Training Implementation of Behavior Intervention Plans using Behavioral Skills Training

Most trainings conducted in today in schools are ineffective at improving acquisition of new skills. Poor training can have a collateral effects on student outcomes, including worsening problem behavior. Behavioral skills training (BST) is an evidence-based training package that can be used to train staff and parents to implement interventions to fidelity with individuals with disabilities. This presentation is designed for practitioners who are responsible for training others who implement behavior intervention plans. Through this presentation you will learn why BST is an effective strategy, how to implement the steps of BST, and how to evaluate your training

Investigating uncertainty in global hydrology modelling

As projections of future climate raise concerns over water availability and extreme hydrological events, global hydrology models are increasingly being employed to better understand our global water resources and how they may be affected by climate change. Being a relatively recent development in hydrological science, global hydrology modelling has not yet undergone the same level of assessment and evaluation as catchment scale hydrology modelling. Until now, global hydrology models have presented just one deterministic model output for use in scientific research. Recently, multi-model ensembles have compared these outputs for different global models, but this has been done prematurely as the uncertainties within individual models have yet to be understood. This study demonstrates a rigorous uncertainty investigation of the 123 parameters within the Mac-PDM global hydrology model over 21 global river catchments. Mac-PDM was selected for its relative simplicity amongst global hydrology models, and its suitability for application using high performance computer clusters. A new version of the model, Mac-PDM.14 is provided, with updated soil and vegetation classifications. This model is then subjected to a 100,000 parameter realisation Generalised Likelihood Uncertainty Estimation (GLUE) experiment, requiring 40 days of high performance computing time, and outputting over 2Tb of data. The top performing model parameterisation from this experiment provides an annual average error of 47% when compared to observed records, a 45% improvement over the previous version of the model, Mac-PDM.09. Given the computational expense of such an experiment, smaller sample sizes of parameter realisations are explored. Whilst the top performing parameterisation in a sample size as small as 1,000 can perform almost as well as that from 100,000 parameterisations, the number of good parameterisations is fewer, and the range of model uncertainty may therefore be significantly underestimated. Mac-PDM.14 is shown to have a lower mean absolute relative error than all models involved in both the Water and Global Change (WATCH) project and the Inter-Sectoral Impacts Model Intercomparison Project (ISI-MIP). Parameter uncertainty is compared to model uncertainty, and the uncertainty range between the models within the WATCH and ISI-MIP projects is comparable to the parameter uncertainty within Mac-PDM.14. Catchment specific calibrations of the global hydrology model are explored, and it is demonstrated that the model performance is improved by 22 to 92%, for the Niger and the Yangtze respectively, with catchment specific parameter values over a global calibration. Approximate Bayesian Rejection is applied to explore the catchment specific parameter values that result in good parameter performance. Few trends can be identified from this analysis, which suggests that Mac-PDM may be over-parameterised. Catchment specific calibrations in both high latitude and arid to semi-arid regions show significant improvement over global calibration, which indicate a deficiency in model structure; the addition of a glacier component to Mac-PDM is recommended. Model calibrations are validated using the ISI-MIP forcing dataset, and the best model performance gives an error of 44%. This is a betterment on the performance with the WATCH forcing data used in calibration, and so implies that models not need to be recalibrated every time new forcing datasets are employed. This research highlights that the performance of global hydrology models can be significantly improved by running a parameter uncertainty assessment, and that in catchment scale studies, catchment specific calibration should be carefully considered. Furthermore, the uncertainty within individual global hydrology models is an important consideration that should not be overlooked as these models are increasingly included in ensembles and interdisciplinary studies

Investigating uncertainty in global hydrology modelling

As projections of future climate raise concerns over water availability and extreme hydrological events, global hydrology models are increasingly being employed to better understand our global water resources and how they may be affected by climate change. Being a relatively recent development in hydrological science, global hydrology modelling has not yet undergone the same level of assessment and evaluation as catchment scale hydrology modelling. Until now, global hydrology models have presented just one deterministic model output for use in scientific research. Recently, multi-model ensembles have compared these outputs for different global models, but this has been done prematurely as the uncertainties within individual models have yet to be understood. This study demonstrates a rigorous uncertainty investigation of the 123 parameters within the Mac-PDM global hydrology model over 21 global river catchments. Mac-PDM was selected for its relative simplicity amongst global hydrology models, and its suitability for application using high performance computer clusters. A new version of the model, Mac-PDM.14 is provided, with updated soil and vegetation classifications. This model is then subjected to a 100,000 parameter realisation Generalised Likelihood Uncertainty Estimation (GLUE) experiment, requiring 40 days of high performance computing time, and outputting over 2Tb of data. The top performing model parameterisation from this experiment provides an annual average error of 47% when compared to observed records, a 45% improvement over the previous version of the model, Mac-PDM.09. Given the computational expense of such an experiment, smaller sample sizes of parameter realisations are explored. Whilst the top performing parameterisation in a sample size as small as 1,000 can perform almost as well as that from 100,000 parameterisations, the number of good parameterisations is fewer, and the range of model uncertainty may therefore be significantly underestimated. Mac-PDM.14 is shown to have a lower mean absolute relative error than all models involved in both the Water and Global Change (WATCH) project and the Inter-Sectoral Impacts Model Intercomparison Project (ISI-MIP). Parameter uncertainty is compared to model uncertainty, and the uncertainty range between the models within the WATCH and ISI-MIP projects is comparable to the parameter uncertainty within Mac-PDM.14. Catchment specific calibrations of the global hydrology model are explored, and it is demonstrated that the model performance is improved by 22 to 92%, for the Niger and the Yangtze respectively, with catchment specific parameter values over a global calibration. Approximate Bayesian Rejection is applied to explore the catchment specific parameter values that result in good parameter performance. Few trends can be identified from this analysis, which suggests that Mac-PDM may be over-parameterised. Catchment specific calibrations in both high latitude and arid to semi-arid regions show significant improvement over global calibration, which indicate a deficiency in model structure; the addition of a glacier component to Mac-PDM is recommended. Model calibrations are validated using the ISI-MIP forcing dataset, and the best model performance gives an error of 44%. This is a betterment on the performance with the WATCH forcing data used in calibration, and so implies that models not need to be recalibrated every time new forcing datasets are employed. This research highlights that the performance of global hydrology models can be significantly improved by running a parameter uncertainty assessment, and that in catchment scale studies, catchment specific calibration should be carefully considered. Furthermore, the uncertainty within individual global hydrology models is an important consideration that should not be overlooked as these models are increasingly included in ensembles and interdisciplinary studies

Development and usability testing of a very brief intervention for personalised cancer risk assessment to promote behaviour change in primary care using normalisation process theory.

BACKGROUND: Cancer is the second leading cause of death worldwide. Lifestyle choices play an important role in the aetiology of cancer with up to 4 in 10 cases potentially preventable. Interventions delivered by healthcare professionals (HCPs) that incorporate risk information have the potential to promote behaviour change. Our aim was to develop a very brief intervention incorporating cancer risk, which could be implemented within primary care. METHODS: Guided by normalisation process theory (NPT), we developed a prototype intervention using literature reviews, consultation with patient and public representatives and pilot work with patients and HCPs. We conducted focus groups and interviews with 65 HCPs involved in delivering prevention activities. Findings were used to refine the intervention before 22 HCPs completed an online usability test and provided further feedback via a questionnaire incorporating a modified version of the NoMAD checklist. RESULTS: The intervention included a website where individuals could provide information on lifestyle risk factors view their estimated 10-year risk of developing one or more of the five most common preventable cancers and access lifestyle advice incorporating behaviour change techniques. Changes incorporated from feedback from the focus groups and interviews included signposting to local services and websites, simplified wording and labelling of risk information. In the usability testing, all participants felt it would be easy to collect the risk information. Ninety-one percent felt the intervention would enable discussion about cancer risk and believed it had potential to be easily integrated into National Health Service (NHS) Health Checks. However, only 36% agreed it could be delivered within 5 min. CONCLUSIONS: With the use of NPT, we developed a very brief intervention that is acceptable to HCPs in primary care and could be potentially integrated into NHS Health Checks. However, further work is needed to assess its feasibility and potential effectiveness

A Role for the Kolliker-Fuse Nucleus in Cholinergic Modulation of Breathing at Night During Wakefulness and NREM Sleep

For many years, acetylcholine has been known to contribute to the control of breathing and sleep. To probe further the contributions of cholinergic rostral pontine systems in control of breathing, we designed this study to test the hypothesis that microdialysis (MD) of the muscarinic receptor antagonist atropine into the pontine respiratory group (PRG) would decrease breathing more in animals while awake than while in NREM sleep. In 16 goats, cannulas were bilaterally implanted into rostral pontine tegmental nuclei (n = 3), the lateral (n = 3) or medial (n = 4) parabrachial nuclei, or the Kölliker-Fuse nucleus (KFN; n = 6). After \u3e2 wk of recovery from surgery, the goats were studied during a 45-min period of MD with mock cerebrospinal fluid (mCSF), followed by at least 30 min of recovery and a second 45-min period of MD with atropine. Unilateral and bilateral MD studies were completed during the day and at night. MD of atropine into the KFN at night decreased pulmonary ventilation and breathing frequency and increased inspiratory and expiratory time by 12–14% during both wakefulness and NREM sleep. However, during daytime studies, MD of atropine into the KFN had no effect on these variables. Unilateral and bilateral nighttime MD of atropine into the KFN increased levels of NREM sleep by 63 and 365%, respectively. MD during the day or at night into the other three pontine sites had minimal effects on any variable studied. Finally, compared with MD of mCSF, bilateral MD of atropine decreased levels of acetylcholine and choline in the effluent dialysis fluid. Our data support the concept that the KFN is a significant contributor to cholinergically modulated control of breathing and sleep

What is the role of a specialist regional mesothelioma multidisciplinary team meeting?:A service evaluation of one tertiary referral centre in the UK

BACKGROUND: Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting. OBJECTIVES: To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment. DESIGN AND SETTING: A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England. PARTICIPANTS: All cases discussed between 1/1/2014 and 31/12/2015. OUTCOME MEASURES: The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected. RESULTS: A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was <2 weeks in 75% of cases. CONCLUSIONS: This specialist mesothelioma multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core requirements of a specialist mesothelioma multidisciplinary team meeting were met. The process was timely, with most outcomes returned within 2 weeks of referral

Hyperspectral and Physiological Analyses of Coral-Algal Interactions

Space limitation leads to competition between benthic, sessile organisms on coral reefs. As a primary example, reef-building corals are in direct contact with each other and many different species and functional groups of algae. Here we characterize interactions between three coral genera and three algal functional groups using a combination of hyperspectral imaging and oxygen microprofiling. We also performed in situ interaction transects to quantify the relative occurrence of these interaction on coral reefs. These studies were conducted in the Southern Line Islands, home to some of the most remote and near-pristine reefs in the world. Our goal was to determine if different types of coral-coral and coral-algal interactions were characterized by unique fine-scale physiological signatures. This is the first report using hyperspectral imaging for characterization of marine benthic organisms at the micron scale and proved to be a valuable tool for discriminating among different photosynthetic organisms. Consistent patterns emerged in physiology across different types of competitive interactions. In cases where corals were in direct contact with turf or macroalgae, there was a zone of hypoxia and altered pigmentation on the coral. In contrast, interaction zones between corals and crustose coralline algae (CCA) were not hypoxic and the coral tissue was consistent across the colony. Our results suggest that at least two main characteristic coral interaction phenotypes exist: 1) hypoxia and coral tissue disruption, seen with interactions between corals and some species of CCA. Hyperspectral imaging in combination with oxygen profiling provided useful information on competitive interactions between benthic reef organisms, and demonstrated that some turf and fleshy macroalgae can be constant source of stress for corals, while CCA are not

The Landscape of Galaxies Harboring Changing-Look Active Galactic Nuclei in the Local Universe

We study the properties of the host galaxies of Changing-Look Active Galactic Nuclei (CL AGNs) with the aim of understanding the conditions responsible for triggering CL activity. We find that CL AGN hosts primarily reside in the so-called green valley that is located between spiral-like star-forming galaxies and dead ellipticals, implying that CL AGNs are activated during distinct periods of quenching and galaxy transformation processes. CL AGN hosts have low galaxy asymmetry indicators, suggesting that secular evolutionary processes (the influence of bars and spirals, and possibly minor mergers) might be the primary mechanism for transporting gas to the vicinity of the supermassive black hole (SMBH) rather than major mergers. Similar to tidal disruption events (TDEs) and highly variable AGNs, we find that CL AGN hosts are associated with SMBHs residing in high density pseudo-bulges and appear to overlap most significantly with the population of low-ionization nuclear emission-line region (LINER) galaxies. As such, CL AGN are likely fueled by strong episodic bursts of accretion activity, which appear to take place preferentially as the amount of material accessible for star formation and accretion dwindles. We also identify that CL AGN hosts are characterized by either large S\'ersic indices or high bulge fractions, which suggests a simple metric for identifying candidates for spectroscopic follow-up observations in forthcoming synoptic surveys.Comment: 17 pages, 9 figures. Accepted to ApJ Letters. Revised version includes an expanded discussion on asymmetry measurements and galaxy disturbance

Cervical auscultation in the diagnosis of oropharyngeal aspiration in children: a study protocol for a randomised controlled trial

BackgroundOropharyngeal aspiration (OPA) can lead to recurrent respiratory illnesses and chronic lung disease in children. Current clinical feeding evaluations performed by speech pathologists have poor reliability in detecting OPA when compared to radiological procedures such as the modified barium swallow (MBS). Improved ability to diagnose OPA accurately via clinical evaluation potentially reduces reliance on expensive, less readily available radiological procedures. Our study investigates the utility of adding cervical auscultation (CA), a technique of listening to swallowing sounds, in improving the diagnostic accuracy of a clinical evaluation for the detection of OPA. MethodsWe plan an open, unblinded, randomised controlled trial at a paediatric tertiary teaching hospital. Two hundred and sixteen children fulfilling the inclusion criteria will be randomised to one of the two clinical assessment techniques for the clinical detection of OPA: (1) clinical feeding evaluation only (CFE) group or (2) clinical feeding evaluation with cervical auscultation (CFE + CA) group. All children will then undergo an MBS to determine radiologically assessed OPA. The primary outcome is the presence or absence of OPA, as determined on MBS using the Penetration-Aspiration Scale. Our main objective is to determine the sensitivity, specificity, negative and positive predictive values of &lsquo;CFE + CA&rsquo; versus &lsquo;CFE&rsquo; only compared to MBS-identified OPA. DiscussionEarly detection and appropriate management of OPA is important to prevent chronic pulmonary disease and poor growth in children. As the reliability of CFE to detect OPA is low, a technique that can improve the diagnostic accuracy of the CFE will help minimise consequences to the paediatric respiratory system. Cervical auscultation is a technique that has previously been documented as a clinical adjunct to the CFE; however, no published RCTs addressing the reliability of this technique in children exist. Our study will be the first to establish the utility of CA in assessing and diagnosing OPA risk in young children

Longitudinal Body Composition Changes in NCAA Division I College Football Players

Many athletes seek to optimize body composition to fit the physical demands of their sport. American football requires a unique combination of size, speed, and power. The purpose of the current study was to evaluate longitudinal changes in body composition in Division I collegiate football players. For 57 players (Mean ± SD; Age=19.5 ± 0.9 yrs; Height=186.9 ± 5.7 cm; Weight=107.7 ± 19.1 kg), body composition was assessed via dual-energy x-ray absorptiometry in the off-season (March-Pre), end of off-season (May), mid-July (Pre-Season), and the following March (March-Post). Outcome variables included weight, body fat percentage (BF%), fat mass (FM), lean mass (LM), android (AND) and gynoid (GYN) fat, bone mineral content (BMC), and bone density (BMD). For a subset of athletes (n=13 out of 57), changes over a 4-year playing career were evaluated with measurements taken every March. Throughout a single year, favorable changes were observed for BF% (Δ=−1.3 ± 2.5%), LM (Δ=2.8 ± 2.8 kg), GYN (Δ=−1.5 ± 3.0%), BMC (Δ=0.06 ± 0.14 kg), and BMD (Δ=0.015 ± 0.027g·cm−2; all p<0.05). Across four years, weight increased significantly (Δ=6.6 ± 4.1kg), and favorable changes were observed for LM (Δ=4.3 ± 3.0 kg), BMC (Δ=0.18 ± 0.17 kg), and BMD (Δ=0.033 ± 0.039 g·cm−2; all p<0.05). Similar patterns in body composition changes were observed for linemen and non-linemen. Results indicate that well-trained collegiate football players at high levels of competition can achieve favorable changes in body composition, even late in the career, which may confer benefits for performance and injury prevention