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2015

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Full-Text Articles in Medicine and Health Sciences

Rapamycin Rescues Vascular, Metabolic And Learning Deficits In Apolipoprotein E4 Transgenic Mice With Pre-Symptomatic Alzheimer’S Disease, Ai-Ling Lin, Jordan B. Jahrling, Wei Zhang, Nicholas Derosa, Vikas Bakshi, Peter Romero, Veronica Galvan, Arlan Richardson Dec 2015

Rapamycin Rescues Vascular, Metabolic And Learning Deficits In Apolipoprotein E4 Transgenic Mice With Pre-Symptomatic Alzheimer’S Disease, Ai-Ling Lin, Jordan B. Jahrling, Wei Zhang, Nicholas Derosa, Vikas Bakshi, Peter Romero, Veronica Galvan, Arlan Richardson

Sanders-Brown Center on Aging Faculty Publications

Apolipoprotein E ɛ4 allele is a common susceptibility gene for late-onset Alzheimer's disease. Brain vascular and metabolic deficits can occur in cognitively normal apolipoprotein E ɛ4 carriers decades before the onset of Alzheimer's disease. The goal of this study was to determine whether early intervention using rapamycin could restore neurovascular and neurometabolic functions, and thus impede pathological progression of Alzheimer's disease-like symptoms in pre-symptomatic Apolipoprotein E ɛ4 transgenic mice. Using in vivo, multimodal neuroimaging, we found that apolipoprotein E ɛ4 mice treated with rapamycin had restored cerebral blood flow, blood–brain barrier integrity and glucose metabolism, compared …


Factors Associated With Providers’ Perceptions Of Mental Health Care In Santa Luzia’S Family Health Strategy, Brazil, Angela R. Ghesquiere, Rogerio M. Pinto, Rahbel Rahman, Anya Y. Spector Dec 2015

Factors Associated With Providers’ Perceptions Of Mental Health Care In Santa Luzia’S Family Health Strategy, Brazil, Angela R. Ghesquiere, Rogerio M. Pinto, Rahbel Rahman, Anya Y. Spector

Publications and Research

Brazil has a unique mental health care system, characterized by universal coverage delivered by interdisciplinary teams both in the community and in specialized centros de atenção psicossocial (CAPS—psychosocial care centers). Provision of patient-centered mental health care is an important principle of Brazilian mental health care, but this topic has not been well-studied. We analyzed data from a cross-sectional survey of 151 community health workers (CHWs), nurses, and physicians in Santa Luzia, Minas Gerais State, Brazil. Chi-squares, t-tests and multivariate regression analyses examined differences in socio-demographics, caseload, engagement in evidence-based practices (EBPs), and transdisciplinary collaboration between providers who reported providing high …


Impact Of Executive Order 13211 On Environmental Regulation: An Empirical Study, Elizabeth Ann Glass Geltman Dec 2015

Impact Of Executive Order 13211 On Environmental Regulation: An Empirical Study, Elizabeth Ann Glass Geltman

Publications and Research

A great deal has been written about the Energy Policy Act of 2005 exempting oil and gas operations using hydraulic fracturing from the purview of certain federal environmental laws. Far less attention has been paid to George W. Bush’s Executive Order 13211 (EO 13211), entitled “Actions Concerning Regulations that Significantly Affect Energy Supply, Distribution or Use.” The executive order requires federal agencies to evaluate the impact of federal regulations on “supply, distribution and use of energy.” This study examined the impact of EO 13211 on United States environmental and conservation regulations proposed and promulgated by federal agencies. The study found …


Inter-Organizational Network Effects On The Implementation Of Public Health Services, Glen P. Mays Dec 2015

Inter-Organizational Network Effects On The Implementation Of Public Health Services, Glen P. Mays

Health Management and Policy Presentations

Background: The Affordable Care Act created new incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing inter-organizational relationships and expanding implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities; (2) whether network changes attenuate or exacerbate disparities in public health implementation across communities; and (3) how network changes affect preventable mortality and resource use.

Methods: We follow a longitudinal cohort of …


Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum Dec 2015

Puerto Rico’S Community Health Centers In A Time Of Crisis, Peter Shin, Jessica Sharac, Marie Nina Luis, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2014, Puerto Rico’s twenty federally funded community health centers, operating in 71 sites located throughout the Commonwealth, served 330,736 patients, approximately one in ten Commonwealth residents. Compared to other Puerto Rico residents, health center patients are less likely to be insured. Despite considerable growth in Medicaid as a result of the supplemental funding provided under the Affordable Care Act, in 2014, 12.2% of health center patients remained uninsured.

Compared to health centers outside Puerto Rico, Puerto Rico’s health centers show a greater proportion of Medicaid patients served (69% compared to 46% outside Puerto Rico), a greater dependence on physician …


Effects Of Repeated Quetiapine Treatment On Conditioned Avoidance Responding In Rats, Jun Gao, Min Feng, Natashia Swalve, Collin Davis, Nan Sui, Ming Li Dec 2015

Effects Of Repeated Quetiapine Treatment On Conditioned Avoidance Responding In Rats, Jun Gao, Min Feng, Natashia Swalve, Collin Davis, Nan Sui, Ming Li

Department of Psychology: Faculty Publications

The present study characterized the behavioral mechanisms of avoidance–disruptive effect of quetiapine in the conditioned avoidance response test under two behavioral testing (2 warning signals vs. 1 warning signal) and two drug administration conditions (subcutaneous vs. intravenous). In Experiments 1 and 2, well-trained adult male Sprague-Dawley rats were tested under the subcutaneous (s.c.) quetiapine treatment (5.0, 15.0, 25.0, 50.0 mg/kg) for 7 days in a novel procedure consisting of two conditioned stimuli (CS) (white noise serving as CS1 and pure tone as CS2). Only the highest dose (50.0 mg/kg) produced a persistent suppression of the avoidance response without impairing the …


The Challenges Of Leading Change In Health-Care Delivery From The Frontline, Vivienne Byers Dec 2015

The Challenges Of Leading Change In Health-Care Delivery From The Frontline, Vivienne Byers

Articles

Aim: The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change.

Background: Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person- centred policy, nurses can be seen to be doing the best they can within a constrained environment.

Method: A survey of nursing practice in person-centred health-policy …


Effects Of Acceptance Of Disability On Death Or Dialysis In Chronic Kidney Disease Patients: A 3-Year Prospective Cohort Study, Hsin-Hung Chiang, Hanoch Livneh, How-Ran Guo, Mei-Ling Yen, Tzung-Yi Tsai Dec 2015

Effects Of Acceptance Of Disability On Death Or Dialysis In Chronic Kidney Disease Patients: A 3-Year Prospective Cohort Study, Hsin-Hung Chiang, Hanoch Livneh, How-Ran Guo, Mei-Ling Yen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background: Acceptance of disability (AOD) is a useful construct that assesses the ability of a patient to psychologically cope with chronic diseases, but its effect on long-term outcomes of patients with chronic kidney disease (CKD) remains unclear. This study aimed to evaluate the relation between AOD level and clinical outcomes in a cohort of CKD patients in Taiwan.

Methods: 262 CKD patients without dialysis at a hospital in Taiwan were consecutively recruited, from 2010 to 2011, and followed up for 3 years. At enrollment, demographic and clinical data were obtained, including baseline level measurement of AOD, using the …


Services For People With Intellectual And/Or Developmental Disabilities In The U.S. Territories, John Butterworth, Thinkwork! At The Institute For Community Inclusion At Umass Boston Dec 2015

Services For People With Intellectual And/Or Developmental Disabilities In The U.S. Territories, John Butterworth, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

The following report represents an expansion of the data collection activities mandated by a 2012 Administration of Intellectual and Developmental Disabilities (AIDD) Funding Opportunity Announcement (FOA). Prior to 2012, the AIDD funded data projects, Access to Integrated Employment, Family and Individual Information Systems project (FISP), Residential Information Systems Project (RISP) and the State of the States in Developmental Disabilities only collected data from the 50 states and the District of Columbia. The 2012 FOA requested that three of the AIDD data projects work together to include the five U.S. Territories (American Samoa and the Commonwealth of the Northern Marianas Islands, …


Prescription Drug Diversion: Predictors Of Illicit Acquisition And Redistribution In Three U.S. Metropolitan Areas, Shana Harris, Valentina Nikulina, Camila Gelpi-Acosta, Cory Morton, Valerie Newsome, Alana Gunn, Heidi Hoefinger, Ross Aikins, Vivian Smith, Victoria Barry, Martin J. Downing Jr. Dec 2015

Prescription Drug Diversion: Predictors Of Illicit Acquisition And Redistribution In Three U.S. Metropolitan Areas, Shana Harris, Valentina Nikulina, Camila Gelpi-Acosta, Cory Morton, Valerie Newsome, Alana Gunn, Heidi Hoefinger, Ross Aikins, Vivian Smith, Victoria Barry, Martin J. Downing Jr.

Publications and Research

Objective: Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors.

Methods: Data were drawn from a cross-sectional Internet …


Greater Magnocellular Saccadic Suppression In High Versus Low Autistic Tendency Suggests A Causal Path To Local Perceptual Style., David P Crewther, Daniel Crewther, Stephanie Bevan, Melvyn A Goodale, Sheila G Crewther Dec 2015

Greater Magnocellular Saccadic Suppression In High Versus Low Autistic Tendency Suggests A Causal Path To Local Perceptual Style., David P Crewther, Daniel Crewther, Stephanie Bevan, Melvyn A Goodale, Sheila G Crewther

Brain and Mind Institute Researchers' Publications

Saccadic suppression-the reduction of visual sensitivity during rapid eye movements-has previously been proposed to reflect a specific suppression of the magnocellular visual system, with the initial neural site of that suppression at or prior to afferent visual information reaching striate cortex. Dysfunction in the magnocellular visual pathway has also been associated with perceptual and physiological anomalies in individuals with autism spectrum disorder or high autistic tendency, leading us to question whether saccadic suppression is altered in the broader autism phenotype. Here we show that individuals with high autistic tendency show greater saccadic suppression of low versus high spatial frequency gratings …


Bridging The Divide White Paper On Medication Abortion: Overview Of Research & Policy In The United States, Liz Borkowski, Julia Strasser, Amy Allina, Susan Wood Dec 2015

Bridging The Divide White Paper On Medication Abortion: Overview Of Research & Policy In The United States, Liz Borkowski, Julia Strasser, Amy Allina, Susan Wood

Jacobs Institute of Women's Health

Medication abortion (also called medical abortion) is a safe method of abortion available for the past 15 years in the US. The Bridging the Divide white paper summarizes the scientific evidence related to the current medication abortion process and potential changes to the process that could make it even safer and more accessible for patients, as well as policy considerations and directions for future research.

In the fall of 2000, the US Food & Drug Administration (FDA) approved the drug Mifeprex© (generic: mifepristone) for use in medication abortions. That approval included requirements that affect both patients and providers and that …


Beyond Pain—Controlling Suffering In Laboratory Animals, Bernard E. Rollin Dec 2015

Beyond Pain—Controlling Suffering In Laboratory Animals, Bernard E. Rollin

Experimental Research and Animal Welfare Collection

No abstract provided.


Autonomic Nervous System Reactivity In A Free-Ranging Mammal: Effects Of Dominance Rank And Personality, Elodie F. Briefer, James A. Oxley, Alan G. Mcelligott Dec 2015

Autonomic Nervous System Reactivity In A Free-Ranging Mammal: Effects Of Dominance Rank And Personality, Elodie F. Briefer, James A. Oxley, Alan G. Mcelligott

Ethology Collection

Modulation of the autonomic nervous system (ANS) activity allows animals to effectively respond to internal and external stimuli in everyday challenges via changes in, for example, heart and respiration rate. Various factors, ranging from social such as dominance rank to internal such as personality or affective states can impact animal physiology. Our knowledge of the combinatory effects of social and internal factors on ANS basal activity and reactivity, and of the importance that each factor has in determining physiological parameters, is limited, particularly in nonhuman, free-ranging animals. In this study, we tested the effects of dominance rank and personality (assessed …


Sports Broadcasting News Analysis [Career Paper], Jefferson Sanders Dec 2015

Sports Broadcasting News Analysis [Career Paper], Jefferson Sanders

Undergraduate Research Award

No abstract provided.


How To Start A Movement: Ted Talk Annotated Resource List, Daulton Cowan Dec 2015

How To Start A Movement: Ted Talk Annotated Resource List, Daulton Cowan

Undergraduate Research Award

No abstract provided.


Nursing: The Career That Saves Lives [Career Paper], Maggie Flanagan Dec 2015

Nursing: The Career That Saves Lives [Career Paper], Maggie Flanagan

Undergraduate Research Award

No abstract provided.


Physical Aggression, Compromised Social Support, And 10-Year Marital Outcomes: Testing A Relational Spillover Model, Kieran T. Sullivan, Lauri A. Pasch, Erika E. Lawrence, Thomas N. Bradbury Dec 2015

Physical Aggression, Compromised Social Support, And 10-Year Marital Outcomes: Testing A Relational Spillover Model, Kieran T. Sullivan, Lauri A. Pasch, Erika E. Lawrence, Thomas N. Bradbury

Psychology

The purpose of the present study was to test a relational spillover model of physical aggression whereby physical aggression affects marital outcomes due to its effects on how spouses ask for and provide support to one another. Newlywed couples (n = 172) reported levels of physical aggression over the past year and engaged in interactions designed to elicit social support; marital adjustment, and stability were assessed periodically over the first 10 years of marriage. Multilevel modeling revealed that negative support behavior mediated the relationship between physical aggression and 10-year marital adjustment levels whereas positive support behavior mediated the relationship between …


Health Center Trends: Recent Experience In Medicaid Expansion And Non-Expansion States., Peter Shin, Jessica Sharac, Julia Zur, Sara J. Rosenbaum, Julia Paradise Dec 2015

Health Center Trends: Recent Experience In Medicaid Expansion And Non-Expansion States., Peter Shin, Jessica Sharac, Julia Zur, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In thousands of medically underserved communities across the U.S., community health centers enroll lowincome people in health coverage and provide care to millions of patients. Against the backdrop of significant health center expansion over several years and a full year of expanded health coverage under the Affordable Care Act (ACA), this brief examines change between 2013 and 2014 in the volume and health coverage profile of health center patients, and health center enrollment activities and service capacity, comparing states that implemented the ACA Medicaid expansion in 2014 and states that did not expand Medicaid in 2014. The study is based …


Himmelfarb Library Liaison Letter - December 2015, George Washington University, Himmelfarb Health Sciences Library Dec 2015

Himmelfarb Library Liaison Letter - December 2015, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.


Quality And Cost Of Diabetes Mellitus Care In Community Health Centers In The United States., Patrick Richard, Peter Shin, Tishra Beeson, Laura S. Burke, Susan F. Wood, Sara Rosenbaum Dec 2015

Quality And Cost Of Diabetes Mellitus Care In Community Health Centers In The United States., Patrick Richard, Peter Shin, Tishra Beeson, Laura S. Burke, Susan F. Wood, Sara Rosenbaum

Health Policy and Management Faculty Publications

OBJECTIVE: To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings.

RESEARCH DESIGN AND METHODS: We used data from the 2005-2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to …


The Creation Of A Model Pediatric Ward For African American Children In 1920s Kansas City., Jane F. Knapp, Robert Schremmer Dec 2015

The Creation Of A Model Pediatric Ward For African American Children In 1920s Kansas City., Jane F. Knapp, Robert Schremmer

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.


Predicting Human Drug Toxicity And Safety Via Animal Tests: Can Any One Species Predict Drug Toxicity In Any Other, And Do Monkeys Help?, Jarrod Bailey, Michelle Thew, Michael Balls Dec 2015

Predicting Human Drug Toxicity And Safety Via Animal Tests: Can Any One Species Predict Drug Toxicity In Any Other, And Do Monkeys Help?, Jarrod Bailey, Michelle Thew, Michael Balls

Laboratory Experiments Collection

Animals are still widely used in drug development and safety tests, despite evidence for their lack of predictive value. In this regard, we recently showed, by producing Likelihood Ratios (LRs) for an extensive data set of over 3,000 drugs with both animal and human data, that the absence of toxicity in animals provides little or virtually no evidential weight that adverse drug reactions will also be absent in humans. While our analyses suggest that the presence of toxicity in one species may sometimes add evidential weight for risk of toxicity in another, the LRs are extremely inconsistent, varying substantially for …


The Problem Of Masculinity For Male Health, Kieran Geary, Maurice Murphy Dec 2015

The Problem Of Masculinity For Male Health, Kieran Geary, Maurice Murphy

Dept. of Management & Enterprise Publications

Men’s health has historically received little attention in terms of consultation, planning, strategy development or project implementation, but in recent years there has been an increased focus on gender in the context of men’s health. Whilst in the past the focus on gender and health in Ireland has tended to be synonymous with women’s health, the significance of gendered health practices (particularly gendered patterns of help-seeking) have more recently come to the forefront in the context of men. Men’s reluctance to seek help and use health services is a concern across most Western cultures. Some commentary has suggested that men …


Assessing The Psychoeducational Approach To Transcendence And Health (Path) Program : An Intervention To Foster Self-Transcendence And Well-Being In Community-Dwelling Older Adults., Valerie Lander Mccarthy, Sharon Bowland, Lynne A. Hall, Jennifer Connelly Dec 2015

Assessing The Psychoeducational Approach To Transcendence And Health (Path) Program : An Intervention To Foster Self-Transcendence And Well-Being In Community-Dwelling Older Adults., Valerie Lander Mccarthy, Sharon Bowland, Lynne A. Hall, Jennifer Connelly

Faculty Scholarship

The late-life developmental process of self-transcendence shapes elders’ perspectives on self, others, the nature of this world, and of a dimension beyond the here and now. This qualitative pilot study evaluated the Psychoeducational Approach to Transcendence and Health (PATH) Program, a psychoeducational intervention to promote self-transcendence and well-being in community-dwelling women at a senior center. The intervention involved eight weekly group sessions using group processes, mindfulness practices, creative experiences, and independent at-home practice. The findings supported the underlying theory-based structure and content of the intervention and indicated the intervention may empower elders to attend to self-care, develop acceptance, and learn …


Evaluating The Impact Of Pharmacist Health Education On The Perceptions Of The Pharmacist’S Role Among Women Living In A Homeless Shelter, Laura V. Tsu, Kelsey Buckley, Sarah Nguyen, Jennifer Kohn Dec 2015

Evaluating The Impact Of Pharmacist Health Education On The Perceptions Of The Pharmacist’S Role Among Women Living In A Homeless Shelter, Laura V. Tsu, Kelsey Buckley, Sarah Nguyen, Jennifer Kohn

Pharmacy Faculty Articles and Research

Objectives: To determine the impact of pharmacist-provided educational seminars on the participant’s perception of the pharmacist’s role in providing women’s health education. Secondary objectives include the participant’s level of perceived benefit from the information provided during each presentation, as well as determining characteristics of participants who are interested in attending seminars.

Methods: This is a prospective study conducted within a homeless women’s shelter in Phoenix, Arizona. Pharmacists and pharmacy students provided 10 monthly educational seminars on topics related to women’s health. Participants completed a pre- and post-seminar survey regarding their perceptions of the presentations and pharmacists.

Results: …


Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman Nov 2015

Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman

Health Workforce Research Center Publications

In the United States, changing demographics, rising costs, and the impact of new regulations and payment models arising from the Affordable Care Act have placed unprecedented pressures on healthcare providers to increase access to care, improve quality and to control costs. To meet these challenges, some providers are forming accountable care organizations (ACOs) while others are pursuing medical homes or other novel payment and care delivery models designed to help meet these challenges. Within established organizations such as federally funded community health centers (CHCs), healthcare leaders are exercising significant latitude in developing innovative solutions for meeting their patients’ needs more …


Research Brief: "Military Service Absences And Family Members’ Mental Health: A Timeline Followback Assessment", Institute For Veterans And Military Families At Syracuse University Nov 2015

Research Brief: "Military Service Absences And Family Members’ Mental Health: A Timeline Followback Assessment", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief examines mental health correlating with a parent's absence during a military deployment. The findings show that adolescents were affected by a military parent being absent from significant events, and that they would benefit from programs that offer pre and post-deployment briefings. In the future, research should investigate how contact during military deployment affects the service member and their family.


Contemplating Mindfulness At Work: An Integrative Review, Christopher Lyddy, Darren J. Good, Theresa M. Glomb, Joyce E. Bono, Kirk W. Brown, Michelle K. Duffy, Ruth A. Baer, Judson A. Brewer, Sara W. Lazar Nov 2015

Contemplating Mindfulness At Work: An Integrative Review, Christopher Lyddy, Darren J. Good, Theresa M. Glomb, Joyce E. Bono, Kirk W. Brown, Michelle K. Duffy, Ruth A. Baer, Judson A. Brewer, Sara W. Lazar

School of Business Faculty Publications

Mindfulness research activity is surging within organizational science. Emerging evidence across multiple fields suggests that mindfulness is fundamentally connected to many aspects of workplace functioning, but this knowledge base has not been systematically integrated to date. This review coalesces the burgeoning body of mindfulness scholarship into a framework to guide mainstream management research investigating a broad range of constructs. The framework identifies how mindfulness influences attention, with downstream effects on functional domains of cognition, emotion, behavior, and physiology. Ultimately, these domains impact key workplace outcomes, including performance, relationships, and well-being. Consideration of the evidence on mindfulness at work stimulates important …


Critical Time Intervention For People Leaving Shelters In The Netherlands: Assessing Fidelity And Exploring Facilitators And Barriers, Renee De Vet, Danielle A. M. Lako, Marielle D. Beijersbergen, Linda Van Den Dries, Sarah Conover, Albert M. Van Hemert, Daniel Herman, Judith R. L. M. Wolf Nov 2015

Critical Time Intervention For People Leaving Shelters In The Netherlands: Assessing Fidelity And Exploring Facilitators And Barriers, Renee De Vet, Danielle A. M. Lako, Marielle D. Beijersbergen, Linda Van Den Dries, Sarah Conover, Albert M. Van Hemert, Daniel Herman, Judith R. L. M. Wolf

Publications and Research

International dissemination of evidence-based interventions calls for rigorous evaluation. As part of an evaluation of critical time intervention (CTI) for homeless people and abused women leaving Dutch shelters, this study assessed fidelity in two service delivery systems and explored factors influencing model adherence. Data collection entailed chart review (n = 70) and two focus groups with CTI workers (n = 11). The intervention obtained an overall score of three out of five (fairly implemented) for compliance fidelity and chart quality combined. Fidelity did not differ significantly between service systems, supporting its suitability for a range of populations. The eight themes …