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This field guide is a first step by a collaborative of California child-serving education, health, and social service experts and leaders to further California's current efforts toward one effective, integrated, comprehensive, school-based child-serving system. The guide includes guidance for both local education agencies (LEAs) and state leaders, with details and implementation guidance on a wide variety of cross-sector initiatives to support the whole child. Using a whole-child approach, this guide outlines resources and strategies for LEAs and state leaders to use to support the implementation of funding that centers children and families. The guide includes six major initiatives that can serve as part of an integrated, school-based system of care: Adverse Childhood Experiences (ACES) Aware Initiative, Children and Youth Behavioral Health Initiative (CYBHI), Children and Youth System of Care, community schools initiatives, early childhood initiatives, and expanded learning. The guide also focuses specifically on how to fund various components of an integrated, school-based system of care, providing strategies for funding sustainability and further details about funding sources for comprehensive services. The guide concludes with a discussion of how state leaders facilitate the ability of LEAs to establish integrated, school-based systems of care by modeling cross-sector collaboration at the state level to reduce the current barriers that LEAs face. [This guide was produced with Breaking Barriers, California Alliance of Child and Family Services, and the Santa Clara County Office of Education.]

Focusing on Wagner Group (WG) forces, liberal interveners too readily dismiss the scope of WG’s Africa engagements, including economic and political “flows” that, in combination, challenge liberal interveners’ taken-for-granted access in several states on the African continent. Operationalising the notion of “flows,” we present an analysis that foregrounds both the scope of WG’s Africa engagements and the challenges. We portray WG as a broad enterprise by attending to military, economic, and political flows. This broadening is relevant to how WG is understood to challenge liberal interveners. Besides country-specific challenges to liberal interveners’ access (notably in states where they have been asked to depart or co-exist with WG), a broader reading of WG’s Africa presence also foregrounds challenges at a different level, namely to liberal interveners’ assumptions about the inevitable attractiveness of the liberal international order. A liberal order that Russia has utilised WG’s Africa presence to contest. As such, challenges at the level of liberal order go beyond WG’s Africa presence and must, therefore, be viewed alongside other challenges to liberal intervention and order, from the Taliban’s takeover of Kabul to Russia’s invasion of Ukraine. If liberal interveners’ missteps and historicity, as well as the scope of WG’s Africa engagements, remain underappreciated, then various challenges specific to the WG, but also broader challenges to liberal interveners’ assumptions about liberal order as self-evidently attractive, are too readily dismissed. Liberal actors’ dismissiveness may invite misguided responses and unintentionally become an enabling factor for WG’s influence in Africa., Focusing on Wagner Group (WG) forces, liberal interveners too readily dismiss the scope of WG’s Africa engagements, including economic and political “flows” that, in combination, challenge liberal interveners’ taken‐for‐granted access in several states on the African continent. Operationalising the notion of “flows,” we present an analysis that foregrounds both the scope of WG’s Africa engagements and the challenges. We portray WG as a broad enterprise by attending to military, economic, and political flows. This broadening is relevant to how WG is understood to challenge liberal interveners. Besides country‐specific challenges to liberal interveners’ access (notably in states where they have been asked to depart or co‐exist with WG), a broader reading of WG’s Africa presence also foregrounds challenges at a different level, namely to liberal interveners’ assumptions about the inevitable attractiveness of the liberal international order. A liberal order that Russia has utilised WG’s Africa presence to contest. As such, challenges at the level of liberal order go beyond WG’s Africa presence and must, therefore, be viewed alongside other challenges to liberal intervention and order, from the Taliban’s takeover of Kabul to Russia’s invasion of Ukraine. If liberal interveners’ missteps and historicity, as well as the scope of WG’s Africa engagements, remain underappreciated, then various challenges specific to the WG, but also broader challenges to liberal interveners’ assumptions about liberal order as self‐evidently attractive, are too readily dismissed. Liberal actors’ dismissiveness may invite misguided responses and unintentionally become an enabling factor for WG’s influence in Africa.

Objective. Histopathological examinations will diminish as minimally invasive epilepsy surgery increasingly replaces open surgery. The objective of this study was to test if visual and computer-aided quantitative analyses of presurgical high-quality 3 Tesla MRIs complying with the International League Against Epilepsy (ILAE) Neuroimaging Task Force recommendations can inform on histopathological diagnosis. Methods. Ninety-two patients from Copenhagen and Oslo University Hospitals fulfilled patient-, imaging-, and histopathological inclusion criteria: 69 patients were diagnosed with hippocampal sclerosis (HS) ILAE type 1 or 2, and 23 patients had normal appearing hippocampi or other histopathology than HS (no-HS). MRIs from 52 healthy controls (HC) were included. Image processing was performed in FreeSurfer v.6.0 with the built-in cross-sectional hippocampal subfield segmentation tool and multimodal MRI input. Volume outputs were used to calculate volume asymmetry ratios (VARs) for whole hippocampus (WH) and subfields. Results. HS patients had significantly larger WH VARs compared to no-HS patients and HC, with a sensitivity=0.93 and specificity=1.0 for histopathological HS diagnosis. Visual MRI assessment yielded a sensitivity=0.90 and specificity=0.96 for histopathological HS diagnosis. CA1 and CA4 VARs and the number of seizure-free patients were not significantly different in HS ILAE type 1 compared to type 2 patients. Significance. FreeSurfer analyses of presurgical MRIs are excellent at separating patients histopathologically diagnosed with HS from patients with other pathology or normal appearing hippocampi. Using the FreeSurfer hippocampal subfield segmentation tool did not allow for separating HS ILAE subtypes.

The Russian private military company (PMC), the Wagner Group, went from being a public secret to openly fighting alongside Russian forces in Russia’s war in Ukraine. By looking at Russian pro-government media discourses on PMCs, this paper argues that this development is largely made possible by a discursive shift, which happened before the war. Two basic discourses are found in the period leading up to the war – a discourse that denies the existence of Russian PMCs, and a discourse of normalization, which constructs PMCs as legitimate businesses and Russia as a great power. The two discourses previously kept the PMCs in a grey zone, allowing the Russian political elite deniability, while also taking credit for the foreign policy successes the PMCs achieved. However, this paper shows a discursive shift of recognizing PMCs as legitimate actors, which allowed for the Wagner Group to play a key role in Russia’s war., The Russian private military company (PMC), the Wagner Group, went from being a public secret to openly fighting alongside Russian forces in Russia’s war in Ukraine. By looking at Russian pro-government media discourses on PMCs, this paper argues that this development is largely made possible by a discursive shift, which happened before the war. Two basic discourses are found in the period leading up to the war–a discourse that denies the existence of Russian PMCs, and a discourse of normalization, which constructs PMCs as legitimate businesses and Russia as a great power. The two discourses previously kept the PMCs in a grey zone, allowing the Russian political elite deniability, while also taking credit for the foreign policy successes the PMCs achieved. However, this paper shows a discursive shift of recognizing PMCs as legitimate actors, which allowed for the Wagner Group to play a key role in Russia’s war.

Introduction: Overall caecum intubation rate(oCIR) and overall polyp detection rate(oPDR) have been proposed as performance indicators, but varying complexity in case mix among endoscopists may potentially affect validity. The study aims to explore the effect of adjusting for case mix on individual endoscopist performance by calculating case mix-adjusted performance estimates (cmCIR and cmPDR) and comparing them to overall performance estimates (oCIR and oPDR). The study also provides an R program for case mix analysis. Methods: Logistic regression associated endoscopist, colonoscopy indication, patient age and patient gender with the binary outcomes of cecum intubation and polyp detection. Case mix-adjusted performance indicators were calculated for each endoscopist based on logistic regression and bootstraps. Endoscopists were ranked from best to worst by overall and case mix-adjusted performance estimates, and differences were evaluated using percentage points(pp) and rank changes. Results: The dataset consisted of 7376 colonoscopies performed by 47 endoscopists. The maximum rank change for an endoscopist comparing oCIR and cmCIR was eight positions, interquartile range (IQR 1–3). The maximum change in CIR was 1.95 percentage point (pp) (IQR 0.27–0.86). The maximum rank change in the oPDR versus cmPDR analysis was 17 positions (IQR 1.5–8.5). The maximum change in PDR was 11.21 pp (IQR 2.05–6.70). Three endoscopists improved their performance from significantly inferior to within the 95% confidence interval (CI) range of performance targets using case mix-adjusted estimates. Conclusions: The majority of endoscopists were unaffected by adjustment for case mix, but a few unfortunate endoscopists had an unfavourable case mix that could invite incorrect suspicion of inferior performance.

Germline pathogenic variants in CDKN2A predispose to various cancers, including melanoma, pancreatic cancer, and neural system tumors, whereas CDKN2B variants are associated with renal cell carcinoma. A few case reports have described heterozygous germline deletions spanning both CDKN2A and CDKN2B associated with a cancer predisposition syndrome (CPS) that constitutes a risk of cancer beyond those associated with haploinsufficiency of each gene individually, indicating an additive effect or a contiguous gene deletion syndrome. We report a young woman with a de novo germline 9p21 microdeletion involving the CDKN2A/CDKN2B genes, who developed six primary cancers since childhood, including a very rare extraskeletal osteosarcoma (eOS) at the age of 8. To our knowledge this is the first report of eOS in a patient with CDKN2A/CDKN2B deletion.