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Implementation Research and Practice 2022Effective implementation of evidence-based prevention interventions in schools is vital to reducing the burden of drug use and its consequences. Universal prevention...
BACKGROUND
Effective implementation of evidence-based prevention interventions in schools is vital to reducing the burden of drug use and its consequences. Universal prevention interventions often fail to achieve desired public health outcomes due to poor implementation. One central reason for suboptimal implementation is the limited fit between the intervention and the setting. Research is needed to increase our understanding of how intervention characteristics and context influence intervention implementation in schools to design implementation strategies that will address barriers and improve public health impact.
METHODS
Using a convergent mixed methods design we examined qualitative and quantitative data on implementation determinants for an evidence-based health curriculum, the Michigan Model for Health (MMH) from the perspective of health teachers delivering the curriculum in high schools across the state. We examined data strands independently and integrated them by investigating data alignment, expansion, and divergence.
RESULTS
We identified three mixed methods domains: (1) Acceptability, (2) intervention-context fit, and (3) adaptability. We found alignment across data strands as teachers reporting low acceptability also reported low fidelity. The fit between student needs and the curriculum predicted fidelity (expansion). Teachers mentioned instances of poor intervention-context fit (discordance), including when meeting the needs of trauma-exposed youth and keeping updated on youth drug use trends. Teachers reported high adaptability (concordance) but also instances when adaptation was challenging (discordance).
CONCLUSIONS
This investigation advances implementation research by deepening our understanding of implementation determinants for an evidence-based universal prevention intervention in schools. This will support designing effective implementation strategies to address barriers and advance the public health impact of interventions that address important risk and protective factors for all youth.
PLAIN LANGUAGE SUMMARY
(1) What is Already Known About the Topic? While many evidence-based interventions (EBIs) exist to address key health issues among youth including substance use and mental health, few of these interventions are effectively implemented in community settings, such as schools. Notable multilevel barriers exist to implement universal prevention in schools. Researchers identify that misalignment between the intervention and the context is a key reason why many implementation efforts do not achieve desired outcomes. (2) What Does This Paper Add? This paper combines the strengths of qualitative and quantitative research methods to identify and understand challenges to intervention-context fit for a comprehensive health curriculum, the Michigan Model for Health (MMH) which is widely adopted throughout Michigan, from the perspective of end users. This paper also utilizes the consolidated framework for implementation research and implementation outcomes framework to guide our understanding of implementing complex interventions and key barriers to implementation in schools. This research provides a foundation to design effective strategies that will balance curriculum fidelity and adaptation to achieve public health objectives. (3) What are the Implications for Practice, Research, or Policy? We need implementation strategies that guide flexibility and fidelity in EBI delivery in schools. While overall teachers felt the curriculum was adaptable and met student needs, they also mentioned specific instances when they would benefit from additional implementation support, such as making adaptations to meet the needs of trauma-exposed youth and keeping up-to-date with emerging drugs. Implementation strategies designed to address these challenges can improve fidelity and ultimately student well-being.
PubMed: 37091102
DOI: 10.1177/26334895221124962 -
Travel Medicine and Infectious Disease 2023The high-altitude hypoxia environment will cause poor acclimatization in a portion of the population. Remote ischemic preconditioning(RIPC)has been demonstrated to... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The high-altitude hypoxia environment will cause poor acclimatization in a portion of the population. Remote ischemic preconditioning(RIPC)has been demonstrated to prevent cardiovascular and cerebrovascular diseases under ischemic or hypoxic conditions. However, its role in improving acclimatization and preventing acute mountain sickness (AMS) at high altitude has been undetermined. This study aims to estimate the effect of RIPC on acclimatization of individuals exposed to high altitude.
METHODS
The project was designed as a randomized controlled trial with 82 healthy young males, who received RIPC training once a day for 7 consecutive days. Then they were transported by aircraft to a high altitude (3680 m) and examined for 6 days. Lake Louise Score(LLS) of AMS, physiological index, self-reported sleep pattern, and Pittsburgh Sleep Quality Index(PSQI)score were applied to assess the acclimatization to the high altitude. Five neurobehavioral tests were conducted to assess cognitive function.
RESULTS
The result showed that the RIPC group had a significantly lower AMSscore than the control group (2.43 ± 1.58 vs 3.29 ± 2.03, respectively; adjusted mean difference-0.84, 95% confidence interval-1.61 to -0.06, P = 0.036). and there was no significant difference in AMS incidence between the two groups (25.0% vs 28.57%, P = 0.555). The RIPC group performed better than the control group in spatial memory span score (11[9-12] vs 10[7.5-11], P=0.025) and the passing digit (7[6-7.5] vs 6[5-7], P= 0.001). Spatial memory was significantly higher in the high-altitude RIPC group than in the low-altitude RIPC group (P<0.01). And the RIPC group obtained significantly lower self-reported sleep quality score (P = 0.024) and PSQI score (P = 0.031).
CONCLUSIONS
The RIPC treatment improved spatial memory and sleep quality in subjects exposed to acute hypoxic exposure and this may lead to improved performance at high altitude.
Topics: Male; Humans; Altitude; Spatial Memory; Altitude Sickness; Acute Disease; Hypoxia; Ischemic Preconditioning; Sleep; Acclimatization
PubMed: 37068619
DOI: 10.1016/j.tmaid.2023.102576 -
American Journal of Physiology.... Jan 2012Appropriate quantification of analytical and biological variation of thermoregulatory sweating has important practical utility for research design and statistical...
Appropriate quantification of analytical and biological variation of thermoregulatory sweating has important practical utility for research design and statistical analysis. We sought to examine contributors to variability in local forearm sweating rate (SR) and sweating onset (SO) and to evaluate the potential for using bilateral measurements. Two women and eight men (26 ± 9 yr; 79 ± 12 kg) completed 5 days of heat acclimation and walked (1.8 l/min VO(2)) on three occasions for 30 min in 40°C, 20% RH, while local SR and SO were measured. Local SR measures among days were not different (2.14 ± 0.72 vs. 2.02 ± 0.79 vs. 2.31 ± 0.72 mg·cm(2)·min(-1), P = 0.19) nor was SO (10.47 ± 2.54 vs. 10.04 ± 2.97 vs. 9.87 ± 3.44 min P = 0.82). Bilateral SR (2.14 ± 0.72 vs. 2.16 ± 0.71 mg·cm(2)·min(-1), P = 0.56) and SO (10.47 ± 2.54 vs. 10.83 ± 2.48 min, P = 0.09) were similar and differences were ≤ 1 SD of day-to-day differences for a single forearm. Analytical imprecision (CV(a)), within (CV(i))-, and between (CV(g))-subjects' coefficient of variation for local SR were 2.4%, 22.3%, and 56.4%, respectively, and were 0%, 9.6%, and 41%, respectively, for SO. We conclude: 1) technologically, sweat capsules contribute negligibly to sweat measurement variation; 2) bilateral measures of SR and SO appear interchangeable; 3) when studying potential factors affecting sweating, changes in SO afford a more favorable signal-to-noise ratio vs. changes in SR. These findings provide a quantitative basis for study design and optimization of power/sample size analysis in the evaluation of thermoregulatory sweating.
Topics: Acclimatization; Adult; Body Temperature; Body Temperature Regulation; Exercise; Female; Humans; Male; Oxygen Consumption; Regional Blood Flow; Research Design; Stress, Physiological; Sweating
PubMed: 22071159
DOI: 10.1152/ajpregu.00456.2011 -
Annals of the New York Academy of... Sep 2020Convergent evolution, where independent lineages evolve similar phenotypes in response to similar challenges, can provide valuable insight into how selection operates... (Review)
Review
Convergent evolution, where independent lineages evolve similar phenotypes in response to similar challenges, can provide valuable insight into how selection operates and the limitations it encounters. However, it has only recently become possible to explore how convergent evolution is reflected at the genomic level. The overlapping outlier approach (OOA), where genome scans of multiple independent lineages are used to find outliers that overlap and therefore identify convergently evolving loci, is becoming popular. Here, we present a quantitative analysis of 34 studies that used this approach across many sampling designs, taxa, and sampling intensities. We found that OOA studies with increased biological sampling power within replicates have increased likelihood of finding overlapping, "convergent" signals of adaptation between them. When identifying convergent loci as overlapping outliers, it is tempting to assume that any false-positive outliers derived from individual scans will fail to overlap across replicates, but this cannot be guaranteed. We highlight how population demographics and genomic context can contribute toward both true convergence and false positives in OOA studies. We finish with an exploration of emerging methods that couple genome scans with phenotype and environmental measures, leveraging added information from genome data to more directly test hypotheses of the likelihood of convergent evolution.
Topics: Acclimatization; Adaptation, Physiological; Animals; Animals, Wild; Biological Evolution; Evolution, Molecular; Genome; Genomics
PubMed: 31241191
DOI: 10.1111/nyas.14177 -
BMC Medical Education Jan 2021Medical students navigate complex personal learning pathways from entry into medical school, through an educational program, and into life-long practice. However, many...
BACKGROUND
Medical students navigate complex personal learning pathways from entry into medical school, through an educational program, and into life-long practice. However, many stakeholders have called for substantive reforms in contemporary curricula, citing concerns about the lack of key abilities amongst newly graduated doctors to work in complex healthcare environments. Despite the need for educators to focus on curricula design, there is a paucity of overarching perspectives that allow synthesis of the various curricular elements in a way that lends meaningfulness and appreciation to the students in terms of navigating the immediate program requirements and beyond. Without such guidance, educators risk creating fragmented program designs that can lead to both unintended and unactionable outcomes for students as well as curriculum designers. Using systems thinking, we set out to address this gap by providing an overarching perspective for curriculum designers to appreciate the relationships and the interactions of the various curricular elements that inform and impact student's preparedness for practice.
METHODS
By framing a curriculum as a complex adaptive system, we used soft systems thinking to develop an initial prototype of a conceptual curricular toolkit, underpinned by an appraisal of relevant literature within health professional education and the broader educational context. The prototype was further refined iteratively after critical reflection by the authors with a diverse range of national and international colleagues via posters, short communications, and workshops at several conferences, and through social media.
RESULTS
We describe how the 3P-6Cs toolkit captures a learner's personal journey through an educational program into a field of practice by logically linking the three key elements: the personal, the program, and the practice. We demonstrate its application in three examples related to contemporary health profession education curricula. These are: creating integrated educational designs to capture students' developmental continua, conceptualising immersive clinical placements in non-traditional settings, and complexity-consistent evaluation of curricular interventions.
CONCLUSION
Applying the 3P-6Cs curricular toolkit to problems of curricula (re)design can provide overarching perspectives that enable educators to have a better understanding of how integration of elements within education programs can inform and impact student's preparation for lifelong practice.
Topics: Curriculum; Education, Medical; Humans; Learning; Schools, Medical; Systems Analysis
PubMed: 33407403
DOI: 10.1186/s12909-020-02442-5 -
Implementation Science Communications Jun 2023Retention in care and HIV viral load suppression remains sub-optimal among HIV positive adolescents in many settings including TASO Uganda, despite the implementation of...
Improving retention and HIV viral load suppression among adolescents living with HIV in TASO Soroti and TASO Mbale centers of excellence using Operation Triple Zero model: a before and after study protocol.
BACKGROUND
Retention in care and HIV viral load suppression remains sub-optimal among HIV positive adolescents in many settings including TASO Uganda, despite the implementation of interventions such as regimen optimization and community-based approaches like multi-month drug dispensing. To this end, the implementation of additional intervention is urgently required to address gaps in current programming which include inadequate centralization of the HIV positive adolescents and their caregivers in the designs. This study, thus, proposes to adapt and implement the Operation Triple Zero (OTZ) model in TASO Soroti and Mbale centers to improve both retention and viral load suppression among the adolescents living with HIV.
METHODOLOGY
A before and after study design is preferred, employing both qualitative and quantitative approaches. To identify barriers and facilitators to retention and HIV viral load suppression among the HIV positive adolescents, secondary data, focused group discussions, and key informant interviews will be used to understand perspectives of the adolescents, their caregivers, and the health-workers. The Consolidated Framework for Implementation Research (CFIR) will help in designing the intervention, while Knowledge to Action (K2A) will support the adaptation process. To test the intervention, Reach, Effectiveness, Adaption, Implementation and Maintenance (RE-AIM) framework will be used. A paired t-test will be used to compare means of retention and viral load suppression in the before and after study periods.
DISCUSSION
This study aims at adapting and implementing the OTZ model in TASO Soroti and Mbale Centers of Excellence (COEs) to attain optimal retention and HIV viral load suppression rates among the HIV positive adolescents in care. Uganda is yet to adapt the touted OTZ model and findings from this study will be important in providing the necessary lessons to inform a policy shift for potential scale up of the model. Furthermore, results of this study could provide additional evidence for the effectiveness of OTZ in attaining optimal HIV treatment outcomes among the adolescents living with HIV.
PubMed: 37308985
DOI: 10.1186/s43058-023-00449-9 -
PloS One 2020Helping the world's coastal communities adapt to climate change impacts requires evaluating the vulnerability of coastal communities and assessing adaptation options....
Helping the world's coastal communities adapt to climate change impacts requires evaluating the vulnerability of coastal communities and assessing adaptation options. This includes understanding the potential for 'natural' infrastructure (ecosystems and the biodiversity that underpins them) to reduce communities' vulnerability, alongside more traditional 'hard' infrastructure approaches. Here we present a spatially explicit global evaluation of the vulnerability of coastal-dwelling human populations to key climate change exposures and explore the potential for coastal ecosystems to help people adapt to climate change (ecosystem-based adaptation (EbA)). We find that mangroves and coral reefs are particularly well situated to help people cope with current weather extremes, a function that will only increase in importance as people adapt to climate change now and in coming decades. We find that around 30.9 million people living within 2km of the coast are highly vulnerable to tropical storms and sea-level rise (SLR). Mangroves and coral reefs overlap these threats to at least 5.3 and 3.4 million people, respectively, with substantial potential to dissipate storm surges and improve resilience against SLR effects. Significant co-benefits from mangroves also accrue, with 896 million metric tons of carbon stored in their soils and above- and below-ground biomass. Our framework offers a tool for prioritizing 'hotspots' of coastal EbA potential for further, national and local analyses to quantify risk reduction and, thereby, guide investment in coastal ecosystems to help people adapt to climate change. In doing so, it underscores the global role that conserving and restoring ecosystems can play in protecting human lives and livelihoods, as well as biodiversity, in the face of climate change.
Topics: Acclimatization; Animals; Biodiversity; Carbon Sequestration; Climate Change; Conservation of Natural Resources; Coral Reefs; Cyclonic Storms; Ecosystem; Global Warming; Humans; Sea Level Rise; Wetlands
PubMed: 32469978
DOI: 10.1371/journal.pone.0233005 -
Journal of the Formosan Medical... Dec 2008Developing a new medicine is an expensive and time-consuming process. Researchers are interested in applying better designs to expedite the approval of potential... (Review)
Review
Developing a new medicine is an expensive and time-consuming process. Researchers are interested in applying better designs to expedite the approval of potential medicinal products. Adaptive designs, which allow for some types of prospectively planned mid-study change, can improve the efficiency of a trial and maximize the chance of success. Possible design adaptations of clinical trials include sample size re-estimation, change in primary endpoint, interim dropping of treatment arms, change in statistical hypothesis, and change in the primary analysis. In this article, the regulatory considerations of the methodological issues with respect to adaptive design are discussed. Several examples of design adaptation that the Center for Drug Evaluation has encountered during the past 3 years are presented.
Topics: Clinical Trials, Phase III as Topic; Drug Evaluation; Endpoint Determination; Humans; Research Design; Sample Size; Statistics as Topic
PubMed: 19129039
DOI: 10.1016/s0929-6646(09)60002-4 -
Pharmaceutical Research Oct 2015In this study we aimed to evaluate adaptive designs (ADs) by clinical trial simulation for a pharmacokinetic-pharmacodynamic model in oncology and to compare them with...
Influence of the Size of Cohorts in Adaptive Design for Nonlinear Mixed Effects Models: An Evaluation by Simulation for a Pharmacokinetic and Pharmacodynamic Model for a Biomarker in Oncology.
PURPOSE
In this study we aimed to evaluate adaptive designs (ADs) by clinical trial simulation for a pharmacokinetic-pharmacodynamic model in oncology and to compare them with one-stage designs, i.e., when no adaptation is performed, using wrong prior parameters.
METHODS
We evaluated two one-stage designs, ξ0 and ξ*, optimised for prior and true population parameters, Ψ0 and Ψ*, and several ADs (two-, three- and five-stage). All designs had 50 patients. For ADs, the first cohort design was ξ0. The next cohort design was optimised using prior information updated from the previous cohort. Optimal design was based on the determinant of the Fisher information matrix using PFIM. Design evaluation was performed by clinical trial simulations using data simulated from Ψ*.
RESULTS
Estimation results of two-stage ADs and ξ * were close and much better than those obtained with ξ 0. The balanced two-stage AD performed better than two-stage ADs with different cohort sizes. Three- and five-stage ADs were better than two-stage with small first cohort, but not better than the balanced two-stage design.
CONCLUSIONS
Two-stage ADs are useful when prior parameters are unreliable. In case of small first cohort, more adaptations are needed but these designs are complex to implement.
Topics: Biomarkers; Clinical Trials as Topic; Computer Simulation; Humans; Medical Oncology; Models, Biological; Models, Statistical; Nonlinear Dynamics; Pharmaceutical Preparations; Research Design; Sample Size; Software
PubMed: 26123680
DOI: 10.1007/s11095-015-1693-3 -
Public Health May 2023This study aimed to discuss the overlap between property-level flood adaptation and public health and flood risk management and identify areas of future research.
OBJECTIVES
This study aimed to discuss the overlap between property-level flood adaptation and public health and flood risk management and identify areas of future research.
DESIGN AND METHODS
A short essay-based contribution arguing in favour of a future research direction from the perspective of a disaster risk researcher.
RESULTS
Promoting property-level flood adaption has multiple areas of benefit to both flooding and mental health risk management as a potential invention. This is because both fields display common interests in enabling and promoting personal responsibility to limit disaster consequences and build resilience.
CONCLUSIONS
The promotion and development of property-level flood adaptation strategies can be a productive locus of behaviour for further active collaboration and research, as well as a joint intervention for improving human welfare postdisaster. However, more proactive research is required.
Topics: Humans; Floods; Mental Health; Disasters; Acclimatization
PubMed: 37060736
DOI: 10.1016/j.puhe.2023.03.008