An analysis of request-centered relational communication within behavioral consultation using a sample of practicing school psychologists

The Folger and Puck (1976) request-centered relational communication coding system was used to examine the relationship between measures of consultant and consultee control in behavioral consultation and (a) consultee satisfaction; (b) client behavior change; (c) perceived treatment integrity; and (d) perceptions of client behavior change. School psychologists from across Iowa served as consultants to one consultee each across three problem-solving interviews. The Problem Identification Interview was audiotaped and request-response transactions were coded. Requests were coded as either: dominant, dominant-affiliative, or submissive and served as measures of consultant and consultee control. Measures of consultant and consultee control and the outcome measures were correlated. The hypotheses regarding the relationship between consultant and consultee measures of control and consultation outcomes were not supported. Consultant and consultee total bids, which provide a measure of interview length, were significantly related to consultee satisfaction with consultation and treatment integrity. The longer the consultation interview the more dissatisfied the consultees were with consultation and the less likely they were to implement interventions with integrity. Consistent with previous research (e.g., Erchul, 1987; Erchul & Chewning, 1990; Erchul et al., 1995) a pattern of interaction where the consultant leads and the consultee follows during consultation was found. Further, consultation resulted in positive outcomes for clients. These results were not, however, adequately explained by the variables studied in this research. Several explanations were advanced for these nonsignificant findings

Increasing Medication Adherence in a Primary Care Practice

The focus of this Doctor of Nursing Practice project was to target medication adherence in a private, rural primary care office, designated as a Rural Health Clinic, in a Tier 1 county in central North Carolina. The project site identified that not enough patients with Medicare were demonstrating medication adherence to statins, oral antidiabetics, and renin-angiotensin system antagonists to achieve a 5-star rating for quality metrics. The purpose of the project was to develop and implement a standardized process to increase medication adherence for patients with Medicare and increase star ratings in a rural primary care office. The project included a four-part intervention to assess for medication adherence and address barriers, to use patient-friendly prescription practices, to increase scheduled follow-up visits, and to recapture patients who were identified as nonadherent. Findings from the project revealed a significant increase in the star rating for oral antidiabetics, the star rating remained stable for the renin-angiotensin system antagonists, and there was a slight decrease in the star rating for statins. There were positive results for four process measures, including improvement in prescribing prescriptions for 90 days or more, scheduling follow-up visits, including diagnosis or procedural codes in the chart, and sending prescriptions to a mail-order pharmacy. However, the trend decreased for the number of DOSE-Nonadherence measure forms completed during the project period. This project contributed to the creation of a quality committee and increased focus on quality measures, laid a foundation for improved medication adherence, and demonstrated the importance of nursing leadership in improving patient outcomes.D.N.P

Bring Back My Daddy To Me

https://digitalcommons.library.umaine.edu/mmb-vp/1122/thumbnail.jp

Impact of guidance on intervention adherence in computerised interventions for mental health problems: A meta-analysis.

Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [g = 0.29, 95% confidence interval (CI) 0.18-0.40] and the proportion of intervention completers [log odds ratio (OR) = 0.50, 95% CI 0.34-0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.</p

Ecological restoration of tallgrass prairie: grazing management benefits plant and bird communities in upland and riparian habitats

Master of ScienceDepartment of BiologyBrett K. SandercockCattle-grazing is a dominant land use in the United States, with more than 300 million hectares of land grazed each year. The habitat changes facilitated by cattle grazing can influence resource availability and habitat selection for associated wildlife. To investigate the potential for changes in traditional livestock management to restore native grassland and riparian habitat, we evaluated biological community responses to winter-grazing and livestock exclusion at the Kansas Army Ammunition Plant in southeastern Kansas. In grassland habitats, we combined winter-grazing by domestic cattle and discontinued fertilization in an attempt to restore pastures dominated by tall fescue to native tallgrass prairie and improve habitat for grassland-breeding birds. We observed a decrease in tall fescue and an increase in native, warm-season grasses in winter-grazed pastures compared to fertilized, year-round grazed pastures. Grassland-breeding bird responses to winter-grazing were species-specific. Dickcissels preferred winter-grazed pastures, while Eastern Meadowlarks and Grasshopper Sparrows tended to prefer year-round grazed pastures. Dickcissels were negatively correlated with the presence of cattle during the breeding season and the abundance of tall fescue. Grasshopper Sparrows were negatively correlated with native, warm-season grass abundance and visual obstruction, but were positively correlated with forb abundance. Henslow’s Sparrows and Common Yellowthroats were detected breeding in low numbers on pastures that had been winter-grazed for five years. Our results suggest that winter-grazing and discontinued fertilization of agricultural grasslands can direct semi-natural plant communities toward tallgrass prairie and benefit some grassland-breeding birds. In riparian habitats, livestock were excluded from 1996 to 2005. We measured bird community responses in grazed and ungrazed sites using baseline data collected in 1996-97 and post-treatment data collected in 2004-05. Riparian bird community data were analyzed using robust design mark-recapture models that allowed us to evaluate changes in bird species richness while accounting for differences in detectability among species. We detected increases in species richness in both ungrazed and grazed treatments. We observed few differences in community vital rates between treatments; however, we did detect differences in guild responses. The changes observed within both grazed and ungrazed riparian bird communities were likely influenced by regional fluctuations in species richness and composition

Direct and indirect effects of livestock grazing intensity on processes regulating grassland bird populations

In grasslands, grazing by large ungulates can influence vegetation structure, composition, primary productivity, and ultimately, ecosystem functioning. While grazing represents a complex disturbance, grazing intensity largely determines the effects of grazing on vegetation. Structural and compositional changes in the plant community caused by grazing could have bottom-up effects on species and interactions at higher trophic levels. Thus, particular management strategies for domestic livestock in rangeland systems could exert a strong affect on grassland wildlife. Grassland-dependent songbirds may be particularly susceptible to the effects of domestic grazers because they depend on grassland vegetation for foraging and nesting. Domestic livestock may influence grassland-breeding bird populations by affecting settlement decisions, resource availability, or reproductive success. We investigated the effects of grazing intensity on grassland vegetation structure and songbird demography in a northwestern bunchgrass prairie using paddocks with experimentally-manipulated cattle stocking rates. We compared effects of four stocking rates (0, 14.4, 28.8, and 43.2 animal unit months) on songbirds using a randomized complete block design with four replicates of each stocking rate to address hypotheses regarding demography of grassland songbirds. Overall paddock-level vegetation structure decreased and structural heterogeneity of vegetation increased with higher stocking rates, and those effects carried over one-year post-grazing. However, most bird species were able to locate nesting sites with similar vegetation structure regardless of paddock-level effects of stocking rate. The exceptions were western meadowlarks and vesper sparrows; nests of these species in paddocks with higher stocking rates had less vegetative cover. Apparent nest density for grasshopper sparrows was negatively affected by higher stocking rates. Grazing treatment effects on songbird population density were restricted to negative effects of higher stocking rates on savannah sparrows, but this relationship was not observed until the post-treatment year. Songbird community composition differed between control and heavily-grazed paddocks, but diversity was not affected by stocking rate. Nest fates were evaluated to determine whether stocking rate influenced nest survival or cause-specific nest failure. Other variables such as vegetation structure and predator community, date, year, and nest age were included to help clarify which mechanisms might be responsible for differences in nest survival or failure rates among treatments. For our analysis, we introduce the use of a novel software package, McNestimate, to estimate the daily probability of nest survival and failure from specific causes. McNestimate estimates the probability of nest failure from competing causes when the exact dates of failure are unknown using a Markov Chain framework, and incorporates a model selection approach which allows the use of covariates to help identify variables important in explaining variation in the daily probability of nest failure. Nest predation rates increased with the age of the nest and throughout the breeding season, but were not affected by stocking rate. The probability of nest failure from adverse weather declined throughout the season, but the rate of decline depended on year. Nest failure rates due to trampling were higher in paddocks with higher stocking rates, but also depended on the number of days cattle were present during the nesting period. Patterns of overall probability of nest success were driven by predation patterns in the first year, but in the second year were strongly influenced by the chances of weather-related nest failure. Although starvation was not identified as a significant source of nest failure, grazing-induced changes to vegetation structure and composition could influence food availability for breeding songbirds, ultimately affecting the composition of nestling diets and nestling condition. To better understand the relationship between grazing intensity, nestling diet composition, and subsequent effects on nestling condition, we examined the invertebrate composition of nestling fecal samples. All species showed strong preferences for Lepidoptera (moths and butterflies) larvae, and partial preferences for Coleoptera (beetles) and Araneae (spiders). The proportion of preferred prey items was not affected by stocking rate. There were effects of bird species on the proportion of Araneae and Coleoptera and the proportion of Acrididae (short-horned grasshoppers) in the diet of western meadowlark nestlings decreased with high stocking rates. Growth rates for western meadowlarks and vesper sparrows were negatively affected by higher stocking rates. These results suggest that stocking rates can have variable effects on grassland songbird population and nest density depending on each species' habitat requirements. However, negative effects of high stocking rates on nest survival and nestling condition could have consequences for juvenile survival and recruitment. Overall, low-to-moderate stocking rates are likely compatible with many grassland bird species in northwest bunchgrass prairie, and although heavier livestock grazing may help create suitable vegetation structure for some songbird species, high stocking rates may influence grassland songbird diet quality, or have negative effects on nestling condition. We hypothesized that grazing intensity could influence the grassland songbird community through "bottom-up" effects on vegetation, but effects of grazing at different intensities did not translate directly through the food web to influence songbird populations as strongly as lower trophic levels. Processes responsible for changes in community composition such as immigration or emigration may not have had time to ensue during our short-term experiment; alternatively, sufficient spatial or temporal heterogeneity remained in the system, even at the highest grazing intensity, such that grazing-induced changes in lower trophic levels were irrelevant for most songbird species. Our results contribute to understanding grassland songbird demographic responses to different grazing intensities and identify specific mechanisms by which conservation measures for declining grassland bird populations can be improved

One Health proof of concept: Bringing a transdisciplinary approach to surveillance for zoonotic viruses at the human-wild animal interface.

As the world continues to react and respond inefficiently to emerging infectious diseases, such as Middle Eastern Respiratory Syndrome and the Ebola and Zika viruses, a growing transdisciplinary community has called for a more proactive and holistic approach to prevention and preparedness - One Health. Such an approach presents important opportunities to reduce the impact of disease emergence events and also to mitigate future emergence through improved cross-sectoral coordination. In an attempt to provide proof of concept of the utility of the One Health approach, the US Agency for International Development's PREDICT project consortium designed and implemented a targeted, risk-based surveillance strategy based not on humans as sentinels of disease but on detecting viruses early, at their source, where intervention strategies can be implemented before there is opportunity for spillover and spread in people or food animals. Here, we share One Health approaches used by consortium members to illustrate the potential for successful One Health outcomes that can be achieved through collaborative, transdisciplinary partnerships. PREDICT's collaboration with partners around the world on strengthening local capacity to detect hundreds of viruses in wild animals, coupled with a series of cutting-edge virological and analytical activities, have significantly improved our baseline knowledge on the zoonotic pool of viruses and the risk of exposure to people. Further testament to the success of the project's One Health approach and the work of its team of dedicated One Health professionals are the resulting 90 peer-reviewed, scientific publications in under 5 years that improve our understanding of zoonoses and the factors influencing their emergence. The findings are assisting in global health improvements, including surveillance science, diagnostic technologies, understanding of viral evolution, and ecological driver identification. Through its One Health leadership and multi-disciplinary partnerships, PREDICT has forged new networks of professionals from the human, animal, and environmental health sectors to promote global health, improving our understanding of viral disease spillover from wildlife and implementing strategies for preventing and controlling emerging disease threats

Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial

Background: We conduct supplementary analyses of the NEI VFQ-25 data to evaluate where changes occurred within subscales of the NEI VFQ-25 leading to change in the composite scores between the three treatment arms, and evaluate the NEI VFQ-25 with and without the Neuro 10 supplement. Methods: A prospective, multicentre, parallel, single-blind, three-arm RCT of fourteen UK acute stroke units was conducted. Stroke survivors with homonymous hemianopia were recruited. Interventions included: Fresnel prisms for minimum 2 h, 5 days/week over 6-weeks (Arm a), Visual search training for minimum 30 min, 5 days/week over 6-weeks (Arm b) and standard care-information only (Arm c). Primary and secondary outcomes (including NEI VFQ-25 data) were measured at baseline, 6, 12 and 26 weeks after randomisation. Results: Eighty seven patients were recruited (69% male; mean age (SD) equal to 69 (12) years). At 26 weeks, outcomes for 24, 24 and 22 patients, respectively, were compared to baseline. NEI VFQ-25 (with and without Neuro 10) responses improved from baseline to 26 weeks with visual search training compared to Fresnel prisms and standard care. In subscale analysis, the most impacted across all treatment arms was ‘driving’ whilst the least impacted were ‘colour vision’ and ‘ocular pain’. Conclusions: Composite scores differed systematically for the NEI VFQ-25 (Neuro 10) versus NEI VFQ-25 at all time points. For subscale scores, descriptive statistics suggest clinically relevant improvement in distance activities and vision-specific dependency subscales for NEI VFQ-25 scores in the visual search treatment arm. Trial Registration: Current Controlled Trials ISRCTN05956042