Stakeholder intention to engage in fidelity measurement methods in community mental health settings: A mixed methods study.

Background: The current gold standard for measuring fidelity (specifically, adherence) to cognitive behavioral therapy (CBT) is direct observation, a costly, resource-intensive practice that is not feasible for many community organizations to implement regularly. Recent research indicates that behavioral rehearsal (i.e., role-play between clinician and individual with regard to session delivery) and chart-stimulated recall (i.e., brief structured interview between clinician and individual about what they did in session; clinicians use the client chart to prompt memory) may provide accurate and affordable alternatives for measuring adherence to CBT in such settings, with behavioral rehearsal yielding greater correspondence with direct observation. Methods: Drawing on established causal theories from social psychology and leading implementation science frameworks, this study evaluates stakeholders' intention to use behavioral rehearsal and chart-stimulated recall. Specifically, we measured attitudes, self-efficacy, and subjective norms toward using each, and compared these factors across the two methods. We also examined the relationship between attitudes, self-efficacy, subjective norms, and intention to use each method. Finally, using an integrated approach we asked stakeholders to discuss their perception of contextual factors that may influence beliefs about using each method. These data were collected from community-based supervisors (n = 17) and clinicians (n = 66). Results: Quantitative analyses suggest moderately strong intention to use both methods across stakeholders. There were no differences in supervisors' or clinicians' attitudes, self-efficacy, subjective norms, or intention across methods. More positive attitudes and greater reported subjective norms were associated with greater reported intention to use either measure. Qualitative analyses identified participants' specific beliefs about using each fidelity measure in their organization, and results were organized using the Consolidated Framework for Implementation Research. Conclusions: Strategies are warranted to overcome or minimize potential barriers to using fidelity measurement methods and to further increase the strength of intention to use them.Plain Language Summary: The best way to measure fidelity, or how closely a clinician follows the protocol, to Cognitive Behavioral Therapy (CBT) is watching the session. This is an expensive practice that is not feasible for many community organizations to do regularly. Recent research indicates that behavioral rehearsal, or a role-play between the clinician and individual with regard to session delivery, and chart-stimulated recall, or a brief discussion between an individual and the clinician about what they did in session with the clinician having access to the chart to help them remember, may provide accurate and affordable alternatives for measuring fidelity to CBT. We just completed a study demonstrating that both methods are promising, with behavioral rehearsal offering scores that are the most similar to watching the session. Drawing on established theories from social psychology and leading implementation science frameworks, this study evaluates future supervisor and clinician motivation to use these fidelity measurement methods. Specifically, we measured supervisor (n = 17) and clinician (n = 66) attitudes, norms, self-efficacy, intentions, and anticipated barriers and facilitators to using each of these fidelity measurement tools. Quantitative and qualitative analyses suggest similar intention to use both methods, and concerns about barriers to using each method. Further research is warranted to minimize the burden associated with implementing fidelity measurement methods and deploying strategies to increase use.

Splenic volume as a biomarker of hepatic damage after chemotherapy in patients with resected colorectal liver metastases (CRLM).

BACKGROUND: Chemotherapy-associated liver injury (CALI) is a matter of concern for hepatobiliary surgeons as it can entail postoperative liver failure after an extensive hepatectomy. Recent studies have taken special interest in liver function parameters which can correlate with CALI to decrease this adverse event. Therefore, the current study investigates the usefulness of splenic volume as a biomarker of CALI through a portal hypertension mechanism, in patients with colorectal liver metastases (CRLM). STUDY DESIGN: We carried out a study in patients with CRLM operated on between 2009 and 2014 in our center. All samples of healthy liver were graded for non-alcoholic fatty liver disease (NAFLD) and sinusoidal obstructive syndrome. Computarized tomography scans for spleen volumetry were analyzed for each patient at CRLM diagnosis, after neoadjuvant chemotherapy, 1 and 6 months after resection. RESULTS: A group of 65 consecutive patients with CRLM of large bowel adenocarcinoma submitted to liver resection were included. Patients receiving neoadjuvant chemotherapy had a greater spleen volume increase than those who did not receive treatment (p = 0.053), finding a statistically significant spleen growth in patients with NAFLD (p = 0.036). There was no correlation between spleen enlargement and postoperative complications or average stay. However, survival was decreased in patients with spleen growth and CALI. CONCLUSIONS: Patients who receive neoadjuvant chemotherapy for liver metastasis surgery have a greater splenic volume increase, which correlates with NAFLD and a lower survival.

A snapshot of homeless youth in Seattle: their characteristics, behaviors and beliefs about HIV protective strategies.

The purpose of this study was to determine how initial HIV prevention efforts for homeless youth were received and to determine areas where homeless youth's beliefs and behaviors continue to put them at risk for HIV infection. Interviews were conducted with 289 Seattle homeless youth. Youth reported using condoms with casual partners during vaginal and anal sex and with clients during oral, anal and vaginal sex. Condoms are often not used during vaginal sex with main partners or during oral sex with casual or main partners. Knowledge of HIV protective strategies differed according to youth's behavioral characteristics with heterosexual youth having the weakest knowledge of HIV protective strategies especially compared with young men who have sex with men. There is room for improvement in youth's knowledge and beliefs about HIV.

Modelling adaptation effects in vergence and accommodation after exposure to a simulated virtual reality stimulus.

Natural viewing conditions place equal demands on the vergence and accommodation systems. The two responses are co-ordinated via the interactive components which couple the two systems: accommodative vergence and vergence accommodation. The crosslink components are usually quantified by the AC/A and CA/C ratios. Whether these ratios are stable entities, genetically determined, or modifiable by experience has been the subject of some debate. A 'Virtual Reality' stimulus was used to place unequal demands on the vergence and accommodation systems. Pre-task and post-task measures of AC/A and CA/C were objectively determined. The changes in the post-task measures are discussed with reference to a dual interactive model of vergence and accommodation. Model simulations suggest that adaptation of the vergence and accommodative controllers (tonic adaptation) may also play a part by altering the open loop bias. The results therefore support the idea that vergence accommodation and accommodative vergence are capable of adaptation.

Evolution of control system models of ocular accommodation, vergence and their interaction.

This paper reviews the evolution of inferential models describing ocular accommodation and vergence, which have been developed using the techniques of control engineering. The models are developed by inferring that the observed behaviour of the ocular systems could be produced by particular types of feedback control systems. The models are subsequently tested and improved by modifications resulting from the comparison of model predictions with physiological experimentation. Current models of accommodation and vergence have had considerable success in describing both the steady-state and dynamic behaviours of the individual systems. However, controversy currently exists among researchers, particularly with respect to the composition of models that describe the interaction of the two systems.

Meta-analysis of antibiotics in tube thoracostomy.

The use of antibiotics for patients undergoing tube thoracostomy was determined to be highly variable based on a study conducted at a national meeting of surgeons. A meta-analysis of six randomized studies previously reported was performed. The analysis was carried out using the Confidence Profile Method software FAST*PRO. The meta-analysis was structured using dichotomous outcomes of infectious chest processes (empyema, effusion, pneumonia, wound infection, tracheitis, etc.) versus no infectious chest process in patients with and without antibiotics. The effect measures calculated included actual difference in probabilities, relative risk, percent differences in probabilities, and odds ratio. The results of this meta-analysis suggest that antibiotics should be used in patients undergoing tube thoracostomy. Antibiotic selection should maximize therapy for Staph. aureus. The implementation of this practice guideline will require the co-operation of multiple specialty oriented physicians and surgeons.

Compliance assessment and accreditation in dental practices.

The introduction of compliance assessment and accreditation in dental practices providing sedation and anaesthesia. A critical assessment of the background to compliance and an analysis of the options available for its introduction.

Home investment in husband's human capital and the wife's decision to work.

"This paper explores the importance of husbands' career demands and assortative mating patterns for market-specific human capital on the decision of married women to work or not....[It] has three goals: (1) to derive, within the framework of a standard model of home production, a testable hypothesis concerning the effect of home investment in husband's human capital on a wife's decision to work; (2) to reconcile the theory with the existing empirical evidence by noting that issues of joint husband and wife decision-making cannot be viewed without considering the role of the marriage sorting market; and (3) to provide new empirical evidence that isolates the home investment effect from the sorting effect." Data are from 281 married couples in the United States.

Intra-family bargaining and time allocation.

"This paper investigates a new empirical implication of the cooperative bargaining model of family decision-making: the effect of threat point variations on time allocation decisions of the husband and wife....The bargaining model examined in this paper utilizes the cooperative game theory approach which assumes, among other things, that both players (spouses) know each other's utility function. With many family decisions such as marital dissolution, timing and spacing of children, labor market entry or reentry for the wife, it is not necessarily true that the preferences of each spouse are accurately known by the other.... In the context of the two-period model sketched out in this paper, bargaining between husband and wife over the extent of human capital investment for the wife, and the time allocation tradeoffs necessary to attain such an investment might be fruitfully modelled in a noncooperative framework." Data are from a variety of sources, including a University of Michigan study of couples' time-allocation patterns in 37 U.S. states and the District of Columbia.

Testicular self-examination: a public awareness program.

Testicular cancer is responsible for one out of seven deaths among late adolescent and young adult males. It is the number one cancer killer of men in the second and third decade of life. However, the population at risk, men between the ages 15 and 35, is singularly unaware of this cancer's existence and its potential danger. A public awareness program has been designed to increase consciousness about this possibly fatal disease and to enhance early detection and cure through a program of testicular self-examination (TSE). This proposal incorporates intervention at local, State, and national levels. It contemplates an innovative campaign beginning at the local level, focusing on the target population and utilizing a collaboration between nonprofessionals and professionals. The aim is for a grass-roots beginning and continued public interest to culminate in a national campaign, similar to that of breast self-examination. The ultimate goal of the program is to prevent the loss of lives to testicular cancer through public education and through use of TSE.