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This study utilized a qualitative approach to learn about a co-educational housing pilot program in a rural serving, four-year regional university in the mid-south United States. Four individuals involved in the program took part in semi-structured interviews. Open coding analysis revealed four themes: sense of belonging, learning, gender and sexuality, and secrets. [ABSTRACT FROM AUTHOR]

This paper examines whether larger tick sizes improve or hinder price efficiency for small‐capitalization stocks using data from implementing and terminating the Tick Size Pilot Program (TSPP). We show that the TSPP led to increases in various liquidity measures, and its termination restored them to their pre‐TSPP levels. We also find evidence that the TSPP led to trader migration from the pilot to control stocks. The TSPP implementation (termination) is associated with decreases (increases) in price efficiency, indicating that price efficiency decreases with tick sizes. Liquidity and informed trading are two channels through which the TSPP changes price efficiency. [ABSTRACT FROM AUTHOR]

Although comprehensive school-wide interventions targeting bullying have proven effective, many schools, particularly those in low-to-middle income countries like Pakistan, lack the necessary resources to implement them. As a result, implementing cost-effective antibullying bystander programs that train students to become peer advocates is a promising approach for intervening in bullying incidents. Peer training in antibullying intervention involves training students to take on leadership roles and advocate for antibullying initiatives within their school communities. The aim of this study was to design, implement, and evaluate a peer-training module that was subsequently implemented in four schools (N = 38, boys = 26, girls = 12) in Pakistan. The aim was to raise awareness and prepare a team of peer mentors to effectively implement antibullying policies in educational institutions. Pre-post tests and participant feedback were used to evaluate the effectiveness of the peer-training program in increasing knowledge and awareness of bullying and the role of bystanders among trained peer mentors. To determine the impact of the peer mentor training on improving the school environment, data were also collected from students (N = 219, boys = 152, girls = 67) before and after the implementation of the program. The pilot implementation of the peer-training module was considered successful, indicating that the training was effective in improving the knowledge of peer mentors and could be used in a similar way in future cases. The results also showed a significant improvement in the development of prosocial bystanders. However, although improvements were observed in other aspects of the school environment, these did not reach statistical significance. The discussion section includes recommendations and explanations for differences based on gender and urban–rural factors. Suggestions are also made to improve the results for future applications. [ABSTRACT FROM AUTHOR]

Background: The Extracorporeal Life Support Organization Supplies Platform was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product shortage prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables from other Centers when alternative avenues are exhausted. Methods: Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing Platform. The pandemic created by COVID-19 became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. Conclusions: Records kept on the Platform website are helpful to the industry by providing insights into where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, of how critical situations can stretch resources and challenge our resolve for the best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply shortages. [ABSTRACT FROM AUTHOR]

Background: Veterans Affairs Farming and Recovery Mental Health Services (VA FARMS) is an innovative pilot program to provide supportive resources for veterans with interests in agricultural vocations. Implemented at 10 pilot sites, VA FARMS will provide mental health services and resources for veterans while supporting training in gardening and agriculture. As each pilot site project has unique goals, outreach strategies, and implementation efforts based on the local environment and veteran population, evaluating the pilot program provides a unique challenge for evaluators. This paper describes the protocol to evaluate VA FARMS, which was specifically designed to enable site variation by providing both site-specific and cross-site understanding of site implementation processes and outcomes. Objective: The objectives of this paper are to (1) describe the protocol used for evaluating VA FARMS, as an innovative Department of Veterans Affairs (VA) agriculturally based, mental health, and employment pilot program serving veterans at 10 pilot sites across the Veterans Health Administration enterprise; and (2) provide guidance to other evaluators assessing innovative programs. Methods: This evaluation uses the context, inputs, process, product (CIPP) model, which evaluates a program's content and implementation to identify strengths and areas for improvement. Data collection will use a concurrent mixed methods approach. Quantitative data collection will involve quarterly program surveys, as well as three individual veteran participant surveys administered upon the veteran's entrance and exit of the pilot program and 3 months postexit. Quantitative data will include baseline descriptive statistics and follow-up statistics on veteran health care utilization, health care status, and agriculture employment status. Qualitative data collection will include participant observation at each pilot site, and interviews with participants, staff, and community stakeholders. Qualitative data will provide insights about pilot program implementation processes, veterans' experiences, and short-term participation outcomes. Results: Evaluation efforts began in December 2018 and are ongoing. Between October 2018 and September 2020, 494 veterans had enrolled in VA FARMS and 1326 veterans were reached through program activities such as demonstrations, informational presentations, and town-hall discussions. A total of 1623 community members and 655 VA employees were similarly reached by VA FARMS programming during that time. Data were collected between October 2018 and September 2020 in the form of 336 veteran surveys, 30 veteran interviews, 27 staff interviews, and 11 community partner interviews. Data analysis is expected to be completed by October 2022. Conclusions: This evaluation protocol will provide guidance to other evaluators assessing innovative programs. In its application to the VA FARMS pilot, the evaluation aims to add to existing literature on nature-based therapies and the rehabilitation outcomes of agricultural training programs for veterans. Results will provide programmatic insights on the implementation of pilot programs, along with needed improvements and modifications for the future expansion of VA FARMS and other veteran-focused agricultural programs. [ABSTRACT FROM AUTHOR]

Although comprehensive school-wide interventions targeting bullying have proven effective, many schools, particularly those in low-to-middle income countries like Pakistan, lack the necessary resources to implement them. As a result, implementing cost-effective antibullying bystander programs that train students to become peer advocates is a promising approach for intervening in bullying incidents. Peer training in antibullying intervention involves training students to take on leadership roles and advocate for antibullying initiatives within their school communities. The aim of this study was to design, implement, and evaluate a peer-training module that was subsequently implemented in four schools (N = 38, boys = 26, girls = 12) in Pakistan. The aim was to raise awareness and prepare a team of peer mentors to effectively implement antibullying policies in educational institutions. Pre-post tests and participant feedback were used to evaluate the effectiveness of the peer-training program in increasing knowledge and awareness of bullying and the role of bystanders among trained peer mentors. To determine the impact of the peer mentor training on improving the school environment, data were also collected from students (N = 219, boys = 152, girls = 67) before and after the implementation of the program. The pilot implementation of the peer-training module was considered successful, indicating that the training was effective in improving the knowledge of peer mentors and could be used in a similar way in future cases. The results also showed a significant improvement in the development of prosocial bystanders. However, although improvements were observed in other aspects of the school environment, these did not reach statistical significance. The discussion section includes recommendations and explanations for differences based on gender and urban–rural factors. Suggestions are also made to improve the results for future applications.

Abstract Young adults experiencing homelessness are at high risk of opioid and other substance use, poor mental health outcomes, exposure to trauma, and other risks. Providing access to stable housing has the potential to act as a powerful preventive intervention, but supportive housing programs have been studied most often among chronically homeless adults or adults with serious mental illness. The Housing First model, which does not precondition supportive housing on sobriety, may reduce drug use in homeless adults. In the present study, we piloted an adapted model of Housing First plus prevention services that was tailored to the needs of young adults (18–24 years) experiencing homelessness in the USA. Preventive services were added to the Housing First model and included youth-centered advocacy services, motivational interviewing, and HIV risk prevention services. This model was piloted in a single-arm study (n = 21) to assess the feasibility, acceptability, and initial efficacy of a Housing First model over a 6-month period in preparation for a larger randomized trial. We use repeated measures ANOVA to test for changes in alcohol and drug use (percent days of use; alcohol or drug use consequences), housing stability, social network support, and cognitive distortions over 6 months of follow-up. A total of 17 youth completed the study (85% retention), and a high proportion of youth were stably housed at 6-month follow-up. Participation in intervention services was high with an average of 13.57 sessions for advocacy, 1.33 for MI, and 0.76 for HIV prevention. Alcohol use did not change significantly over time. However, drug use, drug use consequences, and cognitive distortions, and the size of youths’ social networks that were drug using individuals decreased significantly. The Housing First model appeared to be feasible to deliver, and youth engaged in the supportive intervention services. The study demonstrates the potential for an adapted Housing First model to be delivered to youth experiencing homelessness and may improve outcomes, opening the way for larger randomized trials of the intervention.

Background: In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns., Objective: This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective., Methods: Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable)., Results: We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts., Conclusions: This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions., (©Jean-Eric Tarride, Justin N Hall, Shawn Mondoux, Katie N Dainty, Joy McCarron, J Michael Paterson, Lesley Plumptre, Emily Borgundvaag, Howard Ovens, Shelley L McLeod. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.07.2024.)

Abstract Background To achieve the health equity, it is important to reduce socioeconomic inequalities when managing chronic diseases. In South Korea, a pilot program for chronic diseases was implemented at the national level. This study aimed to examine its effect on socioeconomic inequalities in chronic disease management at the individual and regional levels. Methods Korean National Health Insurance data from September 2016 to October 2017 were used. Study subjects in the national pilot program for chronic diseases included 31,765 participants and 5,741,922 non-participants. The dependent variable was continuity of prescription medication. Socioeconomic position indicators were health insurance contribution level and the area deprivation index. Covariates were gender, age, and the Charlson Comorbidity Index (CCI). A multilevel logistic regression model was used to address the effects at both the individual and regional levels. This is a cross-sectional study. Results Unlike the group of non-participants, the participants showed no inequality in prescription medication continuity according to individual-level socioeconomic position. However, continuity of prescription medication was higher among those in less deprived areas compared to those in more deprived areas in both the participation and non-participation groups. Conclusions This study found that the pilot program for chronic diseases at the least did not contribute to the worsening of health inequalities at the individual level in South Korea. However, there was a trend showing health inequalities based on the socioeconomic level of the area. These findings suggest that additional policy measures are needed to attain equality in the management of chronic diseases regardless of the regional socioeconomic position.

Young adults experiencing homelessness are at high risk of opioid and other substance use, poor mental health outcomes, exposure to trauma, and other risks. Providing access to stable housing has the potential to act as a powerful preventive intervention, but supportive housing programs have been studied most often among chronically homeless adults or adults with serious mental illness. The Housing First model, which does not precondition supportive housing on sobriety, may reduce drug use in homeless adults. In the present study, we piloted an adapted model of Housing First plus prevention services that was tailored to the needs of young adults (18–24 years) experiencing homelessness in the USA. Preventive services were added to the Housing First model and included youth-centered advocacy services, motivational interviewing, and HIV risk prevention services. This model was piloted in a single-arm study (n = 21) to assess the feasibility, acceptability, and initial efficacy of a Housing First model over a 6-month period in preparation for a larger randomized trial. We use repeated measures ANOVA to test for changes in alcohol and drug use (percent days of use; alcohol or drug use consequences), housing stability, social network support, and cognitive distortions over 6 months of follow-up. A total of 17 youth completed the study (85% retention), and a high proportion of youth were stably housed at 6-month follow-up. Participation in intervention services was high with an average of 13.57 sessions for advocacy, 1.33 for MI, and 0.76 for HIV prevention. Alcohol use did not change significantly over time. However, drug use, drug use consequences, and cognitive distortions, and the size of youths' social networks that were drug using individuals decreased significantly. The Housing First model appeared to be feasible to deliver, and youth engaged in the supportive intervention services. The study demonstrates the potential for an adapted Housing First model to be delivered to youth experiencing homelessness and may improve outcomes, opening the way for larger randomized trials of the intervention. [ABSTRACT FROM AUTHOR]

Introduction: Pilot programs are integral to catalyzing and accelerating research at Clinical and Translational Science Award (CTSA) hubs. However, little has been published about the structure and operationalization of pilot programs or how they impact the translational research enterprise at CTSAs. The North Carolina Translational and Clinical Science Institute (NC TraCS), the CTSA hub at the University of North Carolina at Chapel Hill (UNC-CH) conducted an evaluation case study to describe the pilot program structure, assess process outcomes, and provide a framework for other institutions to utilize for the evaluation of their respective pilot programs. Methods: We describe the operationalization of our pilot program, the evaluation framework utilized to evaluate the program, and how we analyzed available data to understand how our pilot funding opportunities were utilized by investigators. We calculated application volumes and funding rates by investigator position title and pilot application type. We also reviewed feedback provided by pilot Principal Investigators (PIs) to understand how many pilot projects were completed, NC TraCS service utilization, and barriers to research. Limited data on publications and subsequent funding was also reviewed. Results: Between 2009 and 2019 the NC TraCS Pilot Program received 2343 applications and funded 933 projects, ranging from $2000 to $100,000 in amount, with an overall funding rate of 39.8%. Utilization of NC TraCS services had positive impacts on both resubmission funding and project completion rates. Conclusion: This process evaluation indicates that the program is being operationalized in a way that successfully fulfills the program mission while meeting the needs of a diverse group of researchers. [ABSTRACT FROM AUTHOR]

Background: To achieve the health equity, it is important to reduce socioeconomic inequalities when managing chronic diseases. In South Korea, a pilot program for chronic diseases was implemented at the national level. This study aimed to examine its effect on socioeconomic inequalities in chronic disease management at the individual and regional levels.Methods: Korean National Health Insurance data from September 2016 to October 2017 were used. Study subjects in the national pilot program for chronic diseases included 31,765 participants and 5,741,922 non-participants. The dependent variable was continuity of prescription medication. Socioeconomic position indicators were health insurance contribution level and the area deprivation index. Covariates were gender, age, and the Charlson Comorbidity Index (CCI). A multilevel logistic regression model was used to address the effects at both the individual and regional levels. This is a cross-sectional study.Results: Unlike the group of non-participants, the participants showed no inequality in prescription medication continuity according to individual-level socioeconomic position. However, continuity of prescription medication was higher among those in less deprived areas compared to those in more deprived areas in both the participation and non-participation groups.Conclusions: This study found that the pilot program for chronic diseases at the least did not contribute to the worsening of health inequalities at the individual level in South Korea. However, there was a trend showing health inequalities based on the socioeconomic level of the area. These findings suggest that additional policy measures are needed to attain equality in the management of chronic diseases regardless of the regional socioeconomic position. [ABSTRACT FROM AUTHOR]

The authors developed a patient decision aid (PDA) to educate patients regarding CAD. Patients were randomized to standard of care or a PDA. PDA group had increased medical knowledge of CAD and decreased decisional conflict. Patients presenting in an outpatient setting with symptoms may benefit from the use of a PDA. (Level of Difficulty: Beginner.)

Abstract Introduction: Pilot programs are integral to catalyzing and accelerating research at Clinical and Translational Science Award (CTSA) hubs. However, little has been published about the structure and operationalization of pilot programs or how they impact the translational research enterprise at CTSAs. The North Carolina Translational and Clinical Science Institute (NC TraCS), the CTSA hub at the University of North Carolina at Chapel Hill (UNC-CH) conducted an evaluation case study to describe the pilot program structure, assess process outcomes, and provide a framework for other institutions to utilize for the evaluation of their respective pilot programs. Methods: We describe the operationalization of our pilot program, the evaluation framework utilized to evaluate the program, and how we analyzed available data to understand how our pilot funding opportunities were utilized by investigators. We calculated application volumes and funding rates by investigator position title and pilot application type. We also reviewed feedback provided by pilot Principal Investigators (PIs) to understand how many pilot projects were completed, NC TraCS service utilization, and barriers to research. Limited data on publications and subsequent funding was also reviewed. Results: Between 2009 and 2019 the NC TraCS Pilot Program received 2343 applications and funded 933 projects, ranging from $2000 to $100,000 in amount, with an overall funding rate of 39.8%. Utilization of NC TraCS services had positive impacts on both resubmission funding and project completion rates. Conclusion: This process evaluation indicates that the program is being operationalized in a way that successfully fulfills the program mission while meeting the needs of a diverse group of researchers.

Evaluation researchers at Clinical and Translational Science Award (CTSA) hubs are conducting retrospective case studies to evaluate the translational research process. The objective of this study was to deepen knowledge of the translational process and identify contributors to successful translation. We investigated the successful translation of the HemeChip, a low-cost point-of-care diagnostic device for sickle cell disease, using a protocol for retrospective translational science case studies of health interventions developed by evaluators at the National Health Institutes (NIH) and CTSA hubs. Development of the HemeChip began in 2013 and evidence of device use and impact on public health is growing. Data collection methods included five interviews and a review of press, publications, patents, and grants. Barriers to translation included proving novelty, manufacturing costs, fundraising, and academic-industry relations. Facilitators to translation were CTSA pilot program funding, university resources, entrepreneurship training, due diligence, and collaborations. The barriers to translation, how they were overcome, and the key facilitators identified in this case study pinpoint areas for consideration in future funding mechanisms and the infrastructure required to enable successful translation.

Entrustable professional activities (EPAs) are observable clinical skills and/or procedures that have been introduced into medical education at the student and resident levels in most specialties to determine readiness to advance into residency or independent practice, respectively. This publication describes the process and outcomes of a pilot study looking at the feasibility of using two anatomic pathology and two clinical pathology EPAs in pathology residency in 6 pathology residency programs that volunteered for the study. Faculty development on EPAs and their assessment was provided to pilot program faculty, and EPA assessment tools were developed and used by the pilot programs. Pre- and post-study surveys were given to participating residents, faculty, and program directors to gauge baseline practices and to gather feedback on the EPA implementation experience. Results demonstrated overall good feasibility in implementing EPAs. Faculty acceptance of EPAs varied and was less than that of program directors. Residents reported a significant increase in the frequency with which faculty provided formative assessments that included specific examples of performance and specific ways to improve, as well as increased frequency with which faculty provided summative assessments that included specific ways to improve. EPAs offered the most benefit in setting clear expectations for performance of each task, for providing more specific feedback to residents, and in increasing Program director's understanding of resident strengths abilities and weaknesses., (© 2024 The Author(s).)

Introduction: The idea of implementing theatrical acts in medical education has recently been gaining attention, with the inclusion of art-based programs in medical curricula being a growing trend. This study aimed to present an innovative pilot program of presenting medical emergencies through theatrical presentation. Materials and Methods: Students-members of the theatrical team of Democritus University of Thrace and the Scientific Society of Hellenic Medical Students were appointed into eight groups, supervised by a clinical tutor. The groups were given four weeks to prepare scenarios for eight different medical emergencies and organize a theatrical sketch accordingly. A 25-item questionnaire was formed and distributed to the audience. Each theatrical act lasted 10 min, followed by a 10 min discussion between the tutors and the audience. After the event, the impressions of the attendees were documented in the questionnaire as responses on a Likert scale from one (strongly disagree) to five (strongly agree). Results: Two hundred and thirty-two fully completed questionnaires were returned. The contribution of theatrical presentation to medical education was widely acknowledged (Likert score 4.14 ± 0.68). Theatrical seminars were not deemed insufficient to provide medical information (disagreed or strongly disagreed 53.8 % and 12.1 %, respectively). Most students were optimistic about the long-term maintenance of the theatrical-aided knowledge, with the majority of attendees (52.1 %) adapting a more favorable response after the seminar (p <0.001). The students' efficacy to recognize medical emergencies was improved (from 2.96 to 3.43, p <0.001). Conclusion: Students find the theatrical approach of emergency cases entertaining and educational, facilitating teaching in medicine and enhancing their efficacy to recognize medical emergencies and the commonest pitfalls in their diagnosis and management. Such events may be established as a supplementary educational tools to the classical amphitheatric didactic lectures. Future studies with specific objective tools are needed to validate the abovementioned tasks. [ABSTRACT FROM AUTHOR]

Transit accounts for just two percent of total travel in the U.S. One reason for low ridership is limited access; many individuals either live or work too far from a transit station. In developing transit connectivity solutions, researchers often employ a range of study instruments, such asstated-preference surveys, focus groups, and pilot programs. To better understand response to one innovative transit solution, the authors employed a number of research tools, including: a longitudinal survey, field test, and pilot program. The innovation examined was a commutercarsharing model, called CarLink, which linked short-term rental vehicles to transit andemployment centers. Over several years, researchers explored user response to the CarLinkconcept, a field operational test (CarLink I), a pilot program (CarLink II), and a commercial operation (the pilot was turned over to Flexcar in summer 2002). This multi-staged approach provided an opportunity for researchers to learn and adapt as each phase progressed. In thispaper, the authors outline the CarLink model, technology, and early lessons learned; describe CarLink II operational understanding; provide a synopsis of the pilot program transition; and offer recommendations for future model development.

Transit accounts for just two percent of total travel in the U.S. One reason for low ridership is limited access; many individuals either live or work too far from a transit station. In developing transit connectivity solutions, researchers often employ a range of study instruments, such as stated-preference surveys, focus groups, and pilot programs. To better understand response to one innovative transit solution, the authors employed a number of research tools, including: a longitudinal survey, field test, and pilot program. The innovation examined was a commuter carsharing model, called CarLink, which linked short-term rental vehicles to transit and employment centers. Over several years, researchers explored user response to the CarLink concept, a field operational test (CarLink I), a pilot program (CarLink II), and a commercial operation (the pilot was turned over to Flexcar in summer 2002). This multi-staged approach provided an opportunity for researchers to learn and adapt as each phase progressed. In this paper, the authors outline the CarLink model, technology, and early lessons learned; describe CarLink II operational understanding; provide a synopsis of the pilot program transition; and offer recommendations for future model development.

The place of clinical, medical, or health professional interventions in addressing violent radicalization is a topic of ongoing debate. Although violent radicalization is primarily a social phenomenon with significant psychological dimensions, the high prevalence of mental health “issues” and past psychiatric diagnosis in lone actors suggests that it may be useful to distinguish socialized actors who have strong ties to structured extremist organizations from relatively socially isolated actors who claim, and even boast about, virtual affiliation to extremist groups. For the latter, the potential efficacy of mental health interventions should be considered. However, because of the risk of profiling, stigmatization of minorities, pathologizing social dissent, and resistance, clinical intervention may cause harm and should be carefully evaluated. Until the effectiveness of clinical interventions in reducing radical violence is improved through evaluative research, exchanges about existing clinical models can be useful to support practitioners in the field and provide initial insights about good and potentially harmful practices. The Quebec model of clinical services to mitigate violent radicalization (secondary and tertiary prevention) is structured around three pillars: multiple access points to facilitate outreach and decrease stigma; specialized teams to assess and formulate treatment plans based on existing best evidence in forensic, social, and cultural psychiatry; and collaborative involvement with primary care services, such as community mental health, education, and youth protection institutions, which are in charge of social integration and long-term management. Beyond the initial assessment, the program offers psychotherapy and/or psychiatric interventions services, including mentorship to foster clients’ social integration and life-skill development. Artistic programs offering a semi-structured, nonjudgmental environment, thus fostering self-expression and creativity, are very well received by youth. A multimedia pilot program involving young artists has been shown to provide them with alternative means of expressing their dissent. Three years on from its inception, the preliminary evaluation of the Quebec clinical model by its partners and clinicians suggests that it could be considered a promising approach to address the specific challenges of individuals who present as potential lone actors at high risk of violent radicalization. The model does not, however, appear to reach many members of extremist groups who do not present individual vulnerabilities. While initial signs are positive, a rigorous evaluation is warranted to establish the short, medium, and long-term efficacy of the model, and to eventually identify the key elements which may be transferable to other clinical settings. In 2020, a five-year evaluative research project began to examine these questions. It is important to consider that any intervention can be harmful if due attention is not paid to structural discrimination and violence stemming from associated marginalization and exclusion. Clinical care can in no way replace social justice, equity, and human rights—all key pillars in primary prevention against violent radicalization. In the meantime, however, providing empathy and care in the face of despair and rage may prove most beneficial in decreasing the risk of violent acts.

National parks have been adopted for over a century to enhance the protection of valued natural landscapes in countries worldwide. For decades, China has emphasized the importance of economic growth over ecological health to the detriment of its protected areas. After decades of environmental degradation, dramatic loss of biodiversity, and increasing pressure from the public to improve and protect natural landscapes, China’s central government recently proposed the establishment of a pilot national park system to address these issues. This study provides an overview of the development of selected conventional protected areas (CPAs) and the ten newly established pilot national parks (PNPs). A literature review was conducted to synthesize the significant findings from previous studies, and group workshops were conducted to integrate expert knowledge. A qualitative analysis was performed to evaluate the effectiveness of the pilot national park system. The results of this study reveal that the PNP system could be a potential solution to the two outstanding issues facing CPAs, namely the economic prioritization over social and ecological considerations that causes massive ecological degradation, and the conflicting, overlapping, and inconsistent administrative and institutional structures that result in serious inefficiencies and conflicts.

The Pilot Program was an initiative of the Brazilian government, the G7 countries and the World Bank in international cooperation to conserve the Brazilian rain forests. Compatibility between ecological, economic and social interests should be proved, revaluing the natural legacy, production potentialities and the cultural diversity of the regional population. The subprograms concentrated on supporting sustainable production, implementation of protected areas, strengthening of regional public institutions, responsible for environmental management, support of scientific research and cooperation with NGOs. In spite of structural deficiencies, the Program was one of the most successful examples in conserving tropical rain forests and in sustainable use of natural resources. The Pilot Program stood for the beginning of a new phase of responsible environmental policy for the Amazon region, with social participation, public-private partnership and qualification of people and institutions in environmental management. After the conclusion of the Program which has fallen into oblivion in the meantime, the positive results should be much more considered in future environmental programs. [ABSTRACT FROM AUTHOR]