In return-to-work (RTW) programs, coordinators are often provided in order to integrate services. However, models of coordinating services vary widely internationally, and across different programs, where one distinction is between vertical and horizontal integration . The aim of this study was therefore to explore and describe if and how a coordinator was provided in RTW-programs, and whether the provision of a coordinator was associated with certain personal or intervention characteristics.n = 39). Employees (n = 494) answered a self-administered questionnaire, which was linked to register-data on diagnoses and sickness-absence. Employees who replied yes/no to the question “Did the program provide a person who tailored or coordinated your services?” were included in this analysis. Associations for being provided with a coordinator were tested in adjusted logistic regression models.The study was designed as a cohort study following employees participating in a variety of Rapid-RTW-programs in Norway . As expected, rehabilitation programs more often provided a coordinator compared to treatment programs (OR 3.87 95% CI 2.42–6.24). The odds for being provided with a coordinator were reduced for each additional year of age of the employee . More professions were involved in programs that provided coordinators, also more contact with other stakeholders like leaders and social insurance services (NAV), but only contact with supervisor remained statistically significant in adjusted analysis (OR 1.69 95% CI 0.31–9.27). The programs with a coordinator more often provided adaptations at the workplace for the individual employee (OR 0.08 95% CI 0.01–0.60). However, these signs of vertical integration were only evident for a limited number of employees.In this study, seven of ten employees reported to have a coordinator, which was associated with more professions and stakeholder involvement in the RTW-process. Most of these coordinators did not coordinate vertically between the service levels and types of intervention arenas for sick listed employees , as recommended in earlier research. Internationally there is a trend towards building more integrated health care, focusing on improving the linkages between functions, institutions and professions in the health and social services . This tySeveral intervention components are found to be essential for facilitating RTW, including centralized coordination of the employees RTW, formal individual psychological and occupational interventions, workplace-based interventions, work accommodations, contact between various stakeholders and interventions to foster concerted action , 11, 12.Internationally, integration of services is often solved by RTW-coordinators employed by insurers, employers, or governmental agencies , with RTIn Scandinavia, coordination between stakeholders in RTW-processes is lacking , 24–27. As shown above, coordination of services are reported to be inadequate, at the same time coordination and provision of a RTW-coordinator are emphasised as important intervention components in research as well as in policy documents. Accordingly, there is still a need for more comprehensive research in the field of coordination and provision of a coordinator in RTW-processes , 34. StuThe aim of this study was therefore to explore and describe if and how a coordinator was provided in RTW-programs in Norway, and whether the provision of a coordinator was associated with certain employee, program or intervention characteristics.The study was designed as a longitudinal cohort study of 494 employees participating in Rapid-RTW-programs in Norway.The present cohort-study was one of several studies in the Rapid-RTW-project, an evaluation of the national Rapid-RTW-program in Norway , called n = 50) provided a local study coordinator, who recruited participants to the study in the period February to December 2012. Some programs did not manage to recruit personnel to manage the study, and some did not manage to recruit participants, or collect data appropriate, resulting in a total of 46 programs included in this study. Both employees (patients) and their providers answered self-administered questionnaires, including questions about the provision of a coordinator. The questionnaire was developed for this project  or did not answer this question (n = 65) were excluded.Each program, clinic or institution offering a rapid-RTW-program was contacted with an invitation to participate in the study. Programs that agreed to participate (n = 494) from 46 different institutions were included in the present study. The participants’ median age was 46 years (min-max. 21–70), and the majority had a history of sickness absence i.e. been on sick leave on at least one earlier occasion (96%). The most common diagnoses were musculoskeletal problems (55%) and mental health problems (16%). Occupational rehabilitation was the most common type of Rapid-RTW-programs, and 57% of the informants received such programs. These programs included rehabilitation in hospitals and institutions, both inpatient and outpatient [See Table tpatient . Furtherp-value =/< 0.2 in the univariate analyses were entered into a multiple logistic regression model, and the results are presented as odds ratio (OR), with 95% confidence intervals (CI).Continuous variables were described using median (range), categorical variables with counts and percentages. Unadjusted associations were assessed using Mann-Whitney-Wilcoxon and Chi-square tests for continuous and categorical variables, respectively. Multiple logistic regression models were fitted to identify adjusted associations between the dependent variable (provision of a coordinator vs no provision) and the independent variables , marital status , sickness absence before receiving RTW-program (days), diagnosis , self-reported symptoms as experienced at start of program , and educational level (elementary or upper secondary school (up to 12 years)/ university degree). Variables with a P-values < 0.05 were considered statistically significant. All tests were two-sided. All analyses were performed using IBM SPSS Statistics 24.n = 335) reported that they were provided with a coordinator. As shown in Table n = 156), meaning the coordinator’s role was managed by one of the professionals involved in the RTW-program. Furthermore, the coordinators were mostly responsible for coordinating their own programs , and to a lesser extent other services or stakeholders . In the adjusted analysis, the odds for being provided with a coordinator were reduced for each additional year of age of the employee .There were no statistical significant differences between those who were provided with a coordinator, compared to those who were not, concerning gender, social status, educational level, or history of sickness absence except for age. See Table Almost half 43%) of the employees reported upper secondary school (12 years of schooling) as their highest educational level. There was no statistical difference between those provided with and those not provided with a coordinator (neither unadjusted nor adjusted results) when comparing low and high educational levels. See Table % of the Diagnosis was statistically significant associated with the provision of a coordinator, compared to not being provided with a coordinator. The highest proportion of employees who were referred to a RTW-program were those diagnosed with Musculoskeletal disorders (MSD) (55%). Employees with MSD were 1.8 times more likely to be provided with a coordinator compared to employees with other diagnoses in the unadjusted analysis . However, this association did not remain statistically significant in the adjusted analysis. Regarding symptoms, both depressive mood and anxiety were not associated with higher odds for being provided with a coordinator, compared to not being provided with a coordinator. Employees who reported having pain were twice as likely to be provided with a coordinator compared to those who did not report pain, OR 2.26 (95% CI 1.36–3.75) and 2.01 (95% CI 1.12–3.60) for those with pain at rest and pain in activity, respectively. However, neither pain at rest nor pain in activity remained statistically significant in the adjusted analyses.Nearly all participants (96%) had a history of sickness absence during the last three years prior to participation in the program. There was statistically significant differences between those provided with and those not provided with a coordinator related to days of sickness absence before the RTW-program started, and related to being on sick leave at baseline (RTW-program start). Those provided with a coordinator had been on sick leave for more days (median 159 days) before the RTW-program compared to those not provided with a coordinator (median 119 days), and this association remained statistically significant in the adjusted analysis. The odds for having a coordinator for employees on sick leave (100%) compared to those not on sick leave or on graded sick leave did not remain statistically significant in adjusted analysis (OR 1.06 95% CI 0.63–1.79).There was a statistically significant difference between those provided with a coordinator versus those who were not regarding the type of RTW-program provided. See Table The RTW-programs provided the coordinator in most cases. However, a few participants were provided with a coordinator from other programs, where NAV was the second largest provider of coordinators (7%).In the programs that provided coordinators, more contact with other stakeholders  was reported, compared to the programs that did not provide a coordinator. However, only having “contact with supervisor” was statistically significant for those provided with a coordinator compared to those not provided with a coordinator, but this association did not remain statistically significant in the adjusted analysis (OR 1.69 95% CI 0.31–9.27). See Table Furthermore, the employees with a coordinator received more adaptations at the workplace. Programs providing a coordinator were more likely to make adaptations in their intervention: It was about 90% less likely that the answer to the question “Did this program provide one of the following types of adaptations?” were “No adaptations were performed” for employees provided with a coordinator, compared to those not provided with a coordinator (OR 0.08 95% CI 0.01–0.60). This association remained statistically significant in the adjusted analysis.In general, employees provided with a coordinator met more professions in the RTW-programs. The association between those provided with, compared to those not provided with a coordinator was statistically significant related to medical doctor, vocational consultant, occupational therapist, nutritionist, physical therapist and pedagogue. Meeting a psychologist was more common in the group without a coordinator compared to those with a coordinator, however, this association was not statistically significant. In this study, the odds for being provided with a coordinator when having a physical therapist in the program were more than four and a half times higher compared to not having a physical therapist in the program . This association remained statistically significant in the adjusted analysis.The aim of this study was to explore and describe if and how a coordinator was provided in RTW-programs in Norway, and whether the provision of a coordinator was associated with certain personal or intervention characteristics. Our main findings were; (1) about two-thirds of the employees were provided with a coordinator by the RTW-program, most often coordinating their own programs, (2) younger age and length of sickness absence were predictors for being provided with a coordinator, (3) occupational rehabilitation programs provided a coordinator more often than the other types of RTW-programs, (4) more professions were involved, and there was more contact with other stakeholders and instances outside their program when the employee had a coordinator, and (5) adaptations to the workplace were more common for those provided with a coordinator. These findings will be discussed below.Two out of three employees who received services from the Rapid-RTW-programs were provided with a coordinator offered by the program. The coordinators were mainly responsible for coordinating their own program. Such linking of programs at the same level is referred to as horizontal integration . Thus, tBeing young was a predictor for being provided with a coordinator. One reason for this association might be that younger employees with sickness absence at risk for disability pension have more complex health problems or diagnosis, such as severe mental health problems , indicatEmployees with MSD constituted the majority of this study’s participants, and provision of a coordinator was most frequent for employees with MSD in the unadjusted analysis. The effect of provision of a coordinator is also best documented for this group of sick-listed employees , 34, altEmployees provided with a coordinator often received occupational rehabilitation programs and had been on sick leave for a longer period before the RTW-intervention. It seems reasonable that those with long-lasting problems are offered more comprehensive interventions with more professionals involved. However, provision of such comprehensive interventions versus brief interventions is debated . It seemAlthough the coordinator model revealed in Rapid-RTW-programs builds mainly on horizontal integration, some signs of vertical integration in the coordinator practices were found. Some of the intervention components offered in the RTW-programs with a coordinator were associated with factors reflecting vertical integration. More professionals were involved in RTW-programs that provided a coordinator. Multiprofessional involvement is a characteristic of the occupational rehabilitation program , and is The odds of being offered adaptations was improved for those provided with a coordinator in the present study. Employees who had a coordinator were generally offered more adaptations, including adaptations in the work environment, work time and work tasks. Accommodations at and contact with the workplace has earlier been revealed as success factors for RTW , 12, 18.n = 185) were excluded based on missing or unreliable information on the provision of a coordinator, and this could be a weakness. It might be that a large proportion of those excluded did not have a coordinator, however it might also be that the provision of a coordinator was not well communicated when the coordination was internally oriented. The main focus in the current study has been on the provision of a coordinator, and additional information on coordination provided without involvement of a coordinator could have made the total picture of the coordination practices richer. However, the question of contact with other stakeholders etc. was not limited to the coordinator, but involved the whole programs’ practice. Although the analyses show that it might be that severity or complexity (i.e. pain and length of sickness absence) explains some of coordinator distribution on the individual level, the relationship does not remain statistically significant in the adjusted analysis. Studies with more information on complexity or severity of injury, as well as on the individual programs’ criteria for provision of a coordinator should be performed. In addition, the coordinator’s competencies and activities, i.e. contact with the workplace should be further explored in future research. Furthermore, the sample in this study was exclusively from Rapid-RTW-programs, and it might be that other RTW-programs differ in their RTW- and coordination of RTW-models. On the other hand, the Rapid-RTW-program is the largest effort to promote RTW in Norway and therefore the sample is generally representative of RTW-programs provided to sick listed employees in this country.For some of the variables the proportion of missing data was high, and this of course lowers the quality of the results for these variables. Consequently, some variables were not included in statistical testing due to low n, for instance the different types of adaptations, provision of a coordinator from other instances, and some of the categories of contact with other instances. Hence, this needs to be further explored and tested in future studies. Even though the difference between having a physical therapist versus not in the program remained statistical significant in adjusted analysis, the confidence intervals were wide, and therefore these results should be replicated to validate their significance. Additional knowledge of the coordinator like their education, profession etc. and how they were distributed would provide valuable insight to the study, as the background of the coordinator has previously been reported to be associated with intensity of engagement and activities the coordinator is involved in . In thisOur results revealed that it is common to provide a coordinator in the Rapid RTW-programs in Norway. However, the coordinators for the most part coordinate their own programs, and to a limited degree integrate services vertically across stakeholders, levels and providers. Employees in occupational rehabilitation programs are, in this study, those most likely to be provided with a coordinator. Provision of a coordinator is associated with more involvement of different professions in the program, more contact with other services and more adaptations in regard to the program and the workplace. However, only few experience vertical integration of services in Rapid-RTW-programs. The model of RTW-coordination and provision of a coordinator should be further developed. To distinguish between internal and single level horizontal integration and vertical across levels and stakeholders integration could be one way to test different models’ effects on RTW when providing a coordinator in RTW-programs in the future.Additional file 1: Questionnaire for patient and providers in Rapid-RTW-programs. The questions used in analysis to explore and describe if and how a coordinator was provided in RTW-programs in Norway, and whether the provision of a coordinator was associated with certain employee, program or intervention characteristics included in the file.


The Kentucky (KY) Rural & Underserved Geriatric Interprofessional Education Program (KRUGIEP) participated in a unique innovative approach to the implementation of the Medicare Annual Wellness visit in collaboration with the Dartmouth GWEP. The model focused on the integration of students into the process of conducting the Health Risk Assessment through community based home visits. This talk will focus on this unique program and the participation in a multi-GWEP learning collaborative.


In 2004, the Alfred P. Sloan Foundation launched a new program focused on incubating a new field, “Microbiology of the Built Environment” (MoBE). By the end of 2017, the program had supported the publication of hundreds of scholarly works, but it was unclear to what extent it had stimulated the development of a new research community. We identified 307 works funded by the MoBE program, as well as a comparison set of 698 authors who published in the same journals during the same period of time but were not part of the Sloan Foundation-funded collaboration. Our analysis of collaboration networks for both groups of authors suggests that the Sloan Foundation’s program resulted in a more consolidated community of researchers, specifically in terms of number of components, diameter, density, and transitivity of the coauthor networks. In addition to highlighting the success of this particular program, our method could be applied to other fields to examine the impact of funding programs and other large-scale initiatives on the formation of research communities. In 2004, the Alfred P. Sloan Foundation launched a program focusing on the “Microbiology of the Built Environment”, sometimes known as “MoBE”. The aims of this program were to catalyze research on microbes and microbial communities in human built environments, such as homes, vehicles, and water systems; and to develop the topic into a whole field of inquiry. Prior to 2004, many new developments  had catalyzed innovation in studies of microbes found in other environments , but these innovations had not spread rapidly enough to studies of the microbes in the built environment. Similarly, many developments had occurred in studies of the built environment , but focus had not yet been placed on the living, microbial components of built environments. This is not to say there had been no studies on the MoBE topic prior to 2004, but rather that the pace of advances in the area were modest at best compared to advances in other areas of microbiology and built environment studies. The MoBE area was founded on the belief that institutionally supported, integrated, trans-disciplanary scientific inquiry could address these shortfalls and lead to major benefits in areas such as indoor health, disease transmission, biodefense, forensics, and energy efficiency.https://sloan.org/grants-database?setsubprogram=2). The products of these grants included a diverse collection of programs and projects, dozens of new collaborations, many novel and sometimes large data sets on various MoBE topics, new software and tools for MoBE studies, and hundreds of scholarly publications.The Sloan Foundation’s program ultimately lasted 15 years and invested more than $50 million on work in the MoBE field. A key goal of this program was to bring together the highly disparate fields of microbiology  and building science  with their different approaches, cultures, incentives, and rewards. Grants were given to many projects and a diverse collection of people covering many fields including microbiology, architecture, building science, software development, and meeting organization  hav) hav2]) Programs explicitly dedicated to funding interdisciplinary research may have an important role to play in the development of new research communities.  finds th proposesAs  acknowleHowever, the fact that a network of researchers are working with each other (or not) does provide insight into the structural possibilities for the circulation of ideas and information among researchers. Information flow within and across the boundaries of scientific communities has long been a major topic in science and technology studies (STS) and philosophy of science ; 9]; ; . Increas moves fr examinesAll of these studies use dynamic analysis of coauthor networks to examine development and change in research communities over time. However, none of these studies is designed to examine the effect of a particular funding program on the research community, and only  situatesIn contrast,  uses coa and 17]17] use dOf these four program assessment studies, only  incorporIn the present study, we use the theoretically-informed approach developed in  and 7]  7] to exCompared to the literature reviewed above, our study is distinctive for using network analysis methods and a comparison group of researchers to analyze the community-level impacts of a particular research funding program. To be clear, we make no claims here about the impacts of research funding programs more generally, but we do think that the MoBE program is an interesting case of an explicit attempt to create an interdisciplinary, multi-institution research community. Insofar as we find that the MoBE program was successful in this attempt, future research might identify specific features of the program that contributed to this success and could be generalized to other such programs.Publications funded by the Sloan Foundation’s MoBE program provided the starting point for our data collection and analysis. We evaluate the effect of this program by analyzing these publications in the context of previous work by the same authors, as well as a “control” or comparison set of authors working in the same general areas. We identify the comparison set as authors publishing frequently in the same journals as MoBE-funded publications.https://sloan.org/grants-database?setsubprogram=2. The MoBE program awarded USD 51,000,000 in grants ranging from USD 3,500 to USD 2,500,000 . A list of awards made within the Sloan-funded MoBE program is available at ~50)) was contacted directly and asked whether the publication list we had for them was both accurate and complete. This feedback led to some publications being removed from the list (as having not derived from the Sloan Foundation’s program) and others being added. In addition, we posted requests for feedback in various social media settings  asking for feedback on the list . The final list contained 327 publications. 20 of these publications did not have digital object identifiers (DOIs) on record and were excluded from further analysis.A list of publications associated with the MoBE program was compiled through a combination of strategies. An initial set of papers was identified by manually searching for acknowledgement of Sloan Foundation funding in any publications authored by the grantees during the program period. Additional publications were identified by searching Google Scholar for relevant MoBE papers and identifying those authored by grantees during the program period. Finally, each grantee  and research communities . In what follows, researchers funded by the Sloan Foundation’s program are referred to as the “collaboration” authors; their peers are the “comparison” authors.Several methods were considered for developing this comparison set. Keyword searches were judged to be too noisy, producing significant numbers of false positive and false negative matches, as well as highly sensitive to the particular keywords used. Forward-and-backward citation searches using the 307 MoBE articles (compare ) producercrossref package  subject areas identified by Scopus, (b) all words used in paper abstracts, and (c) the 1000 most-informative words used in paper abstracts . In each case, principal component analysis indicated that there were no useful associations that could be used to classify all authors within this disciplinary space . In light of these unpromising exploratory results and limited resources, efforts to interdisciplinary collaboration were not pursued further.The analysis dataset of 85,306 papers was used as the basis for constructing time-indexed collaboration networks. Each author forms a node (distinguished by author ID); edges correspond to papers published in a given year, so that two authors are connected by an edge for a given year if they coauthored at least one paper published in that year. All collaboration authors had at least one edge; 72 comparison authors did not have at least one edge , and were dropped from the network analysis (remaining comparison n = 698). Authors who collaborated on multiple papers in a given year were connected with multiple edges, except when calculating density (see below).After constructing the combined (collaboration + comparison) network, separate cumulative-annual networks were constructed for each set of authors. For example, two authors would be connected in the 2011 network if and only if (1) they were in the same author set and (2) they had coauthored at least one publication between 1999 and 2011 inclusive. Cumulative networks were used to reduce noise in the most recent years, due to incomplete data for 2018 and as the Sloan Foundation’s funding program was starting to wind down. Analyzing separate cumulative networks allows the examination of the development of research communities through time and between the author sets.H) of the component size distribution, diameter, density , mean distance, and transitivity in each year.For network analysis, we extended the approach developed by  and 7]..7]. SpecNumber of authors simply measures the total size of each network. Because these are cumulative networks, the number of authors necessarily increases. The number of components, coverage of the giant component, and entropy of the component distribution are measures of the large-scale structure of the network. More components indicate that the network is divided into subcommunities that do not interact (at least in terms of coauthoring papers); fewer components indicates consolidation of the research community. Giant component coverage and entropy measure the relative sizes of these different components; higher giant component coverage and lower entropy indicate that more authors can be found in a single component, which in turn indicates research community consolidation.Diameter, density, and mean distance can be interpreted as measures of the ability of information to flow through the network. Lower diameter, higher density, and lower mean distance indicate that it is easier for information to move between any two given researchers, as there are fewer intermediary coauthors and a higher probability of a direct connection. These therefore indicate research community consolidation.Transitivity is an aggregate measure of the local-scale structure of the network. Low transitivity indicates that the network is comprised of loosely connected clusters; there is collaboration across groups of researchers, but it is relatively rare. High transitivity, by contrast, indicates that the network cannot be divided into distinguishable clusters. High transitivity therefore indicates research community consolidation.Two robustness checks were incorporated into our analysis. First, to account for the possibility of data errors or missingness, perturbed networks were generated for each year by randomly switching the endpoints of 5% of edges. Second, the construction of the comparison set is likely to exclude students, postdoctoral researchers, and other early-career researchers. Insofar as these types of authors are included in the collaboration set, the collaboration network may appear to be more well-connected than the comparison set. To account for this possibility, we construct and analyze filtered versions of the annual cumulative networks. Authors are included in the filtered versions only if they have 50 or more papers total in the analysis analysis dataset.Acknowledgment sections and other sources of funding information are not included in the metadata retrieved for this analysis. We are therefore unable to identify funding sources except for MoBE-funded papers, for which we have our own metadata. The comparison method is thus designed to test only whether or not the removal of MoBE-funded research produces a response effect in the shape of the overall discursive space. It does not consider independent relationships between MoBE and other sources nor relationships between non-MoBE sources. An underlying assumption of the analysis is, therefore, that the rates of impact from other sources of research funding are constant and that there is no underlying relationship between MoBE funding and other funding sources such that the removal of MoBE funding results in uneven removal of another source(s) of funding. Examining these relationships is potential direction for future study.https://doi.org/10.5281/zenodo.2548839.All data collection and analysis was carried out in R . CompletThe development of the combined network is shown in Prior to the beginning of the MoBE funding in 2004, subset of MoBE researchers are actively working with each other; but many MoBE researchers are isolated in this network, and the largest component is only loosely connected. Qualitatively, the combined network has a sparse “lace” structure, with many long loops, as well as an “archipelago” of numerous small disconnected components.During the early years of the funding period (2005-2008 and 2009-2013), a tighter cluster of MoBE researchers appears on the margins of the overall research community; but many MoBE researchers can be found scattered among the comparison authors and in disconnected components. The combined network has a “hairy ball” appearance, with a dense central “ball” and many peripheral “hairs,” and again an extensive “archipelago.” Part of the MoBE collaboration appears as a somewhat coherent “sub-ball.” We infer that this indicates that this part of the MoBE collaboration is highly integrated within the larger community.During the peak period of MoBE funding (2015-2018), the vast majority of MoBE researchers appear to form one or two large, coherent communities at the center of the giant component—well-defined “blobs” of blue within a larger blob of red. Very few MoBE researchers appear outside of this coherent community. We suggest that this indicates tight integration involving almost all members of the MoBE collaboration.However, because qualitative features of a visualized network are heavily dependent on the visualization method, this qualitative analysis should not be overinterpreted. Below we provide a quantitative analysis, less susceptible to overinterpretation.Current Biology or Nature Biotechnology as well as a few neuroscientists.Note that a few comparison set authors remain in small disconnected components even in the final time slice. These likely reflect “false positives” in the construction of the comparison set: authors who appear relatively frequently in the same journals as the MoBE publications, but do not actually conduct research in relevant research areas. We manually identified some such false positives, including authors of news stories in journals such as H approaches 0, indicating that both networks contain a single giant component; the comparison set simply has several disconnected components with isolated researchers. As observed in the qualitative analysis, we believe this is plausibly due to “false negatives” in constructing the comparison set. The remaining statistics are generally robust to the inclusion of such “false negatives”.The most notable differences between the two author sets appear with the number of components, diameter, density, and transitivity. The comparison set stabilizes at 15-20 distinct components, while the MoBE collaboration approaches fewer than 5 components. However, for both author sets giant component coverage approaches 1 and Prior to 2010, the MoBE and comparison sets have a similar diameter: increasing during 1999-2005 as new researchers are added; then roughly stable until about 2010. Diameter remains above 10 for the comparison set, with a notable increase in 2008 followed by a decrease after 2013. By contrast, starting around 2010, the MoBE collaboration diameter is consistently less and decreasing.However, diameter might be criticized as sensitive to network size. The relatively low diameter of the MoBE collaboration might be explained by the fact that this network has about half as many researchers as the comparison set.Density and transitivity are automatically normalized against network size, and so avoid this potential confounder. For the collaboration set, transitivity peaks near 90% in 2012, indicating that at this time the connected components of the MoBE collaboration have almost no internal structure: everyone involved in the collaboration in 2012 is working directly with almost everyone else. Density plateaus at about 10% at this same time, and remains roughly stable over the remaining years of the study period. Transitivity and density then drop somewhat, but still remain remarkably high, indicating a highly interconnected research community even as the number of authors approaches its peak of just over 400. Transitivity is greater than 60% for both author sets in 2008-2009, but then diverges, dropping to around 50% in the comparison set by 2018. Density is consistently below about 2.5% for the comparison set throughout the entire study period.Because of the delay between research and journal article publication, these network statistics provide a lagging indicator of community formation, of roughly 2-3 years. Taking this lag into account, our network analysis indicates that the MoBE research community consolidated around the period 2008-2010.Shaded regions in The dashed lines in Overall, we believe our results support the hypothesis that the Sloan Foundation-funded researchers consolidated as a community over the course of the program during 2008-2010. Whereas at the start of the program there were relatively few connections between researchers, especially across domains, by the end of our study period the network was dense and highly interconnected. In particular, while the Sloan Foundation-funded community was initially less connected than the control community it reached a similar level of consolidation by the end of the study period. This suggests to us that the program was successful in the stated goal of increasing collaboration between researchers.We note that the most dramatic differences between the MoBE collaboration and the comparison set could not have been detected using the two statistics calculated by , namely,


OBJECTIVES/SPECIFIC AIMS: The goal of this abstract/presentation is to share lessons learned from participation in the NIH SBIR I-Corps Train-The-Trainer Program, discuss our experiences offering programs at our local institutions, and communicate our plans to develop an I-Corps@NCATS program that can be disseminated across the CTSA network. We believe that an I-Corps@NCATS program will enhance the process of scientific translation by taking best practices from NSF I-Corps and adapting the program to meet the needs of biomedical scientists in academic medical centers. By integrating I-Corps@NCATS training, we hypothesize that the clinical and translational investigator base will be better prepared to identify new innovations and to accelerate translation through commercialization. METHODS/STUDY POPULATION: The diverse, interdisciplinary team of investigators involved in this project span 9 CTSA Hubs, including UAB, Rockefeller, UC Denver, HMC-Penn State, UMass, UC Davis, Emory/Georgia Tech, Miami and Michigan. This team was funded by NCATS in 2015–2016 to participate in the CTSA I-Corps Train-The-Trainer Program in conjunction with the NIH-SBIR/STTR I-Corps national program. The goals were to observe the curriculum, interact with and learn from the NSF National Teaching Team and begin implementation of similar programs at our home institutions. Our I-Corps@NCATS team has been holding monthly, and more recently weekly, conference calls to discuss our experiences implementing local programs and to develop a strategy for expanding CTSA offerings that include innovation and entrepreneurship. Our experience revealed several challenges with the existing NSF/NIH I-Corps program offerings: (1) there is no standard curriculum tailored to academic clinical and translational research and biomedical innovations in the life sciences, and (2) the training process to certify instructors in the I-Corps methodology is a much more rigorous and structured process than just observing an I-Corps program . Our team is proposing to address these gaps by taking best practices from NSF I-Corps and adapting the program to create the I-Corps@NCATS Program, tailored to meet the needs of researchers and clinicians in academic medical centers. RESULTS/ANTICIPATED RESULTS: There are 3 primary anticipated results of our project. First, develop a uniform curriculum for the I-Corps@NCATS Program using the National Teaching Team of experts from the NIH’s SBIR I-Corps program. Second, build the I-Corps@NCATS network capacity through a regional Train-The-Trainer Program. Third, develop a set of common metrics to evaluate the effectiveness and impact of the I-Corps@NCATS Program across the community of CTSA Hubs and their respective collaborative networks. DISCUSSION/SIGNIFICANCE OF IMPACT: Over the past 10 years, CTSA Hubs have accelerated science by creating/supporting programs that provide research infrastructure, informatics, pilot funding, education/training, and research navigator services to investigators. These investments help to ensure that we are “doing science right” using the best practices in clinical research. Even so, it is equally important to make investments to ensure that we are “doing the right science.” Are our investigators tackling research problems that our stakeholders, patients, and communities want and need, to make sure that our investments in science have real-world impact? In order to accelerate discoveries toward better health, scientists need to have a better way to understand the needs, wants and desires of the people for whom their research will serve, and how to overcome key obstacles along the path of innovation and commercialization. To fill this gap, we propose that the CTSA Hubs should include in their portfolio of activities a hands-on, lean startup program tailored after the highly successful NSF Innovation Corps (I-Corps) program. We hypothesize that by adapting the NSF I-Corps program to create an I-Corps@NCATS program tailored to medical research, we will better prepare our scientists and engineers to extend their focus beyond the laboratory and broaden the impact of their research. Investigators trained through I-Corps@NCATS are expected to be able to produce more innovative ideas, take a more informed perspective about how to evaluate the clinical and commercial impact of an idea, and quickly prototype and test new solutions in clinical settings.


The Retired Senior Volunteer Program (RSVP) is a national program with many regional offices that offers a variety of volunteer opportunities for seniors. Research demonstrates the importance of volunteering and social participation on the well-being, health and longevity of older individuals. Further, studies of RSVP volunteers have demonstrated marked improvement in their perceived physical, mental health and quality of life . Little evidence exists, however, supporting the effectiveness of using senior volunteers to assist with or even lead activities programming for persons with dementia (PWDs). Seniors Making Connections through Music, a group program designed to engage persons in the moderate to advance stages of dementia, included the training of 21 RSVP volunteers to lead or assist with the program. Volunteers were mostly female (95%) and educated (80% college/advanced degree), with more than half reporting professional or personal experiences with dementia (62%). Data were gathered through structured interviews and post-session debrief meetings. Findings suggest volunteers felt they were able to use existing knowledge and experience, received good and helpful supervision, and reported increased knowledge of dementia after volunteering for the group. Other results summarize: Volunteer satisfaction with program, role, tools and materials used, the program’s impact on the community, and willingness to volunteer for the program in the future. Programmatic features, training protocols, and the impact of using retired senior volunteers to strengthen program sustainability will be discussed. Volunteer testimonials and video demonstrations will also be shared.


Each Program of Merit Application goes through a process of review. It is the same regardless if the application is for a gerontology program or a health professions program. In this session, the reviewer perspective will be shared and tips for how to complete an application to provide information in a format that aids the review will be shared.


Early childhood intervention services support children with disabilities or developmental delays from birth to school entry with the aim to achieve optimal outcomes for children and their families. A transdisciplinary approach to delivering early childhood intervention, particularly the key worker model, is considered the best practice, where allied health professionals  and the family worktogether as a collaborative team to share information, knowledge, and skills across disciplinary boundaries, with a key worker coordinating and delivering most of the intervention to achieve the goals for the child and their family. Initial qualitative research demonstrated parents want their key worker to also support their mental well-being. Poor mental well-being of parents of a child with a disability is of relevance to key workers because of its association with poor child-related outcomes. One of the major challenges key workers report in supporting families is managing parent distress and, because of lack of confidence, is a secondary negative impact on their own well-being.This trial has been developed in response to the negative cycle of low professional confidence to support parents’ mental health, increased key worker stress, and high turnover of employees working within a disability service setting.A stepped-wedge design is used to deliver and evaluate a capacity building intervention program, over a 9-month period, for key workers to improve both parent and staff mental well-being. The primary outcome is key workers’ self-efficacy in supporting parental mental well-being. Secondary outcomes include manager self-efficacy in supporting key workers and staff perceptions of supervisory support, staff job-related mental well-being, parental satisfaction with their key worker, parental mental well-being, and cost-consequence of the program.This study was funded in October 2014, supported by an Australian National Health and Medical Research Council Partnership Project grant (Grant number 1076861). Focus groups and individual face-to-face interviews were conducted from February to November 2015 with 40 parents who have a child with a disability and 13 key workers to gain insight into how the disability service could better promote child and family health and well-being and to inform about the development of the trial.The stepped-wedge study design is practical and ethical for research with a vulnerable population group of parents of a child with a disability, providing high quality data with all participants exposed to the intervention by the end of the trial.Australian New Zealand Clinical Trials Registry ACTRN12617001530314; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372578 (Archived by WebCite at http://www.webcitation.org/76XjDavnG)DERR1-10.2196/12531 In 2015, 4.3 million Australians were reported as having a disability, including 327,400 children (7.6%) aged 0 to 14 years [A transdisciplinary approach to delivering early childhood intervention, particularly the key worker model, is considered the best practice, where allied health professionals  and the family work together as a collaborative team to share information, knowledge, and skills across disciplinary boundaries, with a key worker coordinating and delivering most of the intervention to achieve the goals for the child and their family -5.Family-centered practice (FCP) is important to the delivery of care in ECISs. This is a broadly defined philosophy which places families in central and pivotal roles in decisions and actions involving the child, parent, and family priorities and preferences . ImpliciResearch on the mental well-being of parents of children with a disability is of particular relevance to FCP within ECISs. Mental well-being is defined as “a dynamic state that refers to individuals’ ability to develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community” . SeveralPursuit of Wellbeing program involves staff within their ECIS, which provides services to children aged up to 6 years, who vary in their severity of disability or developmental delay, family circumstances, and cultural background. The service has 6 different ECIS sites across metropolitan Melbourne which for the purpose of this study are known as hubs. They are geographically spread, approximately 25 kilometers apart, to service the suburban population. Each family has a key worker assigned to them from a transdisciplinary team of allied health professionals. Across the 6 hubs, there are approximately 60 key workers supporting 600 families. The disability service provider will implement the program across the 6 hubs using a phased process over a 9-month period, and all key workers and managers will receive the program as part of the trial, which is supported by the executive management team at the service.This research study was codeveloped by a cross-sectoral team of academics and clinicians in partnership with a major Victorian nongovernment disability service provider in Victoria, Australia, and included an initial qualitative scoping study to identify what children with a disability and their families required to optimize their health and well-being and how staff can facilitate this through the service. The disability service provider offers a wide range of support services to people of all ages who either are born with or acquire a disability. The In the first phase of development of this trial, a combination of focus groups and individual face-to-face interviews were conducted with 40 parents who have a child with a disability and 13 key workers to gain insight into how the disability service could better promote child and family health and well-being. Parents reported they were satisfied with the professional advice and support that their child received; however, they felt that they did not receive adequate support for their own mental well-being . ConcurrThe Pursuit of Wellbeing, was then codeveloped based on the findings identified in phase 1 of the research and the current literature, with the aim to build the self-efficacy of key workers to better support the mental health and well-being of parents ; Clarification of key worker role boundaries; How to debrief with staff; How to promote staff self-care. It is anticipated that managers will be a key resource for staff seeking expertise in addressing parental mental well-being. Managers will also discuss the support required for a senior staff member in their team acting as parental well-being champion (further details below). This role will likely be assumed by a key worker appointed also as a team leader position.ResourcesFor key workers and managersThe following are provided as hard copies and Web-based via the staff intranet after completion of the study: Organisational Practice Framework incorporating the key messages of the training; Toolkit of positive psychology activities and resources; Tailored referral pathway of local support services; Well-being for parents and carers resource .A formalized debriefing process for staff includes: Building the capacity of managers to improve their approach to debriefing during monthly supervision meetings; Developing of a flow chart for staff to know their immediate options to access debriefing and counseling.The appointment of a senior staff member in each team to act as a parental well-being champion. Additional training will be provided to support the champion in their conversations with key workers on supporting parental mental well-being.For parentsThe following are provided as hard copies: Tailored referral pathway of local support services; Well-being for parents and carers resource .The objective of this study is to trial a capacity building program that aims to increase the self-efficacy of key workers to support parental mental wellbeing. The research questions are outlined in The predicted outcomes and impacts of the intervention are presented in a logic model .pre versus post control and, in the first 2 periods, there are at least 2 hubs acting as controls and at least 2 hubs receiving the program . Randomization will be conducted by a statistician who is independent of the administration of the intervention . The fir program . The staDoes the capacity building program increase:Key workers’ self-efficacy in supporting parental mental well-being (primary outcome);Managers’ self-efficacy in supporting staff and parental well-being;Parental mental well-being;Key workers’ and managers’ job-related wellbeing and mental wellbeing;Parental satisfaction with the service provided by their key worker; and/orKey workers’ and managers’ perceptions of supervisory support?Are the program and evaluation methodologies appropriate and feasible for key workers, managers, and parents?Is the program good value-for-money?Is it affordable?value-for-money. Simple dominance would establish this—that is, compared with current practice, is it cheaper with improved effectiveness or cost neutral with improved effectiveness. Similarly, on the flip side, if the program is dominated, then it is not value-for-money—that is, more expensive and less effective or more expensive with no improvement in effectiveness. If the program is both more expensive and more effective, then more complex tests of efficiency are required that establish value-for-money by reference to established guidelines using a metric that enables comparison across alternate uses for limited budgets . Value-for-money considerations, together with affordability considerations, will inform the program’s potential to be scaled-up and adopted by other disability organizations.The cost of the capacity building program will be estimated to help determine whether this program is All key workers and managers at each hub have the opportunity to participate in the intervention and this will be strongly encouraged by the management. All key workers and managers at each hub, and families that they support, are eligible and will be invited to participate in the evaluation. To recruit staff, the researchers will attend a staff meeting to talk about the study and commitments involved. Staff will be given a plain language statement and consent form. The manager of each hub will be blinded to which key workers are taking part in the evaluation of the trial to allow key workers to feel comfortable in providing feedback on their current management and any adverse experiences they may have had. Reminder emails will be sent to managers to distribute to all staff to enhance recruitment until the intervention begins. To recruit parents, all key workers, regardless of their involvement in the evaluation, will be requested to give the plain language statement and consent form to parents in their regular fortnightly visits. Many parents do not act immediately on this type of survey because of their day-to-day pressures. To enhance recruitment and reach all parents, key workers will remind each parent in subsequent visits, email reminders will be distributed by an administrator at each site, and the information sheets will be left at the entrance of each service. If a parent requires an interpreter, this can be arranged both to explain the study and, if they consent, to assist them to complete the questionnaires. Parents will be informed and reassured that the service their child receives will not in any way be impacted by their participation in this evaluation. All participants will return their signed consent form directly to the researchers.A mixed-methods approach will be employed to gain an understanding of the process and outcome of delivering this program. Researchers will send the consenting participants a link to the online survey at baseline and each 3-monthly time point. Online surveys will be used to collect quantitative data from all consenting key workers and managers to assess their confidence in supporting parental mental well-being, their perceptions of supervisory support, their work-related well-being, and their own mental well-being. Online surveys will also be sent to all consenting parents to assess their mental well-being, their satisfaction with their key worker, and health care resource use. Paper-based surveys were offered as an alternative for parents. Survey data will be collected at baseline and every 3 months for 9 months to reassess these variables pre- and postdelivery of the program. The survey data collected across the intervals will provide information on the program’s impacts and the practical contribution of the program to the service. Survey data will be collected and managed using Research Electronic Data Capture (REDCap) tools hosted at the University of Melbourne . RemindeQualitative data will be collected by conducting focus groups at the 9-month time point. A total of 1 focus group at each hub (N=6) will be conducted with key workers to explore their experience with the program, discussing their perceptions about the usefulness of the program and any challenges they faced implementing their learnings and strategies with parents post training. In addition, 1 focus group at each hub (N=6) will also be conducted with parents to explore the impact of the program on their interaction with their key worker and their mental well-being. Semistructured interviews will be conducted with parents if focus groups are unable to be organized. Moreover, 1 focus group will be conducted with hub managers from the different sites to explore their view on the impact of the program on their staff, clients, and on their management role.We have developed a set of items to measure how confident key workers are in supporting parental mental well-being. A total of 10 items measured on a visual analogue scale VAS;  assess pWe also developed a set of items, using the scale recommended by Bandura, to measure the perceived confidence of managers in supporting key workers’ well-being in the workplace and to support their staff to adequately support parental mental well-being . A totalParental mental well-being will be measured using the shortened Warwick-Edinburgh Mental Wellbeing Scale WEMWBS; . The WEMJob related well-being will be measured using 2 scales as reported by Warr ,50 Mult.The first instrument measures job-related affective well-being using the Institute of Work Psychology Multi-Affect Indicator and includes 12 items. The staff are questioned using a 6-point Likert scale of agreement about how their job has made them feel across the multiple domains. Domain scores are provided on job related anxiety-contentment and depression-enthusiasm; this 2-dimensional model of job-related affects provides a more comprehensive view of emotional states at work than current measures of job satisfaction . This scFor the second scale assessing job-related mental well-being, 9 items were selected from 2 out of 5 domains within the scale. These items were selected based on relevance to the intervention to assess self-reported job competence and negative job carry-over for staff. Excluded domains were deemed not appropriate for this evaluation. The scores between the 2 measures will be correlated, higher scores indicating greater contentment and enthusiasm as well as greater competence and negative carry-over.New items were developed for this study to assess parental satisfaction with the service provided by the key workers, based on previous assessments utilized by Yooralla . A totalSupervisory support will be measured using some of the high-loading items of the Perceived Supervisor Support scale ,53. The Process data will be collected from staff at each 3-month time point via the online survey to assess attendance, usefulness, and uptake of the intervention components, such as support-seeking behavior and use of the toolkit resources provided. Researchers will also collect data on the fidelity of the training via observation and meetings with the trainer. In addition, the focus groups being conducted at 9 months postintervention with key workers, managers, and parents will provide an opportunity to explore barriers and facilitators to the delivery of the training and translation of the skills learnt within the training to current practice. Any unanticipated outcomes will be discussed in the focus groups with staff.Cost data will be nested within the program and will be closely coordinated with the purpose and data collection of the study. The primary perspective will be that of the service provider, but health sector and client impacts will also be assessed. Cost analysis of the program, comparator, and any cost offsets will be measured based on service activity and resources required for the services to take place. Program cost will reflect the service provider’s accounting practice, for example, cost category and routine cost data collection. A template to standardize the cost data collection will be completed by each hub manager in consultation with the finance manager at baseline and repeated at 3, 6, and 9 months later. Cost offsets refer to the potential for improvement in staff productivity and/or the service provider’s revenue. Staff productivity includes staff turnover rates, absenteeism, and associated implications. The absenteeism and turnover rates can be obtained from the service provider’s records, whereas self-reported absenteeism will be measured using the short version of the World Health Organization Health and Performance Questionnaire ,56, whicbetween-hub variance and the remaining component of the variance of a randomly selected adult splits into between and within individual variance subcomponents according to either of the 2 scenarios—an optimistic intraclass correlation (ICC) of 0.5 or a less optimistic ICC of 0.25. As an example, the baseline mean for KWC may be 70, the total variance may be 18, and the variance components for hubs, individuals, and assessments within individuals may be 2, 4, and 12, respectively (ICC=0.25). We intend to use the method of restricted maximum likelihood (REML) to fit a linear mixed model to the observations of KWC. The model will have random effects terms for hubs, key workers within hubs and assessments within key workers (within hubs), and fixed effects terms for time  and condition (control or intervention). On the basis of 2000 simulations of the trial for each of the 4 scenarios, we find that the minimum effect sizes that can be detected with 80% power range from 0.49 to 0.68 (The sample size (6 hubs) is pragmatically determined by the number of hubs at the service and the roll-out period for the intervention. We expect approximately 8 out of 10 key workers located at each hub to consent to be repeatedly assessed  following the start of the study and approximately 3 out of the 10 families that they each support to consent to be surveyed during the study. The effect of the pragmatically determined sample size on the power of the study was investigated as follows. With 6 hubs randomized 2 at a time every 3 months starting after baseline (0 months), we have a replicated (at the cluster or hub level) stepped-wedge design with 3 periods and we have made provision for between 6 and 8 key workers in each cluster to be repeatedly assessed across the periods. Accordingly, we expect to have between 144 and 192 observations of the primary outcome variable (KWC). KWC is measured on a bounded continuous outcome scale from 0 to 100. As a contingency, we assume that approximately 10% of the variance of a measurement on a randomly selected adult is  to 0.68 . For eaccontrol and new program means (adjusted for period effects) will be assessed with an F test. If required, after inspection of diagnostic plots of residuals and fitted values, an empirical logit transformation will be used to reanalyze any item scales that are bounded and coarse. Generalized linear mixed-model techniques will be used to analyze binomial or other categorical data. Cumulative effects of exposure to the new program on key outcome variables will also be explored using the same methods. The final analysis will be conducted after all participants have had adequate opportunity to be assessed at the end of the third period , and the database has been locked. Process evaluation will assist in the assessment of factors that impact on the feasibility, success, and sustainability of the intervention strategies and new program. A detailed statistical analysis plan can be accessed by contacting the corresponding author.The repeated measurements  on individuals in the 6 hubs over the three 3-month periods will be analyzed using linear mixed models. For measurement scales that are not too coarse , the statistical analyses will make use of the REML algorithm to fit the mixed model. This algorithm will take account of missing (at-random) assessments and also allows the exploration of various autocorrelation models for the repeated measurements. Comparison of the dominance (intervention cheaper/outcomes better or no different) or dominated (intervention more expensive and outcomes same or worse) and (2) more complex analyses that examine cost in relation to different definitions of value.The economic analysis includes a cost analysis, together with efficiency analyses based on either of the following: (1) simple Simple dominance will be established using cost-effectiveness analysis that compares program costs with physical outcomes . The cost analyses will be conducted to determine whether the capacity building program is cheaper or more expensive than current practice, primarily from the service provider perspective but also from the perspective of parents and the health care system.value has to be analyzed to establish value-for-money. One way is to list the range of primary outcomes and secondary outcomes that have policy meaning to stakeholders  and/or express these as a series of cost-effectiveness ratios . A judgment call could then be made by key staff as to whether these benefits constitute sufficient return on the investment.If the costs of the capacity program are not cheaper and the program is more effective, then statistical lives where premature death is prevented; human capital methods; and scenario-based techniques such as willingness-to-pay or conjoint analysis). A decision on the most appropriate technique, if the trial yields this result, will be made in conjunction with the service provider senior management.Another way is to place a dollar value on these outcomes to establish a return on investment using cost-benefit analysis. There are various methods available to do this  and cash and in-kind contribution from Yooralla as the associated partner organization. This is a multiyear study, and the final year comprises the trial outlined in this study. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617001530314), retrospectively registered on 3 November 2017. Results are expected to be available by the end of 2019.Strategies to improve the mental health and well-being of parents of children with a disability are urgently needed  and are This study will pilot an intervention program embedded in a capacity building framework to increase ECISs’ support for the mental health of parents of children with a disability. Providing professional development about the importance of recognizing and supporting parental distress, the implications on positive child development, and the importance of seeking support for their own well-being is novel to this key worker cohort. Evidence for the effectiveness and cost of this type of intervention is lacking in the literature but is urgently needed to further understand the best models of care by staff to achieve well-being outcomes for families and children with a disability. It is anticipated that the capacity of their key worker and thus their confidence and job satisfaction may lead to improvements in their own mental well-being. The training is specifically designed to build the capacity of key workers to understand when a parent is struggling and would like to be connected with additional supports and that they are supporting an at-risk population group for poor mental health. There is a strength in providing training to all key workers to be able to identify and assist parents in the first instance of becoming aware of any psychological stress or distress as the availability of a key worker with a psychology background on each team is subject to recruitment by the service. The trainings focus on providing resources to staff and helping them to identify when the parent’s needs are out of their scope, we anticipate, will raise their awareness of when they need to refer customers to external supports. The focus of the early childhood intervention service is to aid the development of the child and to empower the family so key workers do not provide ongoing support for parental mental health but rather refer as appropriate.On the basis of the research findings that emerged from the exploratory phase of this research, it is imperative to intervene at not only the key worker level but also to introduce and trial strategies at the organizational level to achieve sustainable change for families accessing the service for their child. A partnership between academics, clinicians, and the delivery organization allowed the development of a program that was feasible and relevant to the service that could be embedded in the service delivery system and addressed a current gap in the literature. The study design is practical and ethical for research in this space, with each hub of staff and parents exposed to the intervention by the end of the trial. A knowledge translation plan is in place to embed successful components of the program into policy documents to support the ongoing accessibility of the program for current staff and upskilling of new staff. Successful components of the intervention will be made accessible online via the staff intranet for ease of access and to allow content to be updated as new evidence of best practice arises and external support details require updating. The participatory method taken to develop and deliver the intervention is ideal for the proposed sustainability of the program, with the potential to embed within the organization’s professional development schedule. The scalability of the program is possible for other disability organizations that support parents of a child with a disability, once the trial has assessed if the intervention produces significantly improved self-efficacy and mental health for staff and parents. In addition, if service improvements and increased parent satisfaction have been shown to occur, the service will be more closely aligned with the NDIS.A strength of this study is the stepped-wedged design, which allows the collection of mixed-method data, including quantitative data, also including economic data, and qualitative data from key workers and parents, which historically are a difficult cohort to involve in longitudinal research because of family demands. Particularly, the inclusion of the economic evaluation provides a model for future studies involving service delivery organizations. The design also addresses the ethical issue of conducting a blinded randomized control trial with a vulnerable population, as we deem it inequitable to provide care for mental well-being to only a cohort of parents accessing the service. A limitation of this study is that it is conducted within a changing policy and funding context, with the NDIS roll out underway in Australia, which is having an ongoing impact to service delivery within the partner organization and which we anticipate will be a potential confounder on the outcome measurements. For organizational reasons, the first 2 hubs are not randomly selected. This is not a major issue for assessment of the impact of the program on the partnering organization as we will use both this intrahub (each hub as its own control) as well as the interhub information when estimating the effect of the new program on the organization. Incomplete randomization does, however, impact on the external validity of the program. We seek to minimize potential bias by not revealing to the staff when the new program is scheduled to be allocated to their hub, although this may become self-evident in the last 2 hubs. Owing to this research being conducted in a real-world service delivery context, there is possible contamination because of a small number of key workers working across multiple sites that will receive the intervention at varying times which may not be overcome by the methods introduced to minimize contamination impact on results. Although methods to minimize the impact of this are in place, it is possible that training at 1 site will influence their service delivery approach to parents at their alternative work place that has not yet received the intervention and other staff may observe and learn, particularly because of the transdisciplinary approach. This will be addressed through discussions with relevant key workers who will be asked to avoid talking about their learnings with staff from hubs yet to receive the intervention to minimize contamination as much as possible. A further limitation of the research was that it was not feasible to have a third group that received only the well-being materials that are provided in conjunction with the face-to-face training to assess their impact independent of the impact of the training on parental well-being.This research will investigate a strategy to help break the negative cycle of poor mental health in parents of children with a disability that leads to poorer short and long-term outcomes for themselves, their child, and their family and their ability to contribute to the community and workforce. It is also urgently needed to provide staff training and clear work roles for the provision of support to parents to reduce worker stress, improve staff retention, and decrease stress for coworkers and families. Through building the knowledge and confidence of health professionals to support parents, it is likely that health professionals will feel increased self-efficacy and job-related well-being, which may also increase productivity and reduce job turnover. Furthermore, by improving the provision of mental health support for parents, it is likely children will benefit in terms of their own health, particularly mentally and socially, and their development because of the increased capacity of parents to care for their children.


Although the use of radial endobronchial ultrasound (R‐EBUS) with a guide sheath has shown improved diagnostic capability in peripheral pulmonary lesions, its utility is still low due to variable performance. To overcome its limitation, we evaluated the feasibility and efficacy of R‐EBUS combined with transbronchial biopsy (TBB) under fluoroscopic guidance.t‐test were used to compare characteristics and identify factors that affected the diagnostic yield.We retrospectively reviewed medical records of 74 patients with non‐small cell lung cancer (NSCLC) who underwent R‐EBUS combined with TBB or TBB alone as a diagnostic technique. Subjects were grouped according to the diagnostic modality used . Each group was matched for age, sex, and location of the biopsy. The chi‐square test and paired P < 0.001). The diagnostic yield with the combined use of R‐EBUS and TBB  was significantly higher than that with standard TBB alone . Lung lesions with a positive bronchus sign were associated with a higher diagnostic yield .The mean age of the study cohort was 67.4 ± 12.8 years, with 21 (56.8%) men and 16 (43.2%) women in each group. The lesion size was significantly smaller in the R‐EBUS group (23.6 vs. 33.9, The combination of R‐EBUS with TBB resulted in a higher diagnostic yield than either technique alone. Thus, the addition of R‐EBUS biopsy would be helpful to improve the diagnostic yield of TBB.The combination of R‐EBUS with TBB under fluoroscopic guidance improved the diagnostic yield of PPLs compared to TBB alone. A tissue diagnosis was more likely in pulmonary lesions with the air‐bronchus sign.The use of R‐EBUS could help improve the low diagnostic yield of TBB under fluoroscopic guidance without increasing the incidence of complications. Lung cancer represents a major worldwide disease burden.Recently, with the introduction of low‐dose helical computed tomography (CT) for lung cancer screening, the detection rate of peripheral pulmonary lesions (PPLs) has increased.Conventionally, transbronchial biopsy (TBB) under fluoroscopic guidance has been widely used in the diagnosis of PPLs since the 1970s.Approximately 20 years ago, advanced bronchoscopic modalities, such as endoscopic navigation bronchoscopy (ENB), thin bronchoscopy, and radial endoscopic ultrasound (R‐EBUS), were introduced to overcome the shortcomings of these conventional techniques.R‐EBUS using thin bronchoscopy has a higher diagnostic yield (51%–92%) and lower complication rate than conventional bronchoscopy.Therefore, the purpose of this study was to determine the improved diagnostic capability of R‐EBUS when combined with conventional TBB in the diagnosis of PPLs.This study was conducted at the Severance Hospital, Seoul, Korea. A retrospective review of electronic medical records was conducted on consecutive lung cancer patients at the pulmonary division of the hospital from August 2017 to November 2018. During the study period, TBB was performed in 432 lung cancer patients. Among this cohort, 37 patients underwent TBB combined with R‐EBUS biopsy. They were matched with the remaining 395 patients who underwent TBB under fluoroscopic guidance alone according to age, sex, smoking status, and characteristics of the lesion, including location, type, and size. Among the 395 patients, we selected cases highly suspected of lung cancer on chest CT to reduce the possibility of including those with benign diseases. We also excluded cases with signs of infection such as fever, hypotension, leukocytosis, or elevated C‐reactive protein levels. Even if the study subjects' bronchoscopic biopsy revealed a benign pathology, they were followed up for six months. The diagnosis of lung cancer was made by using follow‐up images, multidisciplinary consultation, as well as another modality of biopsy such as CT‐guided needle aspiration biopsy or surgical biopsy.This study was approved by the institutional review board of the Severance Hospital .Bronchoscopy was performed by six fellowship trainees of the pulmonology division of our institution. Each fellowship trainee underwent a training period of 4–15 months and had performed a minimum of 100 TBBs. Both TBB and R‐EBUS were performed under the supervision of an expert faculty member with previous experience with the procedure. A thin bronchoscope  with a 4.2 mm outer diameter and a 2.0 mm working channel was used in both groups. EBUS was performed using an endoscopic ultrasound system , equipped with a 20‐MHz mechanical radial‐type probe. Prior to sedation, topical anesthesia of the larynx was applied for 5 minutes using a 2% lidocaine spray. To perform bronchoscopy under deep sedation, intravenous midazolam (2–5 mg depending on patient's bodyweight) and fentanyl (50 mcg) were administered. After insertion of the bronchoscope through the mouth, the trachea and whole bronchi were first inspected. The bronchoscope was placed on the segmental bronchus close to the PPL. A radial probe was then inserted through the working channel to advance into the segmental bronchus near the PPL to localize the lesion. This process was completed under fluoroscopic guidance to facilitate visualization. After localization using EBUS, the probe was removed with the guide sheath remaining on the peripheral lesion. Subsequently, biopsy forceps  were introduced via the guide sheath to perform pathological examination. After performing four biopsies using R‐EBUS, both the radial probe and guide sheath were removed via the working channel. The target site was located using typical radial EBUS images that have previously been described for solid nodules, and the blizzard sign for nodules demonstrating ground‐glass opacity (GGO).Patients were hospitalized for more than two days for the bronchoscopy procedure and monitored for complications during the hospital stay. They were specifically monitored for the development of hemoptysis, pneumothorax, fever, desaturation, chest pain, and respiratory failure. In‐hospital mortality among the study subjects was also recorded. Chest radiography was performed within three hours after the procedure to check for possible pneumothorax and TBB‐related bleeding. Desaturation was defined as a drop in oxygen saturation to <95% during or after the procedure.t‐test, chi‐square test, or Fisher's exact test. We performed univariate and multivariate logistic regression analyses to assess the significance of lesion characteristics as an independent predictive factor for diagnostic yield. Statistical analyses were performed using the IBM SPSS software, version 25.0 .Data analysis was completed on demographic and clinicopathologic variables. Descriptive statistics are reported as the mean ± standard deviation, and categorical variables as frequencies and proportions. Differences between the standard TBB and R‐EBUS with TBB groups were analyzed using the Student's P = 0.743)  men and 16 (43.2%) women. The mean age of the study cohort was 67.4 ± 12.8 years. Comorbidities such as hypertension, diabetes, and tumor marker (carcinoembryonic antigen and Cyfra 21–1) levels were not significantly different between the two groups. The mean duration of the bronchoscopy procedure was 42.9 ± 16.4 minutes in all patients. The mean procedural time was longer in the R‐EBUS‐TBB group than in the TBB group (47.6 ± 15.3 vs. 38.1 ± 16.2 minutes); however, the difference was not statistically different (P = 0.241). The mean distance from the pleura to the lesion also showed no significant difference between two groups . The mean size of the pulmonary lesion was 28.7 ± 13.2 mm, which was smaller in the R‐EBUS‐TBB group than in the TBB group .Radiographic characteristics of the target lesions are presented in Table P = 0.025)  were diagnosed with lung cancer. This result was much higher than the diagnostic yield of the TBB‐only group (59.4%). The diagnostic rate of TBB was slightly higher than that of the R‐EBUS‐TBB group  . Desaturation  was the most common complication, following by chest pain , pneumothorax , and hemoptysis . There were no life‐threatening complications such as respiratory failure and no in‐hospital mortality in the study subjects. There was no significant difference in the complications between the TBB and R‐EBUS‐TBB groups (%. DesatuThe present study revealed that combining R‐EBUS with conventional TBB resulted in a higher diagnostic yield than TBB alone. Even though the lesion size was smaller in the R‐EBUS‐TBB group, the diagnostic yield was higher. Ultrasonographic guidance allowed the confirmation of the exact location of the lesion, thereby enabling the precise performance of biopsy. Furthermore, the acquisition of larger specimens was possible when TBB was combined with R‐EBUS.There are several benefits and disadvantages of TBB under fluoroscopic guidance. Real‐time imaging with fluoroscopy enables visual feedback to the operator, allowing precise guidance during biopsy. However, some studies have reported that fluoroscopy does not improve specimen acquisition because it only provides two‐dimensional images. In addition, there are concerns regarding radiation exposure to the operator.Due to the limitations of conventional bronchoscopy, efficacy of newly developed techniques of bronchoscopic biopsy, including R‐EBUS, electromagnetic navigation bronchoscopy, and thin bronchoscopy, has been reported. The overall diagnostic yield is reported to be 53.0%–82.4% using R‐EBUS. Some studies have reported increased diagnostic rates of up to 84.4% when ENB and R‐EBUS were combined.et al. there was no significant difference between combined use of R‐EBUS and TBB and TBB alone in the diagnosis of benign lung disease.Recently, a multicenter prospective study compared the diagnostic yield of standard TBB with that of R‐EBUS‐TBBThe fellowship trainees who performed the procedure in our study had a minimum experience of 5–20 months in the pulmonology department and had performed at least 100 fluoroscopy‐guided TBBs. Although the bronchoscopy skills of these operators were adequate to perform fluoroscopy‐guided TBB, they were less experienced with R‐EBUS.The overall complication rate in the present study was similar to the previously reported complication rate of TBBet al. which reported that R‐EBUS under fluoroscopy was safe and did not increase the total duration of the procedure.The overall procedure time in both groups was longer than that reported in a previous study.To the best of our knowledge, the present study is the first to evaluate the impact of the introduction of R‐EBUS on the diagnostic yield in a hospital where TBB has already been implemented. We believe that this is an important finding as it offers an alternative technique that can overcome the limitations of TBB, which has a low diagnostic yield. Operators who were unfamiliar with R‐EBUS could also improve the diagnostic yield when they used it in combination with TBB.The retrospective study design and small sample size constitute the limitations of our study. Furthermore, the lack of objective assessment data regarding the bronchoscopy skills of individual operators may be a limitation. Therefore, future prospective studies with larger sample sizes are required to determine the impact of operator skills on the diagnostic yield of the R‐EBUS‐TBB combination technique.In conclusion, the combination of R‐EBUS and TBB resulted in a higher diagnostic yield than R‐EBUS or TBB alone. In particular, a tissue diagnosis was more likely in pulmonary lesions with the air‐bronchus sign. In institutions where fluoroscopic TBB has already been implemented, the introduction of the combination technique with R‐EBUS may increase the diagnostic yield of PPLs.The authors have no potential conflicts of interest to disclose.


For older adults to “age in place”, they need to keep engaged and mobile in their communities, whatever their health condition. The impact of age and cognitive decline on community mobility is a growing problem in Europe and worldwide. Engaging in occupations outside home implies being able to get to those places where activities are performed. Yet little is known regarding the types of places visited, maintained or abandoned for older adults with/without dementia. This study addresses community mobility needs through the places people visit, maintain or abandon. People with and without dementia, aged 55+, were interviewed using the Participation in ACTivities and Places OUTside the Home (ACT-OUT) questionnaire across Switzerland (n=70), Sweden (n=69) and the UK (n=128). Results show that people with dementia experience a higher rate of abandonment for more places than regular older adults. Insights about driving cessation and access to travel passes will be presented.


IntroductionSimulation-based continuing education (SBCE) is a widely used tool to improve healthcare workforce performance. Healthcare providers working in geographically remote and resource-limited settings face many challenges, including the development and application of SBCE. Here, we describe the development, trial, and evaluation of an SBCE curriculum in an Alaska Native healthcare system with the aim to understand SBCE feasibility and specific limitations.MethodsThe perceived feasibility and efficacy of incorporating a low-fidelity medical simulation curriculum into this Native Alaskan healthcare system was evaluated by analyzing semi-structured interviews, focus groups, and surveys over a 15-month period (August 2018 - October 2019). Subjects were identified via both convenience and purposive sampling. Included were 40 healthcare workers who participated in the simulation curriculum, three local educators who were trained in and subsequently facilitated simulations, and seven institutional leaders identified as “key informants.” Data included surveys with the Likert scale and dichotomous positive or negative data, as well as a thematic analysis of the qualitative portion of participant survey responses, focus group interviews of educators, and semi-structured interviews of key informants. Based on these data, feasibility was assessed in four domains: acceptability, demand, practicality, and implementation.ResultsStakeholders and participants had positive buy-in for SBCE, recognizing the potential to improve provider confidence, standardize medical care, and improve teamwork and communication, all factors identified to optimize patient safety. The strengths listed support feasibility in terms of acceptability and demand. A number of challenges in the realms of practicality and implementation were identified, including institutional buy-in, need for a program champion in a setting of staff high turnover, and practicalities of scheduling and accessing participants working in one system across a vast and remote geographic region. Participants perceived the simulations to be effective and feasible.ConclusionWhile simulation participants valued an SBCE program, institutional leaders and educators identified veritable obstacles to the practical implementation of a structured program. Given the inherent challenges of this setting, a traditional simulation curriculum is unlikely to be fully feasibly integrated. However, due to the overall demand and social acceptability expressed by the participants, innovative ways to deliver simulation should be developed, trialed, and evaluated in the future. Simulation as a training tool is increasingly utilized in medical education, as it is demonstrated to be effective in improving patient safety and reducing health care costs -3. The dGeographic and ethnic disparities in healthcare service more heavily impact vulnerable populations of infants and children when compared to adults, and death rates for American Indian/Alaska Native (AI/AN) infants and children, the majority of those who reside in a rural area, are nearly three times higher than for Caucasians. Overall, the pediatric death rate for AI/AN youths to 19 years of age was 73.2 as compared with 29.1 for Caucasian youths from 1999-2009, with the AI/AN pediatric death rates highest for the Alaska region across all age categories (P<0.1) .The backbone of the healthcare delivery workforce in the Southwest Native Alaska villages is the Community Health Aide/Practitioner (CHA/P), with hospital personnel, including nurses, advanced practitioners, and physicians, staffing the sub-regional centers and regional hospital. The CHA/Ps practice broad-spectrum medicine, including primary and preventative, chronic, acute, and emergency services. They service 47 Alaska Native villages surrounding the regional city hub, with approximately 25,000 residents, spanning a river delta region more than 50,000 square miles in size -14. The The CHA/Ps, nurses, and providers are required to complete continuing education (CE) as part of the maintenance of certification. Given the geographically remote and resource-limited setting of the hospital, this usually means traveling far, which is time and cost-intensive. CHA/Ps have access to CE boot camps in the regional hospital and until now, their simulation experience is limited to simple procedural task trainers and standardized certificate courses (e.g. Acute Life Support).The inspiration for this project arose from a direct request for simulation-based education from experienced CHA/Ps working in a sub-regional clinic setting in Southwest Alaska. Given the unique job description of these providers, including specific medical knowledge, skills, and teamwork/communication capabilities required for success on the job, simulation-based education seems like a potentially suitable and beneficial endeavor . The autGiven the declared need for an SBCE program for these providers working with this population with significant health disparities, the authors developed and piloted a low-fidelity simulation curriculum for pediatric respiratory distress scenarios common in the region . The simStudy design, participants, sample size, and samplingTwo CE simulation-based boot camps were held for CHA/Ps and one day of simulations was held for hospital-based nurses and emergency room (ER) technicians facilitated by outside simulation educators . Instructors were one pediatrician who worked at the local institution (ES) and one traveling pediatric critical care nurse practitioner (SR), each with over three years of simulation facilitation experience. A convenience sample of 11 CHA/Ps, 15 nurses, and two ER technicians participated in the sessions and were invited to submit survey responses evaluating their perception of the effectiveness and feasibility of the activity in the domains of acceptability, demand, practicality, and implementation. These sessions led by outside facilitators are grouped together as Survey Group #1.In an effort to implement a sustainable program, we trained local educators of the hospital nursing staff and the CHA/Ps simulation facilitation and debriefing with a one-day workshop and subsequently asked them to facilitate two simulation boot camp days with a total of 12 CHA/P participants. All participants received official CE credit for their participation. These sessions facilitated by trained local educators are grouped together as Survey Group #2.Of the five local educators who participated in the training, only three were able to subsequently facilitate the two simulation days due to competing work demands, with one of them facilitating both sessions. Following these simulation days, we conducted focus groups of the facilitators to explore their perceptions of the tool. This is captured as Focus Groups #1 and #2.In addition, seven local “key informant” hospital leaders were identified via purposeful sampling to participate in semi-structured interviews guided with the intent to explore their perception of the feasibility of implementing a simulation program at their institution.These data collection points are summarized in Figure Data collection & analysisSimulation participants were surveyed on their perception of the effectiveness of the exercise on the basis of realism, usefulness in reviewing resuscitation and medical management skills, and whether the debrief felt safe and relevant, using the 5-point Likert scale  and the mean, standard deviation, median, and ranges were calculated . See TabFeasibility data were collected as dichotomous yes/no answers and qualitative responses to participant surveys Table , as wellAcceptability was translated as the perception that the SBCE would be both desirable and culturally appropriate, with the mostly Alaska Native population that makes up the CHA/P workforce, the nursing staff, and educators in a hospital known to have a high staff turnover rate. Demand was operationalized as the perceived need for the SBCE. Practicality was linked to the costs  associated with the program. Implementation was evaluated as the likelihood that the intervention could be fully integrated into the local CE coursework without needing ongoing outside resources.This investigation was approved by the Seattle Children’s Hospital Institutional Review Board and the Yukon-Kuskokwim Health Corporation (YKHC) Human Subjects Committee.ParticipantsFive local educators participated in a simulation facilitation workshop and three of the five subsequently led two simulation days. These three educators train CHA/Ps or nurses, average over 25 years of clinical nursing experience each, and have simulation experience in facilitating the Advanced Cardiac Life Support (ACLS) course. Of the 40 simulation participants, 23 were CHA/Ps, 15 nurses, and two ER technicians. Twelve of the CHA/Ps participated in simulations facilitated by the newly trained local educators (Survey Group #2) while the other 28 participants were led by external simulation facilitators (Survey Group #1). The seven key informants that participated in the semi-structured interviews included three physicians, two doctorate, and two nurse administrators; all informants were selectively identified due to their leadership roles in the hospital system, Community Health Aide Program, and nursing/provider education.Effectiveness outcomesAll 40 simulation participants completed the post-simulation questions assessing feasibility and effectiveness. When asked to evaluate the effectiveness of the simulations on the Likert scale across six questions, the curriculum received a median of 5, mean of 4.59, standard deviation of 0.23, and range 3-5. When comparing the responses of participants with outside facilitators (Survey Group #1) vs local newly trained simulation facilitators (Survey Group #2), the mean (standard deviation) was only slightly higher (4.75 (0.19) vs 4.42 (0.14)) and the range of responses was respectively wider (3-5 vs 4-5) , funding, and creativity in overcoming scheduling and access issues.Our team prioritized the training of local educators in simulation facilitation and created opportunities to practice these newly acquired skills with on-the-ground mentorship in an effort to integrate the didactic method into the existing CHA/P training program. Integration is another feasibility domain, operationalized as the level of system change needed to integrate a new program or process into an existing infrastructure or program . The locParticipants, key informants, and educators alike overwhelmingly brought up the possibility of harnessing the power of the established telecommunication network unique to this setting to overcome the perceived barriers to integrating an SBCE curriculum. One possible solution to enhancing the feasibility of an SBCE program for providers in this remote and resource-limited setting is leveraging the telecommunication system to introduce telesimulation. Telesimulation is a replicable, low-cost, and robust tool that optimizes learning and instructor training with simulation in resource-limited settings . Tele-coThis study is limited by a small convenience sample size. Given that we chose to conduct a feasibility study in a real-life, busy hospital with the actual participants that would ultimately be involved in the proposed SBCE, the authors felt this was necessary. However, we acknowledge the disadvantage that the convenience sample does not accurately represent the entire population of providers seeking CE in this broader geographic region. Thus, feasibility results might be skewed and may represent a barrier. We limited the evaluation of the simulation to learner perceptions of utility and did not directly evaluate the impact on knowledge, acquisition, or communication skills. Pre- and post-tests and/or videotaping with subsequent review are ways to enhance the evaluation piece of simulation in the future.SBCE was found to be acceptable and in demand. Local educators were trained and facilitated simulations that were well-received by participants. While we were able to implement this research project, we uncovered barriers to the true integration of this SBCE program moving forward. A suggested, innovative solution to overcome some feasibility barriers was telesimulation. Future initiatives might consider developing a telesimulation tool to integrate into the established telecommunication system in the region. Studies can build upon this assessment and consider ways to innovate simulation delivery while studying the impact on cost, provider competence, and, ultimately, patient outcomes. The authors herein conclude that a formal low-fidelity SBCE program may be feasible within this rural Alaska Native healthcare system if the acknowledged barriers are addressed creatively.