Integrating exercise interventions into routine care for mental illness and cancer : An implementation science approach

Exercise has been established as an effective intervention that can improve health outcomes in people living with a non-communicable disease (NCD), including mental illness and cancer. Despite the evidence, exercise is not routinely integrated into the treatment of most NCDs. This phenomenon is described as the research-to-practice gap with implementation science seeking to increase the uptake of evidence-based interventions (EBIs), such as exercise, in practice. Multiple factors and processes contribute to the suboptimal use of EBIs in practice. This includes the lack of formative approaches to establish research evidence that is relevant for implementation and scientific methods that explain EBI adoption, implementation, and sustainment. This thesis applies an implementation science approach to explore how exercise EBIs can be integrated into routine healthcare to treat NCDs. This is explored in two NCDs, mental illness and cancer, and through the two following sub-aims: • Conduct novel evidence synthesis for mental illness and cancer to understand how different synthesis methods can support improved implementation in practice. • Explore how healthcare organisations have successfully implemented exercise EBIs within the routine practice for treating mental illness and cancer. To address the first sub-aim, unique approaches were applied to two systematic reviews that were conducted in mental illness and cancer. For the first systematic review, a meta-review design was used to synthesise the evidence on the effectiveness of exercise EBIs for mental illness. effectiveness was defined in clinically useful terms including the anticipated health benefits, safety and cost of exercise EBIs. Although positive effects on health outcomes (i.e., symptoms of mental illness, quality of life, and physical health outcomes) were reported in the majority of reviews, limited safety information and no cost data were identified. For the second systematic review, efficacy studies were excluded to investigate the real-world implementation outcomes of exercise EBIs for cancer care. Implementation outcomes were aligned with Proctor and colleagues’ Implementation Outcomes Framework (IOF), and the review revealed that the most common implementation outcomes assessed were adoption and feasibility. Penetration and sustainability were infrequently measured, and implementation fidelity was difficult to establish because exercise protocols were poorly reported. In sum, the unique methods used in the two systematic reviews enabled the synthesis of broad and contextually relevant information valuable for implementation practice. The research gaps identified suggest that there is significant scope to produce more practice-relevant evidence. To address some of these gaps and the second sub-aim of this thesis, two implementation studies that explored how healthcare organisations have successfully implemented exercise EBI’s in mental health and cancer were conducted. For both studies, a case study design and theoretically-informed approach were used to develop an explanation for the implementation process that included the identification of determinants, implementation strategies, and implementation outcomes. Four data sources informed the studies: semi-structured interviews, document review, observations, and administering the Program Sustainability Assessment Tool (PSAT). Framework analysis was applied, and a theory-informed logic model was developed. Linking implementation science frameworks through the logic model elucidated the causal pathways of implementation. Second, the methods facilitated synthesis across sites to support generalisable knowledge. The first implementation study evaluated an exercise EBI implemented within a youth mental healthcare service. Over 40 determinants that influenced implementation of exercise EBIs and a similar number of implementation strategies were identified. Several activities aided implementation, including the creation of a new clinical team and the auditing and provision of feedback on physical healthcare practices (including exercise). Exercise acceptability was high, and many strengths (identified via the PSAT) contributed to EBI sustainability. However, implementation fidelity was challenging to establish, and penetration was low. The second implementation study was a multiple case study on the implementation of exercise EBIs across three cancer care settings. Across the sites, 18 determinants and 22 implementation strategies were consistent. Sixteen determinants, 24 implementation strategies, and implementation outcomes differed across the sites. Via the commonalities, 11 common causal pathways were developed, wherein the mechanisms theorised to support implementation include: 1) developing knowledge; 2) building skills and capability; 3) securing resources; 4) generating optimism and 5) simplified decision-making processes associated with exercise; 6) developing relationships (social and professional) and support for the workforce; 7) reinforcing positive outcomes; 8) developing capability to action plan through evaluations and 9) interactive learning; 10) aligning goals between the organisation and the EBI; and, 11) establishing a consumer-responsive service. These mechanisms represent transferable elements of the implementation process that can inform future implementation efforts. This thesis uses implementation science to increase our understanding of the evidence, factors, strategies and processes required to implement exercise EBIs in practice. Improved implementation knowledge will help shape healthcare so people living with a NCD can access evidence-based care, such as exercise

Responding to International Health Emergencies: Comparing the World Health Organization Response to Ebola and Zika

This thesis explores explanations for why the WHO and its Member States responded differently in each of the two cases. The epidemiology, securitization, and organizational theory literatures suggest three primary answers to these questions. I have used these literatures to formulate three explanations through which to examine each case. I assess the Ebola and Zika cases along two dependent variables: time from the start of the outbreak to the WHO and Member States’ response, and the amount of financial and human resources allocated to the response. The epidemiological explanation focuses on the lethality and transmissibility of each virus. In this explanation I examine whether a more lethal and easily transmissible virus results in a faster response that garners greater amounts of financial and human resources. Second, the securitization explanation examines whether the framing of each case as a security threat (or not) results in greater amounts of financial and human resources, even if such a process of securitizing disease occurs slowly. Finally, in the organizational structure explanation I examine the WHO’s decentralized structure and budgetary mechanisms to determine whether or not greater decentralization and voluntary contribution mechanisms in the WHO’s budget contribute to a slower response that sees fewer resources allocated to it

Analysis of proteins synthesized by 9.5 day mouse embryos: Determination of cardiac and noncardiac proteins

To catalog polypeptides that were specific to developing hearts, we separated 35 S-methionine-labeled 9.5 day mouse embyros into cardiac and noncardiac (carcass) components. Two-dimensional gels were then used to analyze the polypeptides synthesized in these two fractions. As a result, we were able to distinguish polypeptides that were specific to or increased in the heart as well as those polypeptides that were specific to or inceased in the embryo minus the dissected heart. Using this analysis, there were two polypeptides that were cardiac-specific and 17 that were expressed at increased levels by at least twofold in the heart. The cardiac-specific polypeptides may be used in further studies to identify early cardiac tissue. Conversely, there were 26 polypeptides unique to noncardiac structures and an additional 15 that were increased in the carcass more than twofold relative to the heart. The noncardiac-specific polypeptides may be used to define contamination of putative cardiac tissue with noncardiac material. Two of the polypeptides expressed more abundantly in the carcass appeared to correspond to known proteins in the mouse fibroblast database, cyclin and tropomyosin 4. Thus the heart at 9.5 days of murine development can be distinguished readily from the remainder of the embryonic mouse both macroscopically and on two-dimensional gels.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50419/1/1080290209_ftp.pd

Utilizing microarray spot characteristics to improve cross-species hybridization results

AbstractCross-species hybridization (CSH), i.e., the hybridization of a (target) species RNA to a DNA microarray that represents another (reference) species, is often used to study species diversity. However, filtration of CSH data has to be applied to extract valid information. We present a novel approach to filtering the CSH data, which utilizes spot characteristics (SCs) of image-quantification data from scanned spotted cDNA microarrays. Five SCs that were affected by sequence similarity between probe and target sequences were identified (designated as BS-SCs). Filtration by all five BS-SC thresholds demonstrated improved clustering for two of the three examined experiments, suggesting that BS-SCs may serve for filtration of data obtained by CSH, to improve the validity of the results. This CSH data-filtration approach could become a promising tool for studying a variety of species, especially when no genomic information is available for the target species

Efficient adsorption of chromium ions from aqueous solutions by plant-derived silica

Nowadays, there is great interest in the use of plant waste to obtain materials for environmental protection. In this study, silica powders were prepared with a simple and low-cost procedure from biomass materials such as horsetail and common reed, as well as wheat and rye straws. The starting biomass materials were leached in a boiling HCl solution. After washing and drying, the samples were incinerated at 700 degrees C for 1 h in air. The organic components of the samples were burned leaving final white powders. These powders were characterized by powder X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, dynamic light scattering (DLS), scanning electron microscopy (SEM), and low-temperature nitrogen sorption. The amorphous powders (biosilica) contained mainly SiO2, as indicated by FTIR analysis. Horsetail-derived silica was chosen for testing the removal of dichromate ions from water solutions. This biosilica had a good ability to adsorb Cr(VI) ions, which increased after modification of the powder with the dodecylamine surfactant. It can be concluded that the applied procedure allowed obtaining high purity biosilica from plant waste with good efficiency. The produced biosilica was helpful in removing chromium ions and showed low cytotoxicity to human endothelial cells, suggesting that it can be safely used in environmental remediation

Developing an implementation research logic model : Using a multiple case study design to establish a worked exemplar

Background Implementation science frameworks explore, interpret, and evaluate different components of the implementation process. By using a program logic approach, implementation frameworks with different purposes can be combined to detail complex interactions. The Implementation Research Logic Model (IRLM) facilitates the development of causal pathways and mechanisms that enable implementation. Critical elements of the IRLM vary across different study designs, and its applicability to synthesizing findings across settings is also under-explored. The dual purpose of this study is to develop an IRLM from an implementation research study that used case study methodology and to demonstrate the utility of the IRLM to synthesize findings across case sites. Method The method used in the exemplar project and the alignment of the IRLM to case study methodology are described. Cases were purposely selected using replication logic and represent organizations that have embedded exercise in routine care for people with cancer or mental illness. Four data sources were selected: semi-structured interviews with purposely selected staff, organizational document review, observations, and a survey using the Program Sustainability Assessment Tool (PSAT). Framework analysis was used, and an IRLM was produced at each case site. Similar elements within the individual IRLM were identified, extracted, and re-produced to synthesize findings across sites and represent the generalized, cross-case findings. Results The IRLM was embedded within multiple stages of the study, including data collection, analysis, and reporting transparency. Between 33-44 determinants and 36-44 implementation strategies were identified at sites that informed individual IRLMs. An example of generalized findings describing “intervention adaptability” demonstrated similarities in determinant detail and mechanisms of implementation strategies across sites. However, different strategies were applied to address similar determinants. Dependent and bi-directional relationships operated along the causal pathway that influenced implementation outcomes. Conclusions Case study methods help address implementation research priorities, including developing causal pathways and mechanisms. Embedding the IRLM within the case study approach provided structure and added to the transparency and replicability of the study. Identifying the similar elements across sites helped synthesize findings and give a general explanation of the implementation process. Detailing the methods provides an example for replication that can build generalizable knowledge in implementation research

The effect of precursor system on the resistivity and oxidation susceptibility of C/SiC nanocomposites en route to electronic grade nanomaterials

Abstract Presented are results of a study on specific technological properties of affordable C/SiC composite nanomaterials obtained via pyrolysis of several pitch/silicon-bearing precursor systems (elemental Si, silica SiO 2 , poly(carbomethylsilane) [-CH 2 -Si(H)CH 3 -] n , commercial SiC). For pyrolysis at 1300°C, the formation of nanosized SiC is detected in the systems with elemental Si and poly(carbomethylsilane) while 1650°C pyrolysis is required for silica to achieve such conversion. In situ formed nano-SiC is homogeneously dispersed in the simultaneously evolving graphitic carbon matrix of the composites. Reactivities vs. CO 2 , electrical resistivities, and surface properties of the nanocomposites are determined. Significant differences and patterns in the properties among the materials obtained from these precursor systems and at the selected pyrolysis temperatures are clearly established. Among others, the data suggest potential for carbon removal from the most reactive nanocomposites via reactions with CO 2 to yield unique nano-SiC powder products for further processing towards electronic and ceramic applications

Whitefly (Bemisia tabaci) genome project: analysis of sequenced clones from egg, instar, and adult (viruliferous and non-viruliferous) cDNA libraries

BACKGROUND: The past three decades have witnessed a dramatic increase in interest in the whitefly Bemisia tabaci, owing to its nature as a taxonomically cryptic species, the damage it causes to a large number of herbaceous plants because of its specialized feeding in the phloem, and to its ability to serve as a vector of plant viruses. Among the most important plant viruses to be transmitted by B. tabaci are those in the genus Begomovirus (family, Geminiviridae). Surprisingly, little is known about the genome of this whitefly. The haploid genome size for male B. tabaci has been estimated to be approximately one billion bp by flow cytometry analysis, about five times the size of the fruitfly Drosophila melanogaster. The genes involved in whitefly development, in host range plasticity, and in begomovirus vector specificity and competency, are unknown. RESULTS: To address this general shortage of genomic sequence information, we have constructed three cDNA libraries from non-viruliferous whiteflies (eggs, immature instars, and adults) and two from adult insects that fed on tomato plants infected by two geminiviruses: Tomato yellow leaf curl virus (TYLCV) and Tomato mottle virus (ToMoV). In total, the sequence of 18,976 clones was determined. After quality control, and removal of 5,542 clones of mitochondrial origin 9,110 sequences remained which included 3,843 singletons and 1,017 contigs. Comparisons with public databases indicated that the libraries contained genes involved in cellular and developmental processes. In addition, approximately 1,000 bases aligned with the genome of the B. tabaci endosymbiotic bacterium Candidatus Portiera aleyrodidarum, originating primarily from the egg and instar libraries. Apart from the mitochondrial sequences, the longest and most abundant sequence encodes vitellogenin, which originated from whitefly adult libraries, indicating that much of the gene expression in this insect is directed toward the production of eggs. CONCLUSION: This is the first functional genomics project involving a hemipteran (Homopteran) insect from the subtropics/tropics. The B. tabaci sequence database now provides an important tool to initiate identification of whitefly genes involved in development, behaviour, and B. tabaci-mediated begomovirus transmission