School counsellors have been an occupation in Sweden since the 1940s but despite this, there is very little knowledge and research about school counsellors’ preconditions according to their work. This study aims to examine in what frequencies school counsellors’ use evidence-based methods in their work with students in senior high school. The result is based on a survey with N 215 respondents from all over Sweden and the analysis theoretical perspective is founded on evidence-based practice (EBP) and new institutional theory. The result indicates that school counsellors in Sweden do not use evidence-based methods to such an extent and that there are organisational and structural obstacles for school counsellors to base their work from evidence-based practice. There is a decoupling process where ideals of EBP do not match the reality as different kinds of logic appear and come into conflict with each other over whose legitimacy is the one that should dominate the organizational field. To increase the conditions, a school management that provides support and enables professional guidance and competence development is needed. The research field needs to start looking at the school counsellors’ practice from a bottom-up perspective to see what they do that works and develop EBP and the organizational field based on this. This is one way to give school counsellors’ more legitimacy.

This research was undertaken to study the impact of single and multicomponent knowledge translation interventions (KTIs) on barriers to the integration of Clinical Practice Guidelines (CPG) into Clinical Decision Making (CDM) in the context of physical therapists (PTs) and find out which of the two KTIs was more effective. A literature review showed that research knowledge (e.g. CPG) in the field of PT (Physical Therapy) is not being integrated in to clinical practice (e.g. CDM), thus leading to a research-practice (R-P) gap in other words CPG-CDM gap. It is suggested in the literature that the management and behavioural aspects of PTs might be acting as barriers hindering the integration of the research knowledge into clinical practice consequently affecting the delivery of optimum patientcare. Remedial measures, namely KTIs, are suggested to address those barriers and to bridge the R-P gap. However, the phenomenon of the R-P gap, the causes of it and the possible interventions are not well understood concepts in the literature, particularly in the context of PTs. CPG for Venous Thromboembolism (VTE) in PT was chosen as the example of research knowledge. It was argued that barriers have the potential to affect CDM which in turn can affect the CPG-CDM gap. Lack of knowledge about CPG-CDM gap is a major limitation in the literature that is affecting the integration of CPG into CDM. Other gaps found in the literature that have the potential to affect CPG-CDM gap include management and behavioural variables as probable causes of CPG-CDM gap (or barriers), use of KTIs to bridge the CPG-CDM gap and, KTIs. Furthermore, lack of knowledge about relationship between barriers and CPG-CDM gap, KTIs and barriers, KTIs and CPG-CDM gap and the impact of KTIs (effectiveness) in bridging CPG-CDM gap were the other gaps found in the literature that had potential implications to CPG-CDM gap. These gaps were addressed in this research to some extent. Relationships between the independent variables (lack of knowledge of PTs in CPG, lack of favourable attitude of PTs towards CPG and lack of self-efficacy and motivation of PTs to integrate CPG into CDM) and the dependent variables (CDM and CPG-CDM gap) were defined and models were proposed. Further, it was posited that KTIs could impact barriers based on theories and models found in the literature that provided some basis to create the linkage between KTIs and management and behavioural barriers. Education material (EM) and virtual communities of practice (VCoP) were chosen as of the KTIs in this study. The models of Cabana et al. (1999) and Fischer et al. (2016), primarily, were used to ground the conceptual models represented by figures and equations. Methodologically, a positivist approach with an objective ontological stance was employed and a deductive approach and quantitative research method were used to address the research gaps. The research design included a longitudinal element and survey questionnaire. The target population was licensed PTs in the USA. Random sampling was used. Two groups of PTs were identified namely EM-group and VCoP group. Data was collected from the groups before and after administering the KTIs. The results showed that single and multicomponent KTIs impacted barriers in different ways. EM impacted lack of favourable attitude of PTs towards CPG, and lack of self-efficacy and motivation of PTs to integrate CPG into CDM as barriers and narrow the CPG-CDM gap. VCoP was found to impact the combination of four barriers and narrow CPG-CDM gap. In addition, barriers in groups of two were also impacted by VCoP and narrowed the CPG-CDM gap. Furthermore, a CPG knowledge score card and a corresponding CDM score card developed by the researcher were used to test the change behaviour of PTs in integrating CPG into CDM. This experiment showed that barriers existed and caused CPG-CDM gap and KTIs could narrow the CPG-CDM gap. The findings indicate that this research has contributed to knowledge in many ways, including unearthing the relationship between CPG-CDM gap and barriers, better understanding of KTIs, their relationship with CPG-CDM gap and barriers, gaining knowledge about the impact of single and multicomponent KTIs on single and multiple barriers and identification of methods to bridge the CPG-CDM gap.

Background When planning evidence‐based intervention services for children with phonology‐based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs’ services align with the research evidence. Aims The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day‐to‐day clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second, to investigate SLTs’ clinical practice with children with phonology‐based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence‐based services. Methods & Procedures Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extracted from the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice. Main Contributions There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported to provide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30–60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology‐based SSD. Conclusions & Implications Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice

Evidence-based practice (EBP) is used worldwide to improve the quality of patient care to provide cost-effective care. EBP is a mandate for nursing practice combining individual clinical judgment with available expertise to generate a positive outcome for the patient. Investigators have documented that nurses have varying degrees of confidence and knowledge about EBP. The purpose of this project was to improve knowledge of EBP among registered nurses (RNs). The ACE Star Model of Knowledge transformation was used as the conceptual model. The key project question was to assess the level of knowledge and confidence about EBP among RNs in a cardio-thoracic (CT) intensive care unit (ICU) before and after viewing a computer-based EBP educational module. The quasi-experimental project used a 1 group pretest-posttest design. In the pretest, a convenience sample (n = 29) completed ACE-ERI competencies to self-assess confidence in EBP and an EBP Knowledge Test. The participants then viewed an EBP educational module based on major steps in EBP practice. Afterward, they repeated both tests. As a group, the paired t test showed a significant increase in scores for the ACE-ERI competencies between pretest and posttest scores. Using the Wilcoxon Signed Rank Test, knowledge scores increased but were not statistically significant. These findings suggested that there was improvement in both confidence and knowledge supporting the use of the educational module. In order to effectively implement EBP, nurses require knowledge to assess the quality and evidence for improved patient outcome. These results can guide administrators and educators to enhance RN EBP by the use of educational modules to improve the quality of patient care creating positive social change.

Intestinal epithelial differentiation entails the formation of highly specialized cells with specific absorptive, secretory, digestive and immune functions. Cell-cell and cell-microenvironment interactions appear to be crucial in determining the outcome of the differentiation process. Using the Caco-2 cell line that can undergo spontaneous differentiation when grown past confluency, we observed a loss of VCAM1 (vascular cell adhesion molecule-1) expression while ICAM1 (intercellular cell adhesion molecule-1) expression was seen to be stable in the course of differentiation. Protein kinase C theta (PKC&theta / ) acted downstream of PKC to inactivate Inhibitor of kappa B (IB) and activate NF-&kappa / B in the undifferentiated cells and this axis was inhibited in the differentiated cells. The increase in ICAM1 expression in the differentiated cells was due to a transcriptional upregulation by C/EBP. The protein expressions of both ICAM-1 and VCAM-1, however, were found to decrease in the course of differentiation, with both proteins getting post-translationally degraded in the lysosome. Functionally, a decrease in adhesion to HUVEC cells was observed in the differentiated Caco-2 cells. Thus, the regulation of ICAM-1 and VCAM-1, although both NF-B target genes, appear to be different in the course of epithelial differentiation. microRNAs are known to regulate many cellular pathways. miR-146a, which is known to target NF-&kappa / B, was shown to be highly upregulated in differentiated Caco-2 cells. As a predicted target of miR-146a, mRNA and protein expression of MMP16 was inversely correlated with miR-146a during differentiation of Caco-2 cells. miR-146a could bind to the 3&rsquo / UTR of MMP16 and ectopic expression of miR-146a resulted in a decreased mRNA and protein expression of MMP16 in the undifferentiated Caco-2 and HT-29 cells. Functionally, decreased gelatinase activity determined by gelatin zymography and reduced invasion and migration through Transwells was observed. In the final part of the thesis, the inhibition of NF-&kappa / B via PPAR&gamma / in 15-Lipoxygenase-1 (15LOX1) expressing cells was investigated. The expression of 15LOX1, a member of the inflammatory arachidonate cascade, could lower phosphorylation of I&kappa / B&alpha / and NF-&kappa / B DNA binding activity which was reversed with a 15LOX1 inhibitor. This inhibition was mediated by phospho-PPAR&gamma / , which in turn was phosphorylated by ERK1/2.

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In the United States, one in every 100 adults is confined to a correctional facility. Approximately 60% of inmates have an alcohol use disorder (AUD). When compared to the general population, inmates are twice as likely to have AUD. As they are unable to readily access alcohol, inmates entering a correctional facility with AUD are at high risk for the lethal alcohol withdrawal syndrome (AWS). AWS is preventable and yet correctional nurses process new inmates without an evidence-based clinical practice guideline (CPG) to assess for AUD, the prerequisite for AWS. The purpose of this project was to develop an evidence-based CPG with implementation algorithm to guide the inmate assessment for AUD. The ACE star model of knowledge transformation guided the project, the AGREE II was used to develop the CPG, and the Delphi technique was used to evaluate the final CPG with algorithm. Nationally, 20 correctional health experts were identified and asked to participate in the Delphi expert panel, although 11 experts agreed to participate only 9 completed the evaluation. The experts were correctional health experts, nurses and physicians, from different regions of the United States. The resulting CPG satisfied all 23-items of the AGREE II. Through 2 Delphi panel rounds, all participants recommended the CPG with minor modifications (6 experts recommended as presented while the 3 recommended with modifications). At the project conclusion, all 9 experts agreed the CPG will help improve the identification, referral, and management of inmates with AUD. This project contributes to positive social change as the CPG addresses a serious problem, AUD with possible AWS, in a vulnerable population. The CPG may be generalizable for use in other correctional facilities.

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