Looking inside the black box : a theory-based process evaluation alongside a randomised controlled trial of printed educational materials (the Ontario printed educational message, OPEM) to improve referral and prescribing practices in primary care in Ontario, Canada

Background: Randomised controlled trials of implementation strategies tell us whether (or not) an intervention results in changes in professional behaviour but little about the causal mechanisms that produce any change. Theory-based process evaluations collect data on theoretical constructs alongside randomised trials to explore possible causal mechanisms and effect modifiers. This is similar to measuring intermediate endpoints in clinical trials to further understand the biological basis of any observed effects (for example, measuring lipid profiles alongside trials of lipid lowering drugs where the primary endpoint could be reduction in vascular related deaths). This study protocol describes a theory-based process evaluation alongside the Ontario Printed Educational Message (OPEM) trial. We hypothesize that the OPEM interventions are most likely to operate through changes in physicians' behavioural intentions due to improved attitudes or subjective norms with little or no change in perceived behavioural control. We will test this hypothesis using a well-validated social cognition model, the theory of planned behaviour (TPB) that incorporates these constructs. Methods/design: We will develop theory-based surveys using standard methods based upon the TPB for the second and third replications, and survey a subsample of Ontario family physicians from each arm of the trial two months before and six months after the dissemination of the index edition of informed, the evidence based newsletter used for the interventions. In the third replication, our study will converge with the "TRY-ME" protocol (a second study conducted alongside the OPEM trial), in which the content of educational messages was constructed using both standard methods and methods informed by psychological theory. We will modify Dillman's total design method to maximise response rates. Preliminary analyses will initially assess the internal reliability of the measures and use regression to explore the relationships between predictor and dependent variable (intention to advise diabetic patients to have annual retinopathy screening and to prescribe thiazide diuretics for first line treatment of uncomplicated hypertension). We will then compare groups using methods appropriate for comparing independent samples to determine whether there have been changes in the predicted constructs (attitudes, subjective norms, or intentions) across the study groups as hypothesised, and will assess the convergence between the process evaluation results and the main trial results.The OPEM trial and OPEM process evaluation are funded by the Canadian Institute of Health Research (CIHR). The OPEM process evaluation study was developed as part of the CIHR funded interdisciplinary capacity enhancement team KT-ICEBeRG. Gaston Godin, Jeremy Grimshaw and France Légaré hold Canada Research Chairs. Louise Lemyre holds an R.S. McLaughlin Research Chair

Testing a TheoRY-inspired MEssage ('TRY-ME'): a sub-trial within the Ontario Printed Educational Message (OPEM) trial

<p>Abstract</p> <p>Background</p> <p>A challenge for implementation researchers is to develop principles that could generate testable hypotheses that apply across a range of clinical contexts, thus leading to generalisability of findings. Such principles may be provided by systematically developed theories. The opportunity has arisen to test some of these theoretical principles in the Ontario Printed Educational Materials (OPEM) trial by conducting a sub-trial within the existing trial structure. OPEM is a large factorial cluster-randomised trial evaluating the effects of short directive and long discursive educational messages embedded into <b><it>informed</it></b>, an evidence-based newsletter produced in Canada by the Institute for Clinical Evaluative Sciences (ICES) and mailed to all primary care physicians in Ontario. The content of educational messages in the sub-trial will be constructed using both standard methods and methods inspired by psychological theory. The aim of this study is to test the effectiveness of the TheoRY-inspired MEssage ('TRY-ME') compared with the 'standard' message in changing prescribing behaviour.</p> <p>Methods</p> <p>The OPEM trial participants randomised to receive the short directive message attached to the outside of <b><it>informed </it></b>(an 'outsert') will be sub-randomised to receive either a standard message or a message informed by the theory of planned behaviour (TPB) using a two (long insert or no insert) by three (theory-based outsert or standard outsert or no outsert) design. The messages will relate to prescription of thiazide diuretics as first line drug treatment for hypertension (described in the accompanying protocol, "The Ontario Printed Educational Materials trial"). The short messages will be developed independently by two research teams.</p> <p>The primary outcome is prescription of thiazide diuretics, measured by routinely collected data available within ICES. The study is designed to answer the question, is there any difference in guideline adherence (i.e., thiazide prescription rates) between physicians in the six groups? A process evaluation survey instrument based on the TPB will be administered pre- and post-intervention (described in the accompanying protocol, "Looking inside the black box"). The second research question concerns processes that may underlie observed differences in prescribing behaviour. We expect that effects of the messages on prescribing behaviour will be mediated through changes in physicians' cognitions.</p> <p>Trial registration number</p> <p>Current controlled trial ISRCTN72772651</p

A new methodology for automating acoustic emission detection of metallic fatigue fractures in highly demanding aerospace environments: An overview

The acoustic emission (AE) phenomenon has many attributes that make it desirable as a structural health monitoring or non-destructive testing technique, including the capability to continuously and globally monitor large structures using a sparse sensor array and with no dependency on defect size. However, AE monitoring is yet to fulfil its true potential, due mainly to limitations in location accuracy and signal characterisation that often arise in complex structures with high levels of background noise. Furthermore, the technique has been criticised for a lack of quantitative results and the large amount of operator interpretation required during data analysis. This paper begins by introducing the challenges faced in developing an AE based structural health monitoring system and then gives a review of previous progress made in addresing these challenges. Subsequently an overview of a novel methodology for automatic detection of fatigue fractures in complex geometries and noisy environments is presented, which combines a number of signal processing techniques to address the current limitations of AE monitoring. The technique was developed for monitoring metallic landing gear components during pre-flight certification testing and results are presented from a full-scale steel landing gear component undergoing fatigue loading. Fracture onset was successfully identify automatically at 49,000 fatigue cycles prior to final failure (validated by the use of dye penetrant inspection) and the fracture position was located to within 10. mm of the actual location

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

Linking in-situ charge accumulation to electronic structure in doped SrTiO3 reveals design principles for hydrogen evolving photocatalysts

Recently, record solar to hydrogen efficiencies have been demonstrated using La,Rh co-doped SrTiO3 (La,Rh:SrTiO3) incorporated into a low cost and scalable Z-scheme device, known as a photocatalyst sheet. However, the unique properties that enable La,Rh:SrTiO3 to support this impressive performance are not fully understood. Combining in-situ spectroelectrochemical measurements with density functional theory and photoelectron spectroscopy produces a depletion model of Rh:SrTiO3 and La,Rh:SrTiO3 photocatalyst sheets. This reveals remarkable properties, such as deep flatband potentials (+2 VRHE) and a Rh oxidation state dependent reorganisation of the electronic structure, involving the loss of a vacant Rh 4d mid gap state. This reorganisation enables Rh:SrTiO3 to be reduced by co-doping without compromising p-type character. In-situ time resolved spectroscopies show the electronic structure reorganisation induced by Rh reduction controls electron lifetime in photocatalyst sheets. In Rh:SrTiO3 , enhanced lifetimes can only be obtained at negative applied potentials, where the complete Z-scheme operates inefficiently. La co-doping fixes Rh in the 3+ state, resulting in long-lived photogenerated electrons even at very positive potentials (+1 VRHE), where both components of the complete device operate effectively. This understanding of role of co-dopants provides new insight into the design principles for water splitting devices based on bandgap engineered metal oxides

Compartir los datos de investigación en ciencia: introducción al data sharing

The emergence in the scientific community of an initiative known as data sharing, consisting of sharing research data among researchers and aiming to maximize efforts and resources, is analysed. First, the concept of research data and the related technical difficulties depending on the discipline are reviewed. We also examine the motivations, origins and growth of this movement, which has had an important impact on the scientific community’s behaviour through the creation of reposi- tories and data banks, raising both technical and social challenges. Then we discuss leading funding agencies’ initiatives and scientific journals’ editorial policies promoting these practices. Finally, we examine the impact these major changes in researchers’ habits have for librarians, including the emergence of new professional profiles

SCIPP: An Expanded Community of Practice - Community Publishing

SCIPP redefines and expands the existing notions about what makes for a vibrant and robust community of practice by partnering CSUSB students and professors with K-12 students, parents, and educators, along with committed community partners. SCIPP encourages curiosity in ways that leads to critical thinking, exploration, risk taking , confidence building, open-mindedness, and other personal traits that equip them with the softskills to be active, critical, and creative contributors to our communities. SCIPP pedagogy embraces our students\u27 collective wisdom and focuses on relational building where multi-directional communication is promoted and students are viewed as equal stakeholders in their own educations. SCIPP puts collaboration into action which in turn fosters community-based lifelong learning. SCIPP provides the open intellectual space for future university students (our K-12 students) to engage with existing university students in meaningful ways so as to sustain interconnected partnerships facilitating community engagement. It supports parents as experts in the education of their children and acknowledges parents as the first conduits to spark their children’s imagination while they actively participate in education enriching activities and programs. Everyone involved is committed to creating a secure and open atmosphere for dreaming, sharing, and learning. Together we explore the aspects of community publishing through collaborative learning in formal and informal settings relating to digital and printed medias

Creating and Breaking Habit in Healthcare Professional Behaviours to Improve Healthcare and Health

Healthcare professionals (HCPs) prescribe, provide advice, conduct examinations, perform surgical procedures, and engage in a range of clinical behaviours. Their clinical actions are characteristically performed repeatedly—sometimes multiple times per day—in the same physical locations with the same colleagues and patients, under constant time pressure, and competing demands. This repetition under pressure in a stable setting provides ideal circumstances for creating contingencies between physical and social cues and clinical actions. HCP behaviour provides an ideal setting in which to advance theory, methods, and interventions to better understand habit formation and habit reversal. Contemporary theoretical and methodological development in the psychology of habit has begun to be applied to understand and promote the formation, breaking, and replacement of habitual behaviour in HCPs. This chapter highlights key theoretical approaches, methods, and intervention techniques that have been applied to conceptualize, measure, develop, and break habit and automaticity in HCPs. These insights have the potential to synergistically contribute novel perspectives to the wider habit literature

Public policy and entrepreneurship: Venture capitalism in British Columbia

This study explores policy options to address the reasons of why there is too little venture capitalism in British Columbia. Venture capitalism is the process of investing in potential highgrowth entrepreneurs and small businesses. The unique contribution of this study to the literature is use of the policy analysis approach. That is, combining empirical evidence, case studies, and interviews with market experts to showcase the policy problem, identify policy iilternatives, objectively measure those alternatives and ultimately, put forward some recommendations to government. A number of policy implications of this study serve to coordinate an arena for angel investors and entrepreneurs, use a fund of funds to raise venture capital, and provide a method for institutional investors to participate in the market