Using a theoretically informed process evaluation alongside a trial to improve oral health for care home residents.

BACKGROUND: Poor oral health is common among older adults residing in care homes impacting their diet, quality of life, self-esteem, general health and well-being. The care home setting is complex and many factors may affect the successful implementation of oral care interventions. Exploring these factors and their embedded context is key to understanding how and why interventions may or may not be successfully implemented within their intended setting. OBJECTIVES: This methodology paper describes the approach to a theoretically informed process evaluation alongside a pragmatic randomised controlled trial, so as to understand contextual factors, how the intervention was implemented and important elements that may influence the pathways to impact. MATERIALS AND METHODS: SENIOR is a pragmatic randomised controlled trial designed to improve the oral health of care home residents in the United Kingdom. The trial uses a complex intervention to promote and provide oral care for residents, including education and training for staff. RESULTS: An embedded, theoretically informed process evaluation, drawing on the PAHRIS framework and utilising a qualitative approach, will help to understand the important contextual factors within the care home that influence both the trial processes and the implementation of the intervention. CONCLUSION: Utilising an implementation framework as the basis for a theoretically informed process evaluation provides an approach that specifically focuses on the contextual factors that may influence and shape the pathways to impact a given complex intervention a priori, while also providing an understanding of how and why an intervention may be effective. This contrasts with the more common post hoc approach that only focuses on implementation after the empirical results have emerged.

Setting the context for a complex dental intervention of role substitution in care homes: Initial process evaluation findings.

OBJECTIVES: SENIOR (uSing rolE-substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation. BACKGROUND: The oral health and quality-of-life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs. MATERIALS AND METHODS: Semi-structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway-to-impact. Interviews were fully transcribed and analysed thematically. RESULTS: Three themes (receptive context, culture, and leadership) and 11 codes were generated. Data show the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services, and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice. CONCLUSION: Although role substitution could potentially meet the needs of this population, an in-depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.

Prevalence of Coronavirus Disease 2019 Infection and Outcomes Among Symptomatic Healthcare Workers in Seattle, Washington.

BACKGROUND: Healthcare workers (HCWs) who serve on the front lines of the coronavirus disease 2019 (COVID-19) pandemic have been at increased risk for infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in some settings. Healthcare-acquired infection has been reported in similar epidemics, but there are limited data on the prevalence of COVID-19 among HCWs and their associated clinical outcomes in the United States. METHODS: We established 2 high-throughput employee testing centers in Seattle, Washington, with drive-through and walk-through options for symptomatic employees in the University of Washington Medicine system and its affiliated organizations. Using data from these testing centers, we report the prevalence of SARS-CoV-2 infection among symptomatic employees and describe the clinical characteristics and outcomes among employees with COVID-19. RESULTS: Between 12 March 2020 and 23 April 2020, 3477 symptomatic employees were tested for COVID-19 at 2 employee testing centers; 185 (5.3%) employees tested positive for COVID-19. The prevalence of SARS-CoV-2 was similar when comparing frontline HCWs (5.2%) with nonfrontline staff (5.5%). Among 174 positive employees reached for follow-up at least 14 days after diagnosis, 6 reported COVID-related hospitalization; all recovered. CONCLUSIONS: During the study period, we observed that the prevalence of positive SARS-CoV-2 tests among symptomatic HCWs was comparable to that of symptomatic nonfrontline staff. Reliable and rapid access to testing for employees is essential to preserve the health, safety, and availability of the healthcare workforce during this pandemic and to facilitate the rapid return of SARS-CoV-2-negative employees to work.

The influence of adaptive challenge on engagement of multidisciplinary staff in standardising aseptic technique in an emergency department: A qualitative study.

AIMS AND OBJECTIVES: To explore the challenge of engaging multidisciplinary staff in standardising aseptic technique (AT) in an emergency department (ED) in an Australian tertiary hospital, and to better understand the enablers and barriers to implementing practice change within this setting. BACKGROUND: Healthcare-associated infections are the most common complication for patients in acute care. A clinical practice framework developed in the United Kingdom (UK) standardised AT practice to reduce potential infection risk. One Australian tertiary hospital drew upon this framework to similarly improve clinical practice. It was understood that standardising practice would require some practitioners only to revisit and demonstrate AT principles already embedded in their practice, while others would be challenged to adopt a new approach. DESIGN: Qualitative, descriptive research design. METHODS: Data were collected through focus groups held before and after implementation of the AT programme. Data were analysed using the framework method. The (COREQ) checklist was followed. RESULTS: Four emergent themes described the influence of motivation on individuals' beliefs and attitudes towards practice change, relationships within the ED context, delivery of education and management directives. CONCLUSION: Implementing practice change is more than just providing technical knowledge and includes changing individuals' beliefs and attitudes. An understanding of adaptive challenge can assist in implementing practice change that involves the multidisciplinary team. RELEVANCE TO CLINICAL PRACTICE: Results provide evidence as to how the adaptive challenge framework could be a suitable approach to manage potential enablers and barriers to implementing change within a multidisciplinary team in an acute hospital.

Calliphora vicina (Diptera: Calliphoridae) pupae: a timeline of external morphological development and a new age and PMI estimation tool.

The minimum postmortem interval (PMI(min)) is commonly estimated using calliphorid larvae, for which there are established age estimation methods based on morphological and development data. Despite the increased duration and sedentary nature of the pupal stage of the blowfly, morphological age estimation methods are poorly documented and infrequently used for PMI determination. The aim of this study was to develop a timeline of metamorphosis, focusing on the development of external morphology (within the puparium), to provide a means of age and PMI estimation for Calliphora vicina (Rob-Desvoidy) pupae. Under controlled conditions, 1,494 pupae were reared and sampled at regular time intervals. After puparium removal, observations of 23 external metamorphic developments were correlated to age in accumulated degree hours (ADH). Two age estimation methods were developed based on (1) the combination of possible age ranges observed for each characteristic and (2) regression analyses to generate age estimation equations employing all 23 characteristics observed and a subset of ten characteristics most significantly correlated with age. Blind sample analysis indicated that, using the combination of both methods, pupal age could be estimated to within ±500 ADH with 95% reliability.

Aquatic conditions & bacterial communities as drivers of the decomposition of submerged remains.

Aquatic decomposition, as a forensic discipline, has been largely under-investigated as a consequence of the highly complex and influential variability of the water environment. The limitation to the adaptability of scenario specific results justifies the necessity for experimental research to increase our understanding of the aquatic environment and the development of post-mortem submersion interval (PMSI) methods of estimation. This preliminary research aims to address this contextual gap by assessing the variation in the bacterial composition of aquatic biofilms as explained by water parameter measurements over time, associated with clothed and bare decomposing remains. As part of three field investigations, a total of 9 still-born piglets (n = 3, per trial) were used as human analogues and were submerged bare or clothed in either natural cotton or synthetic nylon. Changes in the bacterial community composition of the water surrounding the submerged remains were assessed at 4 discrete time points post submersion (7, 14, 21 and 28 days) by 16 S rRNA gene Next Generation Sequencing analysis and compared to coinciding water parameter measurements (i.e. conductivity, total dissolved solids (TDS), salinity, pH, and dissolved oxygen (DO)). Bacterial diversity was found to change over time and relative to clothing type, where significant variation was observed between synthetic nylon samples and bare/cotton samples. Seasonality was a major driver of bacterial diversity, where substantial variation was found between samples collected in early winter to those collected in mid - late winter. Water parameter measures of pH, salinity and DO were identified to best explain the global bacterial community composition and their corresponding dynamic trajectory patterns overtime. Further investigation into bacterial community dynamics in accordance with varying environmental conditions could potentially lead to the determination of influential extrinsic factors that may drive bacterial activity in aquatic decomposition. Together with the identification of potential bacterial markers that complement the different stages of decomposition, this may provide a future approach to PMSI estimations.

An examination of the Boston Naming Test: calculation of "estimated" 60-item score from 30- and 15-item scores in a cognitively impaired population.

OBJECTIVE: Multiple versions of the Boston Naming Test (BNT) exist, which makes comparison of findings from different studies difficult. The current project sought to determine if estimated 60-item BNT scores could be reliably calculated from 30- and 15-item administrations with patients diagnosed with Alzheimer's disease (AD). METHODS: Estimated 60-item scores were created for 30-item (even and odd) and 15-item Consortium to Establish a Registry for Alzheimer's disease (CERAD) versions of the BNT from a database containing item-level responses for all BNT items. Correlations were conducted between all three estimated 60-item scores and full 60-item version scores administered to all participants in the sample. RESULTS: The estimated versions were all highly correlated with the standard 60-item version of the BNT across the sample and these findings held when the sample was separated out by case (AD) and control status. Mean difference scores were very small for scores estimated from 30-item administrations; however, difference scores for the 15-item CERAD were much larger. CONCLUSIONS: Estimated 60-item versions of the BNT can be created from 30-item BNT administrations, which will enable comparisons across studies and allow integration of data from various AD research groups for increased power in analytic protocols. Creation of an estimated score from the 15-item CERAD version is not warranted.

Dipteran Attraction to a Variety of Baits: Implications for Trapping Studies as a Tool for Establishing Seasonal Presence of Significant Species.

Monitoring and collection of fly taxa (Diptera: Calliphoridae; Muscidae; Sarcophagidae) of medical, veterinary, and agricultural importance is often routine practice, providing data on target species presence, distribution and abundance. Collection practices currently involve baited trapping and while an inherent bias accompanying the choice of bait is acknowledged, there is little consistency in bait choice between studies and insufficient assessment of trapping success rates for bait types in current use. This study aimed to examine the effect of bait choice on trapping results for six commonly used bait types; a commercial bait (Envirosafe Fly Attractant, Envirosafe Products) and a combination of mixtures of liver, horse manure and 5% sodium sulfide (Na2S). Trapping success was compared under different seasonal conditions (Summer, Autumn, and Spring) to determine the most attractive bait for calliphorid species, with a secondary comparison of kangaroo versus ox liver occurring under summer conditions. Baits containing Na2S were the most successful in captures of all target taxa, with the addition of manure desirable, yielding increased diversity of taxa. Kangaroo liver baits attracted high numbers of Chrysomya spp. (Robineau-Desvoidy, Diptera: Calliphoridae), while Lucilia spp. (Robineau-Desvoidy, Diptera: Calliphoridae) were comparatively underrepresented in traps using liver alone. The use of a combined ox liver/manure/Na2S bait is recommended as the gold standard for generic screening of necrophagous flies. Where more specific target fly taxa are desired, such as Chrysomya spp. or Lucilia spp. only, alternate baits such as kangaroo or lamb may prove more attractive/successful.

The origin of unknown source DNA from touched objects.

The presence of DNA in a criminal investigation often requires scrutiny in relation to how it came to be where it was found. There is a paucity of data with respect to the extent to which one can assume that the last person handling an object, which has previously been touched by others, will contribute to the DNA profile generated from it. There are limited data in detailing the extent to which any foreign DNA is picked-up from a previously touched object and transferred to subsequently touched objects. This study focuses on DNA transfer and persistence on a knife handle after multiple handlings with the knife by different individuals soon after each other, as well as handprints left on flat DNA-free surfaces immediately after touching a knife handle with a known history of prior handling. The profiles of later handlers of a knife are more prominent than earlier handlers; however, the last handler is not always the major contributor to the profile. Proportional contributions to the profiles retrieved from knife handles vary depending on the individuals touching the knife handle. They can also vary when knife handles have been handled in the same manner by the same individuals in the same sequence on different occasions. Hands readily pickup DNA left on objects by others and transfer it to subsequently touched objects. The quantity of foreign DNA picked up by a hand and deposited on subsequently touched objects diminishes as more DNA-free objects are handled soon after each other. Caution is advised when considering how DNA from different individuals may have been transferred to the object from which it was collected.

Avoiding the "brick wall of awkward": Perspectives of youth with autism spectrum disorder on social-focused intervention practices.

Many youth with autism spectrum disorder participate in school-based, peer-mediated intervention programs designed to improve their social experiences. However, there is little research discerning how these youth view intervention practices currently represented in the literature, information which could improve the social validity of intervention programming. In this mixed-methods study, we interviewed 33 youth with autism spectrum disorder about seven social-focused, peer-mediated intervention components. We asked participants to rate the favorability of each component to determine their degree of liking. Subsequently, we asked participants to give a rationale for their rating, in order to explore influencing factors. Chi-square tests indicated that high ratings were most prevalent for recruiting peers and family involvement and medium ratings were most prevalent for meeting with peers. Analyses of variance also indicated that preferences in the specific format intervention components were delivered. Several themes emerged from our qualitative analysis of open-ended responses, including the ramifications of adults in adolescent social life, the advantages of learning through shared activities with peers, and the effects of disclosing disability status. Our findings will offer guidance for researchers and practitioners interested in individualizing interventions to reflect student preferences. Furthermore, we document areas of concern for youth with autism spectrum disorder as they access school-based interventions.

An alternative for the extraction and storage of DNA from insects in forensic entomology.

An important area of recent research in forensic entomology has been the use of insect DNA to provide identification of insects for fast and accurate estimation of time since death. This requires DNA to be extracted efficiently and in a state suitable for use in molecular procedures, and then stored on a long-term basis. In this study, Whatman FTA cards were tested for use with the Calliphoridae (Diptera). In particular, testing examined their ability to effectively extract DNA from specimens, and store and provide DNA template in a suitable condition for amplification using the polymerase chain reaction (PCR). The cards provided DNA that was able to be amplified from a variety of life stages, and thus appears to be of sufficient quality and quantity for use in subsequent procedures. FTA cards therefore appear suitable for use with calliphorids, and provide a new method of extraction that is simple and efficient and allows for storage and transportation without refrigeration, consequently simplifying the handling of DNA in forensic entomological cases.

DNA transfer by examination tools--a risk for forensic casework?

The introduction of profiling systems with increased sensitivity has led to a concurrent increase in the risk of detecting contaminating DNA in forensic casework. To evaluate the contamination risk of tools used during exhibit examination we have assessed the occurrence and level of DNA transferred between mock casework exhibits, comprised of cotton or glass substrates, and high-risk vectors (scissors, forceps, and gloves). The subsequent impact of such transfer in the profiling of a target sample was also investigated. Dried blood or touch DNA, deposited on the primary substrate, was transferred via the vector to the secondary substrate, which was either DNA-free or contained a target sample (dried blood or touch DNA). Pairwise combinations of both heavy and light contact were applied by each vector in order to simulate various levels of contamination. The transfer of dried blood to DNA-free cotton was observed for all vectors and transfer scenarios, with transfer substantially lower when glass was the substrate. Overall touch DNA transferred less efficiently, with significantly lower transfer rates than blood when transferred to DNA-free cotton; the greatest transfer of touch DNA occurred between cotton and glass substrates. In the presence of a target sample, the detectability of transferred DNA decreased due to the presence of background DNA. Transfer had no impact on the detectability of the target profile, however, in casework scenarios where the suspect profiles are not known, profile interpretation becomes complicated by the addition of contaminating alleles and the probative value of the evidence may be affected. The results of this study reiterate the need for examiners to adhere to stringent laboratory cleaning protocols, particularly in the interest of contamination minimisation, and to reduce the handling of items to prevent intra-item transfer.

Mitochondrial DNA cytochrome oxidase I gene: potential for distinction between immature stages of some forensically important fly species (Diptera) in western Australia.

Forensic entomology requires the fast and accurate identification of insects collected from a corpse for estimation of the postmortem interval (PMI). Identification of specimens is traditionally performed using morphological features of the insect. Morphological identification may be complicated however by the numerical diversity of species and physical similarity between different species, particularly in immature stages. In this study, sequencing was performed to study the mitochondrial DNA (mtDNA) as the prospective basis of a diagnostic technique. The sequencing focused on a section of the cytochrome oxidase I encoding region of mtDNA. Three species of calliphorid (blow flies) commonly associated with corpses in western Australia, Calliphora dubia, Chrysomya rufifacies and Lucilia sericata, in addition to specimens of Calliphora augur and Chrysomya megacephala were studied. Phylogenetic analysis of data revealed grouping of species according to genus. The DNA region sequenced allowed identification of all species, providing high support for separation on congeneric species. Low levels of variation between some species of the same genus however indicate that further sequencing is required to locate a region for development of a molecular-based technique for identification.

Optical coherence tomography: age estimation of Calliphora vicina pupae in vivo?

Necrophagous blowfly pupae are valuable contributors to the estimation of post-mortem interval, should an accurate age estimate be obtained. At present, this is reliant on a combination of rearing and destructive methods conducted on preserved samples, including morphological observation and gene expression analyses. This study demonstrates the use of optical coherence tomography (OCT) as a tool for in vivo morphological observation and pupal age estimation. Using a Michelson OCT microscope, alive and preserved four and ten-day old Calliphora vicina pupae were scanned in different orientations. Two and three-dimensional images were created. Morphological characteristics such as the brain, mouthparts and legs were identifiable in both living and preserved samples, with distinct differences noted between the two ages. Absorption of light by the puparium results in a vertical resolution of 1-2 mm, preventing observation of deeper tissues. The use of contrast agents or a longer wavelength laser would improve the images obtainable. At present, the data suggests OCT provides a primary view of external and internal morphology, which can be used to distinguish younger and older pupae for further analysis of age and PMI estimation.

Internal morphological analysis for age estimation of blow fly pupae (Diptera: Calliphoridae) in postmortem interval estimation.

Larvae and pupae of blow fly species are frequently used in postmortem interval estimation, their age indicating minimum time since death. Most studies have considered age estimation of larvae, neglecting study of pupae. Relative development of external pupal features is useful, but there are also internal changes during metamorphosis that may be indicators of age, utilizing histological techniques. This study aimed to optimize preservation and histological analysis of blow fly pupae, specifically Calliphora vicina Robineau-Desvoidy and Lucilia sericata (Meigen), and to examine internal features with potential for age estimation. Effect of hot-water-killing and different preservatives were examined. It was determined that blow fly pupae should be pierced through the three tagma, hot-water-killed, and preserved in 80% ethanol as the optimal preservation for subsequent analyses. Hematoxylin and eosin stained pupal sections revealed differences in brain and thoracic muscle development throughout the pupal stage with potential for age estimation.

Connecting Youth and Young Adults with Autism Spectrum Disorders to Community Life.

Equipping youth with autism spectrum disorders (ASD) to flourish during and after high school is central to the purpose and practice of special education. However, many students with ASD are leaving high school without the preparation and connections needed to engage meaningfully in their communities. This article reviews research-based approaches for connecting adolescents with ASD to life beyond the classroom by describing promising practices for fostering inclusion in postsecondary education and community activities. Recognizing that relationships are at the core of community life, emphasis is placed on fostering social connections as an essential aspect of helping young people with ASD thrive in these settings. We conclude with suggestions for school staff to support the successful transitions of young people with ASD.

Preservation of Calliphora vicina (Diptera: Calliphoridae) pupae for use in post-mortem interval estimation.

Post-mortem interval (PMI) is frequently calculated using immature stages of carrion frequenting Calliphoridae (Diptera). This is based on identification to species level, followed by age estimation of the samples. These two processes depend on suitable preservation of insects for subsequent analyses, yet preservation methods for the pupal stage are poorly defined and inappropriate methods may result in discolouration or nucleic acid degradation. This study examined the effects of 21 common preservation methods on Calliphora vicina pupae of 4 and 7d old, assessing consequences of the various methods for DNA-based species identification, age estimation using morphological analyses, and differential gene expression (DGE) studies. Pupae were examined within two weeks of preservation and again after 6-8 months. Of the methods tested, hot-water-killing (HWK) followed by storage in 80% ethanol at -20°C or 4°C was the best treatment for external morphology and histological analyses respectively. DNA based species identification was possible following all methods. RNA integrity and amplification were best when pupae were stored at -80°C or in RNAlater (-20°C), however HWK and storage in 80% ethanol at -20°C was also acceptable, and thus the latter is proposed as a universal preservative method for pupae. This study proposes a preservation method for pupae that enables DNA-based species identification, internal and external morphological analysis for age estimation, and DGE study to be carried out on a single specimen, enabling a multidisciplinary approach to age estimation from a single pupa.

Entomological evidence: lessons to be learnt from a cold case review.

Insects are known to be useful in estimating time since death, but this is only possible if samples are collected and preserved correctly according to best practices. This report describes a case where an 18-year old female was found dead and during the first medico-legal investigation which determined it was a homicide, entomological samples were collected but not considered. The case was then closed with no suspect. However, 9 years after the first investigation the courts decided that the case needed to be re-examined. In doing so the new review team decided that although the remaining entomological evidence was poorly preserved some extra information may be gained from its analyses. On inspection of the remaining samples of larvae no normal morphological analyses could be conducted. Molecular analyses were combined with an unorthodox morphological analysis to provide an estimate of the post-mortem interval based on insect evidence, indicating the value of multidisciplinary approaches to both cold and contemporary cases.

Performance on a measure of category fluency in cognitively impaired elderly.

Measures of verbal fluency are widely used in the assessment of cognitive functioning of the elderly. However, limited research has evaluated patterns (across specific timed intervals) of performance on tasks of language fluency in different forms of dementia. The current study investigated semantic fluency in 488 elderly individuals (249 with Alzheimer's dementia, 97 Vascular dementia, 97 Mild Cognitive Impairment and 45 cognitively intact) across 15-second intervals in an animal naming task using retrospective chart review. Normal controls produced significantly more exemplars and AD patients produced fewer animal names than the other groups. After the first 15- second time interval, the demented groups produced significantly fewer exemplars than the non-demented. At the end of 30 seconds it was possible to differentiate normal aging from MCI who no longer differed from the VaD group. Overall, it appears that the greatest and most clinically meaningful differences between the diagnostic groups were detected in the first three 15-second intervals. The present findings support the use of time intervals and total scores on tasks of verbal fluency in clinical settings and for research purposes.

Behavioral regulation: factor analysis and application of the Behavioral Dyscontrol Scale in dementia and mild cognitive impairment.

BACKGROUND: Executive dysfunction is a hallmark of both Dementia of the Alzheimer's Type (AD) and Vascular Dementia (VaD). A complete neuropsychological battery contains measures of executive function, but the focus tends to be on cognitive processes with verbal or written output. The Behavioral Dyscontrol Scale (BDS) is purported to be a measure of executive function that addresses control over voluntary motor behavior. Previous factor analyses revealed three-factor solutions using a variety of patient populations. Our goals were to examine the factor structure in a sample of geriatric outpatients and to apply that factor structure to detect possible differences between AD, VaD, amnestic Mild Cognitive Impairment (MCI), non-amnestic MCI, and normal controls. METHODS: An exploratory factor analysis was performed on 260 outpatient evaluations from 2002-2006. Only the seven items requiring motor responses were included. RESULTS: A two-factor solution emerged. We named the factors Motor Problem-Solving and Simple Motor Repetitive Behaviors. For the first factor, the AD and VaD groups differed from the MCI groups and normal controls, but did not differ from each other. There were no differences between the control, amnestic MCI, and non-amnestic MCI groups. There were no differences between the groups for the second factor. CONCLUSION: It was concluded that voluntary control of behavior that requires problem-solving for complex tasks may help differentiate dementia from mild cognitive impairment and normal aging.