Trauma-informed measurement-based care for children: Implementation in diverse treatment settings.

Ongoing and comprehensive assessment is a critical part of the implementation of evidence-based care; yet, most providers fail to routinely incorporate measurement into their clinical practice. Few studies have focused on the complex application of routine assessment or measurement-based care (MBC) with children. This pilot examined the acceptability, appropriateness, adoptability, and feasibility of an MBC effort, the Clinical Improvement through Measurement Initiative (CIMI), across several child-serving settings (e.g., community mental health center, residential treatment facility). CIMI includes a comprehensive mental health assessment protocol and combines a mobile technology platform with implementation support. Survey and focus group information, assessing implementation constructs and outcomes, was collected from 44 clinicians and staff. Overall, participants agreed that the implementation process and technology were acceptable, appropriate, and feasible for use in child mental health and that CIMI can be used to guide case conceptualization, facilitate treatment planning, and monitor outcomes. Strategies that supported the implementation process were identified as were recommendations to enhance adoption. Significant differences were observed by Community versus Specialized settings with respect to feasibility and appropriateness, likely because of factors associated with inner setting (climate, compatibility), outer setting (patient needs), and the phase of implementation achieved by sites. Implications and recommendations for tailoring MBC implementation by characteristics related to setting are discussed. MBC across child service settings are discussed in the context of implementation frameworks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Replicative senescence of activated human hepatic stellate cells is accompanied by a pronounced inflammatory but less fibrogenic phenotype.

Limited proliferative capacity is a characteristic of most normal human cells and results in a growth-arrested state, called replicative senescence. Functional expression of the telomerase catalytic subunit (human telomerase reverse transcriptase; hTERT) in human activated hepatic stellate cells (HSCs) rescues them from death with immortalization and maintains an activated HSC phenotype. The aim of this study was to evaluate alterations in gene and protein expression of in vitro aged human activated HSCs and to define the pathway by which senescent-activated HSCs are eliminated in culture. Altered patterns of gene expression in senescent human HSCs were assessed using DNA microarray analysis and compared with early passage HSCs or hTERT immortalized HSCs. Senescent HSCs showed higher expression of inflammation and stress-associated genes as compared with early passage HSCs. Senescent HSCs expressed reduced levels of extracellular matrix proteins, including collagens, tenascin, and fibronectin. TUNEL staining of senescent HSCs showed approximately 21% positive cells, indicating DNA fragmentation and apoptosis. Apoptosis involved the mitochondrial pathway with decreased levels of Bcl-2 and Bcl-x(L) protein, release of cytochrome c, and increased caspase-3 activity. In contrast, 4% to 5% of early activated HSCs or telomerase positive HSCs were TUNEL positive. In conclusion, cultured human HSCs undergo a switch from a fibrogenic to an inflammatory phenotype, suggesting that senescent human HSCs might modulate chronic wound healing processes. Maintenance of telomere length represents an important survival factor for activated human HSCs.