Indiana University-Purdue University Indianapolis (IUPUI) / Translational research has proven to be a powerful process that bridges the gap between basic science and medical practice. The complexity of translational research is two-fold: integration of vast amount of information in disparate silos, and dissemination of discoveries to stakeholders with different interests. We designed and implemented a hybrid knowledge discovery framework. We developed strategies to leverage both traditional biomedical databases and Health Social Network Communities content in the discovery process. Heuristic and quantitative evaluations were carried out in Colorectal Cancer and Amyotrophic Lateral Sclerosis disease areas. The results demonstrate the potential of our approach to bridge silos and to identify hidden links among clinical observations, drugs, genes and diseases, which may eventually lead to the discovery of novel disease targets, biomarkers and therapies.

As we discussed in our first editorial in the December 2018 issue (Polaha & Sunderji, 2018), an emerging science of knowledge translation (also known as implementation and dissemination science) aims to bridge the disconnect between evidence and practice. Researchers are increasingly engaging with knowledge users and other stakeholders as a key strategy to promote uptake. This may include policymakers, payers, and—the focus of this editorial—patients. Patient-oriented research is featured in national research agendas around the world including in Canada (Canadian Institutes of Health Research, 2018) and the United States (Patient-Centered Outcomes Research Institute, see https://www.pcori.org/), in part as it may contribute one solution to the “bench to bedside” gap (Greenhalgh, Jackson, Shaw, & Janamian, 2016; Jull, Giles, & Graham, 2017; McGavin, 2017). In this editorial, we provide a general introduction to research, its potential, and its realized value. We also suggest strategies for conducting patient-oriented research effectively, including a description of common barriers and how they can be dealt with. We hope this background will inspire you to get started with patient-oriented research and to learn more, as well as to share your patient-oriented research through Families, Systems, & Health.

With medical evidence constantly advancing, the health care system faces pressure to generate, apply and integrate innovations to improve the quality of patient care. This dissertation examines how organizational characteristics influence these processes. The first study, a systematic review, investigates how organizational features influence the translation of basic research findings to clinical applications. Results showed a dearth of peer-reviewed literature on this topic, despite a proliferation of efforts to accelerate translational research by manipulating organizational structures and processes. Few studies effectively linked structures, processes and outcomes and no organizational feature was associated conclusively with translation of research into clinical practice. The second study draws on in-depth qualitative interviews (82 participants at 10 hospitals) to understand how hospitals that reduced readmission rates had applied innovations in clinical practice and organizational context. High performing and low performing hospitals had both implemented similar clinical practice changes in their efforts to reduce readmissions; however, high performing hospitals reported greater investment in creating an organizational context to facilitate readmissions. This included more extensive efforts to improve collaboration within the hospital, greater coordination between the hospital and outside providers, deeper engagement in learning and problem solving related to readmissions, and greater senior leadership support. The third study draws on an expanded set of interviews from the same data collection (90 participants at 10 hospitals) to investigate mechanisms through which innovations become integrated into hospital routines. Despite a well-developed literature on the initial implementation of new practices, we have limited knowledge about the mechanisms by which integration occurs. Results showed that when an innovation was integrated successfully, a small number of key staff held the innovation in place for as long as a year while more permanent integrating mechanisms began to work. Innovations that proved intrinsically rewarding to staff integrated through shifts in attitudes and norms over time. Innovations that did not provide direct benefits to staff were integrated through changed incentives or automation. Together, these studies illuminate opportunities for hospitals to improve patient care by managing the organizational context in which innovations are deployed. Understanding how organizational context affects translation requires further research. / 2017-10-02T00:00:00Z

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Nature of the inquiry: My research inquiry investigated how qualities of personal interaction shape and affect the promotion of research utilisation for quality improvement in the US healthcare sector. The research investigated my own professional practice of consulting, teaching, and research regarding the improvement of healthcare practices and outcomes. Efforts to improve the quality of healthcare services are often difficult to realise and sustain. The quality improvement movement in the USA and elsewhere has not conducted much self-examination of its own processes for sources of these perennially problematic results. Relevance: The quality of healthcare services can be readily understood as having consequences of life or death, wellness or suffering. Healthcare expenditures in the USA are estimated at 16% of GDP and over 9% in the UK. Improving healthcare quality improvement efforts is a matter of profound human and social significance. Approach: The DMan research methodology is a reflexively aware process conducted as a cohort and as small learning groups of researchers during the three-year programme. The research inquiry used the complex responsive process of relating theory of learning as emergent changes of meaning or, equivalently, knowledge. As a social science of qualities, it uses the qualities of human interaction as the unit of analysis. The research utilised an interdisciplinary approach drawing upon: healthcare quality improvement literature; organizational discourse studies; research on strategy as practice; performance management; communications theories; the theory of mindful learning; interpersonal neurobiology; figurational sociology; and American pragmatist philosophy. The methodology employs a mindful reflexivity research strategy related to concepts from mindful learning and social neuroscience literature. Central methods included iterative peer and supervisor debriefing and iterative reflexive narrative practice. Findings: A contribution is made to the healthcare literature by describing how ordinary qualities of social coordination dynamics affect the promoters of healthcare research, not just potential users of research. A contribution is made to professional practice by providing a new perspective from which to analyse the sources of performance challenges prevalent in healthcare quality improvement efforts. The research findings indicate how applications of substantial organisational and social resources to promote research utilisation in the US health sector can be co-opted and dissipated away from ostensive substantive objectives. This occurs by research promoters‟ organizational discourse efforts to favourably shape power relating and other qualities of interaction of improvement initiatives. These efforts restrict the emergence of learning about the promoted changes.

A utilização do conhecimento científico para promoção da saúde humana é o principal objetivo da ciência translacional. Para que isto seja possível, faz-se necessário o desenvolvimento de métodos computacionais capazes de lidar com o grande volume e com a heterogeneidade da informação gerada no caminho entre a bancada e a prática clínica. Uma barreira computacional a ser vencida é o gerenciamento e a integração dos dados clínicos, sócio-demográficos e biológicos. Neste esforço, as ontologias desempenham um papel essencial, por serem um poderoso artefato para representação do conhecimento. Ferramentas para gerenciamento e armazenamento de dados clínicos na área da ciência translacional que têm sido desenvolvidas, via de regra falham por não permitir a representação de dados biológicos ou por não oferecer uma integração com as ferramentas de bioinformática. Na área da genômica existem diversos modelos de bancos de dados biológicos (tais como AceDB e Ensembl), os quais servem de base para a construção de ferramentas computacionais para análise genômica de uma forma independente do organismo de estudo. Chado é um modelo de banco de dados biológicos orientado a ontologias, que tem ganhado popularidade devido a sua robustez e flexibilidade, enquanto plataforma genérica para dados biomoleculares. Porém, tanto Chado quanto os outros modelos de banco de dados biológicos não estão preparados para representar a informação clínica de pacientes. Este projeto de mestrado propõe a implementação e validação prática de um framework para integração de dados, com o objetivo de auxiliar a pesquisa translacional integrando dados biomoleculares provenientes das diferentes tecnologias omics com dados clínicos e sócio-demográficos de pacientes. A instanciação deste framework resultou em uma ferramenta denominada IPTrans (Integrative Platform for Translational Research), que tem o Chado como modelo de dados genômicos e uma ontologia como referência. Chado foi estendido para permitir a representação da informação clínica por meio de um novo Módulo Clínico, que utiliza a estrutura de dados entidade-atributo-valor. Foi desenvolvido um pipeline para migração de dados de fontes heterogêneas de informação para o banco de dados integrado. O framework foi validado com dados clínicos provenientes de um Hospital Escola e de um banco de dados biomoleculares para pesquisa de pacientes com câncer de cabeça e pescoço, assim como informações de experimentos de microarray realizados para estes pacientes. Os principais requisitos almejados para o framework foram flexibilidade, robustez e generalidade. A validação realizada mostrou que o sistema proposto satisfaz as premissas, levando à integração necessária para a realização de análises e comparações dos dados. / The use of scientific knowledge to promote human health is the main goal of translational science. To make this possible, it is necessary to develop computational methods capable of dealing with the large volume and heterogeneity of information generated on the road between bench and clinical practice. A computational barrier to be overcome is the management and integration of clinical, biological and socio-demographics data. In this effort, ontologies play a crucial role, being a powerful artifact for knowledge representation. Tools for managing and storing clinical data in the area of translational science that have been developed, usually fail due to the lack on representing biological data or not offering integration with bioinformatics tools. In the field of genomics there are many different biological databases (such as AceDB and Ensembl), which are the basis for the construction of computational tools for genomic analysis in an organism independent way. Chado is a ontology-oriented biological database model which has gained popularity due to its robustness and flexibility, as a generic platform for biomolecular data. However, both Chado as other models of biological databases are not prepared to represent the clinical information of patients. This project consists in the proposal, implementation and validation of a practical framework for data integration, aiming to help translational research integrating data coming from different omics technologies with clinical and socio-demographic characteristics of patients. The instantiation of the designed framework resulted in a computational tool called IPTrans (Integrative Platform for Translational Research), which has Chado as template for genomic data and uses an ontology reference. Chado was extended to allow the representation of clinical information through a new Clinical Module, which uses the data structure entity-attribute-value. We developed a pipeline for migrating data from heterogeneous sources of information for the integrated database. The framework was validated with clinical data from a School Hospital and a database for biomolecular research of patients with head and neck cancer. The main requirements were targeted for the framework flexibility, robustness and generality. The validation showed that the proposed system satisfies the assumptions leading to integration required for the analysis and comparisons of data.

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Behavioral momentum theory provides a conceptual framework for the study of the recurrence of previously extinguished operant behavior. Commonly referred to as treatment relapse, this is the failure to maintain treatment gains (e.g., reductions in challenging behavior) when there is a change in conditions under which these gains were achieved. One treatment relapse paradigm previously examined in basic and applied research is reinstatement. Reinstatement of challenging behavior has been shown to occur when functional reinforcers are delivered on a fixed-time schedule following extinction of challenging behavior. Although examinations appropriate behavior have applied value, analyses of reinstatement have been conducted almost exclusively with challenging behavior. During the current study, a reinstatement methodology was applied to communicative responses with five children diagnosed with developmental disabilities who exhibited comorbid communication deficits, as well as challenging behavior maintained by positive reinforcement. In the first phase of the reinstatement evaluation, each child received functional communication training (FCT) within a positive reinforcement context within a two-component multiple schedule design with each schedule paired with a distinct communicative response. After achieving steady-state responding in the first phase, in which all participants were independently emitting both communicative responses, all appropriate communication was placed on extinction in the second phase. Extinction continued until rates of appropriate communication were at or near zero. In the third phase, positive reinforcement was delivered and the recurrence of appropriate communication was evaluated. For two of five participants, communicative responding recurred following the fixed-time delivery of the functional reinforcer, indicating a successful demonstration of reinstatement. For three of five participants, communicative responding recurred prior to the delivery of fixed-time reinforcement, indicating that an alternative recurrence phenomenon likely occurred. These results suggest that reinstatement methodologies can be applied to cases in which FCT treatment failures have occurred to efficiently restore clinical gains for some participants. Implications for clinical practice and future directions of this line of research are discussed.

ABSTRACT Purpose of the study. Through secondary data analysis of results from the School Mental Health Services Integration Survey (SMHSIS), this study describes indicators of school mental health integration preparedness, including role identification, willingness to engage in tasks associated with mental health services integration and implementation facilitators. The study also investigated the utility of a modified version of the Evidence-Based Practice Attitude Scale (EBPAS) for use with school staff. Study rationale. With as many as 20% of children meeting criteria for mental disorders that cause impairment, the gaps in mental health services delivery to this special needs population are evident and persistently problematic. Less than a third receive the services they need due to structural as well as attitudinal barriers to accessing services. Trends toward delivering services where children are located are noted and schools have emerged as de facto provider of mental health services to children. Yet, schools are not traditionally arranged or organized toward mental health services delivery, and though school-based mental health innovations are emerging there is no agreed upon unifying framework for integration of mental health services into school settings. Whereas school-based mental health is connecting to the evidence-base more often, evidence-based practices remain under-utilized. The present study examines school mental health services integration readiness in a large urban school district in central Florida. Methods. The SMHSIS was conducted by email and participants included seven group of professional staff, including principals and assistant principals, teachers, guidance counselors, social workers, psychologists, school resource officers, and school health staff. Data analysis involved exploratory factor analysis (EFA) of survey sections, in an effort to uncover indicators of readiness for school mental health integration preparedness in three domains, role identification, willingness, and implementation facilitators. One-way analysis of variance (ANOVA) and post hoc tests were conducted to examine differences in perspectives on these domains, by professional group. Finally, a multiple regression model was used to examine the relationship between 6 predictor variables and a single continuous dependent variable, mean scores on the EBPAS. Results. EFA resulted in the identification of 6 variables in the domains of role identification, willingness, and implementation facilitators. Analysis of variance demonstrated significant differences by professional group in perspectives on these variables. In the role identification domain, social workers, school psychologists, and guidance counselors endorsed adoption of a provider role, and school principals and assistance principals as a group adopted a facilitator role. Social workers and psychologists were uniquely high and emerged as leaders in endorsing willingness to engage in tasks associated with mental health services delivery. However, it was noted that no group endorsed a non-willing, or non-participant role. Implementations facilitators were identified in the areas of overall organizational structure, individual support, and shared professional responsibility. Finally, a summary of the regression showed that indicates that 29.0% of the variance in EBPAS scores was explained by the 6 predictor variables. The Willingness variable made the strongest unique contribution to predicting EBPAS outcomes. One other variable, Shared Professional Responsibility also made a significant unique contribution to the variance in the dependent variable, and none of the remaining four variables approached statistical significance. Conclusions and implications. Taken together, these outcomes form the basis for a better understanding the current environment for integration of mental health services delivery in a large urban school district, and indicators for readiness to adopt evidence-based practices. Survey outcomes provide useful information to school administrators and EBP developers on characteristics that can facilitate services integration, and call attention to training and policy needs. More broadly, outcomes potentially contribute to the development of a formalized framework for mental health services delivery in schools. Finally, areas of divergence in beliefs about services delivery, as well as congruence in the attitudes of groups of professional staff have been examined. By engaging various levels and types of school staff simultaneously on a single survey, the survey design has the added value of addressing the need for more complex research methods in the investigation of mental health services in schools.

Invariant responding among individuals with autism spectrum disorder (ASD) is problematic and can be pervasive across all areas of development. Individuals with ASD demonstrate difficulty communicating wants and needs and often engage in challenging behavior in order to get needs met. Functional communication training (FCT) is one approach for mediating challenging behavior by teaching individuals a communicative response that is functionally equivalent to the demonstrated challenging behavior. However, individuals are often taught a single communicative response (e.g., vocal approximations) that may be unintelligible to the naïve listener and challenging behavior may resurge as a result of a communication breakdown. Recently, the evaluation of lag schedules of reinforcement has shown that it is possible to reinforce operant variability during instruction. Increasing communicative variability for individuals with ASD may decrease the likelihood of resurgence of challenging behavior by providing a broader repertoire of socially appropriate communicative responses that contacted reinforcement through the use of a lag schedule of reinforcement. The purpose of the present study was to evaluate the effect a lag schedule of reinforcement on communicative variability in three individuals with ASD. In this study, communication was reinforced on either a Lag 0 (or FR1 concurrent) schedule of reinforcement, or a Lag 1 (e.g., responses contacted reinforcement only if the response differed from the previous communicative response). Functional analyses were conducted for each participant to determine variables maintaining challenging behavior, all participants were given a mand topography assessment to evaluate mand topography proficiency, and a lag schedule evaluation was conducted. Results showed that increasing the lag schedule of reinforcement from Lag 0 to Lag 1 increased communicative mand topographies for all participants. Results further showed a significant reduction in challenging behavior as compared to baseline conditions contingent on implementation of the FCT package. / text