Ending Street Homelessness in Vanguard Cities Across the Globe: An International Comparative Study

Street homelessness is one of the most extreme, and visible, manifestations of profound injustice on the planet, but often struggles to achieve priority attention at international level. The Institute of Global Homelessness (IGH's) A Place to Call Home initiative, launched in 2017, represented a concerted effort to support cities across the globe to eradicate street homelessness. A first cohort of 13 'Vanguard Cities' committed to a specific target on ending or reducing street homelessness by December 2020. Our independent evaluation of this initiative found that:Two Vanguard Cities – Glasgow and Sydney – fully met their self-defined target reductions for end 2020. In addition, Greater Manchester, while it did not meet its exceptionally ambitious goal of 'ending all rough sleeping', recorded an impressive 52% reduction against baseline.Overall, there was evidence of reductions in targeted aspects of street homelessness in over half of the Vanguard Cities. In most of the remaining cities data limitations, sometimes as a result of COVID, meant that it was not possible to determine trends. In only one Vanguard City – Edmonton – was there an evidenced increase in street homelessness over baseline levels.Key enablers of progress in reducing street homelessness included the presence of a lead coordinating agency, and coordinated entry to homelessness services, alongside investment in specialized and evidence-based interventions, such as assertive street outreach services, individual case management and Housing First.Key barriers to progress included heavy reliance on undignified and sometimes unsafe communal shelters, a preoccupation with meeting immediate physiological needs, and sometimes perceived spiritual needs, rather than structural and system change, and a lack of emphasis on prevention. Aggressive enforcement interventions by police and city authorities, and documentary and identification barriers, were also counter-productive to attempts to reduce street homelessness.A key contextual variable between the Vanguard Cities was political will, with success in driving down street homelessness associated with high-level political commitments. An absolute lack of funds was a major challenge in all of the Global South cities, but also in resource-poor settings in the Global North. Almost all Vanguard Cities cited pressures on the affordable housing stock as a key barrier to progress, but local lettings and other policies could make a real difference.The impact of the COVID-19 crisis differed markedly across the Vanguard Cities, with people at risk of street homelessness most effectively protected in the UK and Australian cities. Responses were less inclusive and ambitious in the North American and Global South cities, with more continued use of 'shared air' shelters, albeit that in some of these contexts the pandemic prompted better coordination of local efforts to address street homelessness.IGH involvement was viewed as instrumental in enhancing the local profile, momentum and level of ambition attached to reducing street homelessness in the Vanguard Cities. IGH's added value to future cohorts of cities could be maximised via a focus on more tailored forms of support specific to the needs of each city, and also to different types of stakeholders, particularly frontline workers

For Baby’s Sake: Intervention Development and Evaluation Design of a Whole-Family Perinatal Intervention to Break the Cycle of Domestic Abuse

For Baby’s Sake is an innovative whole-family intervention that works with parents from pregnancy to two years postpartum to break cycles of domestic abuse and improve outcomes for children. The programme launched in 2015 across two community settings in England, with an independent evaluation led by King’s College London. This paper aims to (1) summarise the process of developing For Baby’s Sake and how it has been embedded within two different settings and (2) describe the evaluation design using early data to illustrate successes and challenges. The programme was developed following a review of the evidence and extensive stakeholder engagement. Three experts co-designed the content in partnership with the Stefanou Foundation and the programme delivery teams have been integrated into two local authorities. The evaluation uses mixed methods to assess abuse victimisation/perpetration, mental health, parenting and child outcomes, alongside service user experiences of early engagement. Forty individuals (27 women and 13 men) have been recruited to the evaluation. Early findings suggest that parents value the novel approach of For Baby’s Sake and their relationships with practitioners. Data on parents’ mental health and childhood adversities supports the decision to create a trauma-informed intervention. Interventions for domestic abuse are necessary to improve health and behaviour outcomes for families and prevent intergenerational transmission of abuse and developmental trauma. For Baby’s Sake addresses limitations of existing interventions, through its trauma-informed, attachment-based, whole-family approach. Early data from the evaluation suggests that the programme is reaching its intended audience and that service users appreciate the supportive approach

Gut Microbial Metabolite TMAO Enhances Platelet Hyperreactivity and Thrombosis Risk

Normal platelet function is critical to blood hemostasis and maintenance of a closed circulatory system. Heightened platelet reactivity, however, is associated with cardiometabolic diseases and enhanced potential for thrombotic events. We now show gut microbes, through generation of trimethylamine N-oxide (TMAO), directly contribute to platelet hyperreactivity and enhanced thrombosis potential. Plasma TMAO levels in subjects (n \u3e 4,000) independently predicted incident (3 years) thrombosis (heart attack, stroke) risk. Direct exposure of platelets to TMAO enhanced sub-maximal stimulus-dependent platelet activation from multiple agonists through augmented Ca2+ release from intracellular stores. Animal model studies employing dietary choline or TMAO, germ-free mice, and microbial transplantation collectively confirm a role for gut microbiota and TMAO in modulating platelet hyperresponsiveness and thrombosis potential and identify microbial taxa associated with plasma TMAO and thrombosis potential. Collectively, the present results reveal a previously unrecognized mechanistic link between specific dietary nutrients, gut microbes, platelet function, and thrombosis risk

Enhanced feedback interventions to promote evidence-based blood transfusion guidance and reduce unnecessary use of blood components:The AFFINITIE research programme including two cluster factorial RCTs

Background: Blood transfusion is a common but costly treatment. Repeated national audits in the UK suggest that up to one-fifth of transfusions are unnecessary when judged against recommendations for good clinical practice. Audit and feedback seeks to improve patient care and outcomes by comparing clinical care against explicit standards. It is widely used internationally in quality improvement. Audit and feedback generally has modest but variable effects on patient care. A considerable scope exists to improve the impact that audit and feedback has, particularly through head-to-head trials comparing different ways of delivering feedback. Objectives: The AFFINITIE (Development & Evaluation of Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE) programme aimed to design and evaluate enhanced feedback interventions, within a national blood transfusion audit programme, to promote evidence-based guidance and reduce the unnecessary use of blood components. We developed, piloted and refined two feedback interventions, ‘enhanced content’ and ‘enhanced follow-on’ (workstream 1), evaluated the effectiveness and cost-effectiveness of the two feedback interventions compared with standard feedback practice (workstream 2), examined intervention fidelity and contextual influences (workstream 3) and developed general implementation recommendations and tools for other audit and feedback programmes (workstream 4). Design: Interviews, observations and documentary analysis in four purposively sampled hospitals explored contemporary practice and opportunities for strengthening feedback. We developed two interventions: ‘enhanced content’, to improve the clarity and utility of feedback reports, and ‘enhanced follow-on’, to help hospital staff with action-planning (workstream 1). We conducted two linked 2 × 2 factorial cross-sectional cluster-randomised trials within transfusion audits for major surgery and haematological oncology, respectively (workstream 2). We randomised hospital clusters (the organisational level at which hospital transfusion teams operate) to enhanced or standard content or enhanced or standard follow-on. Outcome assessment was masked to assignment. Decision-analytic modelling evaluated the costs, benefits and cost-effectiveness of the feedback interventions in both trials from the perspective of the NHS. A parallel process evaluation used semistructured interviews, documentary analyses and web analytics to assess the fidelity of delivery, receipt and enactment and to identify contextual influences (workstream 3). We explored ways of improving the impact of national audits with their representatives (workstream 4). Setting and participants: All NHS hospital trusts and health boards participating in the National Comparative Audit of Blood Transfusions were invited to take part. Among 189 hospital trusts and health boards screened, 152 hospital clusters participated in the surgical audit. Among 187 hospital trusts and health boards screened, 141 hospital clusters participated in the haematology audit. Interventions: ‘Enhanced content’ aimed to ensure that the content and format of feedback reports were consistent with behaviour change theory and evidence. ‘Enhanced follow-on’ comprised a web-based toolkit and telephone support to facilitate local dissemination, planning and response to feedback. Main outcome measures: Proportions of acceptable transfusions, based on existing evidence and guidance and algorithmically derived from national audit data. Data sources: Trial primary outcomes were derived from manually collected, patient-level audit data. Secondary outcomes included routinely collected data for blood transfusion. Results: With regard to the transfusions in the major surgery audit, 135 (89%) hospital clusters participated from 152 invited. We randomised 69 and 66 clusters to enhanced and standard content, respectively, and 68 and 67 clusters to enhanced and standard follow-on, respectively. We analysed a total of 2222 patient outcomes at 12 months in 54 and 58 (enhanced and standard content, respectively) and 54 and 58 (enhanced and standard follow-on, respectively) hospital clusters. With regard to the haematology audit, 134 hospital clusters (95%) participated from 141 invited. We randomised 66 and 68 clusters to enhanced and standard content, respectively, and 67 clusters to both enhanced and standard follow-on. We analysed a total of 3859 patient outcomes at 12 months in 61 and 61 (enhanced and standard content, respectively) and 63 and 59 (enhanced and standard follow-on) hospital clusters. We found no effect of either of the enhanced feedback interventions in either trial across all outcomes. Incremental enhanced intervention costs ranged from £18 to £248 per site. The enhanced feedback interventions were dominated by the standard intervention in cost-effectiveness analyses. The interventions were delivered as designed and intended, but subsequent local engagement was low. Although the enhancements were generally acceptable, doubts about the credibility of the blood transfusion audits undermined the case for change. Limitations: Limitations included the number of participating clusters; loss to follow-up of trial clusters, reducing statistical power and validity; incomplete audit and cost data contributing to outcome measures; participant self-selection; reporting; missing data related to additional staff activity generated in response to receiving feedback; and recall biases in the process evaluation interviews. Conclusions: The enhanced feedback interventions were acceptable to recipients but were more costly and no more effective than standard feedback in reducing unnecessary use of blood components, and, therefore, should not be recommended on economic grounds. Future work: We have demonstrated the feasibility of embedding ambitious large-scale rigorous research within national audit programmes. Further head-to-head comparisons of different feedback interventions are needed in these programmes to identify cost-effective ways of increasing the impact of the interventions

A global database of lake surface temperatures collected by in situ and satellite methods from 1985–2009

Global environmental change has influenced lake surface temperatures, a key driver of ecosystem structure and function. Recent studies have suggested significant warming of water temperatures in individual lakes across many different regions around the world. However, the spatial and temporal coherence associated with the magnitude of these trends remains unclear. Thus, a global data set of water temperature is required to understand and synthesize global, long-term trends in surface water temperatures of inland bodies of water. We assembled a database of summer lake surface temperatures for 291 lakes collected in situ and/or by satellites for the period 1985–2009. In addition, corresponding climatic drivers (air temperatures, solar radiation, and cloud cover) and geomorphometric characteristics (latitude, longitude, elevation, lake surface area, maximum depth, mean depth, and volume) that influence lake surface temperatures were compiled for each lake. This unique dataset offers an invaluable baseline perspective on global-scale lake thermal conditions as environmental change continues

Risks of mining to salmonid-bearing watersheds

Mining provides resources for people but can pose risks to ecosystems that support cultural keystone species. Our synthesis reviews relevant aspects of mining operations, describes the ecology of salmonid-bearing watersheds in northwestern North America, and compiles the impacts of metal and coal extraction on salmonids and their habitat. We conservatively estimate that this region encompasses nearly 4000 past producing mines, with present-day operations ranging from small placer sites to massive open-pit projects that annually mine more than 118 million metric tons of earth. Despite impact assessments that are intended to evaluate risk and inform mitigation, mines continue to harm salmonid-bearing watersheds via pathways such as toxic contaminants, stream channel burial, and flow regime alteration. To better maintain watershed processes that benefit salmonids, we highlight key windows during the mining governance life cycle for science to guide policy by more accurately accounting for stressor complexity, cumulative effects, and future environmental change.This review is based on an October 2019 workshop held at the University of Montana Flathead Lake Biological Station (more information at https://flbs.umt.edu/ newflbs/research/working-groups/mining-and-watersheds/). We thank E. O’Neill and other participants for valuable contributions. A. Beaudreau, M. LaCroix, P. McGrath, K. Schofield, and L. Brown provided helpful reviews of earlier drafts. Three anonymous reviewers provided thoughtful critiques that greatly improved the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency. Our analysis comes from a western science perspective and hence does not incorporate Indigenous knowledge systems. We acknowledge this gap and highlight that the lands and waters we explore in this review have been stewarded by Indigenous Peoples for millennia and continue to be so. Funding: The workshop was cooperatively funded by the Wilburforce Foundation and The Salmon Science Network funded by the Gordon and Betty Moore Foundation. Author contributions: C.J.S. led the review process, writing, and editing. C.J.S. and E.K.S. co-organized the workshop. E.K.S. and J.W.M. extensively contributed to all aspects of the review conceptualization, writing, and editing. A.R.W., S.A.N., J.L.E., D.M.C., S.L.O., R.L.M., F.R.H., D.C.W., and J.W. significantly contributed to portions of the review conceptualization, writing, and editing. J.C., M.Ca., M.Co., C.A.F., G.K., E.D.L., R.M., V.M., J.K.M., M.V.M., and N.S. provided writing and editing and are listed alphabetically. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials.Ye