Protocol for the ROSE sustainment (ROSES) study, a sequential multiple assignment randomized trial to determine the minimum necessary intervention to maintain a postpartum depression prevention program in prenatal clinics serving low-income women

Background: More research on sustainment of interventions is needed, especially return on investment (ROI) studies to determine cost-benefit trade-offs for effort required to sustain and how much is gained when effective programs are sustained. The ROSE sustainment (ROSES) study uses a sequential multiple assignment randomized (SMART) design to evaluate the effectiveness and cost-effectiveness of a stepwise approach to sustainment of the ROSE postpartum depression prevention program in 90 outpatient clinics providing prenatal care to pregnant women on public assistance. Postpartum depression (PPD) is common and can have lasting consequences. Outpatient clinics offering prenatal care are an opportune place to provide PPD prevention because most women visit while pregnant. The ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program is a group educational intervention to prevent PPD, delivered during pregnancy. ROSE has been found to reduce cases of PPD in community prenatal settings serving low-income pregnant women. Methods: All 90 prenatal clinics will receive enhanced implementation as usual (EIAU; initial training + tools for sustainment). At the first time at which a clinic is determined to be at risk for failure to sustain (i.e., at 3, 6, 9, 12, and 15 months), that clinic will be randomized to receive either (1) no additional implementation support (i.e., EIAU only), or (2) low-intensity coaching and feedback (LICF). If clinics receiving LICF are still at risk at subsequent assessments, they will be randomized to either (1) EIAU + LICF only, or (2) high-intensity coaching and feedback (HICF). Additional follow-up interviews will occur at 18, 24, and 30 months, but no implementation intervention will occur after 18 months. Outcomes include (1) percent sustainment of core program elements at each time point, (2) health impact (PPD rates over time at each clinic) and reach, and (3) ROI (costs and cost-effectiveness) of each sustainment step. Hypothesized mechanisms include sustainment of capacity to deliver core elements and engagement/ownership. Discussion: This study is the first randomized trial evaluating the ROI of a stepped approach to sustainment, a critical unanswered question in implementation science. It will also advance knowledge of implementation mechanisms and clinical care for an at-risk population

Evaluating the health "hubs and spokes" interprofessional placements in rural New South Wales, Australia

Australia has been relatively slow in adopting interprofessional learning (IPL) to prepare health professional students for future collaborative professional practice. A collaborative project between two universities placed senior health professional students in IPL teams in rural southeast New South Wales, Australia, to work on small, locally relevant projects with guidance from locally appointed IPL facilitators. This paper reports on the initial stages of an evaluation of this rural-based IPL intervention using the modified Freeth/Kirkpatrick's 4- level evaluation model. METHODS: Students' responses were collected using a debriefing questionnaire, the Interprofessional Education Perception (IEPS) and Team Performance (TPS) scales. An audience feedback questionnaire was structured around project objectives. RESULTS: Seventy-nine students participated in 33 IPL teams during the evaluation period included in this study. IEPS scores increased with participation (t=2.803; p=0.007). The TPS showed a statistically significant difference between teams (ANOVA, F(31,45) = 1.982, p=0.018) and a trend toward agreement with audience perceptions of team performance. CONCLUSIONS: The evaluation demonstrated positive short-term outcomes suggesting benefits of this applied approach in preparing students to work interprofessionally

Computational design of a modular protein sense-response system.

Sensing and responding to signals is a fundamental ability of living systems, but despite substantial progress in the computational design of new protein structures, there is no general approach for engineering arbitrary new protein sensors. Here, we describe a generalizable computational strategy for designing sensor-actuator proteins by building binding sites de novo into heterodimeric protein-protein interfaces and coupling ligand sensing to modular actuation through split reporters. Using this approach, we designed protein sensors that respond to farnesyl pyrophosphate, a metabolic intermediate in the production of valuable compounds. The sensors are functional in vitro and in cells, and the crystal structure of the engineered binding site closely matches the design model. Our computational design strategy opens broad avenues to link biological outputs to new signals

Engagement with a Social Networking Intervention for Cancer-Related Distress

BACKGROUND: Understanding patterns and predictors of engagement could improve the efficacy of Internet interventions. PURPOSE: The purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress. METHODS: Data were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention. RESULTS: Over 12 weeks, average total engagement was 7.3 h (sd=11.7), and 42% of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints. CONCLUSIONS: For many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts