Psychometric properties of two implementation measures: Normalization MeAsure Development questionnaire (NoMAD) and organizational readiness for implementing change (ORIC).

Background: Effective interventions need to be implemented successfully to achieve impact. Two theory-based measures exist for measuring the effectiveness of implementation strategies and monitor implementation progress. The Normalization MeAsure Development questionnaire (NoMAD) explores the four core concepts (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring) of the Normalization Process Theory. The Organizational Readiness for Implementing Change (ORIC) is based on the theory of Organizational Readiness for Change, measuring organization members' psychological and behavioral preparedness for implementing a change. We examined the measurement properties of the NoMAD and ORIC in a multi-national implementation effectiveness study. Method: Twelve mental health organizations in nine countries implemented Internet-based cognitive behavioral therapy (iCBT) for common mental disorders. Staff involved in iCBT service delivery (n = 318) participated in the study. Both measures were translated into eight languages using a standardized forward-backward translation procedure. Correlations between measures and subscales were estimated to examine convergent validity. The theoretical factor structures of the scales were tested using confirmatory factor analysis (CFA). Test-retest reliability was based on the correlation between scores at two time points 3 months apart. Internal consistency was assessed using Cronbach's alpha. Floor and ceiling effects were quantified using the proportion of zero and maximum scores. Results: NoMAD and ORIC measure related but distinct latent constructs. The CFA showed that the use of a total score for each measure is appropriate. The theoretical subscales of the NoMAD had adequate internal consistency. The total scale had high internal consistency. The total ORIC scale and subscales demonstrated high internal consistency. Test-retest reliability was suboptimal for both measures and floor and ceiling effects were absent. Conclusions: This study confirmed the psychometric properties of the NoMAD and ORIC in multi-national mental health care settings. While measuring on different but related aspects of implementation processes, the NoMAD and ORIC prove to be valid and reliable across different language settings.

Why was the study done?: Effective interventions need to be implemented successfully to achieve impact. Reliable measurement instruments are needed to determine if an implementation was successful or not. Two theory-based instruments exist for measuring the effectiveness of implementation strategies and monitor progress. The NoMAD measures aspects of normalization related to sense-making, willingness to implement, the work people do, and reflection. The Organizational Readiness for Implementing Change (ORIC) measures organization members' preparedness for implementing a change. What did we do?: This study examined whether the NoMAD and ORIC measure what they are supposed to measure. We translated the instruments from English to eight languages (Albanian, Danish, Dutch, French, German, Italian, and Spanish/Catalan) We applied various statistical methods to confirm the measurement properties, including correlations of scales, factor structures, test­retest reliability, consistency and floor and ceiling effects. 318 mental health professionals from nine countries participated in the study. What did we find?: For both instruments, total scores can be used as well as the subscale scores. Internal consistency for ORIC was high and for NoMAD adequate. Test­retest reliability was demonstrated, and floor and ceiling effects were rare. What does this mean?: NoMAD and ORIC are reliable instruments for measuring implementation processes and outcomes across mental health care settings in different countries and languages. They measure related but different aspects of implementation processes and outcomes. The measures are brief, and theory supported. However, more work is to be done on interpreting scores in relation to implementation success and regarding changes over time.

Eutrophication of agricultural streams: defining nutrient concentrations to protect ecological condition.

Inputs of nutrients (phosphorus, P, and nitrogen, N) to coastal and fresh waters can accelerate eutrophication, resulting in excessive aquatic plant growth, depletion of oxygen, and deleterious changes in abundance and diversity of organisms. Using long-term (approximately 1995-2005) monitoring data from agriculturally-dominated watersheds in southern Ontario and Quebec, Canada, we developed and tested several approaches for setting targets for N and P. Our research showed that it is possible to set scientifically-credible targets for total P and total N to protect ecological condition of streams in agricultural landscapes, and define achievable targets attainable following adoption of beneficial management practices.

Microscopic investigation of villi from chorionic villous sampling.

The aim of the present study was to investigate the morphology of cytogenetically normal chorionic villi from chorionic villous sampling (CVS) specimens. This information can serve as a reference for morphological investigation of cytogenetically abnormal CVS specimens. We were also interested in any relationship between chorionic villous architecture and the outcome of pregnancy. In a reference group (n = 94, normal karyotype and ongoing pregnancies), we observed a considerable variation in villous diameter (range 116-377 microm) and vascular density (range 0.5-6.7 vessels/villus) and a high incidence of morphological criteria, classically mentioned in relation to chromosomal or other abnormalities, such as: fibrinoid deposition (74.5%), trophoblastic layer degeneration (3.2%) and abnormal proliferation (7.4%), avascular villi (54.2%), stromal oedema (55.3%), trophoblastic inclusions (23.4%) and fibrosis (23.4%). In the cytogenetic abnormal group (n = 10), neither the diameter nor the vascular density of the villi differed from the values observed in the reference group. In the reference group, we only observed a tendency for larger birthweights in relation to respectively larger and more vascularized villi. It is concluded that in CVS specimens, chorionic villous architecture and morphological criteria do not have any clinical relevance, neither do they have any important predictive value.

Periphyton as an indicator of water quality in the St Lawrence River (Québec, Canada).

The performance of various algal indices to document improvements in water quality across a low nutrient concentration gradient was assessed during 2 years in the St Lawrence River (Quebec, Canada). Water-quality variables and periphyton samples were collected on navigational buoys near Montreal during the spring, summer and fall of 1994 and 1995. Exposure to urban wastewater varied widely within the sector surrounding the island of Montreal, with some areas upstream receiving no direct effluents and areas further downstream receiving treated and untreated wastewater. Faecal coliform concentrations provided a good tracer of effluents and were significantly correlated to nutrient concentrations (r = 0.33-0.72, p < 0.001) and water transparency (r = 0.70, p < 0.001). Despite a strong gradient in faecal coliform concentration (< 2 to > 20 000 UFC/100 ml), algal biomass and diversity did not reflect differences between sites with varying levels of urban wastewater. Taxonomic composition of periphyton communities, particularly the presence of the cyanophyte Plectonema notatum Schmidle, was related (r = 0.48, p = 0.004) to exposure to urban effluents. Variables describing seasonal changes (temperature, Julian day, river discharge, conductivity, NO2-NO3) explained a large fraction of total variance (38-52% of total variance) and thus exerted the predominant influence on algal biomass and species composition in the St Lawrence River. Variables describing the presence of effluents explained 1-22% of the variance in compositional data. Subtle changes in periphyton species composition were the only response to different levels of exposure to urban wastewater in the Montreal area, which represented relatively small differences in comparison to natural seasonal variability.

Relationship of granulovacuolar degeneration in hippocampal neurones to aging and to dementia in normal-pressure hydrocephalics.

Neuropathological findings could not explain the dramatic improvement after shunting exhibited by one patient demented with a "normal-pressure" hydrocephalus (NPH)-like syndrome. He contrastred markedly with the unchanged condition of four similar dements also shunted successfully. Quantitative morphometry was done on the five brains to determine the degree of granulovacuolar degeneration in hippocampal neurones. The severity of this change, like that of neurofibrillary tangle formation quantified in earlier work, was not attributable merely to aging, being greater in the four unimproved cases that that in age-matched control brains from 18 normal subjects, and falling in the same elevated range as that of eight dements with necropsy-confirmed Alzheimer's disease. The intensity of granulovacuolar degeneration in the one shunted dement who improved was within normal limits. A positive linear correlation existed between the Granulovacuolar Indices and the total duration of dementia. A similar relationship had been shown for Tangle Indices. These data suggest that earlier diagnosis may improve the chances of reversing dementia in NPH-like syndromes before histopathology is too severe; and that a more careful search for laboratory features of NPH may be warranted in some cases of Alzheimer's dementia.