Understanding the dynamic design of the spliceosome

The spliceosome catalyzes the splicing of pre-mRNAs. Although the spliceosome evolved from a prokaryotic self-splicing intron and an associated protein, it is a vastly more complex and dynamic ribonucleoprotein (RNP) whose function requires at least eight ATPases and multiple RNA rearrangements. These features afford stepwise opportunities for multiple inspections of the intron substrate, coupled with spliceosome disassembly for substrates that fail inspection. Early work using splicing-defective pre-mRNAs or small nuclear (sn)RNAs in Saccharomyces cerevisiae demonstrated that such checks could occur in catalytically active spliceosomes. We review recent results on pre-mRNA splicing in various systems, including humans, suggesting that earlier steps in spliceosome assembly are also subject to such quality control. The inspection-rejection framework helps explain the dynamic nature of the spliceosome.

Assessing the fidelity of supported education programs for first-episode psychosis to the supported employment guidelines adapted for education

INTRODUCTION

Psychotic disorders are associated with academic difficulties. Supported Employment Program (SEP) guidelines have become the gold standard to improve occupational functioning in psychotic disorders. More recently, these guidelines have been adapted to education. In Canada, several community organizations and hospital programs offer supported education to young people with psychotic disorders. However, SEP guidelines are not systematically used. The objective of this study was to assess the fidelity of 6 Canadian (Quebec) organizations offering supported education services to young people with psychotic disorders to the SEP guidelines adapted to education.

METHODS

Six sites offering educational services to young people with psychotic disorders were recruited. Semi-structured interviews were conducted with one supported education professional and one manager of each site, using the Quality of Supported Education Implementation Scale (QSEDIS). This new scale has been developed from the Quality of Supported Employment Implementation Scale. The QSEDIS assesses the fidelity of the quality of the implementation of supported education programs, using three subscales (Employees, Organization and Services).

RESULTS

Acceptable fidelity scores were observed in the three QSEDIS subscales for all six sites combined. The Services subscale received the highest score of fidelity (4.4/5), followed by the Supported Education Employee (4.1/5) and the Organization (3.7/5).

CONCLUSION

The results suggest that supported education services offered to young people with psychotic disorders in the six sites are generally consistent with SEP guidelines adapted to education. Further research is warranted to validate whether acceptable SEP guidelines fidelity according to the QSEDIS translates into educational outcomes.

High-Fidelity, Indigenously Prepared, Low-Cost Moulage as a Valid Simulation Tool to Improve Trauma Education

Background Simulation-based trauma education facilitates repeated practice in a controlled and safer environment for the learner without any risk to the patient's well-being. Moulage contributes to the perception of reality during training using standardized patients. However, the high cost of commercial moulage items is often prohibitive for regular use. This study aimed to assess the effectiveness of indigenously prepared, low-cost moulage as a valid simulation tool to improve trauma education, explore possible replacements of commercial moulage products, and determine their merits and demerits. Methodology Readily available economic items were used to make low-cost moulage on the simulated patients to replicate trauma victims. A cross-sectional design used a pre-validated Modified Moulage Authenticity Rating Scale to collect data from 61 participants of Advanced Trauma Life Support and Advanced Trauma Care for Nurses courses to analyze the effectiveness and fidelity of moulage. Results In total, 54 (89%) participants scored the low-cost moulage to provide high fidelity effectively. The majority of respondents graded the authenticity of moulage as good. Overall, 46 (75%) participants felt moulage injuries were quite realistic. All agreed that the moulage-based simulation offered a good teaching-learning alternative to assess and manage trauma victims. Further, 45 (73%) participants felt they were in an actual clinical situation, and 58 (95%) stated it could help them in their clinical practice. Conclusions Indigenously prepared, low-cost moulage is a feasible and cost-effective means to enhance fidelity in simulation-based trauma education. It can also be a possible replacement for commercial moulage. Further research is needed to rigorously evaluate the effectiveness of indigenously prepared, cost-effective moulage in trauma education to enhance patient care outcomes. This technique can also be easily translated into other simulation-based medical education domains.

Adapting an Effective Health-Promoting Intervention-Choose to Move-for Chinese Older Adults in Canada

Evidence is sparse on how community-based health-promoting programs can be culturally adapted for racially minoritized, immigrant older adult populations. Choose to Move (CTM) is an evidence-based health-promoting program that enhances physical activity and mobility and diminished social isolation and loneliness in older adults in British Columbia, Canada. However, racially minoritized older adults were not reached in initial offerings. We purposively sampled CTM delivery staff (n = 8) from three not-for-profit organizations, in Metro Vancouver, British Columbia, that serve Chinese older adults. We used semistructured interviews, ethnographic observations, and meeting minutes to understand delivery staff's perspectives on factors that influence CTM adaptations for Chinese older adults. Deductive framework analysis guided by an adaptation framework, Framework for Reporting Adaptations and Modifications-Enhanced, found three dominant cultural- and immigration-related factors influenced CTM adaptations for Chinese older adults: (a) prioritizations, (b) familiarity, and (c) literacy. Findings may influence future program development and delivery to meet the needs of racially minoritized older adult populations.

Learning shapes the development of migratory behavior

How animals refine migratory behavior over their lifetime (i.e., the ontogeny of migration) is an enduring question with important implications for predicting the adaptive capacity of migrants in a changing world. Yet, our inability to monitor the movements of individuals from early life onward has limited our understanding of the ontogeny of migration. The exploration-refinement hypothesis posits that learning shapes the ontogeny of migration in long-lived species, resulting in greater exploratory behavior early in life followed by more rapid and direct movement during later life. We test the exploration-refinement hypothesis by examining how white storks (Ciconia ciconia) balance energy, time, and information as they develop and refine migratory behavior during the first years of life. Here, we show that young birds reduce energy expenditure during flight while also increasing information gain by exploring new places during migration. As the birds age and gain more experience, older individuals stop exploring new places and instead move more quickly and directly, resulting in greater energy expenditure during migratory flight. During spring migration, individuals innovated novel shortcuts during the transition from early life into adulthood, suggesting a reliance on spatial memory acquired through learning. These incremental refinements in migratory behavior provide support for the importance of individual learning within a lifetime in the ontogeny of long-distance migration.

Parent implementation of a treatment for late talkers based on cross-situational statistical learning principles: Treatment fidelity and acceptability

PURPOSE

Early intervention based on principles of cross-situational statistical learning (CSSL) for late-talking children has shown promise. This study explored whether parents could be trained to deliver this intervention protocol with fidelity and if they found the intervention to be acceptable.

METHOD

Mothers of four English-speaking children aged 18-30 months who scored <10th centile for expressive vocabulary were recruited to an 8-week group training program. Parents were taught principles of CSSL and asked to perform 16 home treatment sessions (30 minutes each) in total, providing auditory bombardment of target words in full sentences at high dose number and syntactic variability, using a range of physical exemplars. Home diaries and two videotaped sessions measured treatment fidelity. Pre- and post-treatment questionnaires measured acceptability.

RESULT

One parent discontinued the study after the second group training session. Three parents completed 15/16 group training sessions and reported completing 87% of home sessions. Two parents demonstrated implementing the intervention as per the target dose number by the first fidelity session (Weeks 2/3), and the third parent was very close to meeting target dose number by the second fidelity session (Weeks 7/8).

CONCLUSION

Parents can be trained to deliver an intervention based on cross-situational statistical learning principles.

Ensuring Intervention Fidelity of an Attention Control Arm in a Multisite Randomized Controlled Trial

BACKGROUND

Intervention fidelity is a critical element of randomized controlled trials, yet reporting of intervention fidelity among attention control arms is limited. Lack of fidelity to attention control procedures can affect study outcomes by either overestimating or underestimating the efficacy of the intervention under examination.

OBJECTIVES

This brief report describes the approach researchers took to promote fidelity to the attention control arm of a pediatric palliative care randomized controlled trial funded by the National Institutes of Health.

METHODS

The Informational Meetings for Planning and Coordinating Treatment trial aims to determine the efficacy of a communication intervention that uses care team dyads (i.e., physicians partnered with nurses or advanced practice providers) to engage parents of children with cancer who have a poor prognosis in structured conversations about prognostic information, goals of care, and care planning. The intervention is compared with an attention control arm, which provides parents with structured conversations on common pediatric cancer education topics, such as talking to their child about their cancer, clinical trials, cancer treatment, side effects, and so forth. National Institutes of Health guidelines for assessing and implementing strategies to promote intervention fidelity were used to design (a) the attention control arm of a randomized controlled trial, (b) related attention control arm training, and (c) quality assurance monitoring.

RESULTS

Attention control study procedures were designed to mirror that of the intervention arm (i.e., same number, frequency, and time spent in study visits). Cluster randomization was used to allocate care team dyads to one arm of the randomized controlled trial. Care team dyads assigned to the attention control arm participated in online training sessions to learn attention control procedures, the different roles of research team members, and quality assurance methods. Fidelity to attention control procedures is assessed by both the interveners themselves and a quality assurance team.

DISCUSSION

Study design, training, and delivery are all critical to attention control fidelity. Baseline training often needs to be supplemented with booster training when time gaps occur between study start-up and implementation. Quality assurance procedures are essential to determine whether interveners consistently deliver attention control procedures correctly.

Implementation in the "real world" of an evidence-based social and emotional learning program for teachers: effects on children social, emotional, behavioral and problem solving skills

Introduction

The delivery of social and emotional learning (SEL) programs that are developmentally school-based and evidence-based has the potential to benefit many children, and as such, greater efforts are needed to disseminate these programs more widely within the community. The Incredible Years® Teacher Classroom Management (IY-TCM) has shown promising results when applied by teachers in preschool centers and primary schools, as seen in several randomized control trials conducted worldwide, including in Portugal.

Methods

The current study presents a model of the implementation of the program within the framework of a nationwide initiative undertaken in Portugal: the Academias Gulbenkian do Conhecimento. Additionally, results of the program's impact on children were explored using ANOVA, which compared pre- to post- treatment outcomes. To assess which factors affected the efficacy of the intervention, moderation analyses were conducted using the MEMORE macro. Ninety teachers and 535 children (2 to 10 years old) were assessed.

Results

Results revealed that children showed significant increases in social and emotional skills (e.g., social adjustment, empathy) and significant reductions in problem behavior when assessed by their teachers, and in social-cognitive problem solving strategies as evaluated by a set of problem-solving tasks. Moderation analyses showed that, in general, interaction effects were not found, meaning that the intervention was effective for almost all conditions. Nevertheless, significant moderation effects were found for factors pertaining to the child and the mother with respect to pro-social and emotional skills (children who benefited most from the intervention exhibited more behavioral difficulties at the baseline according to the teachers' perceptions and had mothers without a university degree; children attending primary school took less benefit from the intervention than those attending pre-school).

Discussion

The findings contribute both to the reinforcement of the effectiveness of the IY-TCM program as a universal intervention in "real world" schools and to the development of some guidelines for the promotion of effective scaling up and sustainability of program effects.

Development of fidelity of delivery and enactment measures for interventions in communication disorders

OBJECTIVES

This study was part of a process evaluation for a single-blind, randomized controlled pilot study comparing Better Conversations with Primary Progressive Aphasia (BCPPA), an approach to communication partner training, with no speech and language therapy treatment. It was necessary to explore fidelity of delivery (delivery of intervention components) and intervention enactment (participants' use of intervention skills in the form of conversation behaviours comprising facilitators, that enhance the conversational flow, and barriers, that impeded the flow of conversation). This study aimed to: (1) Outline an adapted methodological process that uses video observation, to measure both fidelity of delivery and enactment. (2) Measure the extent to which the BCPPA pilot study was delivered as planned, and enacted.

DESIGN

Observational methods were used alongside statistical analysis to explore the fidelity of intervention and enactment using video recordings obtained from the BCPPA pilot study.

METHODS

A 5-step methodology, was developed to measure fidelity of delivery and enactment for the BCPPA study using video-recorded data. To identify delivery of intervention components, a random sample of eight video recorded and transcribed BCPPA intervention sessions was coded. To examine the enactment of conversation behaviours, 108 transcribed 10 -min-video recorded conversations were coded from 18 participants across the control and intervention group.

RESULTS

Checklists and guidelines for measurement of fidelity of treatment delivery and coding spreadsheets and guidelines for measurement of enactment are presented. Local collaborators demonstrated 87.2% fidelity to the BCPPA protocol. Participants in the BCPPA treatment group increased their use of facilitator behaviours enacted in conversation from a mean of 13.5 pre-intervention to 14.2 post-intervention, whilst control group facilitators decreased from a mean of 15.5 to 14.4, over the same timescale.

CONCLUSIONS

This study proposes a novel and robust methods, using video recorded intervention sessions and conversation samples, to measure both fidelity of intervention delivery and enactment. The learnings from this intervention are transferable to other communication interventions.

The feasibility of measuring fidelity of implementation in parent-child interaction therapy: A clinician and parent fidelity study

PURPOSE

Measuring fidelity of implementation in parent-child interaction therapy (PCIT) involves assessing the training delivered by clinicians and how parents implement the techniques with their children. The aim of this study was to determine the feasibility of measuring fidelity of implementation for a PCIT intervention designed for young children with Down syndrome.

METHOD

We applied a framework to measure dosage, adherence, quality, and participant responsiveness using a mixed methods approach with observational and interview data.

RESULT

Our results showed that clinicians delivered 94% of the planned dosage; they adhered to the goals of program and reached the quality criterion in 4/6 rated sessions. Parents described their ability to engage with the program and perceived that it changed how they interacted and communicated with their children. Parents were unable to collect dosage data, but did adhere to 7/9 of the targeted techniques and met the quality criterion on 6/9 of these. It was also possible to measure the children's responsiveness scores when interacting with parents during the intervention.

CONCLUSION

This study revealed the opportunities and challenges that occur when measuring fidelity of implementation. There is a need to refine definitions of fidelity measures and to develop appropriate measurement tools so that a more consistent and useful framework can be used by speech-language pathologists (SLPs) to measure fidelity.

Feasibility of Using a GENEActiv Accelerometer with Triaxial Acceleration and Temperature Sensors to Monitor Adherence to Shoulder Sling Wear Following Surgery

BACKGROUND

Self-reported adherence to sling wear is unreliable due to recall bias. We aim to assess the feasibility and accuracy of quantifying sling wear and non-wear utilising slings pre-fitted with a GENEActiv accelerometer that houses triaxial acceleration and temperature sensors.

METHODS

Ten participants were asked to wear slings for 480 min (8 h) incorporating 180 min of non-wear time in durations varying from 5-120 min. GENEActiv devices were fitted in sutured inner sling pockets and participants logged sling donning and doffing times. An algorithm based on variability in acceleration in three axes and temperature change was developed to identify sling wear and non-wear and compared to participants' logs.

RESULTS

There was no significant difference between algorithm detected non-wear duration (mean ± standard deviation = 172.0 ± 6.8 min/participant) and actual non-wear (179.7 ± 1.0 min/participant). Minute-by-minute agreement of sensor-detected wear and non-wear with participant reported wear was 97.3 ± 1.5% (range = 93.9-99.0), with mean sensitivity 94.3 ± 3.5% (range = 86.1-98.3) and specificity 99.1 ± 0.8% (range = 93.7-100).

CONCLUSION

An algorithm based on accelerometer-assessed acceleration and temperature can accurately identify shoulder sling wear/non-wear times. This method may have potential for assessing whether sling wear adherence after shoulder surgeries have any bearing on patient functional outcomes.

The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity

There are numerous frameworks for implementing evidence-based practices (EBPs) in novel settings to achieve "fidelity." However, identifying appropriate referents for fidelity poses a challenge. The Core Functions and Forms paradigm offers a model that can inform adaptation decisions throughout all phases of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We applied the Core Functions-Forms paradigm throughout the Exploration and Preparation phases of EPIS in the design of two EBPs targeting family protective factors among Latinos in San Diego, as well as describe plans for its use in Implementation and Sustainment. We employed a distinct approach for each intervention element to contrast adaptation decisions that prioritize adherence to either form or function fidelity. We describe our application of the functions-forms paradigm within the EPIS framework, focusing on the Preparation phase. We also provide functions-forms matrices that map out the relationship between individual intervention components (forms) and the essential processes (functions) by which components are theorized to exert their impact. This case study of how the core functions-forms framework can be mapped onto EPIS can support a conceptual shift from prioritizing form fidelity to also focusing on function fidelity. This might allow interventionists to target appropriate fidelity referents when adapting an EBP, rather than defaulting to maintaining fidelity to forms as described in the protocol. We see great promise for using this framework for guiding actions throughout all EPIS phases and informing future applications of this paradigm to foster more robust fidelity to function.

The relationship between treatment integrity and outcome in group psychotherapy: A systematic review

Treatment integrity is defined as the extent to which the treatment has been implemented according to a specific theoretical model. It consists of two components: adherence, that is, the degree to which the therapist implements the techniques prescribed by the theoretical model, and competence, that is, the degree to which the therapist skilfully and appropriately implements the techniques prescribed by the model. Recently, the issue of integrity is gaining increasing importance in psychotherapy research, especially in an attempt to clarify its role in influencing the effectiveness of treatments. However, most studies focus on the individual setting. Therefore, this systematic review aims at investigating the relationship between integrity and outcome in group clinical treatments. Results highlighted a positive relationship between group treatment integrity and outcome. Moreover, this review provided insights for implications for research, clinical practice, and training of therapists, identifying questions that still need to be answered and tracing possible future research directions.

Square Root Statistics of Density Matrices and Their Applications

To estimate the degree of quantum entanglement of random pure states, it is crucial to understand the statistical behavior of entanglement indicators such as the von Neumann entropy, quantum purity, and entanglement capacity. These entanglement metrics are functions of the spectrum of density matrices, and their statistical behavior over different generic state ensembles have been intensively studied in the literature. As an alternative metric, in this work, we study the sum of the square root spectrum of density matrices, which is relevant to negativity and fidelity in quantum information processing. In particular, we derive the finite-size mean and variance formulas of the sum of the square root spectrum over the Bures-Hall ensemble, extending known results obtained recently over the Hilbert-Schmidt ensemble.

Validation and Calibration for Embedding Rating of Perceived Exertion Into High-Intensity Interval Exercise in Adolescents: A Lab-Based Study

PURPOSE

Rating of perceived exertion (RPE) is a convenient and cost-effective tool that can be used to monitor high-intensity interval exercise (HIIE). However, no methodological study has demonstrated the validity of RPE in this context. Therefore, the aim of this study was to validate and calibrate RPE for monitoring HIIE in adolescents.

METHODS

RPE, heart rate (HR), and oxygen uptake (V˙O2) data were retrospectively extracted from 3 lab-based crossover studies, with a pooled sample size of 45 adolescents, performing either cycling-based or running-based HIIE sessions. Within-participant correlations were calculated for RPE-HR and RPE-V˙O2, and receiver operator characteristic curve analysis was used to establish RPE cut points.

RESULTS

The results showed that RPE-HR demonstrated acceptable criterion validity (r = .53-.74, P < .01), while RPE-V˙O2 had poor validity (r = .40-.48, P < .01), except for HIIE at 100% peak power (r = .59, P < .01). RPE cut points of 4 and 5 were established in corresponding to HR/V˙O2 based thresholds.

CONCLUSION

RPE has some utility in evaluating intensity during lab-based running or cycling HIIE in adolescents. Future studies should expand the validation and calibration of RPE for prescribing and monitoring HIIE in children and adolescents in field-based contexts.

Implementing Dementia Caregiver Programs in Real-World Settings: Fidelity Considerations

Testing interventions in real-world settings requires fidelity monitoring to ensure implementation integrity. However, strategies to enhance, monitor, and measure fidelity deployed in efficacy trials may not be feasible in pragmatic trials or sustainable in practice. This paper reviews published translational or pragmatic studies of dementia caregiver support interventions to understand how fidelity was previously treated in order to derive recommendations for future pragmatic-like trials. A search using SCOPUS, EMBASE, and Google Scholar identified 31 translational caregiver intervention studies of which 20 (64.5%) referenced fidelity. Of these 20, 11 (55.0%) reported fidelity measurement, whereas 9 (45.0%) only recognized its importance. Of the 11 studies, fidelity was assessed using investigator-developed scoring forms, audio/video recordings, evaluations from caregivers and interventionists, and by comparing outcomes with the original efficacy trial. Additionally, 7 (63.6%) of 11 studies reported fidelity results, representing only 22.5% of 31 studies reporting outcomes demonstrating the inconsistency in the field concerning the reporting outcomes of fidelity. We conclude that fidelity methods used in translational studies to date are not practical nor sustainable for ongoing monitoring of evidence-based programs in real-world settings and that only 2 aspects of fidelity, intervention and adherence, are considered. New approaches are needed to ensure fidelity integrity in pragmatic trials and which can be sustained thereafter.

Integration of simulation-based teaching in anaesthesiology curriculum

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

Ensuring treatment fidelity in intervention studies: Developing a checklist and scoring system within a behaviour change paradigm

BACKGROUND

Treatment fidelity refers to the degree to which an intervention is implemented as intended. Promoting treatment fidelity is important to achieve a valid comparison in intervention research. However, it is often underreported: few studies detail the use and development of fidelity measures. This study aims to promote the treatment fidelity of a modified version of the Derbyshire Language Scheme (M-DLS), a manualised intervention for children with language difficulties, by exploring participants' opinions on training and intervention delivery. Results inform development of a checklist and scoring system to monitor and promote treatment fidelity in a comparison trial.

METHOD

Ten student speech and language therapists (SLTs) and two research assistants (RAs) participated in the study. All received training on the M-DLS, and 10 were video-recorded completing role-plays of an M-DLS session in small groups. Feedback was gathered after training and role-plays in focus groups and interviews. Feedback was interpreted using the constructs of the Theoretical Domains Framework (TDF). A treatment fidelity checklist was then developed using the feedback. The first author and two RAs rated role-play videos using the checklist to trial it to inform amendments and to promote interrater reliability. Interrater agreement was calculated using Spearman's test of correlation.

RESULTS

Participants discussed the importance of having clear materials and time to practise sessions. They suggested amendments to the materials and training to promote treatment fidelity. The checklist and scoring system accounted for participants' suggestions, with amendments detailed in a log. Spearman's correlation results suggested agreement between the raters was strong.

CONCLUSIONS

Results emphasise the importance of training quality, practice and reflective opportunities and clear materials to promote treatment fidelity. The construction of the checklist and scoring system was described in detail, informing the development of future checklists. After further trialling, the checklist can be used to ensure the M-DLS is delivered with high treatment fidelity in the comparison trial.

WHAT THIS PAPER ADDS

What is already known on this subject Treatment fidelity is an essential component of intervention effectiveness and efficacy studies, ensuring the intervention is delivered as intended. It is also an essential component of evidence-based clinical practice. However, few research studies report the treatment fidelity process or publish the checklists used, depriving clinicians of useful information for implementation. What this study adds This study describes in detail the iterative process of treatment fidelity checklist development, engaging those implementing the intervention in development. This ensured clarity and interrater reliability of the checklist. Furthermore, a novel scoring system was developed so that accuracy of implementation can be easily compared across users and across practice attempts. What are the clinical implications of this work? The importance of treatment fidelity when implementing effective and efficacious interventions cannot be overstated. The treatment fidelity checklist developed for research can be easily adopted to support accurate implementation in clinical practice through an audit process.

Measurement Characteristics of the Wraparound Fidelity Index Short Form: Results from a Statewide Implementation

Implementation fidelity has been an important issue in the service provision and associated outcomes of Wraparound, an intensive, individualized care planning process that uses a team-based approach to integrate youth into the community to minimize the need for intensive, institutional services. In response to the growing need to monitor fidelity to the Wraparound process, a variety of instruments have been created and tested. In this study, the authors present the results of several analyses designed to better understand the measurement characteristics of the Wraparound Fidelity Index Short Form (WFI-EZ), a multi-informant fidelity instrument. The results from our analysis of 1027 WFI-EZ responses indicate that the internal consistency of the instrument is very good, although the negatively worded items did not appear to function as well as positively worded items. Results from two confirmatory factor analyses were unable to validate the original domains identified by the instrument developers, but for certain outcomes the WFI-EZ demonstrated deseriable predictive validity. Preliminary evidence is also provided that WFI-EZ responses likely differ by respondent type. We conclude by discussing the implications of using the WFI-EZ in programming, policy, and practice considering the findings of our study.

Interpersonal Connections Are Important for Virtual Kidney Transplant Educational Program Development

Introduction: The Living Donor Navigator program is designed to mitigate disparities in living donor kidney transplantation, although geographic disparities in program participation were observed in the initial years of implementation. The purpose of this study was to understand participant perspectives regarding the use of a virtual option/alternative to expand program participation. Methods: Previous participants of the in-person navigator program were purposively sampled. Using the nominal group technique, a well-structured formative methodology to elicit participant perspectives, 2 meetings were conducted among transplant recipients and advocates (N = 13) to identify and prioritize responses to the question "What things would concern you about participating in a virtual and remote Living Donor Navigator program?" Findings: Mean participant age was 59.3 (9.3) years, and participants were 54% male and 62% white. Education levels varied from less than high school to master's degrees. Participants generated 70 unique responses, of which 36 (51.4%) received prioritization. The top 5 ranked responses of each nominal group technique meeting received approximately 50 percent (47.6% vs. 66.7%, respectively) of the total votes and described the potentially limited interpersonal connections, time conflicts, and differing content in a virtual navigator program compared to the in-person model. Discussion: These data suggest that previous participants were concerned with upholding the original design of the program, thus, virtual living donor kidney transplantation programs should aim to maintain interpersonal connections and consistency of content to ensure adequate programmatic engagement. Future research will focus on program fidelity independent of delivery modality.

"It depends on the boss" - a qualitative study of multi-level interventions aiming at office workers' movement behaviour and mental health

PURPOSE

This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level.

METHODS

Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis.

RESULTS

The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult.

CONCLUSIONS

The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study.

Shiftless Is a Novel Member of the Ribosome Stress Surveillance Machinery That Has Evolved to Play a Role in Innate Immunity and Cancer Surveillance

A longstanding paradox in molecular biology has centered on the question of how very long proteins are synthesized, despite numerous measurements indicating that ribosomes spontaneously shift reading frame at rates that should preclude their ability completely translate their mRNAs. Shiftless (SFL; C19orf66) was originally identified as an interferon responsive gene encoding an antiviral protein, indicating that it is part of the innate immune response. This activity is due to its ability to bind ribosomes that have been programmed by viral sequence elements to shift reading frame. Curiously, Shiftless is constitutively expressed at low levels in mammalian cells. This study examines the effects of altering Shiftless homeostasis, revealing how it may be used by higher eukaryotes to identify and remove spontaneously frameshifted ribosomes, resolving the apparent limitation on protein length. Data also indicate that Shiftless plays a novel role in the ribosome-associated quality control program. A model is proposed wherein SFL recognizes and arrests frameshifted ribosomes, and depending on SFL protein concentrations, either leads to removal of frameshifted ribosomes while leaving mRNAs intact, or to mRNA degradation. We propose that SFL be added to the growing pantheon of proteins involved in surveilling translational fidelity and controlling gene expression in higher eukaryotes.

Pilot Study of a Motivational Interviewing Training on Practitioners' Skill Set for Patient Centered Communication

PURPOSE

Increase practitioners' Motivational Interviewing (MI) skill set to develop intrinsic motivation and behavior change competencies.

DESIGN

Pilot comparing intervention group with waitlist-control group.

SETTING

Health Plan in northeast of U.S.

INTERVENTION

Training program including a 3 day 19 hour MI training intensive, 1.5 hour follow-up skill-building trainings, and quality assurance review using an MI assessment tool paired with strengths-based mentoring. Cohort 1 (experimental group) received the intervention for 6-months and cohort 2 for 3 months (control group).

MEASURES

Practitioners' MI skill set was assessed pre- and post-intervention using Motivational Interviewing Competency Assessment (MICA). Practitioners' MI knowledge and attitudes were assessed pre- and post-training using adapted Motivational Interviewing Knowledge and Attitudes Test (MIKAT). Active learning and confidence questionnaires were administered post-training.

ANALYSIS

A generalized linear mixed model with repeated measures to analyze difference in MICA growth rates; paired T-test for MIKAT pre/post training analysis. Descriptive statistics for active learning and confidence.

RESULTS

MICA scores significantly improved for both cohorts (P < .0001). Practitioners had significant increase in knowledge and attitudes for MI (P < .001) and confidence in using MI (P < .01). High levels of active learning were observed (93-100%).

CONCLUSION

With planning, adequate resources/support, and iterative processes for adjustment, practitioners can improve their MI skill set in a short period of time with modest investment of practitioner resources.

Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study

Illness Management and Recovery (IMR) is a psychosocial intervention supporting people with serious mental illnesses. In this study, 15 IMR groups were assessed for fidelity and clinician competency to establish the implementation level of all IMR elements and explore complementarity of the IMR Treatment Integrity Scale (IT-IS) to the standard IMR Fidelity Scale. Use of the IT-IS was adapted, similar to the IMR Fidelity Scale. Descriptive statistics were applied. Implementation success of IMR elements varied widely on the IMR Fidelity Scale and IT-IS (M = 3.94, SD = 1.13, and M = 3.29, SD = 1.05, respectively). Twelve IMR elements (60%) were well-implemented, whereas eight (40%) were implemented insufficiently, including some critical cognitive-behavioral techniques (e.g., role-playing). The scales appeared largely complementary, though strongly correlated (r (13) = 0.74, p = 0.002). Providing all IMR elements adequately requires a variety of clinical skills. Specific additional training and supervision may be necessary.

Examining provider decisions around the delivery and adaptation of a parent-mediated intervention within an Early Intervention system

LAY ABSTRACT

Parent-mediated interventions are an evidence-based practice for autism in which providers support caregivers in learning and applying strategies that support their child's development. Research has begun to study whether parent-mediated interventions can be effectively delivered in Part C Early Intervention systems. This research has been promising; however, it has been difficult to determine how Early Intervention providers deliver and adapt parent-mediated interventions to meet the needs of the families they serve. Examining how parent-mediated interventions are delivered and adapted may help us understand whether parent-mediated interventions are a good fit in these systems. The current study examined the delivery of an evidence-based parent-mediated intervention, Project ImPACT, when delivered by providers within an Early Intervention system. Results from 24 Early Intervention providers demonstrated that, on average, providers delivered Project ImPACT with higher quality during their time in training and consultation. However, there was also variability in how providers delivered Project ImPACT, with some delivering the program inconsistently, some increasing their quality throughout consultation, and others having consistently high-quality delivery. In addition, qualitative data demonstrated that a variety of events arose within Project ImPACT sessions that drove providers to adapt the program. Results suggest the importance of carefully examining how and why providers deliver evidence-based interventions within Early Intervention systems.

Assessing real-world implementability of a multimodal group-based tele-prehabilitation program in cancer care: a pragmatic feasibility study

Introduction

Multimodal prehabilitation is intended to optimize a patient's mental and physical health prior to surgery. Most multimodal prehabilitation interventions are delivered on a one-on-one format, which may limit benefits associated with social interactions that can be achieved in a group context, and are delivered in-person, which may limit the accessibility. The purpose of this study was to develop a group-based, multimodal, tele-prehabilitation intervention for individuals diagnosed with cancer (iACTIF) and assess its implementability in a "real-world" clinical setting by measuring feasibility, acceptability, fidelity, and preliminary effects.

Methods

A prospective, single-group, pragmatic feasibility study was conducted with assessments at baseline, pre-surgery, and 12-weeks post-surgery. iACTIF consisted of three 90-min live videoconference sessions per week, including exercise and educational components. Descriptive statistics were used to document feasibility, acceptability, and fidelity indicators. Paired t-test, Wilcoxon test, and Cohen's D-test were conducted to assess changes in health-related outcomes.

Results

A total of 25 participants (mean age ± SD= 60.2 ± 14.0) were recruited. The feasibility assessment revealed a low referral rate (31.4%) and a high study retention (98%) and program attendance [session attended/possible session] (70.2%), with a prehabilitation window of 32.7 days (SD= 20.9, median= 28). Acceptability was high (84%-100%) according to satisfaction, utility and safety, delivery modality, and intention to continue physical activity and to recommend iACTIF to a relative. Pre-post-intervention assessments suggest positive changes on physical functional capacity based on the 2-min step test (mean difference= +18.9 steps, p=0.005), the 30-s sit-to-stand (mean difference= +1.1 repetition, p=0.011), and volume of moderate intensity physical activity per week (mean difference= +104.8 min, p<0.001). Fidelity was supported by conformity and coherence, with only minimal adjustments required to meet participants' needs.

Discussion

iACTIF implementability in a "real-world" clinical setting is promising, and preliminary outcomes suggest moderate benefits on physical health and small increase in mental health indicators.

A mixed-methods evaluation of the acceptability and fidelity of the James' Place model for men experiencing suicidal crisis

Background

Research supports development of informal, community-based suicide prevention interventions that can be tailored to suit men's unmet needs. The James' Place model (JPM) is a community-based, clinical suicide prevention intervention for men experiencing suicidal crisis. Evidence supports the efficacy of the JPM and there are plans to expand to additional sites across the UK. This study evaluates therapists perceived acceptability of the JPM, and if fidelity to the planned delivery of the model is maintained within therapeutic practice.

Method

A mixed-methods design was used. Descriptive analyses of 30 completed intervention cases were examined to review fidelity of the model against the intervention delivery plan. Eight therapists took part in semi-structured interviews between November 2021 and March 2022 exploring the perceived acceptability, and barriers and facilitators to delivering the JPM.

Results

Descriptive analyses of James' Place audit notes revealed high levels of adherence to the JPM amongst therapists, but highlighted components of the model needed to be tailored according to individual men's needs. Thematic analysis led to the development of five themes. The first theme, therapeutic environment highlighted importance of the therapy setting. The second theme identified was specialised suicide prevention training in the JPM that facilitated therapists understanding and expertise. The third theme identified was therapy engagement which discusses men's engagement in therapy. The fourth theme, person-centred care related to adaptation of delivery of JPM components. The final theme, adapting the JPM to individual needs describes tailoring of the JPM by therapists to be responsive to individual men's needs.

Conclusion

The findings evidence therapist's acceptability and their moderate adherence to the JPM. Flexibility in delivery of the JPM enables adaptation of the model and co-production of therapy to meet men's needs. Implications for clinical practice are discussed.

Talking about cancer: Patient responses to raising awareness of oral cancer in primary dental care

OBJECTIVES

Dentists and other members of the dental team could raise awareness by talking about oral cancer during routine dental check-ups. A communication guide has been developed to facilitate this. However, it has been suggested that discussions about oral cancer may raise patients' anxiety and this has been documented by dentists as a barrier to having these conversations. The current research aimed to investigate implementation of the communication guide and its impact on the dental patient.

METHODS

A consecutive-case sample of adult dental patients attending primary dental care for a routine NHS check-up at one dental practice were invited to take part in the study via letter prior to their appointment. Consultations of participating patients (n = 77) were audio-recorded. Before and after their appointment, patients were asked to rate their current anxiety via the six-item version of Spielberger's State-Trait Anxiety Inventory. Audio recordings of each consultation were reviewed by two raters to determine the extent to which the dentist covered the topics recommended in the communication guide.

RESULTS

The dentist informed all patients that they were being checked for oral cancer, spoke about signs and symptoms, and discussed risk factors. However, they rarely recommended where help should be sought or addressed barriers to seeking help. Discussions took an average of 95 s. The extent to which oral cancer was discussed did not correlate with patients' post-appointment anxiety. Patients made positive or neutral responses to the discussions. The few questions that were asked were easily addressed.

CONCLUSIONS

As findings are based on one dentist working at one practice, generalization of these results should be cautious. The study indicated that using an evidence-based guide to talk about oral cancer did not appear to raise patients' anxiety in this practice population. This could help to increase awareness of oral cancer in the endeavour to facilitate early cancer diagnosis.

The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

BACKGROUND

HIV pre-exposure prophylaxis (PrEP) delivery at private pharmacies is a promising new differentiated service delivery model that may address barriers to PrEP delivery at public health care facilities. We measured the fidelity of this model (ie, delivery as intended) in a pilot study in Kenya.

SETTING

Five private, retail pharmacies in Kisumu and Thika Counties.

METHODS

Trained pharmacy providers delivered PrEP services, including identifying eligible clients, counseling on HIV risk, assessing PrEP safety, testing for HIV, and dispensing PrEP. Pharmacy clients completed surveys that assessed the fidelity of the services received after each visit. Standardized client actors (ie, mystery shoppers) were trained on 4 different case scripts, then made unannounced pharmacy visits, and then completed a 40-item checklist that assessed the fidelity and quality of service delivery components.

RESULTS

From November 2020 to December 2021, 287 clients initiated and 159 (55%) refilled PrEP. At initiation, most clients were counseled on PrEP adherence (99%, 284 of 287) and potential side effects (97%, 279 of 287) and all received provider-assisted HIV self-testing before PrEP dispensing (findings consistent across refill visits). Nine standardized client actors completed 15 pharmacy visits. At each visit, most actors were asked about their behaviors associated with HIV risk (80%, 12/15) and all were counseled on PrEP safety and side effects. All actors reported that pharmacy providers treated them with respect.

CONCLUSIONS

In this first pilot study of pharmacy-delivered PrEP services in Africa, the fidelity of service delivery was high, suggesting that trained providers at private pharmacies can deliver quality PrEP services.

A detailed examination of reporting procedural fidelity in the Journal of Applied Behavior Analysis

Few reviews on procedural fidelity-the degree to which procedures are implemented as designed-provide details to gauge the quality of fidelity reporting in behavior-analytic research. This review focused on experiments in the Journal of Applied Behavior Analysis (2006-2021) with "integrity" or "fidelity" in the abstract or body. When fidelity data were collected, the coders characterized measurement details (e.g., description of calculation, report of single or multiple values, frequency of fidelity checks, checklist use). The researchers found increasing trends in describing the calculation(s), reporting multiple values, and stating the frequency of measurement. Few studies described using a checklist. Most studies reported fidelity as a percentage, with high obtained values (M = 97%). When not collecting fidelity data was stated as a limitation, authors were unlikely to provide a rationale for the omission. We discuss recommendations for reporting procedural fidelity to increase the quality of and transparency in behavior-analytic research.

[Fidelity in acupuncture-moxibustion clinical research: application and reflection]

As an indicator that measures the degree of implementation of intervention measures during the implementation process, fidelity could be used for monitoring and quality evaluation of the completion degree of intervention measures, and plays an important role in improving the degree of intervention implementation and clarifying the factors that affect intervention implementation. This article aims to introduce the connotation and significance, measurement, control, and current application status of fidelity, as well as the current application status of fidelity in acupuncture-moxibustion clinical research and its inspiration for future research. Meanwhile, based on the existing evaluation tool development methods of fidelity and the characteristics of acupuncture-moxibustion clinical research, a preliminary fidelity evaluation framework is proposed. Introducing fidelity into acupuncture-moxibustion clinical research could improve the implementation quality and compliance of acupuncture-moxibustion in clinical research, increase the credibility and effectiveness of clinical research results, and promote the transformation of acupuncture-moxibustion experience into easily learnable and promotable treatment plans.

Implementation of non-insulin-dependent diabetes self-management education (DSME) in LMICs: a systematic review of cost, adoption, acceptability, and fidelity in resource-constrained settings

Background

Type II diabetes (T2D), is a serious health issue accounting for 10.7% of mortality globally. 80% of cases worldwide are found in low- and middle-income countries (LMIC), with rapidly increasing prevalence. Diabetes-self management education (DSME) is a cost-effective program that provides at-risk individuals with the knowledge and skills they need to adopt lifestyle changes that will improve their health and well-being. This systematic review examined the application of DSME in LMICs and identified the corresponding implementation results (cost, fidelity, acceptance, and adoption) associated with successful implementation in low-resource settings.

Methods and analysis

The available research on T2D and the use of DSME in LMIC were systematically searched for using six electronic databases (PubMed, Embase, Cochrane, Web of Science, Google Scholar, PAIS, and EBSCO Discovery) between the months of October and November of 2022. The articles that met the search criteria were subsequently imported into EndNote and Covidence for analysis. The Cochrane RoB methodology for randomized trials was used to evaluate the risk of bias (RoB) in the included studies. A narrative synthesis was used to summarize the results.

Results

A total of 773 studies were imported for screening, after 203 duplicates were removed, 570 remained. Abstract and title screenings resulted in the exclusion of 487 articles, leaving 83 for full-text review. Following a full-text review, 76 articles were excluded and seven were found to be relevant to our search. The most common reasons for exclusion were study design (n = 23), lack of results (n = 14), and wrong patient population (n = 12).

Conclusion

Our systemic review found that DSME can be an acceptable and cost-effective solution in LMIC. While we intended to analyze cost, adoption, acceptability, and fidelity, our investigation revealed a gap in the literature on those areas, with most studies focusing on acceptability and cost and no studies identifying fidelity or adoption. To further evaluate the efficacy of DSME and enhance health outcomes for T2D in LMICs, more research is needed on its application.

Systematic Review Registration

osf.io/7482t.

The "Let's Talk about Children" intervention in a Finnish school context: fidelity, parents' experiences, and perceived benefits

The Let's Talk about Children intervention is a tool for parents and professionals to work together to promote children's positive development, resilience, and psychosocial well-being in social and healthcare services, at school, and in day care. The aim of this study was to evaluate the fidelity, parents' experiences, and perceived benefits of using the Let's Talk about Children intervention in a school context. Participants (N = 65 first-grader parents) completed an online questionnaire after the intervention. The results show that the intervention was delivered as designed and conducted with high fidelity. Parents' experiences of the Let's Talk about Children discussions were positive, parents felt that the atmosphere was good during the discussion, and the participants reported benefits from the intervention. Clinical trial registration:ClinicalTrials.gov, identifier NCT05038280.

Implementation strategies for occupational therapists to advance goal setting and goal management

Background

There is a need for an effective evidence-based system to support high-quality goal setting and goal management implementation. We developed a new system for community-based rehabilitation, MyGoals, along with implementation strategies to support occupational therapists (OTs) in its administration. This study evaluates the acceptability, appropriateness, and feasibility of the implementation strategies, Clinician Education and Audit & Feedback. It also explores whether OTs achieve the change objectives of the MyGoals implementation strategies and MyGoals intervention fidelity.

Methods

This mixed-methods case series study evaluated the MyGoals implementation strategies developed using Implementation Mapping (IM), specifically IM Task 5 - Implementation Outcome Evaluation. Seven OTs and 13 adults with chronic conditions participated in this study. OTs participated in two Clinician Education sessions, delivered two MyGoals interventions, and participated in two Audit & Feedback sessions. We evaluated the implementation strategies using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), Feasibility of Intervention Measure (FIM), and semi-structured interviews and explored the OTs' self-rated MyGoals change objectives achievement and the intervention fidelity using quantitative MyGoals intervention fidelity measures and interviews. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed by two independent coders using content analysis.

Results

Seven OTs participated in this study (mean years of professional experience = 9.3, SD = 5.9). Clinician Education and Audit & Feedback had high AIM (M = 17.9, SD = 2.7), IAM (M = 17.3, SD = 3.60), and FIM scores (M = 17.3, SD = 3). The OTs also had high mean scores on self-perceived achievement of change objectives and intervention fidelity. Qualitative interviews suggested that the time commitment for Clinician Education is a key barrier to its acceptability, appropriateness, and feasibility. Participants also provided suggestions on how to improve the strategies (e.g., providing recorded Clinician Education, etc.).

Conclusions

The MyGoals implementation strategies are acceptable, appropriate, and feasible to OTs working in community-based rehabilitation. They support OTs in achieving the change objectives necessary to deliver MyGoals completely and competently. Thus, the MyGoals implementation strategies may support clinicians in implementing a theory-based, client-engaged goal setting and goal management for adults with chronic conditions in community-based rehabilitation. This can ultimately help improve the integration of evidence-based interventions into practice.

Measuring Implementation of Health Promoting School (HPS) Programs: Development and Psychometric Evaluation of the HPS Implementation Questionnaire

BACKGROUND

Implementation of Health Promoting School (HPS) programs can be challenging due to the dynamic school context. Navigating between program fidelity and adaptation, as well as integrating the program, is essential for successful implementation, and consequently, for program effects. As part of an evaluation study in the Netherlands, this study aimed to develop a measurement instrument that differentiates schools according to fidelity, adaptation, and integration of HPS implementation.

METHODS

This study presents the development and psychometric evaluation of the 28-item HPS Implementation Questionnaire, covering 7 dimensions: adherence, dose, participant responsiveness, quality of delivery, program differentiation, adaptation, and integration. The questionnaire, to be filled out by school employees, was developed for primary, secondary, secondary vocational, and special needs education, in close collaboration with experts (n = 54) in school health promotion.

RESULTS

Semi-structured interviews aimed at dimension clarification resulted in a list of 58 items. Items were revised, combined, and/or removed based on quantitative and qualitative feedback by the evaluation study's Community of Practice, 2-round expert consultation, and pre-tests. Psychometric evaluation (n = 535 schools), consisting of calculating Cronbach's α and confirmatory factor analysis (CFA), confirmed internal consistency (α > .72) and the 7-dimension framework.

CONCLUSION

The brief yet comprehensive HPS Implementation Questionnaire offers possibilities for research into HPS implementation in various educational sectors and contexts, as well as self-monitoring by individual schools. This study provides first evidence for internal consistency and validity of the questionnaire.

DNA Polymerases for Whole Genome Amplification: Considerations and Future Directions

In the same way that specialized DNA polymerases (DNAPs) replicate cellular and viral genomes, only a handful of dedicated proteins from various natural origins as well as engineered versions are appropriate for competent exponential amplification of whole genomes and metagenomes (WGA). Different applications have led to the development of diverse protocols, based on various DNAPs. Isothermal WGA is currently widely used due to the high performance of Φ29 DNA polymerase, but PCR-based methods are also available and can provide competent amplification of certain samples. Replication fidelity and processivity must be considered when selecting a suitable enzyme for WGA. However, other properties, such as thermostability, capacity to couple replication, and double helix unwinding, or the ability to maintain DNA replication opposite to damaged bases, are also very relevant for some applications. In this review, we provide an overview of the different properties of DNAPs widely used in WGA and discuss their limitations and future research directions.

Implementation of a salt substitute intervention using social marketing in resourced-limited communities in Peru: a process evaluation study

Objective

This study aimed to conduct a process evaluation of a salt substitute trial conducted in Peru.

Methods

Through semi-structured interviews of intervention participants, we documented and analyzed process evaluation variables as defined by the Medical Research Council Framework. This study was a stepped wedge trial conducted in Tumbes, Peru in 2014. The intervention was a community-wide replacement of regular salt (100% sodium) with "Salt Liz" (75% sodium and 25% potassium) using social marketing strategies to promote the adoption and continued use of the salt substitute in daily life. The components of the social marketing campaign included entertainment educational activities and local product promoters ("Amigas de Liz"). Another component of the intervention was the Salt Liz spoon to help guide the amount of salt that families should consume. The process evaluation variables measured were the context, mechanism of action, and implementation outcomes (acceptability, fidelity and adoption, perceptions, and feedback).

Results

In total, 60 women were interviewed, 20 with hypertension and 40 without hypertension. Regarding context, common characteristics across the four villages included residents who primarily ate their meals at home and women who were responsible for household food preparation. As the mechanism of action, most participants did not notice a difference in the flavor between regular salt and Salt Liz; those that did notice a difference took around 2 weeks to become accustomed to the taste of the salt substitute. In terms of implementation outcomes, the Salt Liz was accepted by villagers and factors explaining this acceptability included that it was perceived as a "high quality" salt and as having a positive effect on one's health. Participants recognized that the Salt Liz is healthier than regular salt and that it can help prevent or control hypertension. However, most participants could not accurately recall how the compositions of the Salt Liz and regular salt differed and the role they play in hypertension. Although the use of the Salt Liz was far-reaching at the community level, the use of the Salt Liz spoon was poor. Educational entertainment activities were well-received, and most participants enjoyed them despite not always being active participants but rather sideline observers.

Conclusion

This process evaluation identifies key intervention components that enabled a successful trial. Seeking and incorporating feedback from the target population helps deepen the understanding of contextual factors that influence an intervention's success. Furthermore, feedback received can aid the development of the intervention product. Some factors that can be improved for future interventions are acknowledged.

Clinical trial registration

NCT01960972.

Positive Attitude Upper Middle School social and emotional learning program: influences of implementation quality on program outcome

Introduction

There is an increased call for studies analyzing how implementation quality influences Social and Emotional Learning (SEL) program effectiveness.

Methods

The current dissemination study analyzed the effectiveness of the Positive Attitude Upper Middle School SEL program on a Portuguese nationwide sample composed of 813 middle school students (7th and 8th grade; 51.7% boys; M_age = 12.41, S.D. = 1.06), from 36 classrooms (M_classroom = 22.58; S.D. = 2.86), distributed between the control group (179 students), and three intervention groups (643 students) that reflected low, middle, and high implementer experience (respectively, Gulbenkian Academies of Knowledge, Positive Attitude Cadaval and Positive Attitude Torres Vedras). Dosage and fidelity (as implementation quality dimensions), gender, and classroom size (as individual and classroom-level variables) were also analyzed. Self-report questionnaires were administered pre- and post-intervention and at a 6-month follow-up.

Results

Multilevel models were employed, and results showed that participating in the PAUMS SEL program led to more positive trajectories in self-control, social awareness, relationship skills, and responsible decision-making when compared with control groups. Regarding implementation quality, only the implementer's experience impacted the effectiveness of the PAUMS SEL program; students in the Gulbenkian Academies of Knowledge intervention group displayed a less positive trajectory in self-control than students in the Positive Attitude Torres Vedras intervention group.

Discussion

Altogether, results showed that the PAUMS SEL program is ready for dissemination in Portugal, although a higher level of implementer experience is needed to achieve the best effectiveness, and they support the importance of analyzing implementer experience in SEL programs' effectiveness studies.

The development, reliability, and validity of the Facilitator Assessment Tool: An implementation fidelity measure used in Parenting for Lifelong Health for Young Children

BACKGROUND

The Parenting for Lifelong Health for Young Children (PLH-YC) programme aims to reduce violence against children and child behaviour problems among families in low- and middle-income countries (LMICs). Although the programme has been tested in four randomised controlled trials and delivered in over 25 countries, there are gaps in understanding regarding the programme's implementation fidelity and, more generally, concerning the implementation fidelity of parenting programmes in LMICs.

AIMS

This study aims to address these gaps by examining the psychometric properties of the PLH-YC-Facilitator Assessment Tool (FAT)-an observational tool used to measure the competent adherence of PLH-YC facilitators. Examining the psychometric properties of the FAT is important in order to determine whether there is an association between facilitator competent adherence and programme outcomes and, if correlated, to improve facilitator performance. It is also important to develop the implementation literature among parenting interventions in LMICs.

METHODS

The study examined the content validity, intra-rater reliability, and inter-rater reliability of the FAT. Revision of the tool was based on consultation with programme trainers, experts, and assessors. A training curriculum and assessment manual was created. Assessors were trained in Southeastern Europe and their assessments of facilitator delivery were analysed as part of a large-scale factorial experiment (N = 79 facilitators).

RESULTS

The content validity process with PLH-YC trainers, experts, and assessors resulted in substantial improvements to the tool. Analyses of percentage agreements and intraclass correlations found that, even with practical challenges, assessments were completed with adequate yet not strong intra- and inter-rater reliability.

CONCLUSIONS

This study contributes to the literature on the implementation of parenting programmes in LMICs. The study found that the FAT appears to capture its intended constructs and can be used with an acceptable degree of consistency. Further research on the tool's reliability and validity-specifically, its internal consistency, construct validity, and predictive validity-is recommended.

Improving the Capacity of Quantum Dense Coding and the Fidelity of Quantum Teleportation by Weak Measurement and Measurement Reversal

A protective scheme of quantum dense coding and quantum teleportation of the X-type initial state is proposed in amplitude damping noisy channel with memory using weak measurement and measurement reversal. Compared with the noisy channel without memory, the memory factor improves both the capacity of quantum dense coding and the fidelity of the quantum teleportation to a certain extent for the given damping coefficient. Although the memory factor can inhibit decoherence in some degree, it cannot eliminate it completely. In order to further overcome the influence of the damping coefficient, the weak measurement protective scheme is proposed, which found that the capacity and the fidelity can be efficiently improved by adjusting weak measurement parameter. Another practical conclusion is that, among the three initial states, the weak measurement protective scheme has the best protective effect on the Bell-state in terms of the capacity and the fidelity. For the channel with no memory and full memory, the channel capacity of quantum dense coding reaches two and the fidelity of quantum teleportation reaches one for the bit system; the Bell system can recover the initial state completely with a certain probability. It can be seen that the entanglement of the system can be well protected by the weak measurement scheme, which provides a good support for the realization of quantum communication.

Overcoming tensions between family-centered care and fidelity within Early Intervention implementation research

LAY ABSTRACT

Early Intervention systems provide therapeutic services to families of young children birth to 3 years with developmental delays and are considered a natural access point to services for young children and their families. Research studies in the autism field have been interested in training providers to deliver evidence-based practices in Early Intervention systems to increase access to services for young children with an increased likelihood of being autistic. However, research has often overlooked that Early Intervention systems prioritize family-centered care, an approach to working with families that honors and respects their values and choices and that provides supports to strengthen family functioning. This commentary points out that family-centered care deserves greater attention in research being done in Early Intervention systems. We describe how family-centered care may shape how interventions are delivered, and discuss directions for future research to evaluate the impact of family-centered care alongside intervention delivery.

Physical Activity and Social Comparison: The Importance of Group Composition in an Employee Fitbit Intervention

This study examined the impact of group composition of a 6-week group-based employee Fitbit intervention on daily physical activity steps. Group composition comprised heterogenous and homogeneous groupings based on variations in baseline high, medium, and low steppers. The intervention included weekly step leaderboard information, motivational and informative messages, and the ability to participate in group step challenges. Repeated measures analysis of variance (ANOVA) examined differences in change of steps across time, step-level groups (low, medium, and high), and group composition (low/high, similar, and mixed), and replicated with a subgroup of participants who participated in group step challenges. While group and step level did not emerge as significant interactions in the overall sample, when focused within the group step challenge subsample, relationships among time, the group composition, and participant step-level categories emerged. Overall, the greatest increases in steps occurred at the mid-point time period, among lower steppers, and within the low/high comparison group. This study provides evidence of the importance of group composition in physical activity interventions as well as the fidelity of intervention design in facilitating group comparisons.

A trailing ribosome speeds up RNA polymerase at the expense of transcript fidelity via force and allostery

In prokaryotes, translation can occur on mRNA that is being transcribed in a process called coupling. How the ribosome affects the RNA polymerase (RNAP) during coupling is not well understood. Here, we reconstituted the E. coli coupling system and demonstrated that the ribosome can prevent pausing and termination of RNAP and double the overall transcription rate at the expense of fidelity. Moreover, we monitored single RNAPs coupled to ribosomes and show that coupling increases the pause-free velocity of the polymerase and that a mechanical assisting force is sufficient to explain the majority of the effects of coupling. Also, by cryo-EM, we observed that RNAPs with a terminal mismatch adopt a backtracked conformation, while a coupled ribosome allosterically induces these polymerases toward a catalytically active anti-swiveled state. Finally, we demonstrate that prolonged RNAP pausing is detrimental to cell viability, which could be prevented by polymerase reactivation through a coupled ribosome.

Structural basis for reduced ribosomal A-site fidelity in response to P-site codon-anticodon mismatches

Rapid and accurate translation is essential in all organisms to produce properly folded and functional proteins. mRNA codons that define the protein coding sequences are decoded by tRNAs on the ribosome in the aminoacyl (A) binding site. The mRNA codon and the tRNA anticodon interaction is extensively monitored by the ribosome to ensure accuracy in tRNA selection. While other polymerases that synthesize DNA and RNA can correct for misincorporations, the ribosome is unable to correct mistakes. Instead, when a misincorporation occurs, the mismatched tRNA-mRNA pair moves to the peptidyl (P) site and from this location, causes a reduction in the fidelity at the A site, triggering post-peptidyl transfer quality control. This reduced fidelity allows for additional incorrect tRNAs to be accepted and for release factor 2 (RF2) to recognize sense codons, leading to hydrolysis of the aberrant peptide. Here, we present crystal structures of the ribosome containing a tRNA^Lys in the P site with a U•U mismatch with the mRNA codon. We find that when the mismatch occurs in the second position of the P-site codon-anticodon interaction, the first nucleotide of the A-site codon flips from the mRNA path to engage highly conserved 16S rRNA nucleotide A1493 in the decoding center. We propose that this mRNA nucleotide mispositioning leads to reduced fidelity at the A site. Further, this state may provide an opportunity for RF2 to initiate premature termination before erroneous nascent chains disrupt the cellular proteome.

A study of prisms and therapy in attention loss after stroke (SPATIAL): A feasibility randomised controlled trial

OBJECTIVE

Investigate feasibility and acceptability of prism adaptation training for people with inattention (spatial neglect), early after stroke, during usual care.

DESIGN

Phase II feasibility randomised controlled trial with 3:1 stratified allocation to standard occupational therapy with or without intervention, and nested process evaluation.

SETTING

Ten hospital sites providing in-patient stroke services.

PARTICIPANTS

Screened positive for inattention more than one-week post-stroke; informal carers. Occupational therapists participated in qualitative interviews.

INTERVENTION

Adjunctive prism adaptation training at the start of standard occupational therapy sessions for three weeks.

MAIN MEASURES

Feasibility measures included recruitment and retention rates, intervention fidelity and attrition. Outcomes collected at baseline, 3 weeks and 12 weeks tested measures including Nottingham Extended Activities of Daily Living Scale. Acceptability was explored through qualitative interviews and structured questions.

RESULTS

Eighty (31%) patients were eligible, 57 (71%) consented, 54 randomised (40:13, +1 exclusion) and 39 (74%) completed 12-week outcomes. Treatment fidelity was good: participants received median eight intervention sessions (IQR: 5, 12) lasting 4.7 min (IQR: 4.1, 5.0). All six serious adverse events were unrelated. There was no signal that patients allocated to intervention did better than controls. Twenty five of 35 recruited carers provided outcomes with excellent data completeness. Therapists, patients and carers found prism adaptation training acceptable.

CONCLUSIONS

It is feasible and acceptable to conduct a high-quality definitive trial of prism adaptation training within occupational therapy early after stroke in usual care setting, but difficult to justify given no sign of benefit over standard occupational therapy.

CLINICAL TRIAL REGISTRATION

https://www.isrctn.com/ Ref ISRCTN88395268.

A Synthesis of the Conceptualization and Measurement of Implementation Fidelity in Mathematics Intervention Research

In intervention studies, high rates of implementation fidelity are important markers of a study's success; however, the definition of implementation fidelity is both complex and dynamic. In this synthesis, we examined the dimensions of implementation fidelity measured and reported in 99 studies in which researchers utilized a mathematics intervention for elementary students (i.e., Grades 1-5). We examined implementation fidelity following recommendations made by Dane and Schneider (1998), O'Donnell (2008), and DeFouw et al. (2009) to capture a comprehensive representation of the implementation fidelity data collected and reported within mathematics intervention studies. We organized our conceptualization of implementation fidelity into four overarching categories and nine dimensions within those categories: intervention design (i.e., theories of change and logistics), fidelity of implementor (i.e., adherence, quality of delivery, dosage, and implementor knowledge or experience), student engagement, and treatment analysis (i.e., treatment differentiation and analysis of implementation fidelity). Overall, findings indicate many author teams reported adherence data and dosage data, but significantly fewer studies reported quality of delivery data, student engagement data, or treatment differentiation data. In addition, author teams were more likely to report at least one form of logistics, such as implementor support, than theories of change. Implications for research and practice are discussed.

A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers

Managing the complex care needs of seriously ill patients transitioning from hospital to home can have detrimental effects on family caregivers (FCG). Multi-component interventions tailored to FCG needs are most effective at reducing caregiver burden, distress, and depression. However, gaps exist in determining best methods to assess, document, and analyze intervention components for FCGs. Common methods used to capture patient data during transitions in care may not be appropriate or allowed for FCG needs. As such, we present a methodological approach for electronically capturing, reporting, and analyzing multiple intervention components. This approach uses a standardized terminology and pathway for tailoring intervention components in real time while evaluating intervention effects across time. We use examples from a randomized controlled trial to illustrate the benefits of the current approach for analyzing the effectiveness of multi-component interventions in the context of caregiving research.

Simulators and Simulations for Extracorporeal Membrane Oxygenation: An ECMO Scoping Review

High-volume extracorporeal membrane oxygenation (ECMO) centers generally have better outcomes than (new) low-volume ECMO centers, most likely achieved by a suitable exposure to ECMO cases. To achieve a higher level of training, simulation-based training (SBT) offers an additional option for education and extended clinical skills. SBT could also help to improve the interdisciplinary team interactions. However, the level of ECMO simulators and/or simulations (ECMO sims) techniques may vary in purpose. We present a structured and objective classification of ECMO sims based on the broad experience of users and the developer for the available ECMO sims as low-, mid-, or high-fidelity. This classification is based on overall ECMO sim fidelity, established by taking the median of the definition-based fidelity, component fidelity, and customization fidelity as determined by expert opinion. According to this new classification, only low- and mid-fidelity ECMO sims are currently available. This comparison method may be used in the future for the description of new developments in ECMO sims, making it possible for ECMO sim designers, users, and researchers to compare accordingly, and ultimately improve ECMO patient outcomes.

A Scoping Review on Quality Physical Education Programmes and Their Outcomes on Primary-Level Pupils

A scoping review was carried out on the literature relating to the evaluation of the implementation of quality physical education (QPE) programmes and related outcomes on final-stage primary-level pupils' attitudes towards physical education (ATPE), physical activity behaviour (PAB), mental wellbeing (MWB) and academic achievement (AA). The scoping review included studies published between 2000 and 2020 in the PubMed, Elsevier, SCOPUS and CINAHL databases and was completed in accordance with the PRISMA extension for scoping reviews' guidelines. Based on the inclusion criteria, 15 out of 2869 studies were included in the review. A thematic analysis was used to inductively and deductively analyse the studies for common themes of features of QPE programmes in primary schools, arising from nine different countries, considering the four outcome dimensions (ATPE, PAB, MWB and AA). The common themes identified as features of QPE across all four dimensions were as follows: (1) government leadership; (2) PE curriculum; (3) school principal and leaders; (4) organisational management from leadership in school; (5) teachers; (6) parental involvement; and (7) community partnerships. Based on these findings, recommendations were made for an evaluation framework on QPE in primary education.