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Magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) are complementary imaging techniques that detect disease based on viscoelasticity and water mobility, respectively. However, the relationship between viscoelasticity and water diffusion is still poorly understood, hindering the clinical translation of combined DWI-MRE markers. We used DWI-MRE to study 129 biomaterial samples including native and cross-linked collagen, glycosaminoglycans (GAGs) with different sulfation levels, and decellularized specimens of pancreas and liver, all with different proportions of solid tissue, or solid fractions. We developed a theoretical framework of the relationship between mechanical loss and tissue-water mobility based on two parameters, solid and fluid viscosity. These parameters revealed distinct DWI-MRE property clusters characterizing weak, moderate, and strong water-network interactions. Sparse networks interacting weakly with water, such as collagen or diluted decellularized tissue, resulted in marginal changes in water diffusion over increasing solid viscosity. In contrast, dense networks with larger solid fractions exhibited both free and hindered water diffusion depending on the polarity of the solid components. For example, polar and highly sulfated GAGs as well as native soft tissues hindered water diffusion despite relatively low solid viscosity. Our results suggest that two fundamental properties of tissue networks, solid fraction and network polarity, critically influence solid and fluid viscosity in biological tissues. Since clinical DWI and MRE are sensitive to these viscosity parameters, the framework we present here can be used to detect tissue remodeling and architectural changes in the setting of diagnostic imaging. The viscoelastic properties of biological tissues provide a wealth of information on the vital state of cells and host matrix. Combined measurement of viscoelasticity and water diffusion by medical imaging is sensitive to tissue microarchitecture. However, the relationship between viscoelasticity and water diffusion is still poorly understood, hindering full exploitation of these properties as a combined clinical biomarker. Therefore, we analyzed the parameter space accessible by diffusion-weighted imaging (DWI) and magnetic resonance elastography (MRE) and developed a theoretical framework for the relationship between water mobility and mechanical parameters in biomaterials. Our theory of solid material properties related to particle motion can be translated to clinical radiology using clinically established MRE and DWI. [Display omitted] [ABSTRACT FROM AUTHOR]

Title X clinics provide access to a wide range of contraceptive options for individuals of all income levels and documentation statuses. As Title X continues to face political uncertainties, it is important to provide up-to-date information about its clients' use of contraception. This study used recent nationally representative data to compare contraception received by Title X clients with that received by clients of other providers. This article draws on 2015–2017 and 2017–2019 waves of the National Survey of Family Growth. The sample was restricted to 15- to 44-year-old women needing contraception. Logistic regressions estimated associations between receiving services at Title X clinics versus at other providers (including private) and use of a range of contraceptive options, as well as number of months' supply for those using oral contraceptives. In 2015–2017, Title X was associated with using any contraception (adjusted odds ratio [AOR], 4.11; p =.004). In both waves, Title X clients were more likely to use long-acting reversible contraceptives (AOR, 1.78 in 2015–2017 [ p =.023] and AOR, 2.59 in 2017–2019 [ p =.003]) and hormonal methods other than oral contraceptives (AOR, 2.31 in 2015–2017 [ p =.007] and AOR, 3.04 in 2017–2019 [ p =.001]). In both waves, Title X clients using oral contraceptives were also more likely than non-Title X clients to receive more than a 3-month supply (AOR, 3.54 in 2015–2017 [ p =.008] and AOR, 2.61 in 2017–2019 [ p =.043]). Title X was not associated in either wave with use of barrier or time-based methods, such as periodic abstinence or withdrawal. Patterns of contraceptive use by Title X clients compared with those of clients of other providers indicate that the Title X program has allowed access to a wide range of contraceptive methods. Ongoing research is necessary to see whether these patterns change over time. [ABSTRACT FROM AUTHOR]

This study explores how UK mainstream and farming print press report the issues arising from the prevalent use of migrant labour in UK horticulture. Domestic fruit and vegetable production is central to achieving transition to a sustainable diet with positive health, environment and social outcomes, including for its 80,000+ migrant workers. How policymakers understand the issues will determine whether the policy actions they take will address the underlying causes of UK horticulture's dependency on low-paid migrant labour. This study conducts a qualitative content analysis of 92 articles in leading national farming and mainstream press between February 01, 2015–June 26, 2020. Findings show that reporting in both press was significantly slanted toward concerns and interests of farm business groups, correlated with prominent representation of this groups' voice in reporting. This contrasts with minimal presence of the voices of migrant workers and social reform stakeholders. Both press deployed an economic frame in which migrant workers were discussed in purely commercial terms. The prevailing market model of journalism increases the potential for well-resourced groups to dominate media reporting and shape framing. Such stakeholder groups are unhindered – if not aided – by a largely absent neo-liberal state, creating socio-political conditions which militate against policy reforms to bring about a more economically and socially just supply chain. • Farming interest groups were the most frequently quoted and mentioned actors in all reporting, consistent with the market model of journalism dominant in UK mainstream press which depends on well resourced interest groups to supply content. • Although well resourced elite actors, supermarkets are not quoted in reporting and are barely mentioned by farming interest groups despite the dominance of supermarkets in regulating the supply chain and squeezing producers' margins. • Farming interest groups tend to frame dependency on migrant labour as an economic rather than a social issue, and focus on policy fixes rather than fundamental reform of food supply chain dynamics. • The outbreak of Covid-19 shifted reporting from an economic frame to an emergent 'valued workers of the nation' framing evoking the 'war-time spirit' as industry and government attempted to mobilise UK workers to 'dig for victory'. • When mobilisation failed to materialise at the scale required, reporting shifted 'valued workers' framing on to migrant workers despite obvious differences in status and access to entitlements between migrant and home nation workers. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic led to a global food crisis. Like previous food crises how the debate is framed by food policy actors can have a bearing on policy outcomes. This study researches how the policy responses to migrant horticultural labour shortages, due to the pandemic, were framed in the Italian print media and how this relates to longer-term food policy making. Data were gathered from the six highest-circulation Italian daily newspapers. The coverage was dominated by left-leaning outlets and peaked in relation to Covid-19 recovery policies and political processes. Farmer industry bodies were the most quoted group, and the legalisation of undocumented migrant workers was the most frequently discussed policy response. A frames analysis was conducted and identified three principal frames: food security, worker exploitation and immigration. The worker exploitation and immigration frames were most frequently used by left-leaning newspapers, while centre-right papers used the food security frame the most often. The results suggest that media framing could contribute to both policy change, helping to open policy windows, as well as policy lock-ins, side-lining certain debates, actors and policy solutions. The research aims to contribute to growing empirical work which seeks to understand the impact of Covid-19 on migrant agricultural workers and food policy. • First frames analysis of migrant agriculture labour policy debate in Italian print media during Covid-19. • Three frames were used in the media debate – food security, worker exploitation, immigration. • Explores media influence on food policy. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.childyouth.2010.08.002 Byline: Emmeline Chuang (a), Rebecca Wells (b) Keywords: Collaboration; Child welfare; Juvenile justice; Behavioral health Abstract: Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of inter-agency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies -- jurisdiction, shared information systems, and overall connectivity -- and youths' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems. Author Affiliation: (a) Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL 33612-3807, United States (b) Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States Article History: Received 2 June 2010; Revised 30 July 2010; Accepted 2 August 2010

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.childyouth.2005.11.009 Byline: Rebecca Wells Keywords: Child welfare services; Management; Organizational Abstract: Child welfare agency caseworkers play a pivotal role in ensuring these children's safety and well-being, conducting initial investigations, making placement decisions and service referrals, and monitoring children's situations while cases are active. At this point, the empirical literature provides little guidance about how child welfare agency managers can best support caseworkers in these challenging functions. This article draws on available empirical literature to describe how agency management may affect children's experiences in the child welfare system and their resultant outcomes. The author notes what we may currently conclude from available literature as well as what knowledge gaps remain to be addressed. At this point the most robust evidence basis for agency management relates to human resource practices, but even these findings derive mostly from other settings and need to be tested directly in child welfare contexts. There is virtually no empirical evidence about how child welfare agency management affects children's outcomes over time. Author Affiliation: Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7411 Chapel Hill, NC 27599-7411, United States Article History: Received 22 July 2005; Revised 18 September 2005; Accepted 10 November 2005

The media are one of the main arenas in which nutrition information is framed and developed. Research has shown a predominantly individualistic framing of diet-related health issues such as obesity, type-2 diabetes and coronary heart disease in international media coverage. These issues are framed as personal, ’lifestyle’ issues rather than requiring policy or structural change. In addition, research has shown a tendency in nutrition research and media coverage of it, to emphasize individual ingredients or components more than overall diet. The media have a tendency to report diet related research simplistically, often without contextualization. Taking a case study approach, this paper analyses UK news media coverage and framing of British Medical Journal (BMJ) published research into dietary fibre and bowel cancer risk. I investigate how the health issue fibre and bowel cancer is framed and dissect the process of mediation (from press release to mass media to local media), analysing the shifting ’geographies of responsibility’ that result. This paper argues that media coverage of research into diet and bowel cancer can be explained by the technologies, conventions and routines of media representation. Key gatekeepers were found to have an important role in framing the information that was reported. Taking a critical approach, this paper argues that like obesity, type 2 diabetes and coronary heart disease, coverage of nutritional means of preventing bowel cancer is set predominantly in the ’lifestyle’ frame, laying responsibility for increasing dietary fibre at the door of the individual rather than looking at broader social, economic, or political drivers of dietary change. [ABSTRACT FROM AUTHOR]

The goal of the current study was to better understand how deficits in emotional self-awareness (alexithymia) can disrupt social support in romantic relationships by extending past research in two ways. At the methodological level, we wanted to gather data from both partners of support interactions in order to examine whether the lowered levels of support reported by individuals with alexithymia are corroborated by partner reports. We also extended past research by investigating additional facets of social support: provision of support and expectations of support from romantic partners. We tested our hypotheses in a sample of 69 long-term committed relationships. Both partners completed self-report measures of alexithymia and indices of social support. Individuals with elevated scores on alexithymia reported receiving less support from their romantic partners and expected more negative forms of support from their partner. They also reported providing less support to their partner. In addition, there were a number of significant partner effects, such that partners of individuals with alexithymia reported providing and receiving less support from their partners, as compared to partners of non-alexithymics. Our pattern of results, based on self-report and partner report, suggest that alexithymic individuals have difficulty with many different aspects of everyday support exchanges. [ABSTRACT FROM AUTHOR]

Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. [ABSTRACT FROM AUTHOR]

Portal fibroblasts, the resident fibroblasts of the portal tract, are found in the mesenchyme surrounding the bile ducts. Their roles in liver homeostasis and response to injury are undefined and controversial. Although portal fibroblasts almost certainly give rise to myofibroblasts during the development of biliary fibrosis, recent lineage tracing studies suggest that their contribution to fibrogenesis is limited compared with that of hepatic stellate cells. Other functions of portal fibroblasts include participation in the peribiliary stem cell niche, regulation of cholangiocyte proliferation, and deposition of specific matrix proteins. Portal fibroblasts synthesize elastin and other components of microfibrils; these may serve structural roles, providing stability to ducts and the vasculature under conditions of increased ductal pressure, or could regulate the bioavailability of the fibrogenic transforming growth factor β in response to injury. Viewing portal fibroblasts in the context of fibroblast populations throughout the body and studying their niche-specific roles in matrix deposition and epithelial regulation could yield new insights into their contributions in the normal and injured liver. Understanding the functions of portal fibroblasts will require us to view them as more than just an alternative to hepatic stellate cells in fibrosis. [Copyright &y& Elsevier]

Abstract: US public child welfare agencies have faced increasing pressure in the first decade of this century to demonstrate efficiency and accountability, even as the Great Recession increased pressures on millions of families and undermined human service funding. This paper reports on analyses of the two cohorts of local public child welfare agencies from the National Survey of Child and Adolescent Well-Being to identify changes in their structure and practice. Local agency adaptations have included some structural integration and apparently increased use of subcontracting, including investigations. Collectively, these trends appear to be fostering a tighter coupling of local child welfare agencies with other service providers. Some of these connections may improve families' access to a range of services. However, the increased reliance on private providers may also undermine accountability and flexibility to respond to changing needs. [Copyright &y& Elsevier]

Highlights: [•] We conducted a randomized trial of meditation for mild cognitive impairment (MCI). [•] Meditation may increase functional connectivity in the default mode network in MCI. [•] Mediation may reduce hippocampal volume atrophy in MCI. [•] Meditation may have a positive impact on brain regions most related to dementia. [ • ] Further research with larger sample sizes and longer-follow-up are needed. [Copyright &y& Elsevier]

Abstract: Mechanical forces are essential to the development and progression of fibrosis, and are likely to be as important as soluble factors. These forces regulate the phenotype and proliferation of myofibroblasts and other cells in damaged tissues, the activation of growth factors, the structure and mechanics of the matrix, and, potentially, tissue patterning. Better understanding of the variety and magnitude of forces, the characteristics of those forces in biological tissues, and their impact on fibrosis in multiple tissues is needed and may lead to identification of important new therapeutic targets. This article is part of a Special Issue entitled: Fibrosis: Translation of basic research to human disease. [Copyright &y& Elsevier]

Abstract: Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers'' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed. [Copyright &y& Elsevier]

Abstract: States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from the longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive. [Copyright &y& Elsevier]

Abstract: In response to liver injury or loss of liver mass, proliferation of mature liver cells is the first-line defense to restore liver homeostasis. In the setting of chronic liver disease, however, the ability of hepatocytes and cholangiocytes to proliferate is blocked and small bipotential progenitor cells are activated. Recent studies have established the role of these facultative progenitor cells in injury repair and fibrosis in patients with chronic liver disease and in experimental models. Several signaling pathways linking progenitor cell activation and fibrosis have been identified, and there is increasing evidence that cross-talk (both physical and via soluble factors) between progenitor cells and myofibroblasts is essential for both fibrosis and parenchymal regeneration. Even more exciting are new data examining the cellular components of the progenitor cell niche, demonstrating that both resident liver cells and circulating cells from the bone marrow can function as stem cells, suggesting that there is a surprising degree of phenotypic plasticity such that progenitor cells can contribute to the myofibroblast population and vice versa. We highlight here recent findings from the literature demonstrating the cellular and functional complexity of the progenitor cell niche, and emphasize some of the important questions that remain to drive future research. [ABSTRACT FROM AUTHOR]

Abstract: Policy makers and advocates are increasingly encouraging child-serving organizations to work together. This study examined how child welfare agency ties with substance abuse treatment providers and schools correlated with substance abuse treatment for adolescents receiving child protective services. A sample of adolescents with substance use risk was extracted from a national survey of families engaged with child welfare. Logistic regressions with adjustments for complex survey design used child welfare agency ties to substance abuse treatment providers and schools to predict treatment. As expected, adolescents were more likely to report treatment when child protective services and substance abuse treatment were in the same agency and when child welfare agency directors reported joint planning with schools. However, child welfare agency agreements with substance abuse treatment providers were negatively associated with treatment. This unexpected finding implies that agencies may sometimes cooperate to address problems and to improve service utilization. [ABSTRACT FROM AUTHOR]

Objective: Interorganizational relationships (IORs) between child welfare agencies and mental health service providers may facilitate mental health treatment access for vulnerable children. This study investigates whether IORs are associated with greater use of mental health services and improvement in mental health status for children served by the child welfare system. Methods: This was a longitudinal analysis of data from a 36-month period in the National Survey of Child and Adolescent Well-Being (NSCAW). The sample consisted of 1,613 children within 75 child welfare agencies who were 2 years or older and had mental health problems at baseline. IOR intensity was measured as the number of coordination approaches between each child welfare agency and mental health service providers. Separate weighted multilevel logistic regression models tested associations between IORs and service use and outcomes, respectively. Results: Agency-level factors accounted for 9% of the variance in the probability of service use and 12% of mental health improvement. Greater intensity of IORs was associated with higher likelihood of both service use and mental health improvement. Conclusions: Having greater numbers of ties with mental health providers may help child welfare agencies improve children's mental health service access and outcomes. Practice implications: Policymakers should develop policies and initiatives to encourage a combination of different types of organizational ties between child welfare and mental health systems. For instance, information sharing at the agency level in addition to coordination at the case level may improve the coordination necessary to serve these vulnerable children. [Copyright &y& Elsevier]

Objective: This study examined health service access among children of different racial/ethnic groups in the child welfare system in an attempt to identify and explain disparities. Methods: Data were from the National Survey of Child and Adolescent Well-Being (NSCAW). N for descriptive statistics=2,505. N for multiple regression model=537. Measures reflected child health services need, access, and enabling factors. Chi-square and t tests were used to compare across racial/ethnic groups. A logistic regression model further explored the greatest disparity identified, that between non-Latino/a Black and White children in caseworker-reported access to counseling. Results: In general, caseworker reports of health care service receipt did not differ across racial/ethnic groups. However, Latino/a children had better reported access to vision services than non-Latino/a White children, and counseling access was lower for non-Latino/a Black children than non-Latino/a White children. Caseworkers¿ self-reported efforts to facilitate service access did not vary by race/ethnicity for any type of health care. In the multiple regression model, both private health insurance and a lack of insurance were negatively associated with counseling access, while a history of sexual abuse, adolescence, and greater caseworker effort to secure services were positively associated with access. Race was just barely nonsignificant after controlling for other factors expected to affect access. Conclusions: One possible reason why Black children are less likely to be identified as needing counseling is the fact that they are less likely than White children to have reports of sexual abuse, which strongly predicts counseling access. Practice implications: First, child welfare practice may be more equitable than many believe, with generally comparable health service access reported across children's racial/ethnic groups. Second, caseworkers may be under-identifying need for counseling services among Black children, although this might reflect less frequent reports of sexual abuse for Black children. Third, both privately insured and uninsured children were less likely to receive needed mental health counseling than those with public insurance. This suggests that policy makers should focus on increasing the numbers of children enrolled in public health insurance programs such as Medicaid and the State Children's Health Insurance Program (SCHIP). [Copyright &y& Elsevier]

Summary: The epithelial to mesenchymal transition has recently been implicated as a source of fibrogenic myofibroblasts in organ fibrosis, particularly in the kidney. There is as yet minimal evidence for the epithelial to mesenchymal transition in the liver. We hypothesized that this process in biliary epithelial cells plays an important role in biliary fibrosis and might be found in patients with especially rapid forms, such as is seen in biliary atresia. We therefore obtained liver tissue from patients with biliary atresia as well as a variety of other pediatric and adult liver diseases. Tissues were immunostained with antibodies against the biliary epithelial cell marker CK19 as well as with antibodies against proteins characteristically expressed by cells undergoing the epithelial to mesenchymal transition, including fibroblast-specific protein 1, the collagen chaperone heat shock protein 47, the intermediate filament protein vimentin, and the transcription factor Snail. The degree of colocalization was quantified using a multispectral imaging system. We observed significant colocalization between CK19 and other markers of the epithelial to mesenchymal transition in biliary atresia as well as other liver diseases associated with significant bile ductular proliferation, including primary biliary cirrhosis. There was minimal colocalization seen in healthy adult and pediatric livers, or in livers not also demonstrating bile ductular proliferation. Multispectral imaging confirmed significant colocalization of the different markers in biliary atresia. In conclusion, we present significant histologic evidence suggesting that the epithelial to mesenchymal transition occurs in human liver fibrosis, particularly in diseases such as biliary atresia and primary biliary cirrhosis with prominent bile ductular proliferation. [Copyright &y& Elsevier]

Abstract: Licensing and accreditation are widely used to improve and convey organizational quality. The objective of this study was to provide substance abuse treatment stakeholders with better evidence about how well licensing and accreditation actually correlate with staffing and treatment practices. Regressions using data from national surveys of outpatient substance abuse treatment facilities indicated that no form of licensing or accreditation was associated with better staff-to-client ratios or with one important aspect of comprehensive treatment—the percentage of clients receiving routine medical care. There were several positive associations between licensing/accreditation and other aspects of treatment comprehensiveness. Three categories of licensure/accreditation were also positively associated with use of after-treatment plans. Post hoc analyses revealed that accreditation was associated with units'' organizational contexts and referral sources as well as the nature of the competitive environment. Licensing/accreditation may reveal as much about units'' institutional environments as about the quality of treatment provided. [Copyright &y& Elsevier]

Liver fibrosis, the formation of a hepatic scar in chronic liver injury, results from complex interrelated changes in the extracellular matrix, cell populations and cytokines of the liver. Although myofibroblasts derived from hepatic stellate cells are important collagen-producing cells, recent research has identified additional fibrogenic cell populations as well as new soluble, mechanical and immunologic mediators of fibrosis. These findings have greatly expanded the range of possible targets for antifibrotic therapy. [Copyright &y& Elsevier]

Abstract: Previous studies suggest that psychiatric patients mirror the behaviors of the staff members who treat them, but there is little empirical evidence about how staff dynamics affect patients over time. The goals of this study were to examine associations between: (1) team leader discipline and mutual respect among treatment team members; and (2) mutual respect among team members and improvements in patient quality of life. Two models were tested on data from psychiatric treatment teams within the US Veterans Administration. The first examined associations between the discipline of each team''s emergent leader and the level of mutual respect among that team''s members. The second model tested associations between mutual respect among staff and changes over time in patients’ quality of life. The subjects for model 1 were psychiatric staff members () whose responses were aggregated for team-level analyses (). Mutual respect was highest in social worker-led teams and lowest in physician-led teams. The subjects for model 2 were 1638 seriously mentally ill patients in 44 of the units examined in the first model. When mutual respect among staff was greater, patients improved more over time in their satisfaction with the quality of their housing, relations with families, social life, and finances. Together, these analyses imply that mutual respect may improve patient outcomes and that leadership by some disciplines may facilitate such dynamics. In general, leaders may consider learning from other disciplines’ strengths to improve their impact. [Copyright &y& Elsevier]

Presents a critical examination of U.S. market level health care strategy literature between 1981 and 1998. Application of sociological needs; Description of the landscape in U.S. health care; Methods for reviewing health care strategy literature; Differences between diversification and divestiture.

Objectives: Complementary and integrative medicine (CIM) therapies show clinical benefits with minimal side effects, yet challenges to effective integration in hospital settings remain. The current study aimed to better understand the process of integration of CIM therapies at a large urban pediatric hospital from the perspectives of providers, parents, and administrators.Design: The study employed an applied medical ethnography.Setting: The ethnography was conducted before, during, and after an Integrative Medicine Pain Consult Service (IM Pilot) was implemented at a large urban pediatric hospital during the spring of 2017.Main Outcome Measures: Fieldwork interviews, participant observations, and document review captured aspects of the integration of CIM over a 6-month study period. Ethnographic analysis included thematic content analysis. Participants included providers (n = 10), administrators (n = 5), and parents of patients (n = 11).Results: Emergent themes from analysis of the interviews and field notes were organized according to the socio-ecological model. Themes included facilitating factors for CIM pain management at the intrapersonal and community levels (Alignment with Parental Perceptions of Child Needs and Provider Desire to Offer Care, Alignment of CIM with Spiritual Beliefs and Community Norms) and barriers at the interpersonal, organizational, and political levels (Inter-professional Challenges, Lack of Logistics in Place for Referrals and Triaging Patients with Pain, Lack of Remuneration/Insurance Reimbursement for Care).Conclusions: To address barriers, future efforts to implement integrative pain management programs in pediatric hospital settings may consider testing implementation strategies, including engaging program champions and family advocates, providing education on CIM professions and therapies to hospital staff, and billing for provider time rather than individual CIM therapies. [ABSTRACT FROM AUTHOR]

Objective Maternity care coordination (MCC) may provide an opportunity to enhance access to behavioral health treatment services. However, this relationship has not been examined extensively in the empirical literature. This study examines the effect of MCC on use of behavioral health services among perinatal women. Methods Medicaid claims data from October 2008 to September 2010 were analyzed using linear fixed effects models to investigate the effects of receipt of MCC services on mental health and substance use–related service use among Medicaid-eligible pregnant and postpartum women in North Carolina ( n = 7,406). Results Receipt of MCC is associated with a 20% relative increase in the contemporaneous use of any mental health treatment (within-person change in probability of any mental health visit 0.5% [95% CI, 0.1%–1.0%], or an increase from 8.3% to 8.8%); MCC in the prior month is associated with a 34% relative increase in the number of mental health visits among women who receive MCC (within-person change in the number of visits received 1.7% [95 CI, 0.2%–3.3%], or from 0.44 to 0.46 mental health visits). No relationship was observed between MCC and Medicaid-funded substance use–related treatment services. Conclusions MCC may be an effective way to quickly address perinatal mental health needs and engage low-income women in mental health care. However, currently there may be a lost opportunity within MCC to increase access to substance use–related treatment. Future studies should examine how MCC improves access to mental health care such that the program's ability can be strengthened to identify women with substance use–related disorders and transition them into available care. [ABSTRACT FROM AUTHOR]

Background & Aims: Myofibroblasts are the primary cell type involved in physiologic wound healing and its pathologic counterpart, fibrosis. Cellular fibronectin that contains the alternatively spliced extra domain A (EIIIA) is up-regulated during these processes and is believed to promote myofibroblast differentiation. We sought to determine the requirement for EIIIA in fibrosis and differentiation of myofibroblasts in rodent livers. Methods: We used a mechanically tunable hydrogel cell culture system to study differentiation of primary hepatic stellate cells and portal fibroblasts from rats into myofibroblasts. Liver fibrosis was induced in mice by bile duct ligation or administration of thioacetamide. Results: EIIIA was not required for differentiation of rat hepatic stellate cells or portal fibroblasts into fibrogenic myofibroblasts. Instead, hepatic stellate cells cultured on EIIIA-containing cellular fibronectin formed increased numbers of lamellipodia; their random motility and chemotaxis also increased. These increases required the receptor for EIIIA, the integrin α9β1. In contrast, the motility of portal fibroblasts did not increase on EIIIA, and these cells expressed little α9β1. Male EIIIA −/− mice were modestly protected from thioacetamide-induced fibrosis, which requires motile hepatic stellate cells, but not from bile duct ligation-induced fibrosis, in which portal fibroblasts are more important. Notably, myofibroblasts developed during induction of fibrosis with either thioacetamide or bile duct ligation in EIIIA −/− mice. Conclusions: EIIIA is dispensable for differentiation of hepatic stellate cells and portal fibroblasts to myofibroblasts, both in culture and in mouse models of fibrosis. Our findings, however, indicate a role for EIIIA in promoting stellate cell motility and parenchymal liver fibrosis. [ABSTRACT FROM AUTHOR]

Background & Aims: Recurrent hepatitis C with ensuing fibrosis is the leading cause of liver allograft loss. We investigated whether histologic features in early posttransplant liver biopsies could predict the rate of fibrosis progression in this population. Methods: From 1999 to 2007 there were 476 liver transplants performed for hepatitis C at our center. We reviewed all available posttransplant biopsies for these patients; patients were categorized as rapid, intermediate, or slow fibrosers based on their METAVIR fibrosis score at 24 months. Stage F0 biopsies for rapid and slow fibrosers were analyzed histologically and immunohistochemically. Results: We identified 52 rapid fibrosers and 61 slow fibrosers in our cohort. There was a significant increase in the fibrosis progression rate in the group transplanted between 2003 and 2007 compared with between 1999 and 2002. The course of fibrosis progression was determined early in the posttransplant period and the rate was constant. Rapid fibrosers had more hepatocyte apoptosis than slow fibrosers (P = .001), but no difference in hepatitis activity on stage F0 biopsies. Rapid fibrosers also experienced more episodes of acute rejection after transplantation (P < .001). Cytokeratin 19 (CK19) and vimentin expression on F0 stage biopsies could distinguish rapid from slow fibrosers (CK19: area under the curve, 0.71; P = .0034; vimentin: P = .0219). Conclusions: CK19, vimentin, and hepatocellular apoptosis are promising early markers of rapid fibrosis progression in patients transplanted for hepatitis C. The rate of fibrosis progression is established early in the posttransplant period; this initial rate dictates long-term outcome. [Copyright &y& Elsevier]

• A novel regulatory role for a cysteine-rich domain of Type III collagen was examined • CR peptide binds to TGFβ with high affinity and in a dose dependent manner • The CR peptide attenuates TGFβ signaling in fibroblasts and breast cancer cells • CR peptide tempers myofibroblast activation and function • In vivo studies support CR's potential to control scarring, fibrosis and tumor activities TGFβ is a key regulator of the dynamic reciprocity between cells and the extracellular matrix that drives physiologic and pathologic responses in both tissue repair and tumor microenvironments. Our studies define type III Collagen (Col3) as a suppressor of scar formation and desmoplasia through its effects, in part, on myofibroblasts. TGFβ stimulates activation of myofibroblasts, and here, we demonstrate that cultured Col3-deficient fibroblasts have increased TGFβ signaling compared to wild-type fibroblasts. Moreover, kinetic binding studies show that a synthetic peptide containing a Col3 cysteine-rich (CR) domain found within its N-propeptide binds in a dose-dependent manner to TGFβ1, while a CR control peptide with mutated cysteines does not, suggesting that Col3 attenuates TGFβ signaling in part through the N-propeptide CR domain. Consistent with this hypothesis, the CR peptide attenuates TGFβ signaling in fibroblasts and 4T1 breast cancer cells and suppresses fibroblast activation and contraction, as assessed by α-smooth-muscle actin staining, cell wrinkling of deformable silicone, and stressed-fibroblast populated collagen lattice contraction assays. Finally, CR peptide treatment of orthotopically injected breast cancer cells (4T1) suppresses intratumoral fibroblast activation and inhibits primary tumor growth compared to CR control. Treatment with the CR peptide decreases both intratumoral canonical and non-canonical downstream TGFβ signaling targets, consistent with its extracellular binding to TGFβ. Taken together, our results suggest that the Col3 N-propeptide CR domain binds TGFβ1 and attenuates (but importantly does not eliminate) TGFβ signaling in fibroblasts and cancer cells. Expanding on our previous work, this study demonstrates an additional mechanism by which Col3 regulates cell behaviors in post-injury and tumor microenvironments and suggests that novel Col3-targeted strategies could effectively control biologic responses in vivo and improve anti-scarring/fibrosis and oncologic therapies. [ABSTRACT FROM AUTHOR]

Abstract: The Type III TGF-β receptor, betaglycan, is a widely expressed proteoglycan co-receptor for TGF-β superfamily ligands. The full-length protein undergoes ectodomain cleavage with release of a soluble ectodomain fragment. The fate of the resulting transmembrane–cytoplasmic fragment, however, has never been explored. We demonstrate here that the transmembrane–cytoplasmic fragment is stable in transfected cells and in cell lines expressing endogenous betaglycan. Production of this fragment is inhibited by the ectodomain shedding inhibitor TAPI-2. Treatment of cells with inhibitors of the intramembrane protease γ-secretase stabilizes this fragment, suggesting that it is a substrate of γ-secretase. Expression of the transmembrane–cytoplasmic fragment as well as γ-secretase inhibitor stabilization are independent of TGF-β1 or -β2 and are unaffected by mutation of the cytoplasmic domain serines that undergo phosphorylation. γ-Secretase inhibition or the expression of a transmembrane–cytoplasmic fragment in HepG2 cells blunted TGF-β2 signaling. Our findings thus suggest that the transmembrane–cytoplasmic fragment remaining after betaglycan ectodomain cleavage is stable and a substrate of γ-secretase, which may have significant implications for the TGF-β signaling response. [ABSTRACT FROM AUTHOR]

Objective: To examine whether maternity care coordination (MCC) services are associated with utilization of postpartum contraceptive services.Methods: Using a random sample of 7120 live births, we analyzed administrative data to assess whether MCC services affected utilization of contraceptive services within 3months of delivery. Treatment groups were constructed as MCC during the prenatal period only (n=531), MCC in both the prenatal and postpartum periods (n=1723) and a non-MCC control group (n=4866). Inverse probability of treatment weights (IPTWs) were calculated and applied to balance baseline risk factors across groups. We used the IPTW linear probability model to estimate postpartum contraceptive service utilization, controlling for demographic, social, reproductive and medical home enrollment characteristics.Results: At 3months postpartum, MCC participation was associated with a 19-percentage point higher level of utilization of postpartum contraceptive services among women who received both prenatal and postpartum care coordination services (p<.001), as compared with controls. Women who received only prenatal MCC services showed no difference in utilization of services at 3months postpartum from non-MCC controls. Sensitivity modeling showed the effect of MCC was independent of postpartum obstetrical care. Additionally, MCC had differential treatment effects across subpopulations based on maternal age, race, ethnicity and education; women who were white and did not have a medical home were more likely to benefit from MCC services in initiating postpartum contraceptives.Conclusions: MCC programs may be instrumental in increasing timely utilization of postpartum contraceptive services, but continuation of the intervention into the postpartum period is critical.Implication: MCC offered both prenatally and in the postpartum period appears to complement clinical care by increasing postpartum contraceptive service utilization. Providers should consider the potential added benefits of care coordination services in tandem with traditional obstetric care to increase postpartum contraceptive use and subsequently reduce short birth intervals. [ABSTRACT FROM AUTHOR]