Few "intervention agnostic" strategies have been developed that can be applied to the broad array of evidence-based practices (EBPs) in schools. This paper describes two studies that reflect the ...initial iterative redesign phases of an effective leadership-focused implementation strategy-Leadership and Organizational Change for Implementation (LOCI)-to ensure its acceptability, feasibility, contextual appropriateness, and usability when used in elementary schools. Our redesigned strategy-Helping Educational Leaders Mobilize Evidence (HELM)-is designed to improve principals' use of strategic implementation leadership to support the adoption and high-fidelity delivery of a universal EBP to improve student outcomes.
In Study 1, focus groups were conducted (
= 6) with 54 district administrators, principals, and teachers. Stakeholders provided input on the appropriateness of original LOCI components to maximize relevance and utility in schools. Transcripts were coded using conventional content analysis. Key themes referencing low appropriateness were summarized to inform LOCI adaptations. We then held a National Expert Summit (Study 2) with 15 research and practice experts. Participants provided feedback via a nominal group process (NGP;
= 6 groups) and hackathon (
= 4 groups). The research team rated each NGP suggestion for how actionable, impactful/effective, and feasible it was. We also coded hackathon notes for novel ideas or alignment with LOCI components.
Study 1 suggestions included modifications to LOCI content and delivery. Study 2's NGP results revealed most recommendations to be actionable, impactful/effective, and feasible. Hackathon results surfaced two novel ideas (distributed leadership teams and leaders' knowledge to support educators EBP use) and several areas of alignment with LOCI components.
Use of these iterative methods informed the redesign of LOCI and the development of HELM. Because it was collaboratively constructed, HELM has the potential to be an effective implementation strategy to support the use of universal EBP in schools.
Background
Strategies to implement evidence-based interventions (EBIs) in children’s mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are ...outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children’s mental health services, to be used for implementation planning, research, and quality improvement.
Methods
Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants, each representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregivers, and youth. A partially directed conventional content analysis with consensus decision making was used to code ripple effects.
Results
Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Categories include general knowledge, skills, attitudes, and confidence about using EBIs; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one’s own life.
Conclusions
This research advances the field by providing children’s mental health implementers, researchers, funders, policy makers, and consumers with a menu of potential ripple effects. It can be a practical tool to ensure compliance with guidance from Quality Improvement/Quality Assurance, Complexity Science, and Diffusion of Innovation Theory. Future phases will match potential ripple effects with salient children’s mental health implementation strategies for each participant role.
Plain Language Summary: This qualitative study of multiple stakeholders in children’s mental health services identifies several possible ripple effects of implementation strategies, opening a new area of study for implementation science. Ripple effects can be positive, negative, or neutral within the full balance of implementation quality and impact. The list of ripple effects will provide implementation scientists, developers, and others with a useful tool during implementation planning and evaluation. This expert-informed methodology can provide a model for other fields for exploring possible ripple effects within implementation science.
Student-teacher relationships are critical to ensuring successful transitions to high school, but programs focused on building strong relationships have been concentrated at younger school levels. ...Therefore, the purpose of this study was to gather feedback from ninth grade students, teachers/staff, and administrators regarding an existing student-teacher relationship intervention, Establish-Maintain-Restore (EMR), to inform a “scaling-out” adaptation of EMR for high schools. Data were collected from 7 administrators, 8 teachers/staff, and 10 ninth-grade students from diverse ethnic/ racial backgrounds. Participants quantitatively rated the acceptability and effectiveness of EMR strategy for the high school context and then described their rationale for their ratings in focus groups. ANOVAs were used to examine differences in appropriateness and effectiveness of EMR strategies across participant groups. We then used content analysis to explore identified problems and recommendations regarding discrepant strategies. We discuss implications for relationships at the high school level and for scaling-out interventions to novel developmental contexts.
Dynamic Causal Modelling (DCM) is the predominant method for inferring effective connectivity from neuroimaging data. In the 15 years since its introduction, the neural models and statistical ...routines in DCM have developed in parallel, driven by the needs of researchers in cognitive and clinical neuroscience. In this guide, we step through an exemplar fMRI analysis in detail, reviewing the current implementation of DCM and demonstrating recent developments in group-level connectivity analysis. In the appendices, we detail the theory underlying DCM and the assumptions (i.e., priors) in the models. In the first part of the guide (current paper), we focus on issues specific to DCM for fMRI. This is accompanied by all the necessary data and instructions to reproduce the analyses using the SPM software. In the second part (in a companion paper), we move from subject-level to group-level modelling using the Parametric Empirical Bayes framework, and illustrate how to test for commonalities and differences in effective connectivity across subjects, based on imaging data from any modality.
•This guide walks through a group effective connectivity study using DCM and PEB.•Part 1, presented here, covers first level analysis using DCM for fMRI.•It clarifies the specific neural and haemodynamic models in DCM and their priors.•An accompanying dataset is provided with step-by-step analysis instructions.
Abstract
Growth-promoting technologies such as implants, ionophores, and β-agonists improve feedlot performance, efficiency, and carcass characteristics of cattle. The objective of this experiment ...was to determine the effects of dose and duration of ractopamine hydrochloride (RH) on feedlot performance and carcass characteristics when fed to Holstein steers. A randomized complete block design was used with a 3 × 3 factorial arrangement of treatments with 3 RH doses (0, 300, or 400 mg∙steer−1∙d−1) fed for 3 durations (28, 35, or 42 d). Holstein steers (n = 855; initial body weight BW = 448 ± 37 kg) were blocked by BW and randomly allocated to 1 of 9 pens (15 blocks; 9 dose × duration treatment combinations) approximately 72 d before harvest. Weekly pen weights, chute temperament scores, and animal mobility were determined during the RH feeding period. At harvest, carcass data were collected on all steers, and tenderness was measured on steaks from 3 or 4 randomly selected steers from each pen and slice shear force (SSF) was determined on one steak selected from each side of the carcass after aging for 14 or 21 d. For feedlot performance, carcass characteristics, and SSF, no dose × duration interactions were observed (P ≥ 0.11). With increasing RH dose, average daily gain (ADG) and gain-to-feed ratio (G:F) increased linearly (P ≤ 0.01), whereas BW gain increased linearly with RH dose and duration (P ≤ 0.01). Hot carcass weight (P = 0.02) and longissimus muscle (LM) area (P ≤ 0.01) increased linearly with increasing RH dose. The percentage of carcasses in the USDA Yield Grade 2 category increased linearly (P ≤ 0.01) and percentage of carcasses in the USDA Yield Grade 4 category tended (P = 0.08) to decrease linearly as RH dose increased. In the 14-d aged steaks, the percentage of steaks with SSF ≤ 15.3 kg decreased linearly (P ≤ 0.01), whereas the percentage of steaks with ≥20.0 kg SSF increased linearly (P ≤ 0.01) with increasing RH dose. After 21-d aging, there was a tendency (P = 0.06) for a greater percentage of steaks from steers fed RH to have SSF ≥ 20.0 kg (2% of total steaks), but no difference (P ≥ 0.12) in the percentage of steaks with SSF ≤ 19.9 kg. Final chute temperament (P ≥ 0.45) and animal mobility (P ≥ 0.67) scores were not affected by feeding RH. Increasing the dose of RH (300 or 400 mg∙steer−1∙d−1) fed for 28 to 42 d before harvest increased ADG, G:F, hot carcass weight, and LM area when fed to Holstein steers with no negative effects on behavior or mobility. The percentage of steaks classified as not tender improved when steaks were aged for 21 d from steers treated with RH.
Growth-promoting technologies such as implants, ionophores, and beta-agonists improve feedlot performance, efficiency, and carcass characteristics of cattle. The objective of this experiment was to ...determine the effects of dose and duration of ractopamine hydrochloride (RH) on feedlot performance and carcass characteristics when fed to Holstein steers. A randomized complete block design was used with a 3 * 3 factorial arrangement of treatments with 3 RH doses (0, 300, or 400 mg*steer.sup.-1*d.sup.-1) fed for 3 durations (28, 35, or 42 d). Holstein steers (n = 855; initial body weight BW = 448 + or - 37 kg) were blocked by BW and randomly allocated to 1 of 9 pens (15 blocks; 9 dose x duration treatment combinations) approximately 72 d before harvest. Weekly pen weights, chute temperament scores, and animal mobility were determined during the RH feeding period. At harvest, carcass data were collected on all steers, and tenderness was measured on steaks from 3 or 4 randomly selected steers from each pen and slice shear force (SSF) was determined on one steak selected from each side of the carcass after aging for 14 or 21 d. For feedlot performance, carcass characteristics, and SSF, no dose * duration interactions were observed (P greater than or equal to 0.11). With increasing RH dose, average daily gain (ADG) and gain-to-feed ratio (G:F) increased linearly (P less than or equal to 0.01), whereas BW gain increased linearly with RH dose and duration (P less than or equal to 0.01). Hot carcass weight (P = 0.02) and longissimus muscle (LM) area (P less than or equal to 0.01) increased linearly with increasing RH dose. The percentage of carcasses in the USDA Yield Grade 2 category increased linearly (P less than or equal to 0.01) and percentage of carcasses in the USDA Yield Grade 4 category tended (P = 0.08) to decrease linearly as RH dose increased. In the 14-d aged steaks, the percentage of steaks with SSF less than or equal to 15.3 kg decreased linearly (P less than or equal to 0.01), whereas the percentage of steaks with greater than or equal to 20.0 kg SSF increased linearly (P less than or equal to 0.01) with increasing RH dose. After 21-d aging, there was a tendency (P = 0.06) for a greater percentage of steaks from steers fed RH to have SSF greater than or equal to 20.0 kg (2% of total steaks), but no difference (P greater than or equal to 0.12) in the percentage of steaks with SSF less than or equal to 19.9 kg. Final chute temperament (P greater than or equal to 0.45) and animal mobility (P greater than or equal to 0.67) scores were not affected by feeding RH. Increasing the dose of RH (300 or 400 mg*steer.sup.-1*d.sup.-1) fed for 28 to 42 d before harvest increased ADG, G:F, hot carcass weight, and LM area when fed to Holstein steers with no negative effects on behavior or mobility. The percentage of steaks classified as not tender improved when steaks were aged for 21 d from steers treated with RH. Key words: beta-adrenergic agonist, carcass quality, feedlot performance, Holstein steers, mobility, ractopamine hydrochloride
Understanding why and how extremely preterm infants die is important for practitioners caring for these infants.
To examine risk factors, causes, timing, and circumstances of death in a modern cohort ...of extremely preterm infants.
A retrospective cohort review of infants enrolled in the Preterm Erythropoietin Neuroprotection Trial between December 13, 2013, and September 26, 2016, was conducted. A total of 941 infants born between 24 0/7 and 27 6/7 weeks of gestation enrolled at 19 US sites comprising 30 neonatal intensive care units were included. Data analysis was performed from October 16, 2020, to December 1, 2021.
Risk factors, proximal causes, timing, and circumstances of in-hospital death.
Of the 941 enrolled infants, 108 died (11%) before hospital discharge: 38% (n = 41) at 24 weeks' gestation, 30% (n = 32) at 25 weeks' gestation, 19% (n = 20) at 26 weeks' gestation, and 14% (n = 15) at 27 weeks' gestation. An additional 9 infants (1%) died following hospital discharge. In descending order, the primary causes of death included respiratory distress or failure, pulmonary hemorrhage, necrotizing enterocolitis, catastrophic intracranial hemorrhage, sepsis, and sudden unexplained death. Fifty percent of deaths occurred within the first 10 days after birth. The risk of death decreased with day of life and postmenstrual age such that an infant born at 24 weeks' gestation who survived 14 days had the same risk of death as an infant born at 27 weeks' gestation: conditional proportional risk of death, 0.08 (95% CI, 0.03-0.13) vs 0.06 (95% CI, 0.01-0.11). Preterm labor was associated with a decreased hazard of death (hazard ratio HR, 0.45; 95% CI, 0.31-0.66). Infant clinical factors associated with death included birth weight below the tenth percentile for gestational age (HR, 2.11; 95% CI, 1.38-3.22), Apgar score less than 5 at 5 minutes (HR, 2.19; 95% CI, 1.48-3.24), sick appearance at birth (HR, 2.49; 95% CI, 1.69-3.67), grade 2b-3 necrotizing enterocolitis (HR, 7.41; 95% CI, 5.14-10.7), pulmonary hemorrhage (HR, 10.0; 95% CI, 6.76-18.8), severe intracranial hemorrhage (HR, 4.60; 95% CI, 3.24-5.63), and severe sepsis (HR, 4.93; 95% CI, 3.67-7.21). Fifty-one percent of the infants received comfort care before death.
In this cohort study, an association between mortality and gestational age at birth was noted; however, for each week that an infant survived, their risk of subsequent death approximated the risk observed in infants born 1 to 2 weeks later, suggesting the importance of an infant's postmenstrual age. This information may be useful to include in counseling of families regarding prognosis of survival.
Dynamic Causal Modelling (DCM) is the predominant method for inferring effective connectivity from neuroimaging data. In the 15 years since its introduction, the neural models and statistical ...routines in DCM have developed in parallel, driven by the needs of researchers in cognitive and clinical neuroscience. In this tutorial, we step through an exemplar fMRI analysis in detail, reviewing the current implementation of DCM and demonstrating recent developments in group-level connectivity analysis. In the first part of the tutorial (current paper), we focus on issues specific to DCM for fMRI, unpacking the relevant theory and highlighting practical considerations. In particular, we clarify the assumptions (i.e., priors) used in DCM for fMRI and how to interpret the model parameters. This tutorial is accompanied by all the necessary data and instructions to reproduce the analyses using the SPM software. In the second part (in a companion paper), we move from subject-level to group-level modelling using the Parametric Empirical Bayes framework, and illustrate how to test for commonalities and differences in effective connectivity across subjects, based on imaging data from any modality.
This is the first book to concentrate on dysphagia in rare conditions those that occur infrequently or those that may occur more frequently but are only sometimes associated with dysphagia. ...Covering a wide range of conditions from progressive supranuclear palsy (PSP), through connective tissue disease, to conditions as diverse as West Nile virus the editors and expert contributors efficiently synthesize the available information to provide the essentials needed to help clinicians to perform sophisticated assessments,.
Two objectives for the nation for 1990 set goals related to the need for schoolchildren and adults to understand the causes of oral diseases and methods of prevention. Five questions related to these ...objectives were included in the 1985 National Health Interview Survey. Survey responses of adults ages 18 years and older indicated that while the public is generally aware of the importance of a number of factors in the prevention of tooth decay, only 18 percent had both heard of, and knew the purpose of, dental sealants. At the same time, the public fails to discriminate between effective disease preventive factors related to periodontal diseases as opposed to those related to dental decay. Knowledge of oral disease prevention modalities generally varies across educational, income, age, and racial categories. However, there appears to be little variation in knowledge by gender. Additional information from upcoming surveys may shed more light on the relationships between knowledge of oral diseases and their prevention and personal preventive practices.
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