Nutrient Leaching from Compost: Implications for Bioretention and Other Green Stormwater Infrastructure

This work is made available under the terms of the Creative Commons Attribution 4.0 International license,. Compost is often used as a soil amendment in gardens, agricultural fields, and other landscaped systems to alter soil biophysical characteristics and increase availability of valuable nutrients including nitrogen (N), phosphorus (P), and carbon (C). However, leaching of soluble nutrients from compost is of concern, particularly in wet settings, such as within green stormwater infrastructure, riparian areas, and floodplains. This research highlights the importance of saturation as an influencing factor on the nutrient leaching potential of different composts and compost-amended bioretention soils. Nutrient leaching potential was evaluated for five different compost types and two compost-amended bioretention soil mixes under increasing saturation durations, measured at 10 min, 1 day, 5 days, and 10 days of saturation. Results indicated significant increases in NH4+ concentrations in leachate for all composts and bioretention media from 10 min to 10 days. Over the same time period results showed decreases in NO3- concentrations in the leachate from all five composts, but an increase in NO3- concentration for one compost-amended bioretention media and no significant change in the other bioretention media. In response to increased saturation durations, PO43- concentrations in the leachate were found to significantly increase at each stage, from 10 min, to 1 day, to 5 days, to 10 days; overall there were higher PO43- concentrations in the leachate from the five composts than in the leachate from the two bioretention mixes

The Effect of Growth Differentiation Factor 6 on the Epithelial-to-Mesenchymal Transition in Retinal Pigmented Epithelium

As retinal pigmented epithelium (RPE) cells are passaged, they undergo an irreversible epithelial-to-mesenchymal transition (EMT). We have shown previously that growth differentiation factor 6 (GDF6), a member of the transforming growth factor-beta (TGFβ) family, is highly upregulated in RPE cells that have lost the capacity to obtain an epithelial phenotype. We hypothesize that GDF6 plays an integral role in the irreversible transition of an RPE cell from an epithelial state to a mesenchymal state.To test this hypothesis, we overexpressed GDF6 in differentiation competent RPE and assessed the effects on phenotype and gene expression. To evaluate what receptors and signaling pathways might mediate GDF6’s effects, cells were also treated with an Alk5 inhibitor (Repsox), an Alk2/3/6 inhibitor (LDN-193189), or both in combination. Passage 0 RPE transduced with GDF6 produce significantly less pigmentation than cells infected with an empty vector control. This reduction in pigmentation is accompanied with a change in cell morphology; the control cells maintain a cuboidal morphology and the GDF6 expressing cells have a spindle-like morphology. Quantitative PCR analysis reveals that RPE cells transduced with GDF6 significantly upregulate known EMT markers like ACTA2, CTGF, and COL1A1 and downregulate classical RPE markers such as LRAT and PMEL compared to control cells. Both RepSox and LDN-193189 have the ability to reverse the GDF6 phenotype. While the phenotype is recovered, RNA-seq analysis reveals GDF6-mediated regulation of genes that are unaffected by inhibitors, such as TGFβ1, MSX2, and CDH1. GDF6 is involved in the EMT process in RPE. We believe GDF6 upregulates TGFβ1, which in turn promotes EMT. The ability to revert back to an epithelial cell is inhibited by GDF6. Cells exposed to GDF6 will prematurely undergo EMT, simultaneously downregulating traditional RPE markers while upregulating EMT and wound response markers. Inhibition of the BMP receptors rescues the GDF6 phenotype, therefore inhibition of GDF6 may be integral in prolonging the integrity and functional lifespan of the RPE. As such, inhibition of GDF6 may help restore RPE to their epithelial state in diseases like proliferative vitreoretinopathy and age-related macular degeneration

A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: Face validity and feasibility of implementation

Background Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. Methods A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Results Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. Conclusion The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level

A trial-based economic evaluation of 2 nurse-led disease management programs in heart failure

Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice

A brief report on the development of a theoretically-grounded intervention to promote patient autonomy and self-management of physiotherapy patients: face validity and feasibility of implementation

Background Clinical practice guidelines for the treatment of low back pain suggest the inclusion of a biopsychosocial approach in which patient self-management is prioritized. While many physiotherapists recognise the importance of evidence-based practice, there is an evidence practice gap that may in part be due to the fact that promoting self-management necessitates change in clinical behaviours. Evidence suggests that a patient’s motivation and maintenance of self-management behaviours can be positively influenced by the clinician’s use of an autonomy supportive communication style. Therefore, the aim of this study was to develop and pilot-test the feasibility of a theoretically derived implementation intervention to support physiotherapists in using an evidence-based autonomy supportive communication style in practice for promoting patient self-management in clinical practice. Methods A systematic process was used to develop the intervention and pilot-test its feasibility in primary care physiotherapy. The development steps included focus groups to identify barriers and enablers for implementation, the theoretical domains framework to classify determinants of change, a behaviour change technique taxonomy to select appropriate intervention components, and forming a testable theoretical model. Face validity and acceptability of the intervention was pilot-tested with two physiotherapists and monitoring their communication with patients over a three-month timeframe. Results Using the process described above, eight barriers and enablers for implementation were identified. To address these barriers and enablers, a number of intervention components were selected ranging from behaviour change techniques such as, goal-setting, self-monitoring and feedback to appropriate modes of intervention delivery (i.e. continued education meetings and audit and feedback focused coaching). Initial pilot-testing revealed the acceptability of the intervention to recipients and highlighted key areas for refinement prior to scaling up for a definitive trial. Conclusion The development process utilised in this study ensured the intervention was theory-informed and evidence-based, with recipients signalling its relevance and benefit to their clinical practice. Future research should consider additional intervention strategies to address barriers of social support and those beyond the clinician level

Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u

Effect of a self-determination theory-based communication skills training program on physiotherapists' psychological support for their patients with chronic low back pain: a randomized controlled trial

Objective: To examine the effects of communication skills training on physiotherapists' supportive behavior during clinical practice. Design: Randomized trial. Setting: Hospital outpatient physiotherapy clinics. Participants: Physiotherapists (N=24) and patients (N=24) with chronic low back pain. Interventions: Two hospital clinics were randomly assigned to the intervention arm. Physiotherapists (n=12) received 8 hours of communication skills training focused on supporting patients' psychological needs. Physiotherapists (n=12) from 2 other hospital clinics formed a waitlist control arm. Main Outcome Measures: Verbal communication between each physiotherapist and a patient was recorded on an audiotape, and independent, blinded raters used the Health Care Climate Questionnaire to assess physiotherapists' needs-supportive behavior (primary outcome). Results: Independent raters' Health Care Climate Questionnaire scores favored the intervention arm (Cohen's d=2.27; P<.01). Conclusions: Compared with controls, independent ratings demonstrated that physiotherapists who completed the Communication style and exercise compliance in physiotherapy training were found to provide greater support for patients' needs in a single assessed session. Long-term maintenance of this needs-supportive behavior should be examined