Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings

The discontinuation of interventions that should be stopped, or de‐implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de‐implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de‐implemented. We identify three criteria for identifying interventions appropriate for de‐implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well‐documented examples illustrate each of the criteria. We describe de‐implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de‐implementation research as a supplement. Finally, we conclude with a discussion of de‐implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de‐implementation research, especially identifying interventions appropriate for de‐implementation in a systematic manner; and highlight special ethical considerations to advance the field of de‐implementation research.     

The effect of force-controlled biting on human posture control

Several studies have confirmed the neuromuscular effects of jaw motor activity on the postural stability of humans, but the mechanisms of functional coupling of the craniomandibular system (CMS) with human posture are not yet fully understood. The purpose of our study was, therefore, to investigate whether submaximum biting affects the kinematics of the ankle, knee, and hip joints and the electromyographic (EMG) activity of the leg muscles during bipedal narrow stance and single-leg stance. Twelve healthy young subjects performed force-controlled biting (FB) and non-biting (NB) during bipedal narrow stance and single-leg stance. To investigate the effects of FB on the angles of the hip, knee, and ankle joints, a 3D motion-capture system (Vicon MX) was used. EMG activity was recorded to enable analysis of the coefficient of variation of the muscle co-contraction ratios (CVR) of six pairs of postural muscles. Between FB and NB, no significant differences were found for the mean values of the angles of the ankle, knee, and hip joints, but the standard deviations were significantly reduced during FB. The values of the ranges of motion and the mean angular velocities for the three joints studied revealed significant reduction during FB also. CVR was also significantly reduced during FB for five of the six muscle pairs studied. Although submaximum biting does not change the basic strategy of posture control, it affects neuromuscular co-contraction patterns, resulting in increased kinematic precision.     

Motor imagery ability and internal representation of movement in children with probable developmental coordination disorder

It has been hypothesised that deficits in the functioning of the mirror neuron system (MNS) and internal modelling may contribute to the motor impairments associated with DCD. These processes can be explored behaviourally through motor imagery paradigms. Motor imagery proficiency of children with and without probable DCD (pDCD) was examined using a complex hand rotation task to explore whether motor imagery strategies could be used during more complex tasks. Forty-four boys aged 7–13 years participated, 22 with pDCD (mean = 9.90 years ± 1.57) and 22 controls (mean = 9.68 years ± 1.53). Participants completed the task twice: with and without motor imagery instructions. Stimuli were presented in two rotational axes – palm/back, and eight 45° rotational steps. Both groups showed evidence of following the biomechanical and postural constraints of actual movements. Responses of children with pDCD were slower and less accurate than controls, with group differences increasing alongside task complexity. A greater impact of biomechanical constraints for accuracy was observed in the DCD group. The response characteristics of children with pDCD likely reflects a reduced capacity to mentally manipulate a body schema and reduced visuo-motor processing capabilities. Behaviourally, these processes are linked to MNS and internal modelling function, suggesting deficits in these systems may contribute to the movement difficulties characteristic of DCD.     

Empirical Priors in Polytomous Computerized Adaptive Tests: Risks and Rewards in Clinical Settings

The use of empirical prior information about participants has been shown to substantially improve the efficiency of computerized adaptive tests (CATs) in educational settings. However, it is unclear how these results translate to clinical settings, where small item banks with highly informative polytomous items often lead to very short CATs. We explored the risks and rewards of using prior information in CAT in two simulation studies, rooted in applied clinical examples. In the first simulation, prior precision and bias in the prior location were manipulated independently. Our results show that a precise personalized prior can meaningfully increase CAT efficiency. However, this reward comes with the potential risk of overconfidence in wrong empirical information (i.e., using a precise severely biased prior), which can lead to unnecessarily long tests, or severely biased estimates. The latter risk can be mitigated by setting a minimum number of items that are to be administered during the CAT, or by setting a less precise prior; be it at the expense of canceling out any efficiency gains. The second simulation, with more realistic bias and precision combinations in the empirical prior, places the prevalence of the potential risks in context. With similar estimation bias, an empirical prior reduced CAT test length, compared to a standard normal prior, in 68% of cases, by a median of 20%; while test length increased in only 3% of cases. The use of prior information in CAT seems to be a feasible and simple method to reduce test burden for patients and clinical practitioners alike.     

大连地区企业医院产权制度改革的实践与思考

企业医院社会化是区域卫生规划与卫生工作实行全行业管理的前提条件,也是国企改革和社会改革的需要,医企分离势在必行。在企业医院剥离过程中,医院产权制度改革已经成为医院改革的主要矛盾和深化医院改革的首要问题。通过大连地区企业医院产权制度改革的实践经验,对企业医院剥离模式进行探讨,阐述了对医院产权制度改革的认识,并提出合理化建议。     

The Faulty Magnitude Detector: Why SNARC‐Like Tasks Cannot Support a Generalized Magnitude System

Do people represent space, time, number, and other conceptual domains using a generalized magnitude system (GMS)? To answer this question, numerous studies have used the spatial‐numerical association of response codes (SNARC) task and its variants. Yet, for a combination of reasons, SNARC‐like effects cannot provide evidence for a GMS, even in principle. Rather, these effects support a broader theory of how people use space metaphorically to scaffold their understanding of myriad non‐spatial domains, whether or not these domains exhibit variation in magnitude.     

人体生物医学研究中受试者权益保护对策

在人体生物医学研究日益发达的今天,受试者权益保护问题逐渐浮出水面。目前我国对受试者的保护主要依赖于知情同意书和伦理委员会,关于受试者权益保护的规范性文件存在层级低、不系统和不完整等问题。建立专门的受试者保护法,完善受试者权益保护相关制度迫在眉睫。研究认为,制定专门的人体生物医学研究受试者权益保护法律,完善伦理委员会制度,推行强制保险以及救济金制度,建立严格的责任体系、开展积极的社会教育是受试者权益保护的基本对策。     

美国高等临床药学教育体系宏观结构变迁研究（1965年～2015年）

研究了1965年~2015年美国高等临床药学教育体系的层次结构、形式结构和分布结构等宏观结构的变迁情况。从临床药学实践、药师动态短缺、产业结构基础、办学经费来源、人口地理分布等方面,对半个世纪以来美国临床药学教育体系宏观结构变迁情况进行归因分析。在总结并肯定美国高等临床药学教育体系极高的市场敏感性和较强的结构优化灵活性的同时,探讨了美国高等临床药学教育体系宏观结构变迁过程中需要注意的问题。     

The Holland Code of Members of the National Organization for Human Services: A Preliminary Study of Human Services Professionals

This study determined the Holland code of members of the National Organization for Human Services. The authors used the O*NET Interest Profiler–Short Form to find that a sample of 355 human services professionals had a Holland code of Social Artistic, with Investigative, Enterprising, and Conventional codes significantly lower than Artisitc. Demographic differences were not found based on gender, whether participants identified human services as their primary field, or whether they had formal education in human services. Slight differences based on age were noted. Results will be used to advocate for inclusion of “human services professional” in the Standard Occupational Classification system.