly increasing body of work examining metamorphic testing from various perspectives, including metamorphic relation identification, test case generation, integration with other software engineering techniques, and the validation and evaluation of software systems. In this paper, we review the current research of metamorphic testing and discuss the challenges yet to be addressed. We also present visions for further improvement of metamorphic testing and highlight opportunities for new research

Quality standards for the management of alcohol-related liver disease: consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group

Objective Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.Design A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.Results The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.Conclusion It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD