Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): a modified Delphi study.

BACKGROUND: Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. METHOD: MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability and inclusion (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. RESULTS: In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. DISCUSSION: MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.

Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): A modified Delphi study.

Background: Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. Method: MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. Results: In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. Discussion: MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.

The dual pandemics of COVID-19 and systemic racism: Navigating our path forward.

The Coronavirus disease 2019 (COVID-19) disrupted the way of life for humans all around the world. As the consequences continue to be revealed, it has been abundantly clear that the pandemic has disproportionately impacted communities of color. The COVID-19 pandemic shined a magnifying glass on racially based structural inequities in a manner that was impossible to unsee or to look away. COVID-19 disrupted education norms-from forcing online classroom instruction models to hindering our reliance on standardized testing. Education is already rife with evidence of systemic racism as its foundation. Disproportionality in special education, disproportionate punitive discipline, underrepresentation in highly capable learning problems are well established structures that maintain systemic racism in education (Diamond, 2018). As systemic racism is embedded in all of our social and environmental contexts, it is easy to conclude that systemic racism and COVID-19 are not just coexisting, they are interacting to exacerbate negative outcomes for communities of color. This commentary addresses the disproportionate impact of the dual pandemics: COVID-19 and systemic racism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

From traditional practice to tiered comprehensive services for all: Developing a responsive school culture for the future.

In this article, we reflect on the evolution of school psychology practice from the past to the present, and share some thoughts about the future. Although school psychology programs provide training in consultation, prevention, social emotional development, counseling, and mental health interventions, school psychology practice is still dominated by assessment, and the specialty has yet to live up to its promise to address the multiple needs of an increasingly diverse student population. Today's practitioners need to be skilled in systems-level programing that is informed by cultural awareness, knowledge, and skills necessary to responsibly work toward the best outcomes for students and families from all cultural, ethnic, and racial backgrounds. As the demand for mental health and other services in schools continues to increase, we argue for a wholescale adoption of culturally adapted evidence-based practices to address the expanding role of school-based practice. Finally, we offer considerations from the social psychology literature that will help school psychologists prioritize behavioral health while also reducing disparities in educational attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Near Miss Reporting.

Imaging is no stranger to patient safety events. There was a tremendous opportunity at WakeMed in North Carolina to change the safety culture of the imag- ing services department and provide staff with a system that rewarded them for identifying safety risks. Most staff could articulate the difference between a near miss and an actual event, but very few staff knew how to report a near miss. Staff who did know how to report a near miss believed the online process was too lengthy. Staff also reported a fear of punitive action associated with reporting events. Imaging services leadership successfully developed and implemented a "Good Catch" program. One of the most important objectives of the program was to remove the negative stigma associated with near miss reporting.

Ethnic and Gender Variation in Religious Involvement: Patterns of Expression in Young Adulthood.

This study used latent class analysis to empirically derive profiles of religious involvement among a sample of 808 young adults and describe ethnic and gender differences within such religious involvement patterns. Items on the Duke Religion Index were included as part of a larger longitudinal survey of emotional, physical, and behavioral health. The scale measured the organizational, nonorganizational, and intrinsic dimensions of religiosity (Koenig et al. 2001) in a sample of young adults at two waves of the study-age 27 and age 30. At age 27, five religious profiles were distinguishable in the sample while at age 30 six profiles emerged. Ethnic differences were found for each of the religious profiles where religious involvement manifested in different ways. Religious profiles between ages 27 and 30 changed over time and were affected by gender and ethnicity.

Early development of language by hand: composing, reading, listening, and speaking connections; three letter-writing modes; and fast mapping in spelling.

The first findings from a 5-year, overlapping-cohorts longitudinal study of typical language development are reported for (a) the interrelationships among Language by Ear (listening), Mouth (speaking), Eye (reading), and Hand (writing) in Cohort 1 in 1st and 3rd grade and Cohort 2 in 3rd and 5th grade; (b) the interrelationships among three modes of Language by Hand (writing manuscript letters with pen and keyboard and cursive letters with pen) in each cohort in the same grade levels as (a); and (c) the ability of the 1st graders in Cohort 1 and the 3rd graders in Cohort 2 to apply fast mapping in learning to spell pseudowords. Results showed that individual differences in Listening Comprehension, Oral Expression, Reading Comprehension, and Written Expression are stable developmentally, but each functional language system is only moderately correlated with the others. Likewise, manuscript writing, cursive writing, and keyboarding are only moderately correlated, and each has a different set of unique neuropsychological predictors depending on outcome measure and grade level. Results support the use of the following neuropsychological measures in assessing handwriting modes: orthographic coding, rapid automatic naming, finger succession (grapho-motor planning for sequential finger movements), inhibition, inhibition/switching, and phonemes skills (which may facilitate transfer of abstract letter identities across letter formats and modes of production). Both 1st and 3rd graders showed evidence of fast mapping of novel spoken word forms onto written word forms over 3 brief sessions (2 of which involved teaching) embedded in the assessment battery; and this fast mapping explained unique variance in their spelling achievement over and beyond their orthographic and phonological coding abilities and correlated significantly with current and next-year spelling achievement.

Executive functions in becoming writing readers and reading writers: note taking and report writing in third and fifth graders.

Results are reported for a study of 2 separate processes of report writing-taking notes while reading source material and composing a report from those notes-and related individual differences in executive functions involved in integrating reading and writing during these writing activities. Third graders (n = 122) and 5th graders (n = 106; overall, 127 girls and 114 boys) completed two reading-writing tasks-read paragraph (mock science text)-write notes and use notes to generate written report, a reading comprehension test, a written expression test, four tests of executive functions (inhibition, verbal fluency, planning, switching attention), and a working memory test. For the read-take notes task, the same combination of variables was best (explained the most variance and each variable added unique variance) for 3rd graders and 5th graders: Wechsler Individual Achievement Test-Second Edition (WIAT-II) Reading Comprehension, Process Assessment of the Learner Test for Reading and Writing (PAL) Copy Task B, WIAT-II Written Expression, and Delis-Kaplan Executive Function System (D-KEFS) Inhibition. For the use notes to write report task, the best combinations of variables depended on grade level: For 3rd graders, WIAT-II Reading Comprehension, WIAT-II Written Expression, D-KEFS Verbal Fluency, and Tower of Hanoi; for 5th graders, WIAT-II Reading Comprehension, D-KEFS Verbal Fluency, WIAT-II Written Expression, and PAL Alphabet Task. These results add to prior research findings that executive functions contribute to the writing development of elementary-grade students and additionally support the hypothesis that executive functions play a role in developing reading-writing connections.

The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery.

BACKGROUND: Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed. METHODS: Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses of fentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system. RESULTS: The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001). CONCLUSION: In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.

Trends in selenium status of South Australians.

OBJECTIVE: To assess trends in selenium status in South Australians from 1977 to 2002. DESIGN: Six cross-sectional surveys. PARTICIPANTS: 117 participants in 1977, 30 in 1979, 96 and 103 (separate surveys) in 1987, 200 in 1988, and 288 volunteer blood donors in 2002. A total of 834 healthy Australian adults (mean age, 42 years [range, 17-71 years]; 445 were male). MAIN OUTCOME MEASURES: Plasma and whole blood selenium concentrations. RESULTS: The 2002 survey yielded a mean plasma selenium concentration of 103 micro g/L (SE, 0.65), which reached the estimated nutritional adequacy level of 100 micro g/L plasma selenium. Mean whole blood selenium declined 20% from the 1977 and 1979 surveys (mean whole blood selenium concentration, 153 micro g/L) to the 1987, 1988 and 2002 surveys (mean whole blood selenium concentration, 122 micro g/L). Plasma selenium was higher in men (P = 0.01), and increased with age in both men and women (P = 0.008). CONCLUSIONS: In healthy South Australian adults sampled from 1977 to 2002, whole blood and plasma selenium concentrations were above those reported for most other countries and in most previous Australian studies, notwithstanding an apparent decline in selenium status from the late 1970s to the late 1980s.

Stress responses, pressure ulcer development and adaptation.

This case study explores the possible psychosocial concepts underpinning a spinal cord-injured patients' pressure ulcer development, his response to the treatment offered and subsequent self-discharge. By examining both the physiological and psychological reactions of stress through conceptual models, it was possible to depict that there is a close relationship between autonomic responses and an individual's emotional and appraisal attributes. The effect of stress on the immune system was reviewed, with particular focus placed on the wound-healing process and the inflammatory phase. This identified a probable correlation between emotional stress and pressure ulcer development. An individual's reaction to emotional stressors is frequently associated with his/her unique coping strategies and their interplay with social support mechanisms. This case study will depict both positive and negative coping strategies and how the lack of social support influenced the final outcome. Through the provision of an anonymous patient history, investigation will be made into the effects of stress experienced by a patient. Models of stress and the patient's related physiological and psychological reactions will be discussed. Examination will be made into how the use of social support could have influenced the patient's coping mechanisms.