Implementing a Coordinated Care Model for Sex Trafficked Minors in Smaller Cities

Background Addressing the social and clinical service needs of minors who have been sexually exploited remains a challenge across the United States. While larger metropolitan centers have established shelters and service provision specific for trafficked persons, in smaller cities and more rural settings, survivors of trafficking (especially minors) are usually served by multiple, disparate social service and health providers working across different systems. Sexually exploited minors present an even greater challenge due to intersections with child welfare and juvenile justice systems, histories of abuse by family that limit placement options, and limited services that address the complex medical, mental health, and psychosocial needs of these youth. Major health organizations have recommended a coordinated care model that integrates the therapeutic and social service needs of trafficked persons including housing and education; implementation of such service provision requires intensive, multi-sectoral collaboration. Methods We present two case studies from an anti-trafficking coalition established in a smaller urban area. Findings/Conclusions Multi-sector collaboration requires the development of policies and protocols for addressing the diverse needs (acute and ongoing) of trafficked minors who are often “dual jurisdiction,” involved in both the juvenile justice and child welfare systems. Principles of care including autonomy, empowerment, protection, and safety may be at odds as systems may approach these youth differently. A clearly identified care coordinator can help navigate across these systems and facilitate communication among service providers while protecting client privacy, confidentiality, and autonomy. Assessing the quality of services provided and accountability among service providers remain significant challenges, especially in resource limited settings

Early life trauma and its implications for Garda Youth Diversion Services

This research explores the prevalence of adverse childhood experiences (ACEs) among a cohort of young people engaged in Garda Youth Diversion Programmes (GYDP), and the implications for professionals working with these young people. The report begins with an overview of the relevant literature in relation to trauma experiences of people within the criminal justice system and professional responses to trauma, namely trauma-informed practice approaches. The literature review is followed by an outline of the methodology including how ethical concerns were mitigated through the research. Following this, is a profile of the young people in this research group, followed by the primary findings section which presents information on trauma type, prevalence and an analysis by various characteristics such as time in care, employment status and other demographic information. The final two chapters – a thematic analysis of focus groups undertaken with youth workers and Juvenile Liaison Officers, and the discussion section, explore implications of the research findings. The report ends with a recommendation endorsed by the various stakeholders engaged in the research process

The MOSAiC ice floe: Sediment-laden survivor from the Siberian shelf

In September 2019, the research icebreaker Polarstern started the largest multidisciplinary Arctic expedition to date, the MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) drift experiment. Being moored to an ice floe for a whole year, thus including the winter season, the declared goal of the expedition is to better understand and quantify relevant processes within the atmosphere-ice-ocean system that impact the sea ice mass and energy budget, ultimately leading to much improved climate models. Satellite observations, atmospheric reanalysis data, and readings from a nearby meteorological station indicate that the interplay of high ice export in late winter and exceptionally high air temperatures resulted in the longest ice-free summer period since reliable instrumental records began. We show, using a Lagrangian tracking tool and a thermodynamic sea ice model, that the MOSAiC floe carrying the Central Observatory (CO) formed in a polynya event north of the New Siberian Islands at the beginning of December 2018. The results further indicate that sea ice in the vicinity of the CO ( \u3c 40 km distance) was younger and 36 % thinner than the surrounding ice with potential consequences for ice dynamics and momentum and heat transfer between ocean and atmosphere. Sea ice surveys carried out on various reference floes in autumn 2019 verify this gradient in ice thickness, and sediments discovered in ice cores (so-called dirty sea ice) around the CO confirm contact with shallow waters in an early phase of growth, consistent with the tracking analysis. Since less and less ice from the Siberian shelves survives its first summer (Krumpen et al., 2019), the MOSAiC experiment provides the unique opportunity to study the role of sea ice as a transport medium for gases, macronutrients, iron, organic matter, sediments and pollutants from shelf areas to the central Arctic Ocean and beyond. Compared to data for the past 26 years, the sea ice encountered at the end of September 2019 can already be classified as exceptionally thin, and further predicted changes towards a seasonally ice-free ocean will likely cut off the long-range transport of ice-rafted materials by the Transpolar Drift in the future. A reduced long-range transport of sea ice would have strong implications for the redistribution of biogeochemical matter in the central Arctic Ocean, with consequences for the balance of climate-relevant trace gases, primary production and biodiversity in the Arctic Ocean

The MOSAiC ice floe: sediment-laden survivor from the Siberian shelf

In September 2019, the research icebreaker Polarstern started the largest multidisciplinary Arctic expedition to date, the MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) drift experiment. Being moored to an ice floe for a whole year, thus including the winter season, the declared goal of the expedition is to better understand and quantify relevant processes within the atmosphere–ice–ocean system that impact the sea ice mass and energy budget, ultimately leading to much improved climate models. Satellite observations, atmospheric reanalysis data, and readings from a nearby meteorological station indicate that the interplay of high ice export in late winter and exceptionally high air temperatures resulted in the longest ice-free summer period since reliable instrumental records began. We show, using a Lagrangian tracking tool and a thermodynamic sea ice model, that the MOSAiC floe carrying the Central Observatory (CO) formed in a polynya event north of the New Siberian Islands at the beginning of December 2018. The results further indicate that sea ice in the vicinity of the CO (<40 km distance) was younger and 36 % thinner than the surrounding ice with potential consequences for ice dynamics and momentum and heat transfer between ocean and atmosphere. Sea ice surveys carried out on various reference floes in autumn 2019 verify this gradient in ice thickness, and sediments discovered in ice cores (so-called dirty sea ice) around the CO confirm contact with shallow waters in an early phase of growth, consistent with the tracking analysis. Since less and less ice from the Siberian shelves survives its first summer (Krumpen et al., 2019), the MOSAiC experiment provides the unique opportunity to study the role of sea ice as a transport medium for gases, macronutrients, iron, organic matter, sediments and pollutants from shelf areas to the central Arctic Ocean and beyond. Compared to data for the past 26 years, the sea ice encountered at the end of September 2019 can already be classified as exceptionally thin, and further predicted changes towards a seasonally ice-free ocean will likely cut off the long-range transport of ice-rafted materials by the Transpolar Drift in the future. A reduced long-range transport of sea ice would have strong implications for the redistribution of biogeochemical matter in the central Arctic Ocean, with consequences for the balance of climate-relevant trace gases, primary production and biodiversity in the Arctic Ocean

Sensitive and specific detection of Crimean-Congo Hemorrhagic Fever Virus (CCHFV)-Specific IgM and IgG antibodies in human sera using recombinant CCHFV nucleoprotein as antigen in μ-capture and IgG immune complex (IC) ELISA tests.

As the most widespread tick-borne arbovirus causing infections in numerous countries in Asia, Africa and Europe, Crimean-Congo Hemorrhagic Fever Virus (CCHFV, family Nairoviridae) was included in the WHO priority list of emerging pathogens needing urgent Research & Development attention. To ensure preparedness for potential future outbreak scenarios, reliable diagnostic tools for identification of acute cases as well as for performance of seroprevalence studies are necessary. Here, the CCHFV ortholog of the major bunyavirus antigen, the nucleoprotein (NP), was recombinantly expressed in E.coli, purified and directly labeled with horseradish peroxidase (HRP). Employing this antigen, two serological tests, a μ-capture ELISA for the detection of CCHFV-specific IgM antibodies (BLACKBOX CCHFV IgM) and an IgG immune complex (IC) ELISA for the detection of CCHFV-specific IgG antibodies (BLACKBOX CCHFV IgG), were developed. Test performance was evaluated and compared with both in-house gold standard testing by IgM/IgG indirect immunofluorescence (IIF) and commercially available ELISA tests (VectoCrimean-CHF-IgM/IgG, Vector-Best, Russia) using a serum panel comprising paired samples collected in Kosovo during the years 2013-2016 from 15 patients with an acute, RT-PCR-confirmed CCHFV infection, and 12 follow-up sera of the same patients collected approximately one year after having overcome the infection. Reliably detecting IgM antibodies in all acute phase sera collected later than day 4 after onset of symptoms, both IgM ELISAs displayed excellent diagnostic and analytical sensitivity (100%, 95% confidence interval (CI): 85.2%-100.0%). While both IgG ELISAs readily detected the high IgG titers present in convalescent patients approximately one year after having overcome the infection (sensitivity 100%, 95% CI: 73.5%-100.0%), the newly developed BLACKBOX CCHFV IgG ELISA was superior to the commercial IgG ELISA in detecting the rising IgG titers during the acute phase of the disease. While all samples collected between day 11 and 19 after onset of symptoms tested positive in both the in-house gold standard IIFT and the BLACKBOX CCHFV IgG ELISA (sensitivity 100%, 95% CI: 71.5%-100.0%), only 27% (95% CI: 6.0%-61.0%) of those samples were tested positive in the commercial IgG ELISA. No false positive signals were observed in either IgM/IgG ELISA when analyzing a priori CCHFV IgM/IgG negative serum samples from healthy blood donors, malaria patients and flavivirus infected patients as well as CCHFV IgM/IgG IIFT negative serum samples from healthy Kosovar blood donors (for BLACKBOX CCHFV IgM/IgG: n = 218, 100% specificity, 95% CI: 98.3%-100.0%, for VectoCrimean-CHF-IgM/IgG: n = 113, 100% specificity, 95% CI: 96.8%-100.0%)

Inter-laboratory variation of BLACKBOX CCHFV IgG ELISA.

<p>Inter-laboratory variation of BLACKBOX CCHFV IgG ELISA.</p

Analysis of CCHF patient samples: Raw data (OD450 – OD620), dependence from day after onset.

<p><b>(A) BLACKBOX CCHFV IgM ELISA. (B) BLACKBOX CCHFV IgG ELISA. (C) VectoCrimean-CHF-IgM ELISA. (D) VectoCrimean-CHF-IgG ELISA.</b> Paired serum samples from 15 CCHF patients were classified according to their time point of collection (days after onset of symptoms). Filled circles indicate PCR positive serum samples. Cut-off values (represented by dotted lines) were determined by ROC analysis ((A): 0.129, (B): 0.161) or according to the manufacturer’s instructions ((C): 0.240, (D): 0.246), respectively (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006366#pntd.0006366.s003" target="_blank">S2 Fig</a>).</p

Analysis of paired CCHF patient samples: Raw data (OD420 – OD620).

<p>A serum panel consisting of 30 paired serum samples from 15 CCHF patients, serum samples from 12 CCHF patients collected approximately one year after recovery from CCHFV infection, a set of a priori CCHFV IgM/IgG negative serum samples (neg) ((A), (B): n = 120; (C), (D): n = 15, see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006366#pntd.0006366.s002" target="_blank">S1 Fig</a>), and 98 CCHFV IgM/IgG IIFT negative sera from healthy blood donors from Kosovo (HD K) were analyzed with the <b>BLACKBOX CCHFV IgM ELISA (A)</b>, the <b>BLACKBOX CCHFV IgG ELISA (B),</b> the <b>VectoCrimean-CHF-IgM ELISA (C)</b> and the <b>VectoCrimean-CHF-IgG ELISA (D).</b> Cut-off values (represented by dotted lines) were determined by ROC analysis ((A): 0.129, (B): 0.161) or according to the manufacturer’s instructions ((C): 0.240, (D): 0.246), respectively (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006366#pntd.0006366.s003" target="_blank">S2 Fig</a>). Filled circles indicate PCR positive serum samples.</p

Intra- and interassay variation of BLACKBOX CCHFV IgM ELISA.

<p>Intra- and interassay variation of BLACKBOX CCHFV IgM ELISA.</p

Analysis of CCHF patient samples, dependence from day after onset: Comparison of BLACKBOX CCHFV IgG ELISA, VectoCrimean-CHF IgG ELISA and in-house IgG IIFT results.

<p>Analysis of CCHF patient samples, dependence from day after onset: Comparison of BLACKBOX CCHFV IgG ELISA, VectoCrimean-CHF IgG ELISA and in-house IgG IIFT results.</p