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BackgroundCross-system interventions that integrate health, behavioral health, and social services can improve client outcomes and expand community impact. Successful implementation of these interventions depends on the extent to which service partners can align frontline services and organizational operations. However, collaboration strategies linking multiple implementation contexts have received limited empirical attention. This study identifies, describes, and specifies multi-level collaboration strategies used during the implementation of Ohio Sobriety Treatment and Reducing Trauma (Ohio START), a cross-system intervention that integrates services across two systems (child welfare and evidence-based behavioral health services) for families that are affected by co-occurring child maltreatment and parental substance use disorders.MethodsIn phase 1, we used a multi-site qualitative design with 17 counties that implemented Ohio START. Qualitative data were gathered from 104 staff from child welfare agencies, behavioral health treatment organizations, and regional behavioral health boards involved in implementation via 48 small group interviews about collaborative approaches to implementation. To examine cross-system collaboration strategies, qualitative data were analyzed using an iterative template approach and content analysis. In phase 2, a 16-member expert panel met to validate and specify the cross-system collaboration strategies identified in the interviews. The panel was comprised of key child welfare and behavioral health partners and scholars.ResultsIn phase 1, we identified seven cross-system collaboration strategies used for implementation. Three strategies were used to staff the program: (1) contract for expertise, (2) provide joint supervision, and (3) co-locate staff. Two strategies were used to promote service access: (4) referral protocols and (5) expedited access agreements. Two strategies were used to align case plans: (6) shared decision-making meetings, and (7) sharing data. In phase 2, expert panelists specified operational details of the cross-system collaboration strategies, and explained the processes by which strategies were perceived to improve implementation and service system outcomes.ConclusionsWe identified a range of cross-system collaboration strategies that show promise for improving staffing, service access, and case planning. Leaders, supervisors, and frontline staff used these strategies during all phases of implementation. These findings lay the foundation for future experimental and quasi-experimental studies that test the effectiveness of cross-system collaboration strategies.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is associated with severe maternal coronavirus disease (COVID-19) and preterm birth and may increase the risk for other complications of [...]

Quality learning for sustainability can have a transformative effect in terms of promoting empowerment, leadership and wise investments in individual and collective lives and regenerating the local economies of cities, making them more inclusive, safe, resilient and sustainable. It can also help cities move towards achieving the United Nations Sustainable Development Goals (SDGs). Effecting the transformation of cities into Learning Cities, however, requires changes in the structure of governance. Drawing on interviews with key informants as well as secondary data, this article examines how collaborative governance has facilitated quality learning for sustainability in Bristol (United Kingdom), Kitakyushu (Japan) and Tongyeong (Republic of Korea). Focusing on a conceptual framework and practical application of learning initiatives, this comparative study reveals how these cities' governance mechanisms and institutional structures supported initiatives premised on cooperative learning relationships. While recognising differences in the scope and depth of the learning initiatives and the need for further improvements, the authors found evidence of general support for the governance structures and mechanisms for learning in these cities. The authors conclude by recommending that (1) to implement the Learning Cities concept based on UNESCO's "Key Features of Learning Cities", recognition should be given to existing sustainability-related learning initiatives in cities; (2) collaborative governance of the Learning Cities concept at both local and international levels should be streamlined; and (3) UNESCO's Global Network of Learning Cities could serve as a hub for sharing education/learning resources and experiences for other international city-related programmes as an important contribution to the implementation of the SDGs.

Literature from various academic disciplines indicates that in recent decades, community resilience (CR) has evolved significantly in conceptualization and operationalization. However, the relevance and empirical inclusion of CR in social and health sciences research remain sparse and fragmented. This scoping review, therefore, aimed to assess the conceptualization of CR in social and health sciences research; determine the availability of tools measuring this construct; and identify the psychometric properties of available instruments. Findings highlight how CR has shifted from a peripheral ecological concept to a central goal in the psychosociological discourse. Though several common core elements were identified in the included literature, results indicated little consensus regarding the conceptual or operational definitions of CR. Furthermore, there is minimal evidence on robust metrics that comprehensively measure CR as a complex psychosocial construct. Review results thus highlight the importance, and provide pragmatic implications, regarding the inclusion of core elements of CR in community-based strategies and development efforts. [ABSTRACT FROM AUTHOR]

The macroscopic appearance of a tumor such as hepatocellular carcinoma (HCC) may be defined as its phenotype which is de facto dictated by its genotype. Therefore, macroscopic characteristics of HCC are unlikely random but rather reflect genomic traits of cancer, presumably acting as a valuable source of information that can be retrieved and exploited to infer prognosis. This review aims to provide a comprehensive overview of the available data on the prognostic value of macroscopic characterization in HCC. A total of 57 studies meeting eligible criteria were identified, including patients undergoing liver resection (LR; 47 studies, 83%) or liver transplant (LT; 9 studies, 16%). The following macroscopic variables were investigated: tumor size (n = 42 studies), number of nodules (n = 28), vascular invasion (n = 24), bile duct invasion (n = 6), growth pattern (n = 15), resection margin (n = 11), tumor location (n = 6), capsule (n = 2) and satellite (n = 1). Although the selected studies provided insightful data with notable prognostic performances, a lack of standardization and substantial gaps were noted in the report and the analysis of gross findings. This topic remains incompletely covered. While the available studies underscored the value of macroscopic variables in HCC prognostication, important lacks were also observed. Macroscopic characterization of HCC is likely an underexploited source of prognostic factors that must be actively explored by future multidisciplinary research. [ABSTRACT FROM AUTHOR]

Behavioral monitoring is an essential tool for understanding how animal management decisions, including exhibit design choices, impact animal behavior and welfare. The purpose of this study was to use behavioral monitoring techniques to determine the interaction between 2 groups (bachelor and breeding groups) of western lowland gorillas that are housed in separate habitats that partially face one another. We performed simultaneous, 30-minute group observations on the breeding and bachelor groups and recorded all occurrences of agonistic and affiliative behavior, vocalizations, and visual monitoring of the adjacent group. At 5-minute intervals, we also recorded which gorillas in the observed group were potentially visible to the neighboring group. Our results indicated that there was considerable variation in the percentage of time each gorilla spent monitoring the neighboring group. We were also able to demonstrate that the visibility of individuals in the breeding group of gorillas was related to behavior of the gorillas in the bachelor group. Although non-contact aggression increased with the visual presence of the adult male of the breeding group, more severe aggression that could cause injury was not influenced by his presence. Results also showed an association between visual presence of a particular female in the breeding group and a decrease in contact aggression in the bachelor group. Since many zoological exhibits allow visual access to other animals, it is important to determine the impact that neighbors may have on each other. Our study investigating interactions between neighboring gorilla groups is an example of how behavioral monitoring can be used to assess the impact of a wide range of management decisions on animal behavior and welfare.

Relatively little is known of the cognitive and perceptual abilities of mandrill monkeys (Mandrillussphinx sp.). Here, we document how seven adult mandrills were trained to effectively use a touchscreen mediated testing system. Upon mastering use of this device, subjects were presented with two automated discrimination tasks; one requiring discrimination of the target from an array of distracters using color, the second requiring discrimination by shape. Examination of individual differences in both training and testing performance provided evidence that position in the social hierarchy and circumstances of the testing environment impacted learning. Further, examination of error production revealed that errors were not distributed randomly, with subjects being attracted to a biologically relevant color and a shape that was featurally similar to the target.//

Background: Timely restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for salvaging penumbra. We re-evaluated the previously described PROTECT (PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy) Plus technique at a tertiary comprehensive stroke center. Methods: We retrospectively analyzed all patients who underwent mechanical thrombectomy with stentrievers between May 2011 and April 2020. Patients were divided between those who underwent PROTECT Plus and those who did not (proximal balloon occlusion with stent retriever only). We compared the groups in terms of reperfusion, groin to reperfusion time, symptomatic intracranial hemorrhage (sICH), modified Rankin Scale (mRS) score at discharge. Results: Within the study period, 167 (71.4%) PROTECT Plus and 67 (28.6%) non-PROTECT patients which met our inclusion criteria. There was no statistically significant difference in the number of patients with successful reperfusion (mTICI >2b) between the techniques (85.0% vs 82.1%; p = 0.58). The PROTECT Plus group had lower rates of mRS ≤2 at discharge (40.1% vs 57.6%; p = 0.016). The rate of sICH was comparable (p = 0.35) between the PROTECT Plus group (7.2%) and the non-PROTECT group (3.0%). Conclusion: The PROTECT Plus technique using a BGC, a distal reperfusion catheter and stent retriever is feasible for recanalization of large vessel occlusions. Successful recanalization, first-pass recanalization and complication rates are similar between PROTECT Plus and non-PROTECT stent retriever techniques. This study adds to an existing body of literature detailing techniques that use both a stent retriever and a distal reperfusion catheter to maximize recanalization for patients with large vessel occlusions. [ABSTRACT FROM AUTHOR]

A number of clinical isolates of Pseudomonas aeruginosa are cytotoxic to mammalian cells due to the action of the 74-kDa protein ExoU, which is secreted into host cells by the type III secretion system and whose function is unknown. Here we report that the swift and profound cytotoxicity induced by purified ExoU or by an ExoU-expressing strain of P. aeruginosa is blocked by various inhibitors of cytosolic (cPLA2) and Ca2+ -independent (iPLA2) phospholipase A2 enzymes. In contrast, no cytoprotection is offered by inhibitors of secreted phospholipase A2 enzymes or by a number of inhibitors of signal transduction pathways. This suggests that phospholipase A2 inhibitors may represent a novel mode of treatment for acute P. aeruginosa infections. We find that 300-600 molecules of ExoU/cell are required to achieve half-maximal cell killing and that ExoU localizes to the host cell plasma membrane in punctate fashion. We also show that ExoU interacts in vitro with an inhibitor of cPLA2 and iPLA2 enzymes and contains a putative serine-aspartate catalytic dyad homologous to those found in cPLA2 and iPLA2 enzymes. Mutation of either the serine or the aspartate renders ExoU non-cytotoxic. Although no phospholipase or esterase activity is detected in vitro, significant phospholipase activity is detected in vivo, suggesting that ExoU requires one or more host cell factors for activation as a membrane-lytic and cytotoxic phospholipase.

The impact of spoken language skills on the social inclusion of children with hearing loss is of interest for listening and spoken language early intervention providers. This study used spoken language assessments and a parent-report social inclusion survey to investigate this impact for 95 children with hearing loss (M = 5.1 years of age). The survey focused on two facets of social inclusion: education and interacting with society and fulfilling social roles. The majority of participants demonstrated language, vocabulary and speech skills commensurate with peers with typical hearing. Vocabulary and speech skills had an impact on only a few aspects of social inclusion. Specifically, this was primary caregiver satisfaction with the level of teacher support; and children being invited to social activities or using computer or mobile technology devices. Spoken language skills were shown to have some impact on a few aspects of social inclusion. Areas were suggested where early intervention providers could offer additional support to children with hearing loss and their families.