Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

Background: The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without xrays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine xrays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Methods: Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Results: Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied (social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors (social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays (belief about capabilities); and guideline awareness and agreements (knowledge). Conclusions: Chiropractors’ use of diagnostic imaging appears to be influenced by a number of factors. Five key domains may be important considering the presence of conflicting beliefs, evidence of strong beliefs likely to impact the behavior of interest, and high frequency of beliefs. The results will inform the development of a theorybased survey to help identify potential targets for behavioral-change strategies

Methods for analysis of brain connectivity : An IFCN-sponsored review

The goal of this paper is to examine existing methods to study the "Human Brain Connectome" with a specific focus on the neurophysiological ones. In recent years, a new approach has been developed to evaluate the anatomical and functional organization of the human brain: the aim of this promising multimodality effort is to identify and classify neuronal networks with a number of neurobiologically meaningful and easily computable measures to create its connectome. By defining anatomical and functional connections of brain regions on the same map through an integrated approach, comprising both modern neurophysiological and neuroimaging (i.e. flow/metabolic) brain-mapping techniques, network analysis becomes a powerful tool for exploring structural-functional connectivity mechanisms and for revealing etiological relationships that link connectivity abnormalities to neuropsychiatric disorders. Following a recent IFCN-endorsed meeting, a panel of international experts was selected to produce this current state-of-art document, which covers the available knowledge on anatomical and functional connectivity, including the most commonly used structural and functional MRI, EEG, MEG and non-invasive brain stimulation techniques and measures of local and global brain connectivity. (C) 2019 Published by Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology.Peer reviewe

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

MicroRNA-375 plays a dual role in prostate carcinogenesis

Background: Prostate cancer (PCa), a highly incident and heterogeneous malignancy, mostly affects men from developed countries. Increased knowledge of the biological mechanisms underlying PCa onset and progression are critical for improved clinical management. MicroRNAs (miRNAs) deregulation is common in human cancers, and understanding how it impacts in PCa is of major importance. MiRNAs are mostly downregulated in cancer, although some are overexpressed, playing a critical role in tumor initiation and progression. We aimed to identify miRNAs overexpressed in PCa and subsequently determine its impact in tumorigenesis. Results: MicroRNA expression profiling in primary PCa and morphological normal prostate (MNPT) tissues identified 17 miRNAs significantly overexpressed in PCa. Expression of three miRNAs, not previously associated with PCa, was subsequently assessed in large independent sets of primary tumors, in which miR-182 and miR-375 were validated, but not miR-32. Significantly higher expression levels of miR-375 were depicted in patients with higher Gleason score and more advanced pathological stage, aswellaswithregionallymph nodesmetastases. Forced expression of miR-375 in PC-3 cells, which display the lowest miR-375 levels among PCa cell lines, increased apoptosis and reduced invasion ability and cell viability. Intriguingly, in 22Rv1 cells, which displayed the highest miR-375 expression, knockdown experiments also attenuated the malignant phenotype. Gene ontology analysis implicated miR-375 in several key pathways deregulated in PCa, including cell cycle and cell differentiation. Moreover, CCND2 was identified as putative miR-375 target in PCa, confirmed by luciferase assay. Conclusions: A dual role for miR-375 in prostate cancer progression is suggested, highlighting the importance of cellular context on microRNA targeting.Research Center of Portuguese Oncology Institute - Porto (CI-IPOP 4–2012) and by the Federal funds through Programa Operacional Temático Factores de Competitividade (COMPETE) with co-participation from the European Community Fund (FEDER) and by the National funds through Fundação para a Ciência e Tecnología (FCT) under the projects EXPL/BIM-ONC/0556/2012. FQV and JRC were or are supported by FCT-Fundação para a Ciência e a Tecnologia grants (SFRH/BD/70564/2010 and SFRH/BD/71293/2010, respectively)

Implementación de un programa de enseñanza de la lectura y la escritura en los primeros años de primaria dentro del sistema educativo en contextos de "fracaso escolar"

Durante más de cuarenta años se atribuyó el fracaso escolar, que se observa particularmente en los niños de sectores desfavorecidos y que se manifiesta en dificultades para aprender a leer y a escribir y en retrasos en este aprendizaje, a diversos factores asociados al niño y a su entorno familiar y comunitario.Entre estos factores se señalan las diferencias en experiencias de alfabetización que tienen los niños en su hogar. Mientras que los niños de sectores medios y altos ingresan al proceso de alfabetización tempranamente a través de las actividades que realizan con sus padres: lectura de cuentos, rimas, canciones, juegos con letras, los niños de sectores desfavorecidos tienen pocas oportunidades de interactuar con la escritura fuera del ámbito escolar. (Piacente, Marder, Resches, Ledesma, 2006). Sin embargo, experiencias realizadas en nuestro medio, muestran que aún los niños de 5 años en situación de riesgo por pobreza, pueden, a esa edad, aprender a leer y a escribir en español cuando cuentan con una intervención adecuada y sistemática (Borzone de Manrique, 1994; Marder, 2011, 2012). El programa“Leamos juntos” (Borzone, Marder, Sánchez, 2014) concebido desde el modelo de Respuesta a la Intervención (RAI) comprende un cuadernillo para el alumno con 50 secuencias didácticas que incorporan más de 70 textos de distinto tipo, y una Guía para el docente. Se fundamenta en el reconocimiento de la diversidad sociocultural, en el conocimiento del proceso de enseñanza y aprendizaje desde el paradigma sociohistórico y sociocultural (Vigotsky, 1964; Bruner, 1988; Rogoff, 1993) y en el aprendizaje de la lectura y la escritura como adquisición simultánea de diversos conocimientos y estrategias que permiten el dominio progresivo de la escritura, el sistema de escritura y el lenguaje escrito. En este trabajo analizaremos los resultados preliminares de la intervención en una de las escuelas en donde se implementa el programa.Facultad de Psicologí

Implementación de un programa de enseñanza de la lectura y la escritura en los primeros años de primaria dentro del sistema educativo en contextos de "fracaso escolar"

Durante más de cuarenta años se atribuyó el fracaso escolar, que se observa particularmente en los niños de sectores desfavorecidos y que se manifiesta en dificultades para aprender a leer y a escribir y en retrasos en este aprendizaje, a diversos factores asociados al niño y a su entorno familiar y comunitario.Entre estos factores se señalan las diferencias en experiencias de alfabetización que tienen los niños en su hogar. Mientras que los niños de sectores medios y altos ingresan al proceso de alfabetización tempranamente a través de las actividades que realizan con sus padres: lectura de cuentos, rimas, canciones, juegos con letras, los niños de sectores desfavorecidos tienen pocas oportunidades de interactuar con la escritura fuera del ámbito escolar. (Piacente, Marder, Resches, Ledesma, 2006). Sin embargo, experiencias realizadas en nuestro medio, muestran que aún los niños de 5 años en situación de riesgo por pobreza, pueden, a esa edad, aprender a leer y a escribir en español cuando cuentan con una intervención adecuada y sistemática (Borzone de Manrique, 1994; Marder, 2011, 2012). El programa“Leamos juntos” (Borzone, Marder, Sánchez, 2014) concebido desde el modelo de Respuesta a la Intervención (RAI) comprende un cuadernillo para el alumno con 50 secuencias didácticas que incorporan más de 70 textos de distinto tipo, y una Guía para el docente. Se fundamenta en el reconocimiento de la diversidad sociocultural, en el conocimiento del proceso de enseñanza y aprendizaje desde el paradigma sociohistórico y sociocultural (Vigotsky, 1964; Bruner, 1988; Rogoff, 1993) y en el aprendizaje de la lectura y la escritura como adquisición simultánea de diversos conocimientos y estrategias que permiten el dominio progresivo de la escritura, el sistema de escritura y el lenguaje escrito. En este trabajo analizaremos los resultados preliminares de la intervención en una de las escuelas en donde se implementa el programa.Facultad de Psicologí