A Tale of Two Sylamores: Understanding Relationships Among Land Use, Nutrients, and Aquatic Communities Across a Subsidy-Stress Gradient

Agricultural land use is known to degrade aquatic systems with high inputs of nutrients, sediments, and pesticides. Increased nutrients can lead to increased algal growth and thus possible hypoxic conditions in slow moving water, while increased sediment loads have been shown to obstruct light and reduce substrate stability. These conditions negatively impact primary producers, macroinvertebrates, and fish. However, small-scale changes in land use can subsidize an aquatic ecosystem instead, where an increase in nutrients allows nutrient-limited biota to flourish, and minor increases in sedimentation may help support populations of collector-filterers. The stimulation in performance caused by small disturbances is part of the subsidy-stress gradient, where increasing perturbation subsidizes an ecosystem until a certain threshold is reached, at which a decline in performance and increased variability starts to occur. The North and South Sylamore watersheds in north Arkansas provide a useful template to investigate the subsidy-stress gradient in relation to land use. North Sylamore flows through the Ozark National Forest and has a heavily forested catchment, while South Sylamore flows through mostly private land, some of which is pasture (23%). Physicochemical, macroinvertebrate, and fish data were collected from multiple sites within each watershed to determine if South Sylamore is exhibiting a response to pasture/agriculture characteristic of a subsidy-stress gradient. Sites within South Sylamore had significantly higher nitrate levels, larger macroinvertebrate populations dominated by collector-filterers, and greater abundance of algivorous fish, suggesting South Sylamore may be subsidized by the surrounding pastoral lands. However, South Sylamore also had a significantly lower proportional abundance of sensitive macroinvertebrate taxa and more unique tolerant fish taxa, suggesting South Sylamore is experiencing stress as well. Habitat quality of South Sylamore could be improved by restoration of trees within the riparian zone. Monitoring aquatic systems for subsidy-stress responses can inform restoration/management decisions and guide intervention prior to watersheds and aquatic communities becoming overly stressed

Bending Stiffness in Cadaveric and Composite Long Bones Following Total Joint Replacement

Several biomechanics studies have utilized commercially available replicate bone models as an alternative to cadaveric tissue specimens, in part due to their ease of handling and reduced expense. In an effort to validate the use of replicate bone specimens in biomechanics research, a number of studies have compared material properties of whole tibia and femur specimens to those of similar cadaveric specimens. Many of these validation studies have ascertained that the material properties of whole bone composite models fall within the range of those properties of cadaveric specimens, while offering reduced interspecimen variability. Current literature lacks, however, the direct comparison between cadaveric and composite specimens after the implantation of joint replacement components. Because of this, the interactions between orthopaedic implant and replicate bone model, and how those interactions compare with those between implants and cadaveric tissue, are relatively unknown. The purpose of this study was to evaluate the use of composite femur specimens in test scenarios aside from the whole-bone instances currently evaluated in the literature. Six cadaveric and six composite tibias and femurs were tested at different stages of surgical intervention. Flexural rigidity was measured using a 4-point bending test as a whole bone, after unicompartimental cut and implantation (UKA), and after total knee cut and implantation (TKA) or total hip arthroplasty (THA). The data did not show a definite trend between tests and specimens but is conclusive enough to use composite models for cadaveric specimens

Exploring the attentional processes of expert performers and the impact of priming on motor skill execution

It is widely acknowledged that under situations of heightened pressure, many expert athletes suffer from performance decrements. This phenomenon has been termed ‘choking under pressure’ and has been the subject of extensive research in sport psychology. Despite this attention, gaps in the literature remain leaving opportunities for further advancements in knowledge about the phenomenon, particularly in relation to its underlying processes and the development of appropriate interventions that can be adopted in order to alleviate, or even prevent choking. The present programme of research, in general terms, aimed to develop and test the efficacy of an intervention tool, based on priming, to alleviate choking under pressure. It was acknowledged that such a tool should be matched to the mechanisms that underlie the choking process and although an abundance of research has provided valuable information about these mechanisms, it was identified that there still remains a lack of consensus regarding the most appropriate explanatory theory. Therefore the initial study in this thesis aimed to provide further insight into the processes that govern choking by examining accounts from elite international swimmers of their experiences of performing under high levels of pressure. The results provided further support for the postulation that choking under pressure occurs as a result of a combination of conscious processing hypothesis (Masters, 1992) and processing efficiency theory (Eysenck & Calvo, 1992) and that an optimum level of skill-focused attention is beneficial to performance. The following studies utilised this information as well as that of the existent theories of choking, to develop and examine an effective priming based intervention tool (a scrambled sentence task). Specifically, Studies 2, 3 and 4 examined the amount of residual working memory available after activation of the prime, the optimisation of the priming task and the efficacy of the tool in promoting performance under high pressure respectively. Results revealed support for the efficacy of the tool in reducing online skill-focused attention and promoting performance under both low- and high-pressure conditions. Finally, the general themes that emerged throughout the whole programme of study are discussed, as well as the limitations and recommendations for future research. Implications for coaches, athletes and practitioners are also presented.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Exploring the attentional processes of expert performers and the impact of priming on motor skill execution

It is widely acknowledged that under situations of heightened pressure, many expert athletes suffer from performance decrements. This phenomenon has been termed ‘choking under pressure’ and has been the subject of extensive research in sport psychology. Despite this attention, gaps in the literature remain leaving opportunities for further advancements in knowledge about the phenomenon, particularly in relation to its underlying processes and the development of appropriate interventions that can be adopted in order to alleviate, or even prevent choking. The present programme of research, in general terms, aimed to develop and test the efficacy of an intervention tool, based on priming, to alleviate choking under pressure. It was acknowledged that such a tool should be matched to the mechanisms that underlie the choking process and although an abundance of research has provided valuable information about these mechanisms, it was identified that there still remains a lack of consensus regarding the most appropriate explanatory theory. Therefore the initial study in this thesis aimed to provide further insight into the processes that govern choking by examining accounts from elite international swimmers of their experiences of performing under high levels of pressure. The results provided further support for the postulation that choking under pressure occurs as a result of a combination of conscious processing hypothesis (Masters, 1992) and processing efficiency theory (Eysenck & Calvo, 1992) and that an optimum level of skill-focused attention is beneficial to performance. The following studies utilised this information as well as that of the existent theories of choking, to develop and examine an effective priming based intervention tool (a scrambled sentence task). Specifically, Studies 2, 3 and 4 examined the amount of residual working memory available after activation of the prime, the optimisation of the priming task and the efficacy of the tool in promoting performance under high pressure respectively. Results revealed support for the efficacy of the tool in reducing online skill-focused attention and promoting performance under both low- and high-pressure conditions. Finally, the general themes that emerged throughout the whole programme of study are discussed, as well as the limitations and recommendations for future research. Implications for coaches, athletes and practitioners are also presented.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Non-Participants in Policy Efforts to Promote Evidence-Based Practices in a Large Behavioral Health System

Background: System-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings. Methods: We conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate. Results: We found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits. Conclusions: While it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain

Predictors of Community Therapists\u27 Use of Therapy Techniques in a Large Public Mental Health System

Importance Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. Objective To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. Design, Setting, and Participants In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Main Outcomes and Measures Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist–Family Revised. Results Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. Conclusions and Relevance This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique

A Randomized Trial to Identify Accurate and Cost-Effective Fidelity Measurement Methods for Cognitive-Behavioral Therapy: Project FACTS Study Protocol

Background: This randomized trial will compare three methods of assessing fidelity to cognitive-behavioral therapy (CBT) for youth to identify the most accurate and cost-effective method. The three methods include self-report (i.e., therapist completes a self-report measure on the CBT interventions used in session while circumventing some of the typical barriers to self-report), chart-stimulated recall (i.e., therapist reports on the CBT interventions used in session via an interview with a trained rater, and with the chart to assist him/her) and behavioral rehearsal (i.e., therapist demonstrates the CBT interventions used in session via a role-play with a trained rater). Direct observation will be used as the gold-standard comparison for each of the three methods. Methods/design: This trial will recruit 135 therapists in approximately 12 community agencies in the City of Philadelphia. Therapists will be randomized to one of the three conditions. Each therapist will provide data from three unique sessions, for a total of 405 sessions. All sessions will be audio-recorded and coded using the Therapy Process Observational Coding System for Child Psychotherapy-Revised Strategies scale. This will enable comparison of each measurement approach to direct observation of therapist session behavior to determine which most accurately assesses fidelity. Cost data associated with each method will be gathered. To gather stakeholder perspectives of each measurement method, we will use purposive sampling to recruit 12 therapists from each condition (total of 36 therapists) and 12 supervisors to participate in semi-structured qualitative interviews. Discussion: Results will provide needed information on how to accurately and cost-effectively measure therapist fidelity to CBT for youth, as well as important information about stakeholder perspectives with regard to each measurement method. Findings will inform fidelity measurement practices in future implementation studies as well as in clinical practice. Trial registration: NCT02820623, June 3rd, 2016

Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669

A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System

Staff turnover rates in publicly-funded mental health settings are high. We investigated staff and organizational predictors of turnover in a sample of individuals working in an urban public mental health system that has engaged in a system-level effort to implement evidence-based practices. Additionally, we interviewed staff to understand reasons for turnover. Greater staff burnout predicted increased turnover, more openness toward new practices predicted retention, and more professional recognition predicted increased turnover. Staff reported leaving their organizations because of personal, organizational, and financial reasons; just over half of staff that left their organization stayed in the public mental health sector. Implications include an imperative to focus on turnover, with a particular emphasis on ameliorating staff burnout