Connecting the Dots: Stages of Implementation, Wraparound Fidelity and Youth Outcomes

Several necessary system and organizational support conditions for wraparound have been identified (Walker et al. 2003). Yet, the relationship between these necessary system level conditions and wraparound fidelity has only recently begun to be examined. Similarly, few studies have included a measure of wraparound fidelity when examining the relationship between wraparound implementation and youth outcomes. The statewide implementation of a wraparound demonstration grant offers the opportunity to explore these relationships and to identify factors that predict improvement in functioning for youth receiving wraparound. Findings suggest that significant relationships exist between (1) the stage of development of necessary support conditions for wraparound and wraparound fidelity and (2) wraparound fidelity and improvement in youth outcomes. Specific elements of wraparound (i.e., outcomes based and community based) and baseline needs and strengths (e.g., high levels of anxiety and conduct issues, poor functioning at home and in school, judgment, and risks) were found to predict a reduction in youth needs. Other unexpected relationships between youth outcomes and the cultural competence element of wraparound and being multi-racial were also discovered. These findings reinforce the importance of supporting high fidelity wraparound for youth and their families in a recovery focused behavioral health system

Intermittent auscultation versus continuous fetal monitoring: Exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework

Background: Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Methods: Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA Results: We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social influences; Behavioural regulation). Conclusion: We identified potential influences on birthing unit nurses' use of IA as their primary method of fetal surveillance. These beliefs suggest potential targets for behaviour change interventions to promote IA use

Additional file 1: of Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses’ fetal surveillance practice using theoretical domains framework

Patey et al. fetal surveillance interview guide contains that Semi-structured interview guide, based on the TDF, used in this study. (PDF 149 kb

MSC-related gene expression can be observed in whole tumor single cell RNAseq.

UMAP visualization of 130,246 cells analyzed by scRNA-seq and integrated across 26 primary breast tumors (from Wu et al [34]). Clusters were annotated for their cell types as predicted using canonical markers for epithelial cells (EPCAM), proliferating cells (MKI67), T cells (CD3D), myeloid cells (CD68), B cells (MS4A1), plasmablasts (JCHAIN), endothelial cells (PECAM1) and mesenchymal cells (fibroblasts/perivascular-like cells; PDGFRB) and gene signature-based annotation. A) Non-tumor MSC, perivascular and endothelial cells cluster on left side of plot demonstrated the majority of THY1 (CD90), CXCL12 and ACTA2 expression in the whole tumor. B) UMAP visualization of reclustered mesenchymal cells, including CAFs (6,573 cells), PVL cells (5,423 cells), endothelial cells (7,899 cells), lymphatic endothelial cells (203 cells) and cycling PVL cells, demonstrating that the majority of CD90 (THY1) positive cells residing in the assigned MSC cluster. C) Feature plots of gene expression of COL1A1, COL8A1 in whole tumor UMAP demonstrating gene expression restricted to MSC-associated clusters, and D) MSC UMAP demonstrating COL10A1 gene expression restricted to MSC/CAFS.</p

S3 Data -

The tumor microenvironment is a complex mixture of cell types that bi-directionally interact and influence tumor initiation, progression, recurrence, and patient survival. Mesenchymal stromal cells (MSCs) of the tumor microenvironment engage in crosstalk with cancer cells to mediate epigenetic control of gene expression. We identified CD90+ MSCs residing in the tumor microenvironment of patients with invasive breast cancer that exhibit a unique gene expression signature. Single-cell transcriptional analysis of these MSCs in tumor-associated stroma identified a distinct subpopulation characterized by increased expression of genes functionally related to extracellular matrix signaling. Blocking the TGFβ pathway reveals that these cells directly contribute to cancer cell proliferation. Our findings provide novel insight into communication between breast cancer cells and MSCs that are consistent with an epithelial to mesenchymal transition and acquisition of competency for compromised control of proliferation, mobility, motility, and phenotype.</div

Single cell analysis of patient-derived MSCs.

A) CD90+ cells were isolated from normal donors or patients with invasive breast cancer and subjected to single cell analysis. Gene expression profiles from single cells were clustered using tSNE, and 7 distinct cell clusters were observed. B) Candidate gene expression profiles were used to functionally characterize MSCs into 3 main subclasses (osteogenic, chondrogenic or adipogenic). C) Comparison of cells derived from healthy donors or breast cancer patients demonstrated proportional changes in number of cells contributing to specific clusters. D) Ontology categories associated with single cell populations.</p