Adapting the Consolidated Framework for Implementation Research to Create Organizational Readiness and Implementation Tools for Project ECHO.

The Project Extension for Community Healthcare Outcomes (ECHO) model expands primary care provider (PCP) capacity to manage complex diseases by sharing knowledge, disseminating best practices, and building a community of practice. The model has expanded rapidly, with over 140 ECHO projects currently established globally. We have used validated implementation frameworks, such as Damschroder's (2009) Consolidated Framework for Implementation Research (CFIR) and Proctor's (2011) taxonomy of implementation outcomes, combined with implementation experience to (1) create a set of questions to assess organizational readiness and suitability of the ECHO model and (2) provide those who have determined ECHO is the correct model with a checklist to support successful implementation. A set of considerations was created, which adapted and consolidated CFIR constructs to create ECHO-specific organizational readiness questions, as well as a process guide for implementation. Each consideration was mapped onto Proctor's (2011) implementation outcomes, and questions relating to the constructs were developed and reviewed for clarity. The Preimplementation list included 20 questions; most questions fall within Proctor's (2001) implementation outcome domains of "Appropriateness" and "Acceptability." The Process Checklist is a 26-item checklist to help launch an ECHO project; items map onto the constructs of Planning, Engaging, Executing, Reflecting, and Evaluating. Given that fidelity to the ECHO model is associated with robust outcomes, effective implementation is critical. These tools will enable programs to work through key considerations to implement a successful Project ECHO. Next steps will include validation with a diverse sample of ECHO projects.

Building Provincial Mental Health Capacity in Primary Care: An Evaluation of a Project ECHO Mental Health Program.

OBJECTIVE: Project Extension for Community Healthcare Outcomes (Project ECHO©) addresses urban-rural disparities in access to specialist care by building primary care provider (PCP) capacity through tele-education. Evidence supporting the use of this model for mental health care is limited. Therefore, this study evaluated a mental health and addictions-focused ECHO program. Primary outcome measures were PCP knowledge and perceived self-efficacy. Secondary objectives included: satisfaction, engagement, and sense of professional isolation. PCP knowledge and self-efficacy were hypothesized to improve with participation. METHODS: Using Moore's evaluation framework, we evaluated the ECHO program on participant engagement, satisfaction, learning, and competence. A pre-post design and weekly questionnaires measured primary and secondary outcomes, respectively. RESULTS: Knowledge test performance and self-efficacy ratings improved post-ECHO (knowledge change was significant, p < 0.001, d = 1.13; self-efficacy approached significance; p = 0.056, d = 0.57). Attrition rate was low (7.7%) and satisfaction ratings were high across all domains, with spokes reporting reduced feelings of isolation. DISCUSSION: This is the first study to report objective mental health outcomes related to Project ECHO. The results indicate high-participant retention is achievable, and provide preliminary evidence for increased knowledge and self-efficacy. These findings suggest this intervention may improve mental health management in primary care.

A training programme involving automatic self-transcending meditation in late-life depression: preliminary analysis of an ongoing randomised controlled trial.

Late-life depression affects 2-6% of seniors aged 60 years and above. Patients are increasingly embracing non-pharmacological therapies, many of which have not been scientifically evaluated. This study aimed to evaluate a category of meditation, automatic self-transcending meditation (ASTM), in alleviating symptoms of depression when augmenting treatment as usual (NCT02149810). The preliminary results of an ongoing single-blind randomised controlled trial comparing a training programme involving ASTM with a wait-list control indicate that a 12-week ASTM programme may lead to significantly greater reductions in depression and anxiety severity. As such, ASTM may be an effective adjunctive therapy in the treatment of late-life depression. DECLARATION OF INTEREST: R.I.N. is Director of Research and Health Promotion for the Art of Living Foundation, Canada and supervised the staff providing ASTM training. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

The Effect of Task-Irrelevant Fearful-Face Distractor on Working Memory Processing in Mild Cognitive Impairment versus Healthy Controls: An Exploratory fMRI Study in Female Participants.

In mild cognitive impairment (MCI), a risk state for Alzheimer's disease, patients have objective cognitive deficits with relatively preserved functioning. fMRI studies have identified anomalies during working memory (WM) processing in individuals with MCI. The effect of task-irrelevant emotional face distractor on WM processing in MCI remains unclear. We aim to explore the impact of fearful-face task-irrelevant distractor on WM processing in MCI using fMRI. Hypothesis. Compared to healthy controls (HC), MCI patients will show significantly higher BOLD signal in a priori identified regions of interest (ROIs) during a WM task with a task-irrelevant emotional face distractor. Methods. 9 right-handed female participants with MCI and 12 matched HC performed a WM task with standardized task-irrelevant fearful versus neutral face distractors randomized and counterbalanced across WM trials. MRI images were acquired during the WM task and BOLD signal was analyzed using statistical parametric mapping (SPM) to identify signal patterns during the task response phase. Results. Task-irrelevant fearful-face distractor resulted in higher activation in the amygdala, anterior cingulate, and frontal areas, in MCI participants compared to HC. Conclusions. This exploratory study suggests altered WM processing as a result of fearful-face distractor in MCI.

A randomized controlled longitudinal naturalistic trial testing the effects of automatic self transcending meditation on heart rate variability in late life depression: study protocol.

BACKGROUND: The prevalence and socioeconomic cost of late life depression (LLD) is on the rise, while the response rate to antidepressant trials remains poor. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective, yet little is known regarding the effectiveness of such therapies to improve LLD symptoms. Among the mind-body therapies currently in practice, the results of our pilot study have shown that a particular meditation technique called Sahaj Samadhi Meditation, which belongs to the category of meditation termed automatic self-transcending meditation (ASTM) may have some promise in improving cardiovascular autonomic disturbances associated with LLD as well as ameliorating symptoms of depression and anxiety. METHODS/DESIGN: Patients between the ages of 60 and 85 with LLD will be randomized either to ASTM plus treatment as usual (TAU) or TAU alone to assess changes in cardiovascular autonomic parameters, neuropsychological symptoms of depression and anxiety as well as quality of life. The instructional phase of the intervention consists of 4 consecutive days of meditation training, after which participants are encouraged to meditate twice daily for twenty minutes each time at home. The intervention also includes once weekly follow up sessions for the subsequent 11 weeks. The planned study has one and a half year recruitment period. Participants will be assessed at baseline and at 4, 8, 12 and 24 weeks post intervention. DISCUSSION: This study should provide a unique data source from a randomized, controlled, longitudinal trial to investigate the effects of a form of ASTM on cardiovascular autonomic and neuropsychological health in LLD. TRIAL REGISTRATION: Clinicaltrials.gov NCT02149810, date registered: 05/28/2014.

Binocular summation of second-order global motion signals in human vision.

Although many studies have examined the principles governing first-order global motion perception, the mechanisms that mediate second-order global motion perception remain unresolved. This study investigated the existence, nature and extent of the binocular advantage for encoding second-order (contrast-defined) global motion. Motion coherence thresholds (79.4% correct) were assessed for determining the direction of radial, rotational and translational second-order motion trajectories as a function of local element modulation depth (contrast) under monocular and binocular viewing conditions. We found a binocular advantage for second-order global motion processing for all motion types. This advantage was mainly one of enhanced modulation sensitivity, rather than of motion-integration. However, compared to findings for first-order motion where the binocular advantage was in the region of a factor of around 1.7 (Hess et al., 2007), the binocular advantage for second-order global motion was marginal, being in the region of around 1.2. This weak enhancement in sensitivity with binocular viewing is considerably less than would be predicted by conventional models of either probability summation or neural summation.

Visual discrimination in noise: behavioural correlates of age-related cortical decline.

Neurophysiological evidence has consistently shown that, compared to younger animals, single neurons in aged mammalian visual cortex exhibit reduced selectivity to stimulus direction and orientation. It has been suggested that this may be due, in part, to increased internal noise in the aged visual system. This study measured contrast thresholds for judging the motion direction (left vs. right) and spatial orientation (vertical vs. horizontal) of sinusoidal gratings presented alone and with additive noise in young (20-29 years) and older (65-79 years) adults. Compared to their young counterparts, older adults demonstrated reduced sensitivity to direction and orientation when no noise was present. However, when gratings were presented in conjunction with additive noise, older adults required a greater increase in external noise to elicit a corresponding reduction in sensitivity. Subsequent analysis assessing equivalent noise and sampling efficiency attributed performance differences to an increase in equivalent noise with age.

Psychophysical correlates of global motion processing in the aging visual system: a critical review.

The consequences of visual decline in aging have a fundamental and wide-reaching impact on age-related quality of life. It is of concern therefore that evidence suggests that normal aging is accompanied by impairments in the ability to effectively encode global motion. Global motion perception is a fundamentally important process. It enables us to determine the overall velocity of spatially extensive objects in the world and provides us with information about our own body movements. Here, we review what is currently known about the effects of age on performance for encoding the global motion information available in random dot kinematograms (RDKs), a class of stimuli widely used to probe the mechanisms underlying motion perception. We conclude that age-related deficits in global motion perception are not all encompassing. Rather, they appear to be specific to certain stimulus conditions. We also examine evidence for an interaction between age and gender and consider the efficacy of techniques such as visual perceptual learning that may attenuate some of the visual deficits in the older adult population.