Establishing an evidenced-based dietetic model of care in haemodialysis using implementation science

To establish an evidence-based dietetics service in an in-centre haemodialysis unit utilising implementation science.The service was developed through the Knowledge-to-Action Framework. The steps of the Action Cycle were addressed through a literature review, identification of evidence-based guidelines, benchmarking and local staff engagement. The theoretical domains framework (TDF) was used to identify barriers/enablers, and behaviour change wheel to determine appropriate interventions. To monitor, evaluate outcomes and assess sustained knowledge use we employed multidisciplinary team engagement and database use. Audit data were collected at baseline, 6 and 12 months on nutrition assessment (Patient-Generated Subjective Global Assessment), intervention timeliness and alignment to dietetic workforce recommendations. Descriptive statistics, McNemar tests and a linear mixed model were applied.Barriers existed in the knowledge, skills, environmental context and resources TDF domains. Suitable interventions were identified with training on nutritional management of haemodialysis patients delivered to 148 nurses, and nutrition management recommendations summarised into local procedural resources. A database to prompt and monitor outcome measures was created and indicated that over 18 months post-service commencement, eligible patients received nutrition assessment at least 6-monthly, aligning with recommendations. Prevalence of malnutrition was 28% (n = 9/32) at baseline, 23% (n = 5/22) at 6 months and 20% (n = 4/20) at 12 months (P = 0.50).We demonstrated benefits to service development and implementation with implementation science providing a structured and methodical approach to translating guidelines into practice. Development of training, resources and prompts for outcome measures has supported the establishment of an evidence-based dietetics service in a haemodialysis unit

Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework

This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM).The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed.The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an 'alert' tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition.Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients

Creating room for citizen perspectives in ‘smart city’ Amsterdam through interactive theatre

The ‘smart city’ vision is popular, but it lacks citizen perspectives. The aim of this study was to gain insight into whether and how art-based citizen engagement can create more room for citizen perspectives in smart cities by developing and testing an art-based citizen engagement project in Amsterdam, the Netherlands. To that end, a combination of interactive theatre, interaction design and social research methods was used to bring together diverse publics and innovation professionals for joint exploration of increased dataveillance in cities. The events were studied through observations, and through interviews with participants and organisers. Data analysis was guided by the outcomes, processes and challenges of the responsible innovation dimensions: inclusion, reflexivity, anticipation and responsiveness (Stilgoe et al., 2013). The most important achievements of art-based citizen engagement were: engaging people who would not have engaged with the topic otherwise, encouraging participants to question common phrases and assumptions, exploring future social implications of technologies, and staging meaningful interactions between citizens and professionals. The most significant challenge was to involve citizens in a way that could influence innovation trajectories

Are Sensory-Motor Relationships Encoded ad hoc or by Default?: An ERP Study

Published: 03 May 2019In this event-related potentials study we tested whether sensory-motor relations between concrete words are encoded by default or only under explicit ad hoc instructions. In Exp. 1, participants were explicitly asked to encode sensory-motor relations (e.g., “do the following objects fit in a pencil-cup?”), while other possible semantic relations remained implicit. In Exp. 2, using the same materials other group of participants were explicitly asked to encode semantic relations (e.g., “are the following objects related to a pencil-cup?”), and the possible sensory-motor relations remained implicit. The N400 component was sensitive to semantic relations (e.g., “desk” related to “pencil-cup”) both under implicit (Exp. 1) and explicit instructions (Exp. 2). By contrast, most sensory-motor relations (e.g., “pea” fitting in “pencil-cup”) were encoded ad hoc under explicit instructions (Exp. 1). Interestingly some sensory-motor relations were also encoded implicitly, but only when they corresponded to “functional” actions associated with high-related objects (e.g., “eraser” fitting in “pencil-cup”) and occurring at a late time window (500–650 ms; Exp. 2), suggesting that this type of sensory-motor relations were encoding by default.This research was supported by the Spanish MINECO (Grant Nos. PSI2015-66277-R to MdV and PSI2016-79624-P to HB) and the European Regional Development Funds

Exploring the temporal dynamics of speech production with EEG and group ICA

Speech production is a complex skill whose neural implementation relies on a large number of different regions in the brain. How neural activity in these different regions varies as a function of time during the production of speech remains poorly understood. Previous MEG studies on this topic have concluded that activity proceeds from posterior to anterior regions of the brain in a sequential manner. Here we tested this claim using the EEG technique. Specifically, participants performed a picture naming task while their naming latencies and scalp potentials were recorded. We performed group temporal Independent Component Analysis (group tICA) to obtain temporally independent component timecourses and their corresponding topographic maps. We identified fifteen components whose estimated neural sources were located in various areas of the brain. The trial-by-trial component timecourses were predictive of the naming latency, implying their involvement in the task. Crucially, we computed the degree of concurrent activity of each component timecourse to test whether activity was sequential or parallel. Our results revealed that these fifteen distinct neural sources exhibit largely concurrent activity during speech production. These results suggest that speech production relies on neural activity that takes place in parallel networks of distributed neural sources

Засади та історія становлення соціального вчення Українського католицизму

In equine medicine the use of Botox® is experimental. Dosages are determined from human treatment-protocols and limited numbers of equine studies. Determination of target-muscle volume can be helpful to extrapolate human dosages. The aim of the study was to calculate a formula enabling the estimation of the deep digital flexor muscle (DDFM) volume based on distances between anatomical landmarks. Nineteen cadaveric limbs were collected and distance A (top of olecranon to Os carpi accessorium) and B (circumference of limb) were measured. Converting mathematical formulas, C was calculated: π × (((0.5B)/π)(2)) × A. DDFM volume was determined by water displacement. Linear Regression Analysis was used to analyse data. The line best fitting the observed points was: Ln(volume[ml]) = -1.89 + 0.98 × Ln(value C[cm(3)]). Correlation was highest when natural logarithm was applied to both variables and was 0.97. The calculated formula enables estimating DDFM volume of a living horse. This estimated volume can be useful to apply human Botox® treatment-protocols

Electrophysiological signature of the interplay between habits and inhibition in response to smoking-related cues in individuals with a smoking habit: An event-related potential study

First published: 24 February 2023The rigid, stimulus-bound nature of drug seeking that characterizes substance use disorder (SUD) has been related to a dysregulation of motivational and early attentional reflexive and inhibitory reflective systems. However, the mechanisms by which these systems are engaged by drug-paired conditioned stimuli (CSs) when they promote the enactment of seeking habits in individuals with a SUD have not been elucidated. The present study aimed behaviourally and electrophysiologically to characterize the nature of the interaction between the reflexive and reflective systems recruited by CSs in individuals with a smoking habit. We measured the behavioural performance and associated event-related potentials (ERPs) of 20 individuals with a smoking habit and 20 controls, who never smoked regularly, in a modified Go/NoGo task during which smoking-related CSs, appetitive and neutral pictures, presented either in first or third-person visual perspective were displayed 250 ms before the Go/NoGo cue. We show that smoking-related cues selectively influence early incentive motivation-related attention bias (N2 after picture onset), motor readiness and behavioural inhibition (Go-P3, NoGo-P3 and Pc) of individuals with a smoking habit only when presented from a first-person visual perspective. These data together identify the neural signature of the aberrant engagement of the reflexive and reflective systems during the recruitment of an incentive habit by CSs presented as if they had been response-produced, that is, as conditioned reinforcers.This work was conducted at the Laboratory of Cognitive Neuroscience and Psycholinguistics, University of La Laguna. J.D. was supported by a Postdoctoral fellowship from the University of La Laguna (Programa Agustin de Betancourt). HAB was supported by the Spanish Ministry of Science and Innovation (grant PID2020-118487GBI00). D.B. was supported by a Medical Research Council Programme grant (MR/N02530X/1) to DB, Barry Everitt, Amy Milton, Jeffrey Dalley and Trevor Robbins. The authors would to thank Dr Tristan Hynes for their careful reading of the proof of this manuscript

Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods.

<p>Abstract</p> <p>Background</p> <p>Important health benefits can be achieved when physical activity in children from low socio-economic status is promoted and sedentariness is limited. By specifying the mediating mechanisms of existing interventions one can improve future physical activity interventions. This study explored potential mediators of the long-term effect of the school-based multicomponent JUMP-in intervention on sport participation, outdoor play and screen time in Dutch primary schoolchildren from disadvantaged neighborhoods.</p> <p>Methods</p> <p>In total, 600 primary schoolchildren (aged 9.8 ± 0.7, 51% girls, 13% Dutch ethnicity, 35% overweight) from 9 intervention and 10 control schools were included in the analyses. JUMP-in was developed using Intervention Mapping, and targeted psychological and environmental determinants of physical activity. Outcome behaviors were self-reported sport participation, outdoor play, TV-viewing behavior and computer use. Potential mediators were self-reported psychological, social and physical environmental factors.</p> <p>Results</p> <p>JUMP-in was effective in improving sport participation after 20 months, but not in improving outdoor play, or reducing TV-viewing or computer time. JUMP-in was not effective in changing hypothesized mediators so no significant mediated effects could be identified. However, changes in self-efficacy, social support and habit strength were positively associated with changes in sport participation, and changes in social support, self-efficacy, perceived planning skills, enjoyment and habit strength were positively associated with changes in outdoor play. Changes in enjoyment was positively associated with changes in TV-viewing while parental rules were negatively associated. Having a computer in the bedroom and enjoyment were positively associated with changes in computer use, while changes in parental rules were negatively associated.</p> <p>Conclusions</p> <p>Besides a significant positive effect on sports participation, no significant intervention effect on outdoor play, screen time or any of the potential mediators was found. This suggest that other (unmeasured) factors operated as mediating mechanisms of the intervention, that we used unsuccessful intervention strategies, that the strategies were inappropriately implemented, or that children are unable to accurately recall past activities and cognitions. Additionally, the school setting might not be the sole channel to influence leisure time activities. Still, several personal and environmental constructs were found to be relevant in predicting change in sport participation, outdoor play and screen behavior and seem to be potential mediators. Future interventions are recommended including more effective strategies targeting these relevant constructs, addressing different constructs (e.g. pedagogic skills of parents), and focusing on different implementation settings.</p> <p>Trail registration</p> <p>ISRCTN17489378</p

Interobserver and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography

BACKGROUND: Data regarding the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography are missing in the current literature. This study assessed the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography (CBCT). MATERIAL AND METHODS: In 107 patients, 130 salivary glands (65 parotid and 65 submandibular) with clinical signs of obstruction were assessed by four independent observers; 2 residents OMFS and 2 experienced OMFS. The observers analyzed the CBCT images and determined the absence or presence of one or more salivary stones in the affected gland. This procedure was repeated after three months. RESULTS: Interobserver agreements showed kappa values of 0.84 for the parotid gland, and 0.93 for the submandibular gland. Intraobserver agreements for the whole group reported kappa values between 0.83 - 0.95. There was no significant difference between residents and experienced OMFS. CONCLUSIONS: Due to the good inter- and intraobserver agreement, CBCT appears to be a reproducible imaging modality for detecting salivary stones in patients with signs and symptoms of obstructed parotid and submandibular glands. Key words:Salivary gland calculi, cone-beam computed tomography, observer variation

Using the theoretical domains framework to inform strategies to support dietitians undertaking body composition assessments in routine clinical care

BACKGROUND: Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process. METHODS: Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians of an 800-bed tertiary hospital. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel. RESULTS: Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains, particularly in Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, and Environmental context and resources. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement. CONCLUSIONS: This study showed that hospital dietitians experience individual, team, and organisational barriers to adopt BCAs in clinical practice. We were able to formulate targeted implementation strategies to overcome these barriers to assist BCA adoption into routine practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06375-7