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1.
Psychiatr Serv ; : appips20230277, 2024 Mar 06.
Article in English | MEDLINE | ID: mdl-38444365

ABSTRACT

OBJECTIVE: In 2017, the Veterans Health Administration (VHA) implemented a national suicide prevention program, called Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), that uses a predictive algorithm to identify, attempt to reach, assess, and care for patients at the highest risk for suicide. The authors aimed to evaluate whether facilitation enhanced implementation of REACH VET at VHA facilities not meeting target completion rates. METHODS: In this hybrid effectiveness-implementation type 2 program evaluation, a quasi-experimental pre-post design was used to assess changes in implementation outcome measures evaluated 6 months before and 6 months after onset of facilitation of REACH VET implementation at 23 VHA facilities. Measures included percentages of patients with documented coordinator and provider acknowledgment of receipt, care evaluation, and outreach attempt. Generalized estimating equations were used to compare differences in REACH VET outcome measures before and after facilitation. Qualitative interviews were conducted with personnel and were explored via template analysis. RESULTS: Time had a significant effect in all outcomes models (p<0.001). An effect of facilitation was significant only for the outcome of attempted outreach. Patients identified by REACH VET had significantly higher odds of having a documented outreach attempt after facilitation of REACH VET implementation, compared with before facilitation. Site personnel felt supported and reported that the external facilitators were helpful and responsive. CONCLUSIONS: Facilitation of REACH VET implementation was associated with an improvement in outreach attempts to veterans identified as being at increased risk for suicide. Outreach is critical for engaging veterans in care.

2.
Eur J Oncol Nurs ; 69: 102523, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38342058

ABSTRACT

PURPOSE: To examine the role and value of specialist metastatic breast care nurses in Australia from the perspective of metastatic breast care nurses, patients, and family members. Metastatic breast cancer (mBC) is treatable yet incurable, with distinct supportive care needs, yet many of these needs are unmet. METHOD: Diverse sampling methods were used to recruit 10 people with mBC, 5 family members and 10 metastatic breast care nurses. Semi-structured interviews were conducted online or by telephone during August-December 2020, and analysed thematically. RESULTS: The role of the specialist nurse was strongly valued within and across participant groups, with close alignment regarding what was highly valued. Three themes were identified. First, nurses played a vital role in giving voice and visibility to patients with mBC in a healthcare system in which they often felt invisible. Second, nurses combined their clinical and psychosocial skills with a sense of authentic engagement to create a safe space for those with mBC to discuss their feelings, experiences, and topics, especially those that were unlikely to be discussed in their other social and clinical interactions. Finally, nurses supported patients in living as well as possible while managing symptoms, ongoing treatment, and attendant psychosocial impacts of an incurable and life-limiting condition. CONCLUSIONS: This study underscores the central importance of metastatic breast care nurses in enhancing patient well-being, bridging gaps in care, and offering much-needed support. By addressing patients' emotional, clinical, and social needs, these specialist nurses contribute to a more holistic and compassionate approach to managing mBC.


Subject(s)
Breast Neoplasms , Nurses , Humans , Female , Delivery of Health Care , Breast Neoplasms/therapy , Patients , Empathy , Qualitative Research
3.
Sci Rep ; 13(1): 2292, 2023 02 09.
Article in English | MEDLINE | ID: mdl-36759558

ABSTRACT

Oceanic ctenophores are widespread predators on pelagic zooplankton. While data on coastal ctenophores often show strong top-down predatory impacts in their ecosystems, differing morphologies, prey capture mechanisms and behaviors of oceanic species preclude the use of coastal data to draw conclusion on oceanic species. We used high-resolution imaging methods both in situ and in the laboratory to quantify interactions of Ocyropsis spp. with natural copepod prey. We confirmed that Ocyropsis spp. uses muscular lobe contraction and a prehensile mouth to capture prey, which is unique amongst ctenophores. This feeding mechanism results in high overall capture success whether encountering single or multiple prey between the lobes (71 and 81% respectively). However, multiple prey require several attempts for successful capture whereas single prey are often captured on the first attempt. Digestion of adult copepods takes 44 min at 25 °C and does not vary with ctenophore size. At high natural densities, we estimate that Ocyropsis spp. consume up to 40% of the daily copepod standing stock. This suggests that, when numerous, Ocyropsis spp. can exert strong top-down control on oceanic copepod populations. At more common densities, these animals consume only a small proportion of the daily copepod standing stock. However, compared to data from pelagic fishes and oceanic medusae, Ocyropsis spp. appears to be the dominant copepod predator in this habitat.


Subject(s)
Copepoda , Ctenophora , Animals , Ecosystem , Feeding Behavior , Oceans and Seas , Nutritional Status , Predatory Behavior , Food Chain
4.
Arch Suicide Res ; 27(2): 818-828, 2023.
Article in English | MEDLINE | ID: mdl-34547986

ABSTRACT

OBJECTIVE: Suicide by former United States military service members is of great public health concern, and one area, veterans' suicide attempts involving firearms, is understudied. One group that has a unique perspective on this are veterans with a psychiatric admission following a firearm-related suicide crisis, such as making a suicide plan or a suicide rehearsal with a firearm within the preceding 72 hours. This study seeks to address this gap in the literature by describing the characteristics and context of non-fatal suicide events involving firearms among veterans. METHOD: This convergent parallel mixed-methods design study collected both quantitative and qualitative data from male veterans (N = 15) who were hospitalized due to a suicide attempt or serious ideation using a firearm. Veterans admitted to a Veterans Affairs Medical Center (VAMC) were interviewed and asked to complete a survey. Qualitative data on characteristics and context were analyzed using a thematic analysis. RESULTS: The fifteen male U.S. military veterans described their personal characteristics, such as their beliefs, family beliefs and structure, emotions, and employment status. Most participants were unemployed (n = 10; 67%), divorced (n = 7; 47%) or married (n = 5; 33%). Seven themes related to context emerged from qualitative interviews to include: combat trauma, non-combat trauma and negative life event(s), current and past suicide attempt(s), firearms, substance use, known deaths by suicide, and protective factors for suicide. CONCLUSION: Results suggest that engaging support networks and communities is essential when developing programs to promote identification of early warning signs and implementation of interventions or programs for reducing veteran suicide.


Subject(s)
Firearms , Veterans , Humans , Male , United States , Veterans/psychology , Suicide, Attempted/psychology , Suicidal Ideation , Hospitalization
5.
Q J Exp Psychol (Hove) ; 76(4): 792-826, 2023 Apr.
Article in English | MEDLINE | ID: mdl-35422148

ABSTRACT

What are the geometric and information processing characteristics of elementary figures composed of simple physical dimensions? There have been a number of investigations of perception of rectangles, including debate about configurality (e.g., integrality and gestalt properties) as well as the prime perceptual dimensions. Yet, because of ambiguity even in the "right" definition of configurality and an absence of penetrating methodologies, there is still little known concerning the information processing of these patterns. To this end, the present study brings together two separate theory-driven methodologies, general recognition theory (GRT) and systems factorial technology (SFT). The first attacks the problem of dimensional interactions while the latter seeks to uncover process characteristics such as architecture, decisional stopping rules, and workload capacity. The same observers and as much as possible, the same stimuli were used in both approaches. Through our GRT analyses, we found strong evidence for dependencies between the percepts of height and width on both within-stimulus and cross-stimulus bases. Height perception was better with narrow widths and width perception was superior with short heights. In addition, a significant positive within-trial correlation of dimensions was evidenced within squares but not with rectangles. Our SFT initiative uncovered consistent signatures of parallelism paired with super capacity, the latter appearing both through the traditional conditioning on being correct and still present when modest speed accuracy trade-off was accounted for. Thus, the SFT and GRT inferences were quite compatible with a plausible cause of the positive correlations being across-channel facilitatory interactions which led to super capacity processing.


Subject(s)
Cognition , Recognition, Psychology , Humans , Mathematics
6.
Front Psychol ; 13: 910740, 2022.
Article in English | MEDLINE | ID: mdl-36160519

ABSTRACT

The purpose of this study is to take preliminary steps to unify psychoacoustic techniques with reaction-time methodologies to address the perceptual mechanisms responsible for the detection of one vs. multiple sounds. We measured auditory redundancy gains for auditory detection of pure tones widely spaced in frequency using the tools of Systems Factorial Technology to evince the system architecture and workload capacity in two different scenarios (SOFT and LOUD). We adopted an experimental design in which the presence or absence of a target at each of two frequencies was combined factorially with two stimulus levels. Replicating previous work, results did not allow an assessment of system architecture due to a failure to observe factor influence at the level of distribution ordering for dual-target stimuli for both SOFT and LOUD scenarios. All subjects demonstrated very modest redundancy gains for the dual-target compared to the single-target stimuli, and results were similar for both LOUD and SOFT. We propose that these results can be predicted by a mental architecture that falls into the class of integrated subadditive parallel systems, using a well-supported assumption that reaction time is driven by loudness. We demonstrate that modeled loudness of the experimental sounds (which ranged between about 0.2 and 14 sones) is highly correlated with mean reaction time (r = -0.87), and we provide a proof-of-concept model based on Steven's Power law that predicts both a failure of distributional ordering for dual-target stimuli and very modest redundancy gains.

7.
Crit Rev Oncol Hematol ; 176: 103728, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35662585

ABSTRACT

Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.


Subject(s)
Caregivers , Neoplasms , Adult , Anxiety/epidemiology , Anxiety/etiology , Anxiety/therapy , Caregivers/psychology , Health Services Needs and Demand , Humans , Needs Assessment , Neoplasms/psychology , Neoplasms/therapy , Social Support , Surveys and Questionnaires
8.
Psychol Rev ; 129(3): 484-512, 2022 04.
Article in English | MEDLINE | ID: mdl-35446099

ABSTRACT

Systems factorial technology (SFT) is a theoretically derived methodology that allows for strong inferences to be made about underlying processing architectures (e.g., whether processing occurs in a pooled, coactive fashion or in serial or in parallel). Measures of mental architecture using SFT have been restricted to the use of error-free response times (RTs). In this article, through formal proofs and demonstrations, we extended the measure of architecture, the survivor interaction contrast (SIC), to RTs conditioned on whether they are correct or incorrect. We show that so long as an ordering relation (between stimulus conditions of different difficulty) is preserved, we learn that the canonical SIC predictions result when exhaustive processing is necessary and sufficient for a response. We further prove that this ordering relation holds for the popular Wiener diffusion model for both correct and error RTs but fails under some classes of a Poisson counter model, which affords a strong potential experimental test of the latter class versus the others. Our exploration also serves to point to the importance of detailed studies of how errors are made in perceptual and cognitive tasks. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Subject(s)
Technology , Humans , Reaction Time/physiology
9.
Atten Percept Psychophys ; 84(1): 101-123, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34935122

ABSTRACT

The multidimensional generalization of signal detection theory known as General Recognition Theory (GRT, Ashby & Townsend, Psychological Review, 93, 154-179 1986) has been used to model and characterize the ways in which changes in encoded perceptual information and the application of decisional operators can produce patterns in behavior that are consistent with notions such as configural processing and representation. In particular, a set of studies (e.g., Cornes et al.,, 2011; Wenger & Ingvalson; 2002, 2003) have shown how decisional influences might exert themselves in situations of configural perception, such that effects such as the Thatcher illusion can be obtained by way of shifts in decisional criteria. The present investigation brought to bear the combined tools of GRT and Systems Factorial Technology (SFT, Little et al.,, 2017; Townsend & Nozawa, 1995) with a classical illusion, to show that it is possible to induce a shift in a decisional criterion by way of varying payoffs and that this shift is accompanied by regular changes in the workload capacity statistic. The combined sets of analyses on the same stimuli reveal orderly effects on the decisional criteria (i.e., the signal detection parameter c), report independence (suggesting perceptual independence), invariant measures of sensitivity (i.e., the signal detection parameter [Formula: see text]),and exhaustive parallel processing accompanied by super capacity. We therefore propose wider use of the combined sets of tools, further exploration of the ability of decisional alterations to affect processing times while leaving accuracy largely unscathed, and reaching out to explore more of the information processing mechanisms of classical illusions.


Subject(s)
Illusions , Time Perception , Decision Making , Humans , Pattern Recognition, Visual , Recognition, Psychology
10.
Mol Biol Evol ; 38(12): 5806-5818, 2021 12 09.
Article in English | MEDLINE | ID: mdl-34459919

ABSTRACT

Sequence annotation is fundamental for studying the evolution of protein families, particularly when working with nonmodel species. Given the rapid, ever-increasing number of species receiving high-quality genome sequencing, accurate domain modeling that is representative of species diversity is crucial for understanding protein family sequence evolution and their inferred function(s). Here, we describe a bioinformatic tool called Taxon-Informed Adjustment of Markov Model Attributes (TIAMMAt) which revises domain profile hidden Markov models (HMMs) by incorporating homologous domain sequences from underrepresented and nonmodel species. Using innate immunity pathways as a case study, we show that revising profile HMM parameters to directly account for variation in homologs among underrepresented species provides valuable insight into the evolution of protein families. Following adjustment by TIAMMAt, domain profile HMMs exhibit changes in their per-site amino acid state emission probabilities and insertion/deletion probabilities while maintaining the overall structure of the consensus sequence. Our results show that domain revision can heavily impact evolutionary interpretations for some families (i.e., NLR's NACHT domain), whereas impact on other domains (e.g., rel homology domain and interferon regulatory factor domains) is minimal due to high levels of sequence conservation across the sampled phylogenetic depth (i.e., Metazoa). Importantly, TIAMMAt revises target domain models to reflect homologous sequence variation using the taxonomic distribution under consideration by the user. TIAMMAt's flexibility to revise any subset of the Pfam database using a user-defined taxonomic pool will make it a valuable tool for future protein evolution studies, particularly when incorporating (or focusing) on nonmodel species.


Subject(s)
Biodiversity , Immunity, Innate , Databases, Protein , Immunity, Innate/genetics , Markov Chains , Phylogeny , Protein Domains
11.
J Exp Biol ; 224(12)2021 06 15.
Article in English | MEDLINE | ID: mdl-34137893

ABSTRACT

Pulsatile jet propulsion is a common swimming mode used by a diverse array of aquatic taxa from chordates to cnidarians. This mode of locomotion has interested both biologists and engineers for over a century. A central issue to understanding the important features of jet-propelling animals is to determine how the animal interacts with the surrounding fluid. Much of our knowledge of aquatic jet propulsion has come from simple theoretical approximations of both propulsive and resistive forces. Although these models and basic kinematic measurements have contributed greatly, they alone cannot provide the detailed information needed for a comprehensive, mechanistic overview of how jet propulsion functions across multiple taxa, size scales and through development. However, more recently, novel experimental tools such as high-speed 2D and 3D particle image velocimetry have permitted detailed quantification of the fluid dynamics of aquatic jet propulsion. Here, we provide a comparative analysis of a variety of parameters such as efficiency, kinematics and jet parameters, and review how they can aid our understanding of the principles of aquatic jet propulsion. Research on disparate taxa allows comparison of the similarities and differences between them and contributes to a more robust understanding of aquatic jet propulsion.


Subject(s)
Decapodiformes , Swimming , Animals , Biomechanical Phenomena , Hydrodynamics , Rheology
12.
Patient Educ Couns ; 104(12): 3023-3031, 2021 12.
Article in English | MEDLINE | ID: mdl-33941422

ABSTRACT

OBJECTIVE: Given the stressful and emotional nature of cancer, challenging interactions between nurses, patients, and family frequently occur. Nurses are rarely equipped with strategies to avoid or de-escalate stressful situations with carers, which can include displays of conflict, anger, or dominance. A brief online education module (TRIO-Conflict) was developed to provide nurses with management strategies to use in situations of conflict. This study aimed to assess the feasibility, acceptability, and potential efficacy of TRIO-Conflict. METHODS: Nurses were recruited through an Australian breast cancer organisation (McGrath Foundation). Participants completed pre/post module measures of attitudes towards carers, confidence in their skills to effectively navigate challenging interactions with carers, and applied knowledge of management strategies. Data were analysed using Wilcoxon signed-rank tests. Qualitative feedback was analysed using content analysis. RESULTS: 52 nurses completed pre-/post- measures, with 4 semi-structured interviews conducted. Significant improvements in attitudes towards carers (p = .010) and confidence in one's own ability to manage challenging interactions with carers (p < .001) were found, but not knowledge of strategies. Most nurses found TRIO-Conflict very/extremely helpful (87%) and were satisfied with content (94%) and usability (93%). CONCLUSION: TRIO-Conflict utilised evidence-based learning techniques (provision of example phrases, video vignettes, reflective exercises) to improve nurses attitudes and confidence. PRACTICE IMPLICATIONS: TRIO-Conflict is a brief, targeted, clinically relevant, and easily accessible online training programme which could be widely disseminated to oncology nurses.


Subject(s)
Breast Neoplasms , Education, Distance , Nurses , Australia , Breast Neoplasms/therapy , Caregivers , Female , Humans , Pilot Projects
13.
Bio Protoc ; 11(7): e3974, 2021 Apr 05.
Article in English | MEDLINE | ID: mdl-33889668

ABSTRACT

Biohybrid robotics is a growing field that incorporates both live tissues and engineered materials to build robots that address current limitations in robots, including high power consumption and low damage tolerance. One approach is to use microelectronics to enhance whole organisms, which has previously been achieved to control the locomotion of insects. However, the robotic control of jellyfish swimming offers additional advantages, with the potential to become a new ocean monitoring tool in conjunction with existing technologies. Here, we delineate protocols to build a self-contained swim controller using commercially available microelectronics, embed the device into live jellyfish, and calculate vertical swimming speeds in both laboratory conditions and coastal waters. Using these methods, we previously demonstrated enhanced swimming speeds up to threefold, compared to natural jellyfish swimming, in laboratory and in situ experiments. These results offered insights into both designing low-power robots and probing the structure-function of basal organisms. Future iterations of these biohybrid robotic jellyfish could be used for practical applications in ocean monitoring.

14.
Atten Percept Psychophys ; 83(2): 748-762, 2021 Feb.
Article in English | MEDLINE | ID: mdl-33415710

ABSTRACT

Much progress has been made in the investigation of perceptual, cognitive, and action mechanisms under the assumption that when one subprocess precedes another, the first one starts and finishes before the other begins. We call such processes "Dondersian" after the Dutch physiologist who first formulated this concept. Serial systems obey this precept (e.g., Townsend, 1974). However, most dynamic systems in nature do not: instead, each subprocess communicates its state to its immediate successors continuously. Although the mathematics for physical systems has received extensive treatment over the last three centuries, applications to human cognition have been exiguous. Therefore, the pioneering papers by Charles Eriksen and colleagues on continuous flow dynamics (e.g., Eriksen & Schulz, Perception & Psychophysics, 25, 249-263, 1979; Coles et al.,, Journal of Experimental Psychology: Human Perception and Performance, 11(5), 529, 1985) must be viewed as truly revolutionary. Surprisingly, there has been almost no advancement on this front since. With the goal of bringing this theme back into the scientific consciousness and extending and deepening our understanding of such systems, we develop a taxonomy that emphasizes the fundamental characteristics of continuous flow dynamics. Subsequently, we complexify the treated systems in such a way as to illustrate the popular cascade model (Ashby, Psychological Review, 89, 599-607, 1982; McClelland, Psychological Review, 86, 287-330, 1979) and use it to simulate the classic findings of Eriksen and colleagues (Eriksen & Hoffman, Perception & Psychophysics, 12(2), 201-204, 1972).


Subject(s)
Cognition , Consciousness , Comprehension , Humans , Psychophysics
15.
Psychol Rev ; 128(1): 187-201, 2021 01.
Article in English | MEDLINE | ID: mdl-32881552

ABSTRACT

Systems Factorial Technology (SFT) is a popular framework for that has been used to investigate processing capacity across many psychological domains over the past 25+ years. To date, it had been assumed that no processing resources are used for sources in which no signal has been presented (i.e., in a location that can contain a signal but does not on a given trial). Hence, response times are purely driven by the signal-containing location or locations. This assumption is critical to the underlying mathematics of the capacity coefficient measure of SFT. In this article, we show that stimulus locations influence response times even when they contain no signal, and that this influence has repercussions for the interpretation of processing capacity under the SFT framework, particularly in conjunctive (AND) tasks-where positive responses require detection of signals in multiple locations. We propose a modification to the AND task requiring participants to fully identify both target locations on all trials. This modification allows a new coefficient to be derived. We apply the new coefficient to novel experimental data and resolve a previously reported empirical paradox, where observed capacity was limited in an OR detection task but super capacity in an AND detection task. Hence, previously reported differences in processing capacity between OR and AND task designs are likely to have been spurious. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Cognition , Cognitive Science , Models, Psychological , Humans , Reaction Time
16.
Biomimetics (Basel) ; 5(4)2020 Nov 21.
Article in English | MEDLINE | ID: mdl-33233340

ABSTRACT

Biohybrid robotic designs incorporating live animals and self-contained microelectronic systems can leverage the animals' own metabolism to reduce power constraints and act as natural chassis and actuators with damage tolerance. Previous work established that biohybrid robotic jellyfish can exhibit enhanced speeds up to 2.8 times their baseline behavior in laboratory environments. However, it remains unknown if the results could be applied in natural, dynamic ocean environments and what factors can contribute to large animal variability. Deploying this system in the coastal waters of Massachusetts, we validate and extend prior laboratory work by demonstrating increases in jellyfish swimming speeds up to 2.3 times greater than their baseline, with absolute swimming speeds up to 6.6 ± 0.3 cm s-1. These experimental swimming speeds are predicted using a hydrodynamic model with morphological and time-dependent input parameters obtained from field experiment videos. The theoretical model can provide a basis to choose specific jellyfish with desirable traits to maximize enhancements from robotic manipulation. With future work to increase maneuverability and incorporate sensors, biohybrid robotic jellyfish can potentially be used to track environmental changes in applications for ocean monitoring.

17.
BMJ Support Palliat Care ; 10(3): 276-286, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32499405

ABSTRACT

OBJECTIVES: To examine the effects of nurse-led interventions on the health-related quality of life, symptom burden and self-management/behavioural outcomes in women with breast cancer. METHODS: Cochrane Controlled Register of Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Embase databases were searched (January 1999 to May 2019) to identify randomised controlled trials (RCTs) and controlled before-and-after studies of interventions delivered by nurses with oncology experience for women with breast cancer. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomised trials. Intervention effects were synthesised by cancer trajectory using The Omaha System Intervention Classification Scheme. RESULTS: Thirty-one RCTs (4651 participants) were included. All studies were at risk of bias mainly due to inherent limitations such as lack of blinding and self-report data. Most studies (71%; n=22) reported at least one superior intervention effect. There were no differences in all outcomes between those who receive nurse-led surveillance care versus those who received physical led or usual discharge care. Compared with control interventions, there were superior teaching, guidance and counselling (63%) and case management (100%) intervention effects on symptom burden during treatment and survivorship. Effects of these interventions on health-related quality of life and symptom self-management/behavioural outcomes were inconsistent. DISCUSSION: There is consistent evidence from RCTs that nurse-led surveillance interventions are as safe and effective as physician-led care and strong evidence that nurse-led teaching, guidance and counselling and case management interventions are effective for symptom management. Future studies should ensure the incorporation of health-related quality of life and self-management/behavioural outcomes and consider well-designed attentional placebo controls to blind participants for self-report outcomes. PROTOCOL REGISTRATION: The International Prospective Register of Systematic Reviews (PROSPERO): CRD42020134914).


Subject(s)
Breast Neoplasms/nursing , Hospice and Palliative Care Nursing/methods , Palliative Care/methods , Practice Patterns, Nurses'/statistics & numerical data , Quality of Life , Disease Management , Female , Humans , Randomized Controlled Trials as Topic , Treatment Outcome
18.
J Gen Intern Med ; 35(4): 1001-1010, 2020 04.
Article in English | MEDLINE | ID: mdl-31792866

ABSTRACT

BACKGROUND: Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. OBJECTIVE: To examine the time and organizational cost of facilitating implementation of primary care mental health integration. DESIGN: Descriptive analysis. PARTICIPANTS: One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. INTERVENTION: Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. MAIN MEASURES: We documented facilitators' and stakeholders' time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. KEY RESULTS: The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. CONCLUSIONS: Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.


Subject(s)
Mental Health Services , Mental Health , Delivery of Health Care , Humans , Primary Health Care , Stakeholder Participation
19.
PLoS One ; 14(3): e0213191, 2019.
Article in English | MEDLINE | ID: mdl-30913219

ABSTRACT

Biodiversity loss is driven by interacting factors operating at different spatial scales. Yet, there remains uncertainty as to how fine-scale environmental conditions mediate biological responses to broad-scale stressors. We surveyed intertidal rocky shore kelp beds situated across a local gradient of wave action and evaluated changes in kelp diversity and abundance after more than two decades of broad scale stressors, most notably the 2013-2016 heat wave. Across all sites, species were less abundant on average in 2017 and 2018 than during 1993-1995 but changes in kelp diversity were dependent on wave exposure, with wave exposed habitats remaining stable and wave sheltered habitats experiencing near complete losses of kelp diversity. In this way, wave exposed sites have acted as refugia, maintaining regional kelp diversity despite widespread local declines. Fucoids, seagrasses and two stress-tolerant kelp species (Saccharina sessilis, Egregia menziesii) did not decline as observed in other kelps, and the invasive species Sargassum muticum increased significantly at wave sheltered sites. Long-term monitoring data from a centrally-located moderate site suggest that kelp communities were negatively impacted by the recent heatwave which may have driven observed losses throughout the region. Wave-sheltered shores, which saw the largest declines, are a very common habitat type in the Northeast Pacific and may be especially sensitive to losses in kelp diversity and abundance, with potential consequences for coastal productivity. Our findings highlight the importance of fine-scale environmental heterogeneity in mediating biological responses and demonstrate how incorporating differences between habitat patches can be essential to capturing scale-dependent biodiversity loss across the landscape.


Subject(s)
Biodiversity , Kelp/physiology , Canada , Ecosystem , Environmental Monitoring , Pacific Ocean , Sargassum/physiology , Temperature , Zosteraceae/physiology
20.
Biol Bull ; 236(1): 55-65, 2019 02.
Article in English | MEDLINE | ID: mdl-30707604

ABSTRACT

Ctenophores, or comb jellies, are among the earliest-diverging extant animal lineages. Several recent phylogenomic studies suggest that they may even be the sister group to all other animals. This unexpected finding remains difficult to contextualize, particularly given ctenophores' unique and sometimes poorly understood physiology. Colloblasts, a ctenophore-specific cell type found on the surface of these animals' tentacles, are emblematic of this difficulty. The exterior of the colloblast is dotted with granules that burst and release an adhesive on contact with prey, ensnaring it for consumption. To date, little is known about the fast-acting underwater adhesive that these cells secrete or its biochemistry. We present evidence that proteins in the colloblasts of the ctenophore Pleurobrachia bachei incorporate catecholic compounds similar to the amino acid l-3,4-dihydroxyphenylalanine. These compounds are associated with adhesive-containing granules on the surface of colloblasts, suggesting that they may play a role in prey capture, akin to dihydroxyphenylalanine-based adhesives in mussel byssus. We also present unexpected evidence of similar catecholic compounds in association with the subepithelial nerve net. There, catecholic compounds are present in spatial patterns similar to those of l-3,4-dihydroxyphenylalanine and its derivatives in cnidarian nerves, where they are associated with membranes and possess unknown functionality. This "structural" use of catecholic molecules in ctenophores represents the earliest-diverging animal lineage in which this trait has been observed, though it remains unclear whether structural catechols are deeply rooted in animals or whether they have arisen multiple times.


Subject(s)
Catechols/metabolism , Ctenophora/chemistry , Ctenophora/metabolism , Dihydroxyphenylalanine/metabolism , Proteins/chemistry , Animals , Biological Evolution , Dihydroxyphenylalanine/chemistry , Nerve Net/chemistry
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