An approach to the evaluation of recovery community organizations

Program evaluation is a crucial process that involves the systematic assessment of programs with the aim of improving social conditions and promoting individual and collective well-being. By conducting evaluations, we can effectively demonstrate the effectiveness of social programs, which in turn influences program decision-making, shapes public policy related to the program's social focus, and often serves as justification for ongoing support and funding. Currently, there is a scarcity of published program evaluations specifically focusing on recovery-oriented systems of care and peer recovery support services offered within Recovery Community Centers (RCCs). To address this gap, a series of evaluations have been proposed. These evaluations include a process evaluation that was initially developed for the Iowa Recovery Community Center Project under the Iowa Department of Health and Human Services, as well as subsequent follow-up evaluations. An outcome evaluation has been designed to be conducted when the Recovery Community Centers have been operational for approximately three years and can generate data to substantiate their expected outcomes. Furthermore, an impact evaluation has been devised to assess the functioning of the Recovery Community Centers after five or more years of delivering peer-delivered recovery support services. These evaluation frameworks are based on existing research that supports the benefits of peer-delivered recovery support services in various settings such as clinical treatment, emergency rooms, and jail diversion programs. Additionally, insights and best practices from the Connecticut Community for Addiction Recovery (CCAR) were consulted to inform the evaluation process for Recovery Community Centers. The primary purpose of developing these evaluations is to assess the Iowa RCCs network comprehensively, with the aspiration that they can serve as a model for other networks and contribute to the standardization of RCC evaluation practices. Given the significance and growth of these invaluable resources, it is essential to conduct ongoing evaluation to gauge their implementation and outcomes effectively

Allogeneic Stem Cells Alter Gene Expression and Improve Healing of Distal Limb Wounds in Horses.

Distal extremity wounds are a significant clinical problem in horses and humans and may benefit from mesenchymal stem cell (MSC) therapy. This study evaluated the effects of direct wound treatment with allogeneic stem cells, in terms of gross, histologic, and transcriptional features of healing. Three full-thickness cutaneous wounds were created on each distal forelimb in six healthy horses, for a total of six wounds per horse. Umbilical cord-blood derived equine MSCs were applied to each wound 1 day after wound creation, in one of four forms: (a) normoxic- or (b) hypoxic-preconditioned cells injected into wound margins, or (c) normoxic- or (d) hypoxic-preconditioned cells embedded in an autologous fibrin gel and applied topically to the wound bed. Controls were one blank (saline) injected wound and one blank fibrin gel-treated wound per horse. Data were collected weekly for 6 weeks and included wound surface area, thermography, gene expression, and histologic scoring. Results indicated that MSC treatment by either delivery method was safe and improved histologic outcomes and wound area. Hypoxic-preconditioning did not offer an advantage. MSC treatment by injection resulted in statistically significant increases in transforming growth factor beta and cyclooxygenase-2 expression at week 1. Histologically, significantly more MSC-treated wounds were categorized as pro-healing than pro-inflammatory. Wound area was significantly affected by treatment: MSC-injected wounds were consistently smaller than gel-treated or control wounds. In conclusion, MSC therapy shows promise for distal extremity wounds in horses, particularly when applied by direct injection into the wound margin. Stem Cells Translational Medicine 2018;7:98-108

Report on the Texas Legislature, 85th Session: An Urban Perspective-Criminal Justice Edition

In Texas, the legislature meets every 2 years and at the end of a regular legislative session, hundreds of passed bills will have been sent to the governor for approval. The large number of bills and the wide range of topics they cover can make it difficult to gain an understanding of all the new laws that were passed. At the close of each legislative session the Earl Carl Institute publishes, for the benefit of its constituents, highlights from the session in a bi-annual legislative report. In this year’s publication entitled Report on the Texas Legislature, 85th Session: An Urban Perspective the Institute attempted to cover matters that it believes to be of concern to the urban community, however, many of the highlights cover issues of particular concern to other traditionally disenfranchised communities as well. The legislation covered in these reports generally falls under such issues as Election, Criminal Justice (Human Trafficking, Criminal Procedure, Wrongful Convictions, Domestic Violence), Juvenile Justice, Family Law, Property, Education, Healthcare, Wills, Estate and Probate, Wealth and Litigation. We are pleased to present, via The Bridge: Interdisciplinary Perspectives on Legal & Social Policy, an excerpt this year’s legislative report that highlights legislative actions in the area of criminal justice reform in the State of Texas. The full report, published in August 2017, can be accessed via the Institute’s website www.tsulaw.edu/centers/ECI/publications.html

The DURATIONS randomised trial design: estimation targets, analysis methods and operating characteristics

Background. Designing trials to reduce treatment duration is important in several therapeutic areas, including TB and antibiotics. We recently proposed a new randomised trial design to overcome some of the limitations of standard two-arm non-inferiority trials. This DURATIONS design involves randomising patients to a number of duration arms, and modelling the so-called duration-response curve. This article investigates the operating characteristics (type-1 and type-2 errors) of different statistical methods of drawing inference from the estimated curve. Methods. Our first estimation target is the shortest duration non-inferior to the control (maximum) duration within a specific risk difference margin. We compare different methods of estimating this quantity, including using model confidence bands, the delta method and bootstrap. We then explore the generalisability of results to estimation targets which focus on absolute event rates, risk ratio and gradient of the curve. Results. We show through simulations that, in most scenarios and for most of the estimation targets, using the bootstrap to estimate variability around the target duration leads to good results for DURATIONS design-appropriate quantities analogous to power and type-1 error. Using model confidence bands is not recommended, while the delta method leads to inflated type-1 error in some scenarios, particularly when the optimal duration is very close to one of the randomised durations. Conclusions. Using the bootstrap to estimate the optimal duration in a DURATIONS design has good operating characteristics in a wide range of scenarios, and can be used with confidence by researchers wishing to design a DURATIONS trial to reduce treatment duration. Uncertainty around several different targets can be estimated with this bootstrap approach.Comment: 4 figures, 1 table + additional materia

MotivATE: A Pretreatment Web-Based Program to Improve Attendance at UK Outpatient Services Among Adults With Eating Disorders.

BACKGROUND: In the UK, eating disorders affect upward of 725,000 people per year, and early assessment and treatment are important for patient outcomes. Around a third of adult outpatients in the UK who are referred to specialist eating disorder services do not attend, which could be related to patient factors related to ambivalence, fear, and a lack of confidence about change. This lack of engagement has a negative impact on the quality of life of patients and has implications for service costs. OBJECTIVE: To describe the development of a Web-based program ("MotivATE") designed for delivery at the point of referral to an eating disorder service, with the aim of increasing service attendance. METHODS: We used intervention mapping and a person-based approach to design the MotivATE program and conducted a needs assessment to determine the current impact of service nonattendance on patients (via a review of the qualitative evidence) and services (through a service provision survey to understand current issues in UK services). Following the needs assessment, we followed the five steps of program development outlined by Bartholomew et al (1998): (1) creating a matrix of proximal program objectives; (2) selecting theory-based intervention methods and strategies; (3) designing and organizing the program; (4) specifying adoption and implementation plans; and (5) generating program evaluation plans. RESULTS: The needs assessment identified current nonattendance rates of 10%-32%. We defined the objective of MotivATE as increasing attendance rates at an eating disorder service and considered four key determinants of poor attendance: patient ambivalence about change, low patient self-efficacy, recognition of the need to change, and expectations about assessment. We chose aspects of motivational interviewing, self-determination theory, and the use of patient stories as the most appropriate ways to enable change. Think-aloud piloting with people with lived experience of an eating disorder resulted in positive feedback on the MotivATE program. Participants related well to the stories used. Nonetheless, because of feedback, we further modified the program in line with patients' stage of change and addressed issues with the language used. A consultation with service staff meant that we could make clear implementation plans. Finally, a randomized controlled trial is currently underway to evaluate the MotivATE program. CONCLUSIONS: Using intervention mapping, we have developed a novel pretreatment Web-based program that is acceptable to people with eating disorders. To our knowledge, this is the first such program. The model of development described here could be a useful template for designing further programs for other difficult-to-engage populations

Diversity and Keratin Degrading Ability of Fungi Isolated from Canadian Arctic Marine Bird Feathers

We present the first records of fungi associated with feathers from seabirds and sea ducks in the Canadian Arctic and sub-Arctic. Birds sampled in Nunavut and Newfoundland (Canada) included the Common Eider (Somateria mollissima), King Eider (S. spectabilis), Black-legged Kittiwake (Rissa tridactyla), Northern Fulmar (Fulmarus glacialis), Glaucous Gull (Larus hyperboreus), Black Guillemot (Cepphus grylle), and Thick-billed Murre (Uria lomvia). In total 19 fungal species were cultured from feathers, identified using ITS rDNA barcoding, and screened for their ability to degrade keratin using a keratin azure assay. Our results indicate that 1) of the 19 isolates, 74% were ascomycetes, while the remaining 26% were basidiomycetes (yeasts); 2) 21% of the ascomycete isolates demonstrated keratinolytic activity (a known pathogenicity factor for fungi that may potentially be harmful to birds); 3) the largest number of fungi were cultured from the sampled Thick-billed Murre; and 4) based on a multiple correspondence analysis, there is some indication that both the King Eider and the Thick-billed Murre collected in the low Arctic had distinct fungal communities that were different from each other and from the other birds sampled. Although our sample sizes were small, initial trends in point (4) do demonstrate that additional study is merited to assess whether the fungal community differences are influenced by variation in the known ecologies of the avian hosts and fungi identified.Nous présentons les premiers enregistrements de champignons se rapportant aux plumes d’oiseaux et de canards de mer dans l’Arctique et la région subarctique du Canada. Parmi les oiseaux échantillonnés au Nunavut et à Terre-Neuve (Canada), notons l’eider à duvet (Somateria mollissima), l’eider à tête grise (S. spectabilis), la mouette tridactyle (Rissa tridactyla), le fulmar boréal (Fulmarus glacialis), le goéland bourgmestre (Larus hyperboreus), le guillemot à miroir (Cepphus grylle) et le guillemot de Brünnich (Uria lomvia). En tout, 19 espèces de champignons ont été prélevées à partir de plumes. Elles ont été identifiées au moyen de codes à barres ITS ADNr et examinées afin de déterminer si elles sont capables de dégrader la kératine, et ce, à l’aide d’une épreuve de dégradation de la kératine au bleu azur. Nos résultats indiquent : 1) que parmi les 19 isolats, 74 % étaient des ascomycètes et que les 26 % restants étaient des basidiomycètes (levures); 2) que 21 % des isolats d’ascomycètes ont affiché une activité kératinolytique (un facteur de pathogénicité pour les champignons, facteur susceptible de nuire aux oiseaux); 3) que le plus grand nombre de cultures de champignons a été prélevé chez le guillemot de Brünnich; et 4) que d’après une analyse de correspondance multiple, il y a une certaine indication que les échantillons de l’eider à tête grise et du guillemot de Brünnich recueillis dans le Bas-Arctique comprenaient des communautés fongiques distinctes qui différaient les unes des autres ainsi que des autres oiseaux échantillonnés. Même si la taille de nos échantillons était petite, les premières tendances ressortant du point (4) démontrent qu’il y a lieu de faire des études plus poussées afin de déterminer si les différences entre les communautés fongiques sont influencées par la variation des écologies connues des hôtes aviaires et des champignons identifiés