Publications by authors named "A Eliot Shearer"

220 Publications

Improving Mental Health Guardianship: From Prevention to Treatment.

Psychiatr Serv 2021 Nov 29:appips202100020. Epub 2021 Nov 29.

Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California (Shearer, Khodyakov);DMH+UCLA Public Mental Health Partnership, University of California, Los Angeles (Bromley);Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (Bromley);Los Angeles County Department of Mental Health, Los Angeles (Bonds, Draxler);California Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, Willowbrook (Bonds).

Objective: The authors sought to identify the most promising strategies for improving the mental health guardianship process in Los Angeles County for adults with mental illness who are gravely disabled.

Methods: In May and June 2019, 56 experts, working in hospitals or outpatient facilities or representing legal, advocacy, policy, or forensic organizations, participated in an online modified-Delphi panel, rating the ethical appropriateness, impact on care quality, efficiency, and feasibility of nine strategies for improvement of mental health guardianship. Agreement was determined with the RAND/UCLA appropriateness method, and comments were thematically analyzed.

Results: The strategy ranked highest by the participating experts was improving the administrative functioning and judicial processes of entities involved in mental health guardianship proceedings-it was the only strategy that achieved agreement among panelists and was rated highly on all four criteria. Other preferred strategies were enhancing the ability of assertive outpatient mental health teams to serve individuals before they experience a crisis and expanding the continuum of unlocked residential treatment settings.

Conclusions: Opportunities exist to improve all stages of the mental health guardianship process. Experts favored strategies that streamline administrative processes, facilitate community integration into treatment, and ensure fidelity to best practices. Improving the mental health guardianship process has the potential to speed up delivery of services, better manage resources, and increase access to treatment for individuals with mental illness who are gravely disabled.
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http://dx.doi.org/10.1176/appi.ps.202100020DOI Listing
November 2021

Peripheral Vestibular Dysfunction Is a Common Occurrence in Children With Non-syndromic and Syndromic Genetic Hearing Loss.

Front Neurol 2021 21;12:714543. Epub 2021 Oct 21.

Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, United States.

Hearing loss (HL) is the most common sensory deficit in humans and is frequently accompanied by peripheral vestibular loss (PVL). While often overlooked, PVL is an important sensory dysfunction that may impair development of motor milestones in children and can have a significant negative impact on quality of life. In addition, many animal and models of deafness use vestibular hair cells as a proxy to study cochlear hair cells. The extent of vestibular end organ dysfunction associated with genetic pediatric hearing loss is not well-understood. We studied children with a known genetic cause of hearing loss who underwent routine preoperative vestibular testing prior to cochlear implantation between June 2014 and July 2020. Vestibular testing included videonystagmography, rotary chair, video head impulse testing, and/or vestibular evoked myogenic potentials. Etiology of HL was determined through history, physical examination, imaging, laboratory testing, and/or genetic testing. Forty-four children (21 female/23 male) met inclusion criteria; 24 had genetic non-syndromic and 20 had genetic syndromic forms of HL. Mean age at the time of testing was 2.8 ± 3.8 years (range 7 months-17 years). The most common cause of non-syndromic HL was due to mutations in GJB2 ( = 13) followed by MYO15A (3), MYO6 (2), POU3F4 (2), TMPRSS3 (1), CDH23 (1), TMC1 (1), and ESRRB (1). The most common forms of syndromic HL were Usher syndrome (4) and Waardenburg (4), followed by SCID/reticular dysgenesis (3), CHARGE (2), CAPOS (1), Coffin-Siris (1), Jervell and Lange-Nielsen (1), Noonan (1), peroxisome biogenesis disorder (1), Perrault (1), and Trisomy 21 (1). Overall, 23 patients (52%) had PVL. A larger proportion of children with syndromic forms of HL had PVL (12/20, 60%) compared with children with genetic non-syndromic HL (11/24, 46%), though without statistical significant ( = 0.3). The occurrence of PVL varied by affected gene. In conclusion, PVL is a common finding in children with syndromic and non-syndromic genetic HL undergoing vestibular evaluation prior to cochlear implantation. Improved understanding of the molecular physiology of vestibular hair cell dysfunction is important for clinical care as well as research involving vestibular hair cells in model organisms and models.
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http://dx.doi.org/10.3389/fneur.2021.714543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567025PMC
October 2021

Foodborne Illness Outbreak Investigation for One Health Postsecondary Education.

J Microbiol Biol Educ 2021 31;22(2). Epub 2021 Aug 31.

Department of Animal and Food Sciences, University of Delaware, Newark, Delaware, USA.

One Health concepts were incorporated in a foodborne disease outbreak investigation with game features of data presented as visual and manipulative clues. Postsecondary pre-veterinary medicine and animal biosciences students and food science students ( = 319) enrolled in an introductory animal and food sciences course over a 3-year period received a brief introduction to foodborne illness, an outbreak scenario, and investigative tasks to complete individually or in groups. Tasks addressed epidemiology, laboratory, environment, traceback, recall, and prevention concepts. Gamification of the exercise involved generation of a numerical code to unlock a combination lock as an indication of successful organization, compilation, and interpretation of data. Students presented investigation findings and responses to critical thought questions on their roles. Student surveys on engagement and self-perceived change in conceptual understanding indicated that nearly all expressed increased understanding of outbreak investigations, safe food production, and environmental water as a transmission vehicle. Volunteered learned concepts indicated enhanced appreciation for the complexity of food safety and interdisciplinary connections. Students enjoyed the exercise (92%) and cited the clues and group interaction among the most enjoyable features. Objective assessment of student conceptual learning with the subset of students who conducted the investigation individually ( = 58) demonstrated significant increase in correct test responses (49% pretest; 76% posttest) after completion of the investigation for all questions combined and across all learning objectives. These data demonstrate the value of a foodborne disease investigation with escape room gamification features for engaging students in One Health concepts and exercising problem-solving, critical thinking, and skills for independent and collaborative work.
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http://dx.doi.org/10.1128/jmbe.00129-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442033PMC
August 2021

"What We Have Here, Is a Failure to [Replicate]": Ways to Solve a Replication Crisis in Implementation Science.

Prev Sci 2021 Jul 26. Epub 2021 Jul 26.

RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA.

Adapting the classic line from the 1967 film Cool Hand Luke, the title is meant to convey that implementation science (IS), like other fields, has not been embracing replication studies, which is a key component to the open science movement. The purpose of this article is to review what is known about replication of implementation trials and identify the gaps and next steps to continue increasing the transparency, openness, and replicability of implementation research. After presenting an overview of study replication and how it is a key component of open science, the article will examine how replication of implementation studies has (or more accurately has not) been approached in IS. As will be discussed, replication in IS shares some challenges with studies that attempt to replicate interventions, but also presents unique challenges. This article discusses different types of replications (e.g., direct vs. conceptual) and how they can benefit the field of IS. The article then presents a specific example of an implementation strategy called Getting To Outcomes© to describe how to design a replication study and interpret the results. The article ends with multiple options implementation scientists could consider to improve the likelihood and quality of replication studies. The discussion also envisions how implementation science can enable researchers and practitioners to work together in real-world contexts to encourage wide replication of implementation studies and advance the goal of improving public health.
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http://dx.doi.org/10.1007/s11121-021-01286-9DOI Listing
July 2021

Genetic Causes of Hearing Loss in a Large Cohort of Cochlear Implant Recipients.

Otolaryngol Head Neck Surg 2021 Jun 22:1945998211021308. Epub 2021 Jun 22.

Department of Otolaryngology-Head & Neck Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

Understanding genetic causes of hearing loss can determine the pattern and course of a patient's hearing loss and may also predict outcomes after cochlear implantation. Our goal in this study was to evaluate genetic causes of hearing loss in a large cohort of adults and children with cochlear implants. We performed comprehensive genetic testing on all patients undergoing cochlear implantation. Of the 459 patients included in the study, 128 (28%) had positive genetic testing. In total, 44 genes were identified as causative. The top 5 genes implicated were (20, 16%), (13, 10%), (10, 8%), (9, 7%), and (7, 5%). Pediatric patients had a higher diagnostic rate. This study lays the groundwork for future studies evaluating the relationship between genetic variation and cochlear implant performance.
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http://dx.doi.org/10.1177/01945998211021308DOI Listing
June 2021
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