An Overview of Rhodoliths: Ecological Importance and Conservation Emergency.

Red calcareous algae create bio-aggregations ecosystems constituted by carbonate calcium, with two main morphotypes: geniculate and non-geniculate structures (rhodoliths may form bio-encrustations on hard substrata or unattached nodules). This study presents a bibliographic review of the order Corallinales (specifically, rhodoliths), highlighting on morphology, ecology, diversity, related organisms, major anthropogenic influences on climate change and current conservation initiatives. These habitats are often widespread geographically and bathymetrically, occurring in the photic zone from the intertidal area to depths of 270 m. Due to its diverse morphology, this group offers a special biogenic environment that is favourable to epiphyte algae and a number of marine invertebrates. They also include holobiont microbiota made up of tiny eukaryotes, bacteria and viruses. The morphology of red calcareous algae and outside environmental conditions are thought to be the key forces regulating faunistic communities in algae reefs. The impacts of climate change, particularly those related to acidification, might substantially jeopardise the survival of the Corallinales. Despite the significance of these ecosystems, there are a number of anthropogenic stresses on them. Since there have been few attempts to conserve them, programs aimed at their conservation and management need to closely monitor their habitats, research the communities they are linked with and assess the effects they have on the environment.

Advancing environmental health sciences through implementation science.

BACKGROUND: Environmental health sciences have identified and characterized a range of environmental exposures and their associated risk for disease, as well as informed the development of interventions, including recommendations, guidelines, and policies for mitigating exposure. However, these interventions only serve to mitigate exposures and prevent disease if they are effectively disseminated, adopted, implemented, and sustained. MAIN BODY: Numerous studies have documented the enormous time lag between research and practice, noting that dissemination and implementation are not passive processes but rely on active and intentional strategies. Implementation science seeks to build the knowledge base for understanding strategies to effectively disseminate and implement evidence and evidence-based interventions, and thus, bridge the research-to-practice gap. CONCLUSION: Environmental health researchers are well positioned to advance health promotion and disease prevention by incorporating implementation science into their work. This article describes the rationale for and key components of implementation science and articulates opportunities to build upon existing efforts to advance environmental health supported by the National Institute of Environmental Health Sciences and National Institutes of Health broadly.

A new species of Euclymene (Maldanidae, Annelida) from Brazil, with new combinations, and phylogenetic implications for Euclymeninae.

Maldanids are tube-building polychaetes, known as bamboo-worms; inhabit diverse marine regions throughout the world. The subfamily Euclymeninae was proposed to include forms with anal and cephalic plates, a funnel-shaped pygidium, and a terminal anus. Euclymene, the type genus of Euclymeninae, has about 18 valid species. Euclymene vidali sp. nov. is defined and members of the species described from Northeastern Brazil. Members of this species have 23 chaetigers, and one pre-pygidial achaetous segment; nuchal grooves extend through three quarters of the cephalic plate, and there is one acicular spine with a denticulate tip. Euclymene africana, and E. watsoni, are here recognized, respectively, as Isocirrus africana comb. nov., and I. watsoni comb. nov. Three monotypic genera are invalid: Macroclymenella, Eupraxillella, and Pseudoclyemene; their species should be recognized as Clymenella stewartensis com. nov., Praxillella antarctica com. nov., and Praxillela quadrilobata com. nov., respectively. An identification key and a comparative table for all species of Euclymene are provided. A comparative table for all genera of Euclymeninae is also furnished. The paraphyletic status of Euclymene and Euclymeninae is discussed. The taxon Maldanoplaca is not code compliant and should only be regarded as an informal name.

Veteran stroke survivors' lived experiences after being discharged home: a phenomenological study.

BACKGROUND: Stroke is a leading cause of disability in adults and third cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. AIMS: To examine Veterans' lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. METHODS: Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45-80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. RESULTS: Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. CONCLUSIONS: SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment.IMPLICATIONS FOR REHABILITATIONSeveral implications for clinical practice were identified:Providers should acknowledge Veterans' challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood.More emphasis should be given to the Veterans' caregivers' availability and willingness to help with their loved one's recovery, work reinstatement status and financial struggles.Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked.Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits.Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system.Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke.

A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation.

BACKGROUND: Cirrhosis, or scarring of the liver, is a debilitating condition that affects millions of US adults. Early identification, linkage to care, and retention of care are critical for preventing severe complications and death from cirrhosis. OBJECTIVE: The purpose of this study is to conduct a preimplementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. METHODS: Semistructured interviews were conducted between January and May 2016 with frontline providers in liver disease and primary care clinics at 3 Veterans Health Administration medical centers. A total of 10 providers were interviewed, including 8 physicians and midlevel providers from liver-related specialty clinics and 2 primary care providers who managed patients with cirrhosis. The Consolidated Framework for Implementation Research guided the development of the interview guides. Inductive consensus coding and content analysis were used to analyze transcribed interviews and abstracted coded passages, elucidated themes, and insights. RESULTS: The following themes and subthemes emerged from the analyses: outer setting: needs and resources for patients with cirrhosis; inner setting: readiness for implementation (subthemes: lack of resources, lack of leadership support), and implementation climate (subtheme: competing priorities); characteristics of individuals: role within clinic; knowledge and beliefs about P-CIMS (subtheme: perceived and realized benefits; useful features; suggestions for improvement); and perceptions of current practices in managing cirrhosis cases (subthemes: preimplementation process for identifying and linking patients to cirrhosis care; structural and social barriers to follow-up). Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention, but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. CONCLUSIONS: P-CIMS shows promise as a powerful tool for identifying, linking, and retaining care in patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in populations with chronic disease.

Three new species of Androdeloscia Leistikow, 1999 (Oniscidea: Philosciidae) from the Brazilian Amazonia.

Three new species of Androdeloscia Leistikow, 1999 from the Brazilian Amazonian rainforest are described. Androdeloscia bicornuata sp. nov., A. paraleilae sp. nov., and A. micropunctata sp. nov. were distinguished from the 26 other species of the genus mainly based on the shape of male pleopod I endopod. Androdeloscia bicornuata sp. nov. differs from all the species in the genus by the complex morphology of the distal portion of the male pleopod I endopod bearing hyaline lamella and two horn-like tips. Androdeloscia paraleilae sp. nov. is characterized by the male pleopod I endopod with simple distal portion, without hyaline lamella, and apex represented by a curved tip and inner margin serrate proximally; and by the concavity on the lateral margin of the first maxilla (except for the A. leilae that is related to other listed characteristics). Androdeloscia micropunctata sp. nov. differs from the remaining species of the genus by the male pleopod I endopod with simple distal portion, without hyaline lamella, and apex truncate bearing a small acute tip in the outer corner; and 5+5 teeth on the first maxilla. Some characters related to the genus are later discussed.

Marine invertebrates associated with rhodoliths/maërl beds from northeast Brazil (State of Paraíba).

BACKGROUND: This study investigates the marine macroinvertebrate fauna of rhodolith beds (non-geniculated red corallinaceaous algae) in northeast Brazilian. A total of 57 species were identified, belonging to six phyla (Platyhelminthes, Annelida, Sipuncula, Mollusca, Arthropoda and Echinodermata), of which 50 are considered here as new records for the Paraíba State. Annelids (Class Polychaeta) were the most representative taxa in Miramar and Seixas Beaches, while molluscs were dominant in Maceió Beach. NEW INFORMATION: This is the first study that includes an identification key, diagnostic features and distribution patterns worldwide and local (including new records) of the marine invertebrate fauna associated with rhodolith beds in northeast Brazil (State of Paraíba). Sampling events were performed in 2018, at low tide in the intertidal to shallow subtidal zones (1.5 and 4.0 m depth), in Miramar, Seixas and Maceió Beaches. A total of 17 species were found for the first time on Seixas Beach, as well as all identified species for Miramar and Maceió. This study tries to contribute to the knowledge of marine invertebrates in northeast Brazilian shallow habitats, providing a baseline for future environmental studies.

Catalogue of living crinoids (Echinodermata: Crinoidea) from Brazil.

Knowledge of living crinoids from Brazil is chiefly restricted to the contributions of Dr Luis Roberto Tommasi between the decades of 1950 and 1970. Herein we present an updated catalogue of the crinoids occurring along the Brazilian coast, including data on synonyms, type localities, type material, geographical distribution, bathymetric ranges, and occurrences of species along the coast. The data is based on an extensive revision of the literature and on a survey of several databases. A total of 20 species were catalogued, of which two are endemic (Phrixometra longipinna var. brasiliensis and Thaumatometra minutissima). According to information from the literature, P. longipinna var. brasiliensis represents an undescribed taxon. Although Brazil supports the greatest number of crinoid species in the Southwestern Atlantic, its crinoid fauna remains understudied and likely underestimated. Research on crinoids remains a subject of great potential, not only for taxonomy but also for other areas of knowledge.

Personalized implementation of video telehealth for rural veterans (PIVOT-R).

BACKGROUND: A national shortage of mental health (MH) professionals leaves more than 90% of rural individuals without adequate access to services each year, troubling because 33% of Veterans Health Administration (VHA) enrollees live in rural areas and rural Veterans have a greater risk of suicide than urban Veterans. Additional barriers such as travel distance and cost, stigma and extreme weather or geography add to challenges of rural Veterans seeking treatment. Although the VHA has addressed this disparity by providing telemental health services, provision of services via traditional hub-and-spoke and/or establishment of regional centers has not fully addressed barriers or resource limitations. Video telehealth to home (VTH) has assisted in better addressing geographic, attitudinal and systematic barriers to in-person care; however, its uptake and implementation have been problematic. This article describes the Personalized Implementation of Video Telehealth for Rural Veterans (PIVOT-R) approach, developed in response to the unique needs of rural veterans. METHODS: We developed PIVOT, a flexible implementation strategy that is adaptive to site-specific contexts and different digital innovations and relies on a collaborative relationship between external facilitators, internal facilitators and clinical champions. We used formative evaluation (FE) to gather ongoing information about our quality improvement (QI) implementation approach of VTH. Our FE of PIVOT at rural sites provided insight into adaptations to improve rural implementation. This led to development of PIVOT-R, which explicitly focuses on rural implementation. PIVOT-R, developed from provider and patient feedback plus lessons learned during implementation, focuses on rurality as an important diversity factor and addresses relationship building, engaging the site, assessing context and infrastructure and balancing national expectations with site-level goals. During fiscal year 2018 we partnered with a VHA healthcare system in a Western mountain state to pilot the PIVOT-R approach, again using FE which included quantitative and qualitative data collection to evaluate its impact. RESULTS: PIVOT-R effectively increased uptake of VTH for MH care at the healthcare system evaluated. In fiscal year 2019 the percentage of Veterans receiving MH care via VTH at the site was 10 times greater than in fiscal year 2018, matching the mean VHA nationwide percentage and increasing by 43.24% by the end of 2019. Veteran feedback supported a positive experience by users. CONCLUSIONS: Inclusion of a comprehensive assessment of the rural system, including infrastructure and resources, greatly improves understanding of a system's specific needs and enables a tailored approach targeting relevant barriers. Our FE suggests the potential of PIVOT-R to increase VTH uptake at other rural locations and reinforces the value of telehealth technology as an important resource for rural sites.

Experiences of veterans with spinal cord injury related to annual urine screening and antibiotic use for urinary tract infections.

INTRODUCTION: Antimicrobial-resistant bacterial infections are an increasing public health threat and people with spinal cord injury (SCI) are disproportionally at higher risk. National guidelines concerning urine testing after SCI are conflicting. Unnecessary urine testing in the SCI population (with high asymptomatic bacteriuria prevalence) leads to unnecessary antimicrobial use, propagating resistant infections, especially urinary tract infections (UTIs). OBJECTIVES: (a) Describe UTI antimicrobial adherence in patients with SCI. (b) Explore SCI patient knowledge and attitudes toward current urine testing and treatment practices. DESIGN: Mixed methods. SETTING: Veterans Health Administration (VHA) patients with SCI. PARTICIPANTS: Veterans identified as having SCI seen at a VHA facility nationwide. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Self-reported medication adherence, patient beliefs and behaviors toward UTIs and antimicrobial use. RESULTS: A total of 105 Morisky Medication Adherence Scale-8 (MMAS-8) surveys were completed out of 369 distributed surveys (28% response rate). Overall, patients reported high medication adherence (mean score of 7.2/8, with 8 being a perfect adherence score). Ten qualitative interviews were completed. Themes identified include generally high adherence to prescribed antimicrobial courses and high levels of patient satisfaction with current outpatient VHA SCI bladder care. The quantitative findings converge with these themes observed in the qualitative interviews; patients were satisfied with current urine testing and treatment practices. CONCLUSIONS: Veterans with SCI are generally satisfied with their current UTI management and self-report taking antimicrobials for UTIs as prescribed. Veterans with SCI typically report high trust in their SCI providers and value their advice on bladder care management. Therefore, it is imperative for clinicians to provide evidence-based education to patients, as well as ensure that each prescribed course of antibiotics for UTI is clinically necessary. Information from this study will guide an intervention promoting appropriate urine testing and antimicrobial prescription practices by SCI providers.

Engaging patients and caregivers to establish priorities for the management of diabetic foot ulcers.

OBJECTIVE: Effective diabetic foot ulcer (DFU) care has been stymied by a lack of input from patients and caregivers, reducing treatment adherence and overall quality of care. Our objectives were to capture the patient and caregiver perspectives on experiencing a DFU and to improve prioritization of patient-centered outcomes. METHODS: A DFU-related stakeholder group was formed at an urban tertiary care center. Seven group meetings were held across 4 months, each lasting ∼1 hour. The meeting facilitator used semistructured questions to guide each discussion. The topics assessed the challenges of the current DFU care system and identified the outcomes most important to stakeholders. The meetings were audio recorded and transcribed. Directed and conventional content analyses were used to identify key themes. RESULTS: Six patients with diabetes (five with an active DFU), 3 family caregivers, and 1 Wound Clinic staff member participated in the stakeholder group meetings. The mean patient age was 61 years, four (67%) were women, five (83%) were either African American or Hispanic, and the mean hemoglobin A1c was 8.3%. Of the five patients with a DFU, three had previously required lower extremity endovascular treatment and four had undergone at least one minor foot amputation. Overall, stakeholders described how poor communication between medical personnel and patients made the DFU experience difficult. They felt overwhelmed by the complexity of DFU care and were persistently frustrated by inconsistent medical recommendations. Limited resources further exacerbated their frustrations and barriers to care. To improve DFU management, the stakeholders suggested a centralized healthcare delivery pathway with timely access to a coordinated, multidisciplinary DFU team. The clinical outcomes most valued by stakeholders were (1) avoiding amputation and (2) maintaining or improving health-related quality of life, which included independent mobility, pain control, and mental health. From these themes, we developed a conceptual model to inform DFU care pathways. CONCLUSIONS: Current DFU management lacks adequate care coordination. Multidisciplinary approaches tailored to the self-identified needs of patients and caregivers could improve adherence. Future DFU-related comparative effectiveness studies will benefit from direct stakeholder engagement and are required to evaluate the efficacy of incorporating patient-centered goals into the design of a multidisciplinary DFU care delivery system.

Factors Affecting Adoption of Coordinated Anxiety Learning and Management (CALM) in Veterans' Affairs Community-Based Outpatient Clinics.

PURPOSE: Many US military veterans experience anxiety, depression, and trauma-related disorders. A major goal of the Veterans Health Administration (VHA) has been to increase access to evidence-based psychotherapies (EBPs) such as cognitive-behavioral therapy to address veterans' substantial health burden. However, despite widespread implementation of EBPs throughout the VHA, smaller clinics that often serve rural veterans face barriers to delivering these interventions. The Veterans Affairs Coordinated Anxiety Learning and Management (VA CALM) program aims to empower providers in rural areas with varying levels of training and experience in delivering EBPs to provide high-quality cognitive-behavioral therapy for anxiety, depression, and trauma-related disorders. The goal of this study was to better understand, through qualitative interviews, VHA community-based outpatient clinic providers' perspectives on implementing VA CALM. METHODS: Qualitative interviews with providers (N = 22) were conducted to understand implementation of VA CALM. Template analysis was used to organize and summarize responses. FINDINGS: Providers noted several facilitators for implementing VA CALM in rural community clinics, including its perceived effectiveness, broad applicability, and structure. Barriers to implementation included scheduling problems and patient-related barriers. CONCLUSIONS: Incorporating providers' perspectives on factors that affect implementing cognitive-behavioral therapy in this setting may inform future efforts to disseminate-implement EBPs in smaller, more remote VHA clinics.

Dendrochirotida (Echinodermata: Holothuroidea) from the northeastern coast of Brazil.

The study presents a review of the Dendrochirotida species from shallow waters of the northeastern coast of Brazil. A total of 1,268 specimens were analyzed and 24 species were recorded, which were classified into 16 genera of Cucumariidae, Psolidae, Phyllophoridae, and Sclerodactylidae. Detailed descriptions and figures of the taxonomic characters are provided to facilitate species identification. Notes on morphological variation, geographic distribution, and habitat are also provided. We suggest two new species for science, Thyone brasiliana sp. nov. and Havelockia nietae sp. nov., the new combination Parathyone braziliensis (Verrill, 1868) and the first record of Euthyonidiella trita (Sluiter, 1910) for the Brazilian coast. The bathymetric ranges are expanded for Coronatum baiensis, Euthyonidiella trita, Stolus cognatus, and Thyonidium seguroensis.

Spinal Cord Injury Provider Knowledge and Attitudes Toward Bacteriuria Management and Antibiotic Stewardship.

INTRODUCTION: Bacteriuria, either asymptomatic or urinary tract infection, is common in persons with spinal cord injury or disorder (SCI/D). In the Veterans Health Administration (VHA), conflicting clinical practice guidelines make appropriate bacteriuria management and antibiotic stewardship challenging. OBJECTIVE: To explore SCI/D provider knowledge, attitudes, and teamwork around bacteriuria management during the VHA SCI/D annual examination. DESIGN: Mixed methods. SETTING: VHA SCI/D centers. PARTICIPANTS: SCI/D staff providers and physical medicine and rehabilitation resident physicians. MAIN OUTCOME MEASUREMENTS: Knowledge, safety, and teamwork scores on bacteriuria management using a validated questionnaire. Themes on barriers and facilitators to bacteriuria management during the SCI/D annual exam, and attitudes toward antibiotic stewardship in general. RESULTS: We received 84 responses from 344 distributed surveys, with a response rate of 24%. Thirty percent of all participants endorsed incorrect triggers for obtaining a urine culture (change in urine color, cloudiness, or odor). The type of organism identified on culture drove unnecessary antibiotic use; 57% would treat asymptomatic bacteriuria if caused by extended spectrum beta-lactamase Escherichia coli. There were no significant differences between the median (interquartile range [IQR]) knowledge score of the staff providers (70.6 [58.8-82.4]) and the resident physicians (64.7 [58.8-82.4]), but the teamwork climate scores (P = .02) and safety climate scores (P < .01) were higher among staff providers than among resident physicians. Interview analysis identified how the limited recall of content among SCI/D providers of the guidelines for bacteriuria was a potential barrier to their use but attitudes toward guidelines and antibiotic stewardship initiatives were positive. CONCLUSION: All participants objectively demonstrated actionable gaps in bacteriuria management and expressed uncertainty in their knowledge during qualitative interviews. Through addressing these gaps, we can develop effective antibiotic stewardship programs for the VHA SCI/D system of care.

Development and evaluation of an 1-day Acceptance and Commitment Therapy workshop for Veterans with comorbid chronic pain, TBI, and psychological distress: Outcomes from a pilot study.

OBJECTIVES: To 1) develop and refine a 1-day trans-diagnostic psychotherapeutic "ACT on Life" workshop tailored for Veterans with mild traumatic brain injury, stress-based psychopathology, and pain; 2) examine the feasibility, acceptability, and preliminary effects of this intervention. SETTING: A Veterans Health Administration medical center. PARTICIPANTS: Veterans returning from Operations Iraqi Freedom, Enduring Freedom, and New Dawn with mild TBI, stress-based psychopathology, and chronic pain. DESIGN: Phase I involved development of the intervention by experts and subsequent refinement based on Veteran feedback (N = 11). Phase II was a pilot randomized controlled trial comparing the effects of the revised intervention (N = 20) to treatment as usual (TAU; N = 12). MAIN MEASURES: For phase I, qualitative feedback at 2 weeks and 3 months post-workshop was obtained from Veterans. For phase II, quantitative measures included the PTSD Checklist, Depression Anxiety and Stress Scale, Military-to-Civilian Questionnaire, WHO-Disability Assessment Schedule, Brief Pain Inventory, Acceptance and Action Questionnaire. RESULTS: Veterans found the workshop acceptable, innovative and useful. Quantitative data from phase II suggested that participants in the ACT group, relative to TAU, showed improvement in psychiatric symptoms, functioning, and reintegration 3 months post-workshop. Unexpectedly, pain interference was lower in the TAU group at follow-up. CONCLUSIONS: Preliminary results support the feasibility, acceptability, and promising effects on psychological distress and community reintegration of this 1-day, transdiagnostic workshop for Veterans. Future research examining the effectiveness of this workshop with a larger sample size is necessary.

Integrated Model for Patient-Centered Advanced Liver Disease Care.

Advanced liver disease (AdvLD) is a high-risk common condition with a progressive, highly morbid, and often fatal course. Despite effective treatments, there are substantial shortfalls in access to and use of evidence-based supportive and palliative care for AdvLD. Although patient-centered, chronic illness models that integrate early supportive and palliative care with curative treatments hold promise, there are several knowledge gaps that hinder development of an integrated model for AdvLD. We review these evidence gaps. We also describe a conceptual framework for a patient-centered approach that explicates key elements needed to improve integrated care. An integrated model of AdvLD would allow clinicians, patients, and caregivers to work collaboratively to identify treatments and other healthcare that best align with patients' priorities.

Increasing the impact of randomized controlled trials: an example of a hybrid effectiveness-implementation design in psychotherapy research.

Randomized controlled trials (RCTs) are the gold standard for clinical research. However, significant delays between completion of RCTs and adoption of evidence-based practices into clinical settings remain. Engagement of stakeholders and implementation-focused outcomes to augment traditional RCTs hold the potential to increase the impact of RCT outcomes for clinical practice and more rapidly lead to the adoption of evidence-based practices in clinical settings. The purpose of this study is to discuss hybrid effectiveness-implementation designs and use a project example to highlight important methodological considerations to enhance the impact of RCTs. A hybrid effectiveness-implementation study assessed the effectiveness and implementation potential of brief cognitive behavioral therapy (bCBT) for rural Veterans. A patient-randomized trial (bCBT vs. enhanced usual care) explored the impact on depression symptoms. Implementation elements included engagement of stakeholders and a multifaceted provider training and support program to increase bCBT use by providers in Veterans Health Administration (VA) community-based outpatient clinics. Implementation outcomes included the number of providers who adopted bCBT, provider fidelity, and delivery outcomes (e.g., use of measurement-based care, treatment engagement, and completion). Hybrid designs offer opportunities to improve the alignment between research and practice, potentially improving dissemination of evidence-based interventions and reducing known delays in the translation from research to practice. Expansion of traditional RCTs through collaborative stakeholder contributions and stakeholder/consumer-informed implementation approaches is critical to improve adoption postproject. Although hybrid designs offer significant benefits related to generalizability and adoption, these approaches involve complex procedures and processes and often come at the cost of reduced internal study controls.

Personalized Implementation of Video Telehealth.

This article describes the Personalized Implementation for Video Telehealth strategy to increase adoption of video telehealth to home (VTH) across a large, urban Veterans Health Administration medical center and applications for broader use in non-VHA settings. The authors fully integrated VTH into existing mental health clinics, resulting in (1) a significant increase in the number of patients receiving VTH, (2) a significant increase in the number of VTH visits relative to median national improvement, (3) a greater number of unique specialty mental health clinics offering VTH in Houston, and (4) a greater number of community clinics active in delivering VTH.

Is tourism affecting polychaete assemblages associated with rhodolith beds in Northeastern Brazil?

Introduction: Rhodoliths are biogenic structures distributed worldwide, formed by several types of calcareous algae. They may host a great diversity of marine invertebrates, among which polychaetes are conspicuous and diversified representatives. Rhodolith beds are notwithstanding vulnerable to several human activities (e.g. exploitation of commercial species associated with rhodoliths, petroleum exploration, fishing activities, effluent discharges, and tourism), which may compromise that diversity. Tourism is presently increasing its impact on rhodolith beds. Global warming and ocean acidification are also determinant factors in faunal change. Objective: to analyse the polychaete assemblages associated with rhodolith beds subject to different intensities of touristic pressure at Seixas Beach (NE Brazil), where tourism is gradually increasing over time. Methods: Effects were evaluated at two depths, 1.5 m and 4.0 m. Sampling was done every two months during 2015, encompassing the two marked seasons of the year in the region (rainy and dry). Quadrats of 15 x 15 cm were placed in each depth during sampling. All rhodoliths present within the quadrat were collected (usually four to five rhodoliths). Our hypothesis was that the deeper depth and the samples from the dry season months would be increasingly subject to the impact of tourism. Results: Overall, 49 species were found (from 21 different families), and a total of 733 individuals were collected. The most abundant species was Eunice wasinensis (280 individuals, 38.2% of total abundance). The species Eurythoe complanata, Eunice biannulata, E. wasinensis, Lysidice ninetta, Oxydromus pugettensis and Ceratonereis (Ceratonereis) singularis appeared in all months. The study detected a tendency for higher diversity to occur at the depth of 1.5 m for all indices, but only the Shannon-Wiener values were significantly higher there (p < 0.05). No clear differences were found regarding months or season. Conclusions: These results suggest that a higher potential pressure due to tourism may occur at 4.0 m due to more intense craft shipping activities (traffic of catamaran boats transporting tourists to and from the reefs) in that area.

Introducción: Rodolitos son estructuras biogénicas distribuidas en todo el mundo, formadas por varios tipos de algas calcáreas. Pueden albergar una gran diversidad de invertebrados marinos, entre los cuales los poliquetas son representantes conspicuos y diversificados. No obstante, los fondos de los rodolitos son vulnerables a varias actividades humanas (por ejemplo, la explotación de especies comerciales asociadas con rodolitos, exploración petrolera, actividades de pesca, descargas de efluentes y turismo), que pueden comprometer esa diversidad. El turismo está aumentando su impacto en los fondos de rodolitos. El calentamiento global y la acidificación de los océanos también son factores determinantes en el cambio de fauna. Objetivo: El presente estudio tuvo como objetivo analizar los conjuntos de poliquetos asociados con fondos de rodolitos sujetos a diferentes intensidades de presión turística en la playa de Seixas (Nordeste de Brasil), donde el turismo está aumentando gradualmente con el tiempo. Métodos: Los efectos fueron evaluados a dos profundidades, 1.5 m y 4.0 m. El muestreo se realizó cada dos meses durante 2015, abarcando las dos estaciones marcadas del año en la región (lluviosa y seca). Se colocaron cuadrantes de 15 x 15 cm en cada profundidad durante el muestreo. Se recolectaron todos los rodolitos presentes dentro del cuadrante (generalmente de four a five rodolitos). Nuestra hipótesis era que la mayor profundidad y las muestras de la estación seca estarían cada vez más sujetas al impacto del turismo. Resultados: En total, se encontraron 49 especies (de 21 familias diferentes) y se recolectó un total de 733 individuos. La especie más abundante fue Eunice wasinensis (280 individuos, 38.2 % de la abundancia total). La especie Eurythoe complanata, Eunice biannulata, E. wasinensis, Lysidice ninetta, Oxydromus pugettensis y Ceratonereis (Ceratonereis) singularis aparecieron en todos los meses. El estudio detectó una tendencia a mayor diversidad en la profundidad de 1,5 m para todos los índices, pero solo los valores de Shannon-Wiener fueron significativamente mayores allí (p < 0.05). No se encontraron diferencias con respecto a los meses. Conclusiones: Estos resultados sugieren que puede haber una mayor presión potencial debido al turismo a 4.0 m debido a actividades de embarcaciones más intensas (tráfico de catamaranes que transportan turistas hacia y desde los arrecifes) en esa área. Nuestros resultados aumentan nuestro conocimiento sobre la diversidad de poliquetos asociados con los fondos de rodolitos en áreas tropicales, y resaltan la necesidad de estudios de monitoreo para probar el impacto de los factores de estrés locales en estos conjuntos.

The use of structured data elements to identify ASCVD patients with statin-associated side effects: Insights from the Department of Veterans Affairs.

BACKGROUND: Accurate identification of patients with statin-associated side effects (SASEs) is critical for health care systems to institute strategies to improve guideline-concordant statin use. OBJECTIVE: The objective of this study was to determine whether adverse drug reaction (ADR) entry by clinicians in the electronic medical record can accurately identify SASEs. METHODS: We identified 1,248,214 atherosclerotic cardiovascular disease (ASCVD) patients seeking care in the Department of Veterans Affairs. Using an ADR data repository, we identified SASEs in 15 major symptom categories. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed using a chart review of 256 ASCVD patients with identified SASEs, who were not on high-intensity statin therapy. RESULTS: We identified 171,189 patients (13.71%) with documented SASEs over a 15-year period (9.9%, 2.7%, and 1.1% to 1, 2, or >2 statins, respectively). Statin use, high-intensity statin use, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol levels were 72%, 28.1%, 99 mg/dL, and 129 mg/dL among those with vs 81%, 31.1%, 84 mg/dL, and 111 mg/dL among those without SASEs. Progressively lower statin and high-intensity statin use, and higher low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels were noted among those with SASEs to 1, 2, or >2 statins. Two-thirds of SASEs were related to muscle symptoms. Sensitivity, specificity, PPV, NPV compared with manual chart review were 63.4%, 100%, 100%, and 85.3%, respectively. CONCLUSION: A strategy of using ADR entry in the electronic medical record is feasible to identify SASEs with modest sensitivity and NPV but high specificity and PPV. Health care systems can use this strategy to identify ASCVD patients with SASEs and operationalize efforts to improve guideline-concordant lipid-lowering therapy use in such patients. The sensitivity of this approach can be further enhanced by the use of unstructured text data.