Perceptions and beliefs of community-based fitness professionals working with people with disability: a qualitative study.

PURPOSE: There are many benefits of sport and exercise however people with disability experience barriers to participation including negative interactions with fitness professionals. To understand this barrier further, this study explored the perceptions of community-based fitness professionals working with people with disability. MATERIALS AND METHODS: Thirteen fitness professionals took part in one semi-structured interview. Data were analysed inductively using an interpretive description approach. RESULTS: Theme 1, "Understanding your client's individual needs" highlighted the requirement for fitness professionals to be flexible to the needs of their clients. Theme 2 "You have to have a little bit of the knack" discussed the importance of maintaining a mutually respectful relationship, and the skills required to achieve this. Theme 3 "It needs to be a team approach" called for greater interprofessional collaboration with health professionals. Theme 4 "The barriers of gym culture" explored the negative stigma placed on people with disability in relation to sport and exercise. Theme 5 "Change is needed" highlighted changes required within the fitness industry to better support people with disability. CONCLUSION: To facilitate inclusive service delivery, changes are required within the supports and resources available to fitness professionals thereby allowing them to cater to their diversifying client population.

Physical activity is widely acknowledged as crucial to the health and wellbeing of people with disability, with focus being placed on creating inclusive community-based physical activity opportunities rather than disability specific programs alone.Community-based fitness professionals could provide important support towards enhancing inclusive physical activity participation for people with disability.Community-based fitness professionals experience many personal and professional benefits from working with people with disability, although, also experience challenges.To continue to work towards inclusion, community-based fitness professionals require further educational and funding support facilitating them to deliver safe and effective services to people with disability.

Exploring the Relationship between Persons with Hearing Loss/Deafness and Their Hearing Dogs.

The reported positive outcomes of animal-assisted services have led to an emerging interest in many different aspects of human-animal interactions. The influence of an assistance animal is thought to encompass several psychosocial domains in the life of a person with a significant health impairment. However, little is known about the mechanisms underlying the relationship between Hearing Dogs and their owners. A prospective study design using a written questionnaire method was utilized to survey 58 current and 23 prospective Australian Lions Hearing Dogs owners. The Pet Expectations Inventory (PEI) was used to investigate the anticipated role of Hearing Dogs in waitlisted persons with hearing loss/Deafness, whereas the Lexington Attachment to Pets Scale (LAPS) was completed by current owners to assess emotional attachment. The results revealed a high mean PEI score (M = 73.1, SD = 10.9, Mdn = 73.0, range: 55-91), with prospective owners strongly expecting the role of Hearing Dogs to include companionship/love and security. Furthermore, strong attachment features were evident in the owners' relationships with Hearing Dogs, as demonstrated by a high total LAPS score (M = 81.2, SD = 7.5, range: 63-91). Mean scores for statements within the "people substitution" category were highest (range = 3.6/4.00-3.9/4.00). In this demographically homogenous study cohort, it appeared that the high expectations of potential Hearing Dog owners for their animals to serve supportive roles beyond hearing assistance should be achievable, as evidenced by the strong attachment relationships displayed between Hearing Dogs and their owners.

Understanding the experience of assistance dog providers supporting people with disability: an exploratory study.

PURPOSE: Assistance dogs can provide many health and wellbeing benefits to people with disability, however challenges remain. Assistance dog providers provide crucial support to assistance dog handlers, however limited literature exists exploring their experience working with people with disability. This study aimed to understand the experiences of assistance dog providers working in Australia. MATERIALS AND METHODS: Twelve assistance dog providers participated in semi-structured interviews. Inductive thematic analysis was used to analyse the transcripts. RESULTS: Five themes emerged describing the participant experience. Theme one discussed instances of discrimination experienced by assistance dog handlers, stemming from the lack of public awareness. Theme two captured the inconsistencies regarding the training of assistance dog providers with a specific focus on the gaps in the disability specific knowledge. Theme three emphasised the lack of clarity regarding legislation outlining the training requirements of assistance dog providers and the public access rights of the handlers. Theme four emphasised funding barriers, and theme five discussed barriers to interprofessional collaboration between assistance dog providers and allied health professionals. CONCLUSION: These findings contribute to understanding the current barriers experienced by assistance dog providers and assistance dog handlers, as well as the legislative changes required to better support people with disability.

Increasing evidence suggests that assistance dogs may provide benefits for people with disability, however challenges remain.There is a need for national and international legislation outlining the definition of an assistance dog, the training requirements of assistance dog providers, as well as the public access rights of assistance dog handlers.Assistance dog providers require structured education opportunities supporting their knowledge of disability to support assistance dog handlers most effectively.Interprofessional practice between assistance dog providers and allied health professionals has the potential to result in greater client-centred care.

Corticospinal and spinal responses following a single session of lower limb motor skill and resistance training.

Prior studies suggest resistance exercise as a potential form of motor learning due to task-specific corticospinal responses observed in single sessions of motor skill and resistance training. While existing literature primarily focuses on upper limb muscles, revealing a task-dependent nature in eliciting corticospinal responses, our aim was to investigate such responses after a single session of lower limb motor skill and resistance training. Twelve participants engaged in a visuomotor force tracking task, self-paced knee extensions, and a control task. Corticospinal, spinal, and neuromuscular responses were measured using transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS). Assessments occurred at baseline, immediately post, and at 30-min intervals over two hours. Force steadiness significantly improved in the visuomotor task (P < 0.001). Significant fixed-effects emerged between conditions for corticospinal excitability, corticospinal inhibition, and spinal excitability (all P < 0.001). Lower limb motor skill training resulted in a greater corticospinal excitability compared to resistance training (mean difference [MD] = 35%, P < 0.001) and control (MD; 37%, P < 0.001). Motor skill training resulted in a lower corticospinal inhibition compared to control (MD; - 10%, P < 0.001) and resistance training (MD; - 9%, P < 0.001). Spinal excitability was lower following motor skill training compared to control (MD; - 28%, P < 0.001). No significant fixed effect of Time or Time*Condition interactions were observed. Our findings highlight task-dependent corticospinal responses in lower limb motor skill training, offering insights for neurorehabilitation program design.

The past, present, and future of predator-prey interactions in a warming world: Using species distribution modeling to forecast ectotherm-endotherm niche overlap.

Climate change has the potential to disrupt species interactions across global ecosystems. Ectotherm-endotherm interactions may be especially prone to this risk due to the possible mismatch between the species in physiological response and performance. However, few studies have examined how changing temperatures might differentially impact species' niches or available suitable habitat when they have very different modes of thermoregulation. An ideal system for studying this interaction is the predator-prey system. In this study, we used ecological niche modeling to characterize the niche overlap and examine biogeography in past and future climate conditions of prairie rattlesnakes (Crotalus viridis) and Ord's kangaroo rats (Dipodomys ordii), an endotherm-ectotherm pair typifying a predator-prey species interaction. Our models show a high niche overlap between these two species (D = 0.863 and I = 0.979) and further affirm similar paleoecological distributions during the last glacial maximum (LGM) and mid-Holocene (MH). Under future climate change scenarios, we found that prairie rattlesnakes may experience a reduction in overall suitable habitat (RCP 2.6 = -1.82%, 4.5 = -4.62%, 8.5 = -7.34%), whereas Ord's kangaroo rats may experience an increase (RCP 2.6 = 9.8%, 4.5 = 11.71%, 8.5 = 8.37%). We found a shared trend of stable suitable habitat at northern latitudes but reduced suitability in southern portions of the range, and we propose future monitoring and conservation be focused on those areas. Overall, we demonstrate a biogeographic example of how interacting ectotherm-endotherm species may have mismatched responses under climate change scenarios and the models presented here can serve as a starting point for further investigation into the biogeography of these systems.

Failing professional practice placements in allied health: What do we understand about the student experience? A scoping review.

Professional practice placements are an essential component of allied health and nursing programs. Whilst most students pass these placements, a small percentage of students will fail or be at risk of failing. Supporting students undergoing a failing experience is a time critical, time consuming, emotional and resource-heavy task which is often undertaken by key university staff and impacts all stakeholders. Whilst several studies have provided insight into this experience from the educator and/or university perspective, this scoping review aimed to identify the students' experience of failing or nearly failing a professional practice experience. Following Arskey and O'Malley's framework for scoping reviews, 24 papers were included in this review. This review generated six themes including the reasons for failure, how failure looks and feels, how supports, service and strategies influence the student experience of failure, the importance of communication, relationships and organisational culture, the impact infrastructure and policies have, and the consequences of failure. The outcomes of this scoping review highlighted three key characteristics of the research to date: (a) the student voice is still largely missing; (b) the student perspective is distinctly different to that of other stakeholders; and (c) the interventions used appear not to be student-informed or student-led. Better understanding this experience from the student's perspective could create a more sustainable practice education environment by designing and implementing more effective supports, services or strategies that reduce the overall impact a failing experience has on students and key stakeholders.

Canine-Assisted Occupational Therapy for Children within a Student-Led University Clinic: The Influence on Child Engagement from the Perspectives of Student and Parent Participants.

AIMS: Animal-assisted therapy has gained increased attention in occupational therapy. Yet there remains minimal education opportunities available. In addition to supporting student learning, student-led clinics have the potential to provide a valuable, cost-effective health service to the community. This study aimed to explore the potential benefits to the children clients participating in a student-led, canine-assisted occupational therapy pediatric clinic from the perspectives of the students and parents. METHOD: Semi-structured interviews were conducted with nine occupational therapy students, and five parents to describe their experience. Transcripts were analyzed using inductive thematic analysis. RESULTS: Participants emphasized how the presence of the therapy dog supported child engagement within the therapy session. Ways in which participants believed the therapy dog influenced the children's engagement were described within three themes. The first highlighted the importance of the relationship between the children and the therapy dog. The second described how this relationship facilitated a sense of safety within the sessions. The third captured how this sense of safety supported the children's participation within their meaningful occupations. CONCLUSIONS: Parents and students involved in the canine-assisted occupational therapy clinic perceived that canine-assisted therapy was supportive of child engagement in therapy.

Examining the Temporal Relation between Posttraumatic Stress Symptoms and Heavy Drinking among Veterans Receiving Mental Health Treatment in Primary Care.

OBJECTIVE: Evidence for the use of integrated treatments targeting co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders is steadily growing. However, limited work has evaluated the temporal association between posttraumatic stress symptoms (PTSS) and alcohol misuse over the course of integrated treatment, with no studies examining such interventions in primary care (PC). The current study examined temporal changes in PTSS and heavy drinking among individuals who received a brief treatment for co-occurring PTSD and alcohol misuse in PC (Primary Care Treatment Integrating Motivation and Exposure; PC-TIME) compared with those who received PC treatment as usual (PC-TAU). METHOD: A total of 63 veterans (33 randomized to PC-TIME and 30 randomized to PC-TAU) presenting to PC with co-occurring PTSD and alcohol misuse were included in this study. PTSS and heavy drinking were examined at each treatment session for those in PC-TIME. Veterans in both conditions provided reports of PTSS and heavy drinking at baseline, 8-weeks (post-treatment), 14-weeks, and 20-week follow-ups. RESULTS: Session-by-session findings for PC-TIME demonstrated that PTSS at Session 1 predicted a greater decrease in heavy drinking from Session 1 to Session 2. Moreover, heavy drinking at baseline predicted greater decreases in PTSS at 8-weeks for those in PC-TIME, whereas the reverse association was found for those randomized to PC-TAU. Additionally, heavy drinking at 8-weeks predicted decreased PTSS at 14-weeks for those randomized to PC-TAU. CONCLUSIONS: The current study evidenced mixed support for the temporal precedence of PTSS and alcohol misuse. Relations between PTSS and heavy drinking appeared to be linked to treatment targets within PC-TIME and varied between treatment condition (PC-TIME versus PC-TAU). Notably, those with greater than average heavy drinking at the initiation of integrated treatment appeared to have greater reductions in PTSS at post-treatment. Results suggest a mutual maintenance model may best characterize the association between co-occurring PTSS and heavy drinking among treatment-seeking individuals.

Who's Keeping an Eye on the Kids? Changes in Monitoring During Emerging Adulthood.

Previous research indicates that parental monitoring protects adolescents from delinquency. While, emerging adults spend increasing amounts of time outside the family setting, they often remain in or return to reside in the parental home, possibly prolonging the period of parental monitoring. We examine whether parental monitoring, differentiating between child disclosure, parental solicitation, and parental control, is a protective factor for delinquency for emerging adults. We also examine whether monitoring occurs in educational settings, by the partner or in employment settings, and whether this monitoring is associated with delinquency. We use data from a longitudinal survey of 970 Dutch emerging adults (18-24 years), to examine monitoring, using instruments based on Stattin and Kerr's parental monitoring scale. Results indicate that parental monitoring is not associated with delinquency in emerging adulthood. Furthermore, we find no evidence of the protective role of monitoring in educational settings, by the partner or in employment settings. However, the negative relationship between monitoring of the self, self-control, delinquency during emerging adulthood increases in strength.

Cryptic behavior and activity cycles of a small mammal keystone species revealed through accelerometry: a case study of Merriam's kangaroo rats (Dipodomys merriami).

BACKGROUND: Kangaroo rats are small mammals that are among the most abundant vertebrates in many terrestrial ecosystems in Western North America and are considered both keystone species and ecosystem engineers, providing numerous linkages between other species as both consumers and resources. However, there are challenges to studying the behavior and activity of these species due to the difficulty of observing large numbers of individuals that are small, secretive, and nocturnal. Our goal was to develop an integrated approach of miniaturized animal-borne accelerometry and radiotelemetry to classify the cryptic behavior and activity cycles of kangaroo rats and test hypotheses of how their behavior is influenced by light cycles, moonlight, and weather. METHODS: We provide a proof-of-concept approach to effectively quantify behavioral patterns of small bodied (< 50 g), nocturnal, and terrestrial free-ranging mammals using large acceleration datasets by combining low-mass, miniaturized animal-borne accelerometers with radiotelemetry and advanced machine learning techniques. We developed a method of attachment and retrieval for deploying accelerometers, a non-disruptive method of gathering observational validation datasets for acceleration data on free-ranging nocturnal small mammals, and used these techniques on Merriam's kangaroo rats to analyze how behavioral patterns relate to abiotic factors. RESULTS: We found that Merriam's kangaroo rats are only active during the nighttime phases of the diel cycle and are particularly active during later light phases of the night (i.e., late night, morning twilight, and dawn). We found no reduction in activity or foraging associated with moonlight, indicating that kangaroo rats are actually more lunarphilic than lunarphobic. We also found that kangaroo rats increased foraging effort on more humid nights, most likely as a mechanism to avoid cutaneous water loss. CONCLUSIONS: Small mammals are often integral to ecosystem functionality, as many of these species are highly abundant ecosystem engineers driving linkages in energy flow and nutrient transfer across trophic levels. Our work represents the first continuous detailed quantitative description of fine-scale behavioral activity budgets in kangaroo rats, and lays out a general framework for how to use miniaturized biologging devices on small and nocturnal mammals to examine behavioral responses to environmental factors.

The effect of medical grade compression garments on the repeated-bout effect in non-resistance-trained men.

NEW FINDINGS: What is the central question of this study? What are the effects of compression garments on recovery from unaccustomed damaging exercise and subsequent protective adaptations? What is the main finding and its importance? Compression did not influence recovery, but was associated with blunted protective adaptations for isokinetic performance, which were completely absent at high velocities. Based on these findings, the use of compression garments for recovery would not be recommended following unaccustomed exercise, particularly if the maintenance of high-velocity performance following exercise-induced muscle damage is desirable. ABSTRACT: Whilst compression garments (CG) may enhance recovery from exercise-induced muscle damage (EIMD), many recovery strategies can attenuate adaptative responses. Therefore, the effects of CG on recovery from EIMD, and the rapid protective adaptations known as the repeated bout effect (RBE) were investigated. Thirty-four non-resistance-trained males (18-45 years) randomly received class II medical-grade CG or placebo for 72 h following eccentrically-focused lower-body exercise, in a double-blind, randomised controlled trial. Indices of EIMD were assessed at baseline, 0, 24, 48 and 72 h post-exercise, before exercise and testing were repeated after 14 days. Results were analysed using a three-way (time × condition × bout) linear mixed-effects model. Exercise impaired isometric and isokinetic strength, with soreness and thigh circumference elevated for 72 h (P < 0.001). Compression did not enhance recovery (P > 0.05), despite small to moderate effect sizes (ES, reported alongside 90% confidence intervals) for isokinetic strength (ES from 0.2 [-0.41, 0.82] to 0.65 [0.03, 1.28]). All variables recovered faster after the repeated bout (P < 0.005). However, RBE for peak isokinetic force was impaired in CG at 60° s-1 (group × bout interaction: χ2  = 4.24, P = 0.0395; ES = -0.56 [-1.18, 0.07]) and completely absent at 120° s-1 (χ2  = 16.2, P < 0.001, ES = -0.96 [-1.61, -0.32]) and 180° s-1 (χ2  = 10.4, P = 0.001, ES = -0.72 [-1.35, -0.09]). Compression blunted RBE at higher isokinetic velocities without improving recovery in non-resistance-trained males, potentially contraindicating their use following unaccustomed exercise in this population.

Understanding the experience of community-based fitness professionals supporting people with disability to engage in sport and exercise: a national survey.

PURPOSE: The benefits of sport and exercise participation for people with disability are well acknowledged. However, people with disability report numerous barriers to participating in sport and exercise, including negative interactions with fitness professionals. Limited research is available from the perspective of fitness professionals. This study aimed to understand the experience of fitness professionals supporting people with disability to engage in sport and exercise. MATERIALS AND METHODS: A cross sectional survey study was used to gather quantitative and qualitative data on community-based fitness professionals from Australia, with or without experience working with a person with disability. RESULTS: A total of 72 fitness professionals took part in the study with most reporting experience and confidence in working with people with disabilities. Several barriers were identified with participants highlighting the lack of disability-specific training. Participants also identified potential facilitators, including effective collaboration with allied health professionals. CONCLUSION: There is emerging interest for fitness professionals to support people with disability to engage in sport and exercise. However, changes are required within the education provided to fitness professionals and with the current collaborative model with allied health professionals to better support the participation of people with disability in sport and exercise.

As physical activity is pertinent to ongoing health and wellbeing of people with disability, with support, fitness professionals could provide a cost-effective solution to assist in enabling people with disability to access sport and exercise activities.Fitness professionals require continuing disability-specific education and input from allied health professionals to appropriately support their clients with disability.Changes are required within the Australian fitness industry and in the model in which allied health and fitness professionals collaborate to better support people with disability to engage in sport and exercise.Additional barriers external to the fitness professional such as the physical environment, funding restrictions and lack of societal awareness, continue to impede on people with disabilities' participation in sport and exercise settings and should also be acknowledged.

MILBEMYCIN OXIME (INTERCEPTOR) TREATMENT OF PYCNOGONID SEA SPIDER INFESTATION IN THREE SPECIES OF CORALS.

A coral reef system at the Steinhart Aquarium in San Francisco, CA, USA experienced a population explosion of pycnogonid sea spiders (Arthropoda: Class Pycnogonida) with subsequent deleterious health effects on the corals in the system. Sixteen coral colonies across three species (Stylophora pistillata, Pocillopora damicornis, and Acropora tenuis) were chosen from this system for milbemycin oxime immersion therapy trials, with the goal of decreasing or eradicating the sea spider population with minimal detrimental effect to the corals. Corals underwent two milbemycin immersion treatments, administered 1 wk apart, at the previously published aquatic invertebrate dose of 0.016 parts per million (ppm; mg/L), but therapy did not reduce the number of sea spiders. Doubling the dose to 0.032 ppm milbemycin and repeating this immersion therapy 1/wk for three treatments successfully reduced the sea spiders. Histopathology was used to assess the health of the corals and tolerance to therapy, and posttreatment biopsies confirmed that there were no adverse effects to any of the three species of coral. Repeated 1/ wk treatments of milbemycin oxime immersion therapy at 0.032 ppm appears to be both safe and effective for reducing the numbers of pycnogonid sea spiders in the stony corals S. pistillata, P. damicornis, and A. tenuis.

Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder: A Systematic Review.

Guidelines strongly recommend trauma-focused therapies to treat posttraumatic stress disorder. Implementation of cognitive processing therapy (CPT) and prolonged exposure (PE) in Veterans Health Administration (VHA) and non-VHA settings began in 2006. We conducted a systematic review of implementation facilitators and challenges and strategies to address barriers. We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for English-language articles. Two individuals reviewed eligibility and rated quality. Quantitative results were abstracted by one reviewer and verified by a second. Qualitative results were independently coded by two reviewers and finalized through consensus. We used RE-AIM and CFIR frameworks to synthesize findings. 29 eligible studies addressed CPT/PE, mostly conducted in VHA. Training/education with audit/feedback was the primary implementation strategy and was linked to improved provider CPT/PE perceptions and self-efficacy. Use was not widespread. Only six studies tested other implementation strategies with mixed impact. Following VHA implementation, strong support for training, perceived effectiveness for patients and benefits for clinics, and positive patient experiences and relationships with providers were reported. However, barriers persisted including perceived protocol inflexibility, complex referral processes and patient complexity and competing needs. In non-VHA settings, providers perceived fewer barriers, but few were CPT/PE trained. Across both settings, fewer studies targeted patient factors. Training/education with audit/feedback improved perceptions and the availability of CPT/PE, but not consistent use. Studies testing implementation strategies to address post-training challenges, including patient-level factors, are needed. A few studies are underway in VHA to test patient-focused and other implementation strategies. Research assessing actual vs perceived barriers in non-VHA settings is needed to elucidate unique challenges experienced.

Investigating Dog Welfare When Interacting with Autistic Children within Canine-Assisted Occupational Therapy Sessions: A Single Case Study.

Human-animal bond is defined as the mutually beneficial relationship between humans and animals. Recent years have seen increasing research regarding the benefits of interaction with animals for autistic children. However, there continue to be limited studies exploring the impact of this interaction on the welfare of therapy dogs. As part of a pilot randomised control trial assessing the efficacy of canine-assisted occupational therapy with autistic children, this project assessed welfare markers of the therapy dog involved. A total of twenty-one saliva samples were taken from the therapy dog to assess cortisol, alpha amylase, and oxytocin concentrations at home and throughout the treatment days. Additionally, six hours of therapy session videos were analysed for stress indicators of canine behaviour. No significant differences were found between days spent at home and treatment days for any of the biomarkers or stress indicators. Results suggest that the therapy dog involved did not experience increased stress resulting from interaction with the autistic children throughout the therapy sessions. This study supports the need for further research regarding therapy dog welfare when interacting with autistic children including an increased sample size of therapy dogs and therapists.

A bespoke sleep monitoring and sleep hygiene intervention improves sleep in an U18 professional football player: A case study.

This case study reports on a professional football player (age: 17.6 years) who was referred for sleep monitoring and intervention after reporting excessive night-time awakenings. The player undertook a series of subjective sleep assessments and objective sleep monitoring (activity monitor). Based on the data presented, a sleep hygiene intervention was prescribed. Numerical comparisons were made between pre-intervention (Pre) and post-intervention (Post) values. Objective values were also compared to reference data from a similarly aged professional cohort from the same club (n = 11). Wake episodes per night (Pre: 7.9 ± 3, Post: 4.5 ± 1.9; -43%) and wake after sleep onset (WASO; Pre: 74.3 ± 31.8 mins, Post: 50.0 ± 22.8 mins, -33%) were improved from Pre to Post. Compared to the reference data, mean wake episodes per night (Pre: 7.9 ± 3.0, reference: 4.6 ± 2.6; -42%) and WASO (Pre: 74.3 ± 31.8 mins, reference: 44.3 ± 36.5 mins; -40%) were all lower compared to Pre levels. Whilst causality cannot be proven, we observed multiple sleep metrics improving following an intervention. This provides a potential framework for practitioners looking to provide targeted sleep assessment and intervention.

Transcriptome profiling of the Caenorhabditis elegans intestine reveals that ELT-2 negatively and positively regulates intestinal gene expression within the context of a gene regulatory network.

ELT-2 is the major transcription factor (TF) required for Caenorhabditis elegans intestinal development. ELT-2 expression initiates in embryos to promote development and then persists after hatching through the larval and adult stages. Though the sites of ELT-2 binding are characterized and the transcriptional changes that result from ELT-2 depletion are known, an intestine-specific transcriptome profile spanning developmental time has been missing. We generated this dataset by performing Fluorescence Activated Cell Sorting on intestine cells at distinct developmental stages. We analyzed this dataset in conjunction with previously conducted ELT-2 studies to evaluate the role of ELT-2 in directing the intestinal gene regulatory network through development. We found that only 33% of intestine-enriched genes in the embryo were direct targets of ELT-2 but that number increased to 75% by the L3 stage. This suggests additional TFs promote intestinal transcription especially in the embryo. Furthermore, only half of ELT-2's direct target genes were dependent on ELT-2 for their proper expression levels, and an equal proportion of those responded to elt-2 depletion with over-expression as with under-expression. That is, ELT-2 can either activate or repress direct target genes. Additionally, we observed that ELT-2 repressed its own promoter, implicating new models for its autoregulation. Together, our results illustrate that ELT-2 impacts roughly 20-50% of intestine-specific genes, that ELT-2 both positively and negatively controls its direct targets, and that the current model of the intestinal regulatory network is incomplete as the factors responsible for directing the expression of many intestinal genes remain unknown.

Evaluation of Implementation Strategies for Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-Based Stress Reduction (MBSR): a Systematic Review.

BACKGROUND: Improving access to evidence-based psychotherapies (EBPs) is a Veterans Health Administration (VHA) priority. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) are effective for chronic pain and several mental health conditions. We synthesized evidence on implementation strategies to increase EBP access and use. METHODS: We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for articles on EBP implementation within integrated health systems to treat chronic pain or chronic mental health conditions. Reviewers independently screened articles, extracted results, coded qualitative findings, and rated quality using modified criteria from Newcastle-Ottawa (quantitative results) or Critical Appraisal Skills Programme (qualitative results). We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework and classified outcomes using RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, Maintenance). RESULTS: Twelve articles (reporting results from 10 studies) evaluated CBT (k = 11) and ACT (k = 1) implementation strategies in large integrated healthcare systems. No studies evaluated MBSR implementation. Eight articles evaluated strategies within VHA. Six articles reported on national VHA EBP implementation programs; all involved training/education, facilitation, and audit/feedback. CBT and ACT implementation demonstrated moderate to large improvements in patient symptoms and quality of life. Trainings increased mental health provider self-efficacy in delivering EBPs, improved provider EBP perceptions, and increased provider EBP use during programs, but had unclear impacts on Reach. It was unclear whether external facilitation added benefit. Provider EBP maintenance was modest; barriers included competing professional time demands and patient barriers. DISCUSSION: Multi-faceted CBT and ACT implementation programs increased provider EBP Adoption but had unclear impacts on Reach. Future implementation efforts should further evaluate Reach, Adoption, and Maintenance; assess the added value of external facilitation; and consider strategies targeting patient barriers. Future work should use implementation frameworks to guide evaluations of barriers and facilitators, processes of change, and outcomes. REGISTRATION: PROSPERO registration number CRD42021252038.

Barriers and Facilitators of Evidence-Based Psychotherapies for Chronic Pain in Adults: A Systematic Review.

Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) have demonstrated effectiveness for improving outcomes in chronic pain. These evidence-based psychotherapies (EBPs) remain underutilized in clinical practice, however. To identify research gaps and next steps for improving uptake of EBPs, we conducted a systematic review of patient-, provider-, and system-level barriers and facilitators of their use for chronic pain. We searched MEDLINE, Embase, PsycINFO, and CINAHL databases from inception through September 2022. Prespecified eligibility criteria included outpatient treatment of adults with chronic pain; examination of barriers and facilitators and/or evaluation of implementation strategies; conducted in the United States (US), United Kingdom (UK), Ireland, Canada or Australia; and publication in English. Two reviewers independently assessed eligibility and rated quality. We conducted a qualitative synthesis of results using a best-fit framework approach building upon domains of the Consolidated Framework for Implementation Research (CFIR). We identified 34 eligible studies (33 moderate or high quality), most (n = 28) of which addressed patient-level factors. Shared barriers across EBPs included variable patient buy-in to therapy rationale and competing responsibilities for patients; shared facilitators included positive group or patient-therapist dynamics. Most studies examining ACT and all examining MBSR assessed only group formats. No studies compared barriers, facilitators, or implementation strategies of group CBT to individual CBT, or of telehealth to in-person EBPs. Conceptual mismatches of patient knowledge and beliefs with therapy principles were largely analyzed qualitatively, and studies did not explore how these mismatches were addressed to support engagement. Future research on EBPs for chronic pain in real-world practice settings is needed to explore provider and system-level barriers and facilitators, heterogeneity of effects and uptake, and both effects and uptake of EBPs delivered in various formats, including group vs individual therapy and telehealth or asynchronous digital approaches. PERSPECTIVE: This systematic review synthesizes evidence on barriers and facilitators to uptake of cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based stress reduction for chronic pain. Findings can guide future implementation work to increase availability and use of evidence-based psychotherapies for treatment of chronic pain. REGISTRATION: PROSPERO number CRD42021252038.