Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems : short-term outcome

AIMS: Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. METHODS: Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. RESULTS: Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. CONCLUSIONS: Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.

Impact of music therapy to promote positive parenting and child development

The effectiveness of a 10-week group music therapy program for marginalized parents and their children aged 0–5 years was examined. Musical activities were used to promote positive parent–child relationships and children’s behavioral, communicative and social development. Participants were 358 parents and children from families facing social disadvantage, young parents or parents of a child with a disability. Significant improvements were found for therapist-observed parent and child behaviors, and parent-reported irritable parenting, educational activities in the home, parent mental health and child communication and social play skills. This study provides evidence of the potential effectiveness of music therapy for early intervention.

Developing an integrated decision model for the enhancement of sustainability deliverables for Australian road infrastructure projects

Road and highway infrastructure provides the backbone for a nation's economic growth. The versatile dispersion of population in Australia, from sparsely settled communities in remote areas to regenerated inner city suburbs with high density living in metropolitans, calls for continuing development and improvement on roads infrastructure under the current federal government policies and state governments' strategic plans. As road infrastructure projects involve large resources and mechanism, achieving sustainability not only in economic scales but also through environmental and social responsibility becomes a crucial issue. Current efforts are often impeded by different interpretation on sustainability agenda by stakeholders involved in these types of projects. As a result, sustainability deliverables at the project level is not often as transparent and measurable, compared to promises in project briefs and designs. This paper reviews the past studies on sustainable infrastructure construction, focusing on roads and highway projects. Through literature study and consultation with the industry, key sustainability indicators specific to road infrastructure projects have been identified. Based on these findings, this paper introduces an on-going research project aimed at identifying and integrating the different perceptions and priority needs of the stakeholders, and issues that impact on the gap between sustainability foci and its actual realization at project end level. The exploration helps generate an integrated decision-making model for sustainable road infrastructure projects. The research will promote to the industry more systematic and integrated approaches to decision-making on the implementation of sustainability strategies to achieve deliverable goals throughout the development and delivery process of road infrastructure projects in Australia.

Simulation and enhancement of a cardiovascular device test rig

Cardiovascular assist devices are tested in mock circulation loops (MCLs) prior to animal and clinical testing. These MCLs rely on characteristics such as pneumatic parameters to create pressure and flow, and pipe dimensions to replicate the resistance, compliance and fluid inertia of the natural cardiovascular system. A mathematical simulation was developed in SIMULINK to simulate an existing MCL. Model validation was achieved by applying the physical MCL characteristics to the simulation and comparing the resulting pressure traces. These characteristics were subsequently altered to improve and thus predict the performance of a more accurate physical system. The simulation was successful in simulating the physical mock circulation loop, and proved to be a useful tool in the development of improved cardiovascular device test rigs.

FPGA implementation of dual-microphone delay-and-sum beamforming for in-car speech enhancement and recognition

In an automotive environment, the performance of a speech recognition system is affected by environmental noise if the speech signal is acquired directly from a microphone. Speech enhancement techniques are therefore necessary to improve the speech recognition performance. In this paper, a field-programmable gate array (FPGA) implementation of dual-microphone delay-and-sum beamforming (DASB) for speech enhancement is presented. As the first step towards a cost-effective solution, the implementation described in this paper uses a relatively high-end FPGA device to facilitate the verification of various design strategies and parameters. Experimental results show that the proposed design can produce output waveforms close to those generated by a theoretical (floating-point) model with modest usage of FPGA resources. Speech recognition experiments are also conducted on enhanced in-car speech waveforms produced by the FPGA in order to compare recognition performance with the floating-point representation running on a PC.

Extraction of road lanes from high-resolution stereo aerial imagery based on maximum likelihood segmentation and texture enhancement

Accurate road lane information is crucial for advanced vehicle navigation and safety applications. With the increasing of very high resolution (VHR) imagery of astonishing quality provided by digital airborne sources, it will greatly facilitate the data acquisition and also significantly reduce the cost of data collection and updates if the road details can be automatically extracted from the aerial images. In this paper, we proposed an effective approach to detect road lanes from aerial images with employment of the image analysis procedures. This algorithm starts with constructing the (Digital Surface Model) DSM and true orthophotos from the stereo images. Next, a maximum likelihood clustering algorithm is used to separate road from other ground objects. After the detection of road surface, the road traffic and lane lines are further detected using texture enhancement and morphological operations. Finally, the generated road network is evaluated to test the performance of the proposed approach, in which the datasets provided by Queensland department of Main Roads are used. The experiment result proves the effectiveness of our approach.

Robust speech recognition using speech enhancement

Automatic Speech Recognition (ASR) has matured into a technology which is becoming more common in our everyday lives, and is emerging as a necessity to minimise driver distraction when operating in-car systems such as navigation and infotainment. In “noise-free” environments, word recognition performance of these systems has been shown to approach 100%, however this performance degrades rapidly as the level of background noise is increased. Speech enhancement is a popular method for making ASR systems more ro- bust. Single-channel spectral subtraction was originally designed to improve hu- man speech intelligibility and many attempts have been made to optimise this algorithm in terms of signal-based metrics such as maximised Signal-to-Noise Ratio (SNR) or minimised speech distortion. Such metrics are used to assess en- hancement performance for intelligibility not speech recognition, therefore mak- ing them sub-optimal ASR applications. This research investigates two methods for closely coupling subtractive-type enhancement algorithms with ASR: (a) a computationally-efficient Mel-filterbank noise subtraction technique based on likelihood-maximisation (LIMA), and (b) in- troducing phase spectrum information to enable spectral subtraction in the com- plex frequency domain. Likelihood-maximisation uses gradient-descent to optimise parameters of the enhancement algorithm to best fit the acoustic speech model given a word se- quence known a priori. Whilst this technique is shown to improve the ASR word accuracy performance, it is also identified to be particularly sensitive to non-noise mismatches between the training and testing data. Phase information has long been ignored in spectral subtraction as it is deemed to have little effect on human intelligibility. In this work it is shown that phase information is important in obtaining highly accurate estimates of clean speech magnitudes which are typically used in ASR feature extraction. Phase Estimation via Delay Projection is proposed based on the stationarity of sinusoidal signals, and demonstrates the potential to produce improvements in ASR word accuracy in a wide range of SNR. Throughout the dissertation, consideration is given to practical implemen- tation in vehicular environments which resulted in two novel contributions – a LIMA framework which takes advantage of the grounding procedure common to speech dialogue systems, and a resource-saving formulation of frequency-domain spectral subtraction for realisation in field-programmable gate array hardware. The techniques proposed in this dissertation were evaluated using the Aus- tralian English In-Car Speech Corpus which was collected as part of this work. This database is the first of its kind within Australia and captures real in-car speech of 50 native Australian speakers in seven driving conditions common to Australian environments.

The cost effectiveness of Naltrexone added to cognitive-behavioral therapy in the treatment of alcohol dependence

he purpose of this study was to evaluate the comparative cost of treating alcohol dependence with either cognitive behavioral therapy (CBT) alone or CBT combined with naltrexone (CBT+naltrexone). Two hundred ninety-eight outpatients dependent on alcohol who were consecutively treated for alcohol dependence participated in this study. One hundred seven (36%) patients received adjunctive pharmacotherapy (CBT+naltrexone). The Drug Abuse Treatment Cost Analysis Program was used to estimate treatment costs. Adjunctive pharmacotherapy (CBT+naltrexone) introduced an additional treatment cost and was 54% more expensive than CBT alone. When treatment abstinence rates (36.1% CBT; 62.6% CBT+naltrexone) were applied to cost effectiveness ratios, CBT+naltrexone demonstrated an advantage over CBT alone. There were no differences between groups on a preference-based health measure (SF-6D). In this treatment center, to achieve 100 abstainers over a 12-week program, 280 patients require CBT compared with 160 CBT+naltrexone. The dominant choice was CBT+naltrexone based on modest economic advantages and significant efficiencies in the numbers needed to treat.

Motivational misalignment on an iconic infrastructure project

Aligning the motivation of contractors and consultants to perform better than ‘business-as-usual’ (BAU) on a construction project is a complex undertaking and the costs of failure are high as misalignment can compromise project outcomes. Despite the potential benefits of effective alignment, there is still little information about optimally designing procurement approaches that promote motivation towards ‘above BAU’ goals. The paper contributes to this knowledge gap by examining the negative drivers of motivation in a major construction project that, despite a wide range of performance enhancing incentives, failed to exceed BAU performance. The paper provides a case study of an iconic infrastructure project undertaken in Australia between 2002 and 2004. It is shown that incentives provided to contractors and consultants to achieve above BAU performance can be compromised by a range of negative motivation drivers including: • inequitable contractual risk allocation; • late involvement of key stakeholders; • inconsistency between contract intentions and relationship intentions; • inadequate price negotiation; • inconsistency between the project performance goals and incentive goals; •unfair and inflexible incentive performance measurement processes. Future quantitative research is planned to determine the generalisability of these results.

Mechanisms of change in negative thinking and urinary monoamines in depressed patients during acute treatment with group cognitive behavior therapy and antidepressant medication

This naturalistic study investigated the mechanisms of change in measures of negative thinking and in 24-h urinary metabolites of noradrenaline (norepinephrine), dopamine and serotonin in a sample of 43 depressed hospital patients attending an eight-session group cognitive behavior therapy program. Most participants (91%) were taking antidepressant medication throughout the therapy period according to their treating Psychiatrists' prescriptions. The sample was divided into outcome categories (19 Responders and 24 Non-responders) on the basis of a clinically reliable change index [Jacobson, N.S., & Truax, P., 1991. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.] applied to the Beck Depression Inventory scores at the end of the therapy. Results of repeated measures analysis of variance [ANOVA] analyses of variance indicated that all measures of negative thinking improved significantly during therapy, and significantly more so in the Responders as expected. The treatment had a significant impact on urinary adrenaline and metadrenaline excretion however, these changes occurred in both Responders and Non-responders. Acute treatment did not significantly influence the six other monoamine metabolites. In summary, changes in urinary monoamine levels during combined treatment for depression were not associated with self-reported changes in mood symptoms.

A national evaluation of the Australian Occupational Therapy Competency Standards (1994): a multistakeholder perspective

This paper summarises results from an evaluation of the adequacy and utility of the Australian Competency Standards for Entry-Level Occupational Therapists © (OT AUSTRALIA, 1994a). It comprised a two-part study, incorporating an online survey of key national stakeholders (n = 26), and 13 focus groups (n = 152) conducted throughout Australia with occupational therapy clinicians, academics, OT AUSTRALIA association and Occupational Therapy Registration Board representatives, as well as university program accreditors. The key recommendations were that: (i) urgent revision to reflect contemporary practice, paradigms, approaches and frameworks is required; (ii) the standards should exemplify basic competence at graduation (not within two years following); (iii) a revision cycle of five years is required; (iv) the Australian Qualifications Framework should be retained, preceded by an introduction describing the scope and nature of occupational therapy practice in the national context; (v) access to the standards should be free and unrestricted to occupational therapists, students and the public via the OT AUSTRALIA (national) website; (vi) the standards should incorporate a succinct executive summary and additional tools or templates formatted to enable occupational therapists to develop professional portfolios and create working documents specific to their workplace; and (vii) language must accommodate contextual variation while striking an appropriate balance between providing instruction and encouraging innovation in practice.

Developing a life-cycle costing analysis model for sustainability enhancement in road infrastructure project

With increasing pressure to provide environmentally responsible infrastructure products and services, stakeholders are putting significant foci on the early identification of financial viability and outcome of infrastructure projects. Traditionally, there has been an imbalance between sustainable measures and project budget. On one hand, the industry tends to employ the first-cost mentality and approach to developing infrastructure projects. On the other, environmental experts and technology innovators often push for the ultimately green products and systems without much of a concern for cost. This situation is being quickly changed as the industry is under pressure to continue to return profit, while better adapting to current and emerging global issues of sustainability. For the infrastructure sector to contribute to sustainable development, it will need to increase value and efficiency. Thus, there is a great need for tools that will enable decision makers evaluate competing initiatives and identify the most sustainable approaches to procuring infrastructure projects. In order to ensure that these objectives are achieved, the concept of life-cycle costing analysis (LCCA) will play significant roles in the economics of an infrastructure project. Recently, a few research initiatives have applied the LCCA models for road infrastructure that focused on the traditional economics of a project. There is little coverage of life-cycle costing as a method to evaluate the criteria and assess the economic implications of pursuing sustainability in road infrastructure projects. To rectify this problem, this paper reviews the theoretical basis of previous LCCA models before discussing their inability to determinate the sustainability indicators in road infrastructure project. It then introduces an on-going research aimed at developing a new model to integrate the various new cost elements based on the sustainability indicators with the traditional and proven LCCA approach. It is expected that the research will generate a working model for sustainability based life-cycle cost analysis.

The impact of psychosocial factors on adherence to compression therapy to prevent recurrence of venous leg ulcers

Aims To identify self-care activities undertaken and determine relationships between self-efficacy, depression, quality of life, social support and adherence to compression therapy in a sample of patients with chronic venous insufficiency. Background Up to 70% of venous leg ulcers recur after healing. Compression hosiery is a primary strategy to prevent recurrence, however, problems with adherence to this strategy are well documented and an improved understanding of how psychosocial factors influence patients with chronic venous insufficiency will help guide effective preventive strategies. Design Cross-sectional survey and retrospective medical record review. Method All patients previously diagnosed with a venous leg ulcer which healed between 12–36 months prior to the study were invited to participate. Data on health, psychosocial variables and self-care activities were obtained from a self-report survey and data on medical and previous ulcer history were obtained from medical records. Multiple linear regression modelling was used to determine the independent influences of psychosocial factors on adherence to compression therapy. Results In a sample of 122 participants, the most frequently identified self-care activities were application of topical skin treatments, wearing compression hosiery and covering legs to prevent trauma. Compression hosiery was worn for a median of 4 days/week (range 0–7). After adjustment for all variables and potential confounders in a multivariable regression model, wearing compression hosiery was found to be significantly positively associated with participants’ knowledge of the cause of their condition (p=0.002), higher self-efficacy scores (p=0.026) and lower depression scores (p=0.009). Conclusion In this sample, depression, self-efficacy and knowledge were found to be significantly related to adherence to compression therapy. Relevance to clinical practice These findings support the need to screen for and treat depression in this population. In addition, strategies to improve patient knowledge and self-efficacy may positively influence adherence to compression therapy.

The effect of dialect mismatch on likelihood-maximising speech enhancement for noise-robust speech recognition

Traditional speech enhancement methods optimise signal-level criteria such as signal-to-noise ratio, but these approaches are sub-optimal for noise-robust speech recognition. Likelihood-maximising (LIMA) frameworks are an alternative that optimise parameters of enhancement algorithms based on state sequences generated for utterances with known transcriptions. Previous reports of LIMA frameworks have shown significant promise for improving speech recognition accuracies under additive background noise for a range of speech enhancement techniques. In this paper we discuss the drawbacks of the LIMA approach when multiple layers of acoustic mismatch are present – namely background noise and speaker accent. Experimentation using LIMA-based Mel-filterbank noise subtraction on American and Australian English in-car speech databases supports this discussion, demonstrating that inferior speech recognition performance occurs when a second layer of mismatch is seen during evaluation.

The application of phonetic distribution normalisation to likelihood-maximising speech enhancement for robust ASR

Traditional speech enhancement methods optimise signal-level criteria such as signal-to-noise ratio, but such approaches are sub-optimal for noise-robust speech recognition. Likelihood-maximising (LIMA) frameworks on the other hand, optimise the parameters of speech enhancement algorithms based on state sequences generated by a speech recogniser for utterances of known transcriptions. Previous applications of LIMA frameworks have generated a set of global enhancement parameters for all model states without taking in account the distribution of model occurrence, making optimisation susceptible to favouring frequently occurring models, in particular silence. In this paper, we demonstrate the existence of highly disproportionate phonetic distributions on two corpora with distinct speech tasks, and propose to normalise the influence of each phone based on a priori occurrence probabilities. Likelihood analysis and speech recognition experiments verify this approach for improving ASR performance in noisy environments.