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This paper describes and demonstrates the use of the systematic planning process, Intervention Mapping, to adapt an evidence-based public health intervention (EBI). We used a simplified version of Intervention Mapping (IM Adapt) to increase an intervention's fit with a new setting and population. IM Adapt guides researchers and practitioners in selecting an EBI, making decisions about whether and what to adapt, and executing the adaptation while guarding the EBI's essential elements (those responsible for effectiveness). We present a case study of a project in which we used IM Adapt to find, adapt, implement, and evaluate an EBI to improve mammography adherence for African American women in a new practice setting in Houston, Texas. IM Adapt includes the following (1) assess needs and organizational capacity; (2) find EBIs; (3) plan adaptations based on fit assessments; (4) make adaptations; (5) plan for implementation; and (6) plan for evaluation of the adapted EBI. The case study shows an example of how public health researchers and practitioners can use the tool to make it easier to find and use EBIs, thus encouraging greater uptake. IM Adapt adds to existing dissemination and adaptation models by providing detailed guidance on how to decide on effective adaptation, while maintaining the essential elements of the EBI.

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Vancomycin-resistant Enterococcus faecium (VRE) from human wastewater effluents in a nonclinical semiclosed agri-food system in Texas were characterized for susceptibility to antibiotics and disinfectants. The 50 VRE were resistant to eight fluoroquinolones and 10 of 17 antimicrobials typically active against Gram-positive organisms. The VRE were susceptible to quinupristin/dalfopristin and linezolid. Lack of the insertion element IS1251 correlated with VRE susceptibility to streptomycin and gentamicin at p < 0.0001 and p = 0.033, respectively. An association was observed between pulsed-field gel electrophoresis genotypes Ic and II and susceptibility to streptomycin at p = 0.0006. VRE susceptibility for nine disinfectants and five disinfectant components is shown. Ninety-two percent of the isolates had a minimum inhibitory concentration (MIC) for triclosan > or =2 ppm. Triclosan MICs for many of the VRE were well over expected product application levels. No association was observed between antibiotic resistance and disinfectant susceptibility in these VRE. Enterococci multiply-resistant to vancomycin and aminoglycosides were found in a non-hospital environment where one would not expect to find them.

BackgroundConsiderable racial and socio-economic disparities exist in breast cancer. In spite of the existence of numerous evidence-based interventions (EBIs) aimed at reducing breast cancer screening barriers among the underserved, there is a lack of uptake or sub-optimal uptake of EBIs in community and clinical settings. This study evaluates a theoretically based, systematically designed implementation strategy to support adoption and implementation of a patient navigation-based intervention, called Peace of Mind Program (PMP), aimed at improving breast cancer screening among underserved women.Methods/designThe PMP will be offered to federally qualified health centers and charity clinics in the Greater Houston area using a non-randomized stepped wedge design. Due to practical constraints of implementing and adopting in the real-world, randomization of start times and blinding will not be used. Any potential confounding or bias will be controlled in the analysis. Outcomes such as appointment adherence, patient referral to diagnostics, time to diagnostic referral, patient referral to treatment, time to treatment referral, and budget impact of the intervention will be assessed. Assessment of constructs from the consolidated framework for implementation research (CFIR) will be assessed during implementation and at the end of the study (sustainment) from each participating clinic. Data will be analyzed using descriptive statistics (chi-square tests) and generalized estimating equations (GEE).DiscussionWhile parallel group randomized controlled trials (RCT) are considered the gold standard for evaluating EBI efficacy, withholding an effective EBI in practice can be both unethical and/or impractical. The stepped wedge design addresses this issue by enabling all clinics to eventually receive the EBI during the study and allowing each clinic to serve as its own control, while maintaining strong internal validity. We expect that the PMP will prove to be a feasible and successful strategy for reducing appointment no-shows in underserved women.Trial registrationClinical trials registration number: NCT02296177Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0334-x) contains supplementary material, which is available to authorized users.

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Background: Although much work has begun to elucidate contextual factors influencing implementation, the specific processes that facilitate and hinder adoption, implementation, and maintenance of evidence-based interventions (EBIs) in clinical settings remains poorly understood. Intervention Mapping (IM) is a systematic process that facilitates planning and design for dissemination, implementation and maintenance of EBIs in practice. IM has been used to guide the design of many health interventions, focusing on program implementation. Less studied is its use to adapt and scale screening interventions within the healthcare clinic setting. This paper describes the development of an implementation intervention using IM to facilitate the adoption, implementation, and maintenance of an EBI designed to increase mammography adherence in healthcare clinics, the adapted Peace of Mind Program (PMP).Methods: IM framework, Step 5, was used to guide the implementation intervention planning. IM guided identification of specific adoption, implementation, and maintenance performance objectives. We formed an implementation intervention planning group consisting of members of the academic team, our community partner and community health workers (CHWs) with substantial experience working on mammography screening programs in federally qualified health centers (FQHCs) and charity clinics.Results: Results are presented by Intervention Mapping task for Step 5 (Program Implementation Plan). We describe how the consolidated framework for implementation research (CFIR) informed the selection of performance objectives, determinants, methods, and practical applications in the final implementation intervention.Conclusions: This paper provides an example of the use of Intervention Mapping Step 5 and CFIR to create an implementation intervention to support EBI scale up of an evidence-based mammography intervention within a specific setting.Clinical trials registration number: NCT02296177

-Modeling potential disease spread in wildlife populations is important for predicting, responding to and recovering from a foreign animal disease incursion. To make spatial epidemic predictions, the target animal species of interest must first be represented in space. We conducted a series of simulation experiments to determine how estimates of the spatial distribution of white-tailed deer impact the predicted magnitude and distribution of foot-and-mouth disease (FMD) outbreaks. Outbreaks were simulated using a susceptible-infected-recovered geographic automata model. The study region was a 9-county area (24 000 km 2 ) of southern Texas. Methods used for creating deer distributions included dasymetric mapping, kriging and remotely sensed image analysis. The magnitudes and distributions of the predicted outbreaks were evaluated by comparing the median number of deer infected and median area affected (km 2 ), respectively. The methods were further evaluated for similar predictive power by comparing the model predicted outputs with unweighted pair group method with arithmetic mean (UPGMA) clustering. There were significant differences in the estimated number of deer in the study region, based on the geostatistical estimation procedure used (range: 385 939-768 493). There were also substantial differences in the predicted magnitude of the FMD outbreaks (range: 1 563-8 896) and land area affected (range: 56-447 km 2 ) for the different estimated animal distributions. UPGMA clustering indicated there were two main groups of distributions, and one outlier. We recommend that one distribution from each of these two groups be used to model the range of possible outbreaks. Methods included in cluster 1 (such as county-level disaggregation) could be used in conjunction with any of the methods in cluster 2, which included kriging, NDVI split by ecoregion, or disaggregation at the regional level, to represent the variability in the model predicted outbreak distributions. How animal populations are represented needs to be considered in all spatial disease spread models.spatial modeling / epidemic modeling / deer density / sensitivity analysis