The role of adjuvant radiotherapy in completely resected pIIIA‐N2 non‐small cell lung cancer (NSCLC) has long been debated. Evidence from previous retrospective and prospective studies showed that postoperative radiotherapy could reduce the incidence of local recurrence and prolong disease‐free survival, while two recently reported randomized controlled trials (lung ART and PORT‐C) both demonstrated no survival benefit of postoperative radiotherapy. The great gap between our knowledge and reality has made us rethink the value of postoperative radiotherapy. In this mini review, we elaborate on the role of postoperative radiotherapy in completely resected pIIIA‐N2 NSCLC. Non‐small cell lung cancer with N2 is a heterogeneous disease group. Postoperative radiotherapy is still necessary in the management of high‐risk pIIIA‐N2 patients. Locally advanced non‐small cell lung cancer (NSCLC) is thought to be the most challenging disease because of considerable heterogeneity and poor prognosis which requires multidisciplinary team management and effective multimodality combination. For those patients with completely resected IIIA‐N2 NSCLC, the role of postoperative radiotherapy (PORT) remains controversial. The 1998 PORT meta‐analysis showed a detrimental effect in patients with completely resected NSCLC but a slight increase in survival in pN2 disease, presumably due to the excessive late side effect of obsolete radiation technique.p‐value = 0.16). Notably, over such a long enrollment period, the treatment of NSCLC has progressed including systemic and local therapy, especially with regard to radiation techniques. In the trial, 89% of the patients in the PORT arm received 3D‐CRT and it was difficult to achieve the optimal protection of normal tissue exposure compared to IMRT. Additionally, the Lung ART contouring protocol documented that the next nodal station should be included in the CTV when metastases were identified in a nodal station, and it was not difficult to guess that 1 and 2 stations were included in most cases, resulting in a relatively large radiation field.It would be arbitrary to deny the value of PORT simply based on statistical results of one or two studies, and it is worth discussing and exploring the truth behind these numbers in more detail. The Lung ART trial was initiated in August 2007 with target accrual of 700 patients to show a 10% improvement of 3‐year disease free survival (DFS). Due to slow enrollment, a new target of 500 patients was adopted and the difference of 3‐year DFS was modified to 12% (42% in PORT arm and 30% in control arm). By the end of August 2018, 501 patients were enrolled into the trial, and preliminary results were reported in 2020 ESMO. In the ITT analysis, the primary endpoint was no significance between the two arms, the rate of 3‐year DFS was 47.1% and 43.8% in the PORT and control arms, respectively  and all‐cause mortality . Compared to the mean heart dose <10 Gy, >10 Gy would increase 34% hazard ratio of all‐cause mortality.In the RTOG 0617 study, multivariate analysis showed that heart V5 was an independent predictor of survival in patients with locally advanced NSCLC treated with concurrent chemoradiotherapy, and researchers and clinicians should therefore pay more attention to cardiopulmonary toxicities in these patients.The actual rate of mediastinal relapse in the control arm was 46%, and PORT significantly reduced the rate to 25%, even in Lung ART ITT analysis . As for the benefit of local control, this was not transformed into survival improvement, and it is worth further consideration. In addition, the Lung ART study was an international multicenter clinical trial conducted in five countries, and variations of target delineation and violations of radiotherapy quality assurance were also challenging that could potentially confound study results. Both RTOG 0617 and Proclaim trials showed that treatment at institutions with higher clinical trial accrual volume was associated with better clinical outcomes in LA‐NSCLC, highlighting the importance of ensuring radiation quality in RT clinical trials.p‐value = 0.20). Poor adherence of the protocol in this study may account for no difference statistically; 44 of 184 patients (21.7%) in the PORT arm and 10 of 180 patients (5.6%) in the control arm refused scheduled treatment. Actually, in the sensitivity analysis, PORT significantly improved local control and DFS in the per‐protocol and as‐treated population. Therefore, PORT‐C should not simply be regarded as a negative study because of statistical underpower, and we should not easily negate the value of PORT in pN2 patients. Conversely, in a sense, this study identified that PORT reduces the risk of local recurrence and holds the promise of survival benefit.The PORT‐C study was also a phase III clinical trial conducted to evaluate the value of PORT in pN2 NSCLC with a target 3‐year DFS improvement of 14%, which enrolled 364 patients between January 2009 and December 2017 at a single cancer center in China. As shown in Figure Local tumor control is critical to achieve the goal of a radical cure for solid tumors. The treatment of breast cancer is the most successful model of comprehensive therapy, and PORT significantly improves local control and overall survival in both patients undergoing mastectomy and breast conserving‐surgery, indicating that early elimination of local tumor cells has the advantage of reducing subsequent metastasis and improving survival. In particular for early‐stage breast cancer, multiple randomized phase 3 studies designed to assess the role of adjuvant radiotherapy have demonstrated a remarkable risk reduction in local recurrence rates; however, no survival benefit was observed until the meta‐analysis of EBCTCG in which individual information in 23 500 participants was aggregated to evaluate the value of PORT and the survival benefit was finally demonstrated.EGFR mutation population. Recently, the results of immune checkpoint blockers (ICB) in resected NSCLC (IMPower 010) patients have been published in the Lancet.Molecular targeted therapies and immunotherapies have improved outcomes markedly in advanced NSCLC, and the experience of successful treatment is also moving forward. The use of these agents in the adjuvant phase is also bound to affect the risk of both distant metastases and local recurrence. The ADAURA study showed that only 7% of the patients who received adjuvant osimertinib suffered locoregional‐only recurrence (18% in the placebo group), thereby suggesting that effective systemic therapy can lower the risk of local recurrence.NSCLC with N2 is a heterogeneous disease group, including anatomical (location and number of involved nodes) and biological  diversity,So now, what should we do in clinical practice when we encounter a patient with pN2 NSCLC? Recently, a survey was organized by the European Society for Radiotherapy and Oncology (ESTRO) reporting PORT in pN2 NSCLC patients investigated by 22 experts. After the presentation of the Lung ART trial, 82% of experts still used PORT for pN2 patients with risk factors in which the prominent consideration was extent of the lymph nodes .The authors confirm that there are no conflicts of interest.


Grus grus) and sandhill cranes (Grus canadensis) have increased drastically in the last 40 years. Their increase is associated with higher incidences of crane foraging on agricultural crops, causing financial losses to farmers. Our aim was to synthesize scientific knowledge on the bilateral effects of land use change and crane populations. We conducted a systematic literature review of peer‐reviewed publications on agriculture‐crane interactions (n = 135) and on the importance of agricultural crops in the diet of cranes (n = 81). Agricultural crops constitute a considerable part of the diet of all crane species  and wheat (Triticum aestivum L.)). Crop damage was identified in only 10% of all agriculture‐crane interactions, although one‐third of interactions included cranes foraging on cropland. Using a conceptual framework analysis, we identified two major pathways in agriculture‐crane interactions: (1) habitat loss with negative effects on crane species dependent on specific habitats, and (2) expanding agricultural habitats with superabundant food availability beneficial for opportunistic crane species. The degree to which crane species can adapt to agricultural land use changes may be an important factor explaining their population response. We conclude that multi‐objective management needs to combine land sparing and land sharing strategies at landscape scale. To support viable crane populations while guaranteeing sustainable agricultural production, it is necessary to include the perspectives of diverse stakeholders and streamline conservation initiatives and agricultural policy accordingly.While agricultural intensification and expansion are major factors driving loss and degradation of natural habitat and species decline, some wildlife species also benefit from agriculturally managed habitats. This may lead to high population densities with impacts on both human livelihoods and wildlife conservation. Cranes are a group of 15 species worldwide, affected both negatively and positively by agricultural practices. While eleven species face critical population declines, numbers of common cranes ( Grus grus) and sandhill cranes (Grus canadensis) is associated with higher incidences of cranes damaging agricultural crops. We conducted a systematic literature review of peer‐reviewed publications on agriculture‐crane interactions (n = 135) and on the importance of agricultural crops in the diet of cranes (n = 81). A conceptual framework identified two major pathways: (1) habitat loss with negative effects on crane species dependent on specific habitats, and (2) expanding agricultural habitats with superabundant food availability beneficial for opportunistic crane species. While eleven crane species face critical population declines, the drastic increase in common cranes ( However, intensification of agriculture and the associated use of pesticides and decrease in crop varieties are associated with a decline in biodiversity  are a family of 15 bird species distributed globally and have been both negatively and positively affected by agricultural practices  and common cranes (Grus grus Linnaeus) in the last 40 years, with populations reaching sizes above 800,000 and 700,000 individuals, respectively  or blue cranes (Anthropoides paradiseus Lichtenstein) may also cause crop damage ?How do crane species use agricultural areas for foraging (section III.2)?How can knowledge of agriculture‐crane interactions be integrated to inform multi‐objective management of crane populations and agricultural production (section III.3)?Agricultural expansion and intensification have been identified as the leading threat to 74% of the world's bird species, and at least 40% of all bird species exhibit declining population trajectories , recommend management implications to sustain both agricultural production and crane conservation (section IV.2), and identify important research gaps (section IV.3).2grus,” “gruidae,” “balearica,” “anthropoides,” “bugeranus,” “antigone"), English names  and the terms “farm,” “agri*,” and “land use.” These terms were initially discussed and selected by the authors to find information on the leading question “What is the scientific evidence on interactions between agriculture and cranes?” We restricted the bibliographic analysis to original research articles in peer‐reviewed journals published from 1999 to 2019. In Scopus, the subject areas “engineering” and “computing” were excluded; for the search in Web of Science, these subject areas were sorted out manually because of the homonym “crane” (machine). After the exclusion of review articles, the search criteria for agriculture‐crane interactions resulted in 178 original research articles. In a second step, the following articles were excluded: articles selected based on homonyms in the abstract and keywords ) and articles containing no information on our definition of agriculture‐crane interactions ), resulting in a final list of 135 peer‐reviewed publications. To integrate the information in the selected articles, we built on a research method for conceptual analysis described by Jabareen  did not contain information on crane diet and were excluded manually . The 51 remaining articles were screened a second time with the following inclusion criteria: (i) quantitative information on crane diet composition and (ii) methods of stomach content analysis, stable isotope analysis, fecal analysis, or field observation of diet and ingestion. As only 13 articles fit the search criteria, the time horizon was increased to 1970–2019, and articles were screened using the same procedure as described above, resulting in 61 publications with qualitative information and 20 publications with quantitative information on crane diet composition. Some articles contained diet composition data for the staging, wintering, and breeding seasons or data collected at more than one site. In such cases, we chose to display all data separately to create factors for intraspecific variation in diet composition, which were more visible . Weight and volume data were converted to the percentage of crops, other plant‐derived food, and animal‐derived food in the diet. To complement the quantitative results, we performed a topical review of the remaining 61 articles.The second part of our research was a systematic literature review of the diet composition of cranes. Using the same procedure as for the first part of the analysis, we searched the above‐mentioned databases for the above‐mentioned taxonomic terms in combination with the terms “nutrition,” “forag*,” “feces,” “feed,” “resource,” “diet,” and food*.” These terms were discussed and selected by the team of authors to find information on research question 2 . We used the quantitative measure of diet composition as an indicator of how well different crane species can adapt to forage on cropland. In Scopus, the subject areas “engineering” and “computing” were excluded, and in Web of Science, these subject areas were excluded manually. The following inclusion criteria for articles were used: (i) peer‐reviewed original research articles, (ii) information on crane diet composition, and (iii) published between 1999 and 2019. After exclusion of review articles and articles found based on homonyms, we created a list of 586 original research articles. Due to the variety of search terms, a majority of the articles  and permanent crops  including paddy fields. Permanent grassland = all land used permanently (more than five years) to grow herbaceous forage crops through cultivation or naturally (wild prairy or grazing land).33.1Definition of agriculture‐crane interactions and number of corresponding articles selected for analysis in this paper.Based on the 19 agriculture‐crane interactions found in our analysis  (23%), and sandhill cranes (17%). The largest share of publications on common cranes focused on habitat selection, space use, and the effect of land use change on population numbers (46%). In comparison, more publications on sandhill cranes focused on interactions with agriculture, such as agricultural extension, diversionary feeding, and the influence of agricultural practices on forage availability (26%), whereas the largest share of publications on red‐crowned cranes addressed the effect of habitat changes on population numbers (19%). The highest number of interactions in the categories of cranes’ impact on agriculture and societal response were identified for the sarus crane (Antigone antigone Linnaeus)  or the positive attitude of farmers toward cranes) , red‐crowned cranes (l cranes 7%. The l3.23.2.1Grus monacha Temminck) were observed to spend less time foraging in wetlands degraded by aquaculture than in natural wetlands, which indicates lower food availability in wetlands with aquaculture  in China and South Korea  concerned the opportunistic behavior of cranes Figure . The mos3.3.1Grus virgo Linnaeus), hooded cranes, sandhill cranes, and Siberian cranes  forage in permanent pastures   selected agricultural areas over natural habitats for foraging  were associated with large‐scale farms with less human disturbance, whereas gray‐crowned cranes were associated with small‐scale farms and communal grazing land. The crop chufa (Cyperus esculentus L.) and bare ground positively influenced the abundance of both crane species, but the influence was weaker for gray‐crowned cranes than for wattled cranes  using agricultural areas only when the availability of natural habitats was limited , the extent and type of crops in an area was identified as one of several factors influencing their use of staging sites and possibly also contributing to changes in migration route , and the number of sandhill cranes increased at a wintering site when agriculture shifted from rain‐fed to high‐yielding irrigated maize  were planted instead of the traditional winter fallow . However, agricultural practices may also affect crane migration strategies such as the timing and duration of staging. For whooping cranes , potatoes, legumes (Fabaceae spp.), and carrots . A study on sandhill cranes showed that crane use of maize fields decreased seedling density , damage to crops by red‐crowned cranes was estimated to affect 2%–3% of the cultivated area at a wintering site in China  revealed regional differences in crop damage by blue cranes, with 65% of Swartland farmers reporting damages to sweet lupin, canola, and wheat at the early leaf stages, whereas farmers in the Overberg, a grassland‐dominated area, did not perceive that cranes caused damage  in chickpea crops in India  in maize crops in Germany  and assessment of the “conflict” are rare, and only two articles addressed farmer attitudes toward cranes. Among farmers in South Africa, only those with a high number of blue cranes on their fields during times of damage risk perceived cranes as problematic. Similarly, only 25% of US farmers who had observed sandhill cranes in their fields responded that “cranes conflicted with grain production.” In both cases, only farmers with high numbers of cranes in their fields during fall reported conflict , fecal analysis (n = 6), observation (n = 4), and stable isotope analysis (n = 1) (time span: 1970–2019). In these 15 publications, the proportion of crops in the diet of cranes averaged 37%. There is large inter‐ and intraspecific variation in the importance of crops, but all crane species have been documented to forage on crops  and red‐crowned cranes (Grus japonensis Müller) (n = 22); however, the overall data availability on crane diet composition was low, and for three species, neither quantitative nor qualitative information on diet composition was found  than during breeding (50%) and spring staging (54%). This is an expected outcome, since cranes’ physiological need for animal‐derived protein is higher during the breeding period  are much smaller than those of species primarily relying on wetland habitat (Siberian and whooping cranes), which allows the former to consume small insects and grass seeds, while the latter are better adapted to probe below ground for tubers and ground‐dwelling insects. The remaining eleven crane species forage in both wetland and non‐wetland habitats with species‐specific differences between breeding and non‐breeding seasons . The crude protein content of all identified crops ranged between 8 and 20% of the dry weight , wheat, and sorghum, whereas chickpea was replaced by mustard (Brassica campestris L.) during the autumn migration. In that case, the use corresponds to the seasonal variation in the availability of the different crops . The limited available results on diet composition suggest that these species also rely on animal prey to a larger extent than other cranes (see Table 6.3Anatidae) due to a shift in habitat utilization from natural grassland and wetlands to pasture and cropland  due to agricultural intensification  has illustrated how aggregations of large numbers of cranes at few available wetland staging sites increase the risk of crop damage in the surrounding agricultural landscape. Based on this problem and the above‐mentioned limitations of current crop protection strategies, we propose that crop protection measures be coordinated not only at the scale of affected fields or staging sites but at the scale of migratory flyways. Cross‐boundary cooperation in the management of wetlands needs to go beyond borders of protected sites and actively involve stakeholders in adaptive management of crane population numbers and available foraging habitats in agricultural areas . This is in contrast to the findings of previous studies on wildlife damage, which have stressed the importance of social factors in triggering conflict and suggested that technical solutions to crop damage are insufficient to resolve conservation conflicts Dickman, . In cont8For this manuscript, we have analyzed information on cranes and their interactions with the agricultural sector as available in peer‐reviewed scientific publications in English language. We explicitly chose to include only journals listed in Scopus or Web of Science to get an overview of the current discourse within the system of peer‐reviewed scientific literature. In the analyzed publications on both agriculture‐crane interactions and on diet composition, most articles focused on common cranes 23%), red‐crowned cranes (21%), and sandhill cranes (20%), possibly indicating the importance of agricultural areas for these species. The focus on these species may also reflect different available resources for research between regions and a possible bias because of language restrictions  The destruction of natural habitat by agricultural expansion and (ii) the provision of cereal grain in agricultural landscapes.The degree to which crane species can adapt to land use changes and use cereal grain as food source may be important factors explaining their population response.Ecosystem effects associated with the second pathway, such as nutrient transfer to natural habitat or competition with other species need to be analyzed in future research.Conservation needs to combine land sparing and land sharing, by preserving and restoring natural wetland habitat for specialist species and by cooperating with farmers to secure forage availability on agricultural areas for generalist species.While research on farmer attitudes toward cranes is scarce, our results suggest that acceptance for cranes and conservation initiatives, in general, is dependent on effective crop protection as much as on stakeholder participation.Reconciliation of crane conservation and agricultural production needs to be implemented from the local to the flyway scale: By using existing crop protection methods, crop damage can be effectively prevented at the local scale. However, to assure long‐term sustainability, effects of agricultural land use changes and the establishment of protected areas on crane migration pattern and population development need to be addressed and managed at flyway scale. International cooperation in the management of major staging sites needs to address the problem of large congregations of cranes at single sites.Acknowledging the dual nature of agriculture‐crane interactions allows us to merge the perspectives of sustainable agricultural production and species conservation. As current agricultural policies provide incentives that contradict the aim of providing foraging area in harvested fields , conservation initiatives and agricultural policy should be streamlined to achieve multi‐objective management of crane population sustainability, on the one hand, and the habitat capacity and economic productivity of agricultural landscapes on the other hand.The authors declare no conflict of interest.Karoline Hemminger: Conceptualization (lead); Data curation (lead); Formal analysis (lead); Visualization (lead); Writing – original draft (lead); Writing – review & editing (lead). Hannes König: Conceptualization ; Funding acquisition (lead); Project administration (lead); Supervision . Johan Månsson: Conceptualization ; Methodology ; Visualization ; Writing – review & editing . Sonoko‐Dorothea Bellingrath‐Kimura: Supervision ; Writing – review & editing . Lovisa Nilsson: Conceptualization ; Methodology ; Supervision ; Writing – review & editing .Appendix S1Click here for additional data file.Appendix S2Click here for additional data file.


To develop and use planning maps to prioritize and facilitate county‐level recruitment for Together With Veterans (TWV), community‐based rural Veteran suicide prevention program.Choropleth maps were created for 49 U.S. states, with four mutually exclusive categories indicating eligibility for the TWV program and increasing levels of need assigned to each county based on (a) percent Veterans Health Administration enrollees residing in rural communities, (b) percent population that are Veterans, and (c) crude suicide mortality rate.Of 3113 counties, 78.2% were eligible for TWV and 25.8% met our highest priority definition. A national map and state map were provided to demonstrate final products used to engage stakeholders. A table of recommendations for creating and using planning maps was provided for future projects to reference.Geographic information system (GIS) is useful for identifying and prioritizing counties that may benefit most from a rural Veteran suicide prevention program. Choropleth maps allow for dissemination of information about county suicide risk and need for suicide prevention to community members, researchers, and others with a vested interest in suicide reduction. The maps are one tool among many which can support decision‐makers in focusing available resources on populations with the most need. In alignment with the VA National Strategy for Preventing Veteran Suicide 2018–2028, TWV supports the dissemination of evidence‐based best practices in public health suicide prevention  developed, with funding from VA’s Office of Rural Health (ORH) and in partnership with the Office of Mental Health and Suicide Prevention (OMHSP), the Together With Veterans (TWV) community‐based suicide prevention program for rural Veterans (Utilizing county‐level data and geographic information system (GIS) to quickly visualize county suicide prevention need can be invaluable in facilitating conversations with stakeholders to narrow down a list of possible intervention communities, framing the conversation around community risk and need, not just community readiness  officials and/or other state‐ or county‐level leadership to identify and recruit rural communities with high Veteran populations and increased suicide risk that would benefit most from the program. In the early stages of the Together With Veterans program, we sought high‐risk communities to pilot test the project. Our state stakeholders reported they wanted both to glean a quick picture of where the highest need was in their state and a data‐driven approach to expanding the program. With the early demonstration sites, we found that including a large number of data points in order to identify high‐risk communities introduced too much competing information to easily identify need for the program. In order to support stakeholders need for a simple tool, we chose to revise our approach to focus on a limited set of core variables. The TWV research team created maps in ArcGIS to prioritize counties with the highest level of need using three core county‐level variables: existing high rates of suicide, percent Veterans, and percent rural Veterans.The planning maps discussed in this paper serve as a decision tool rather than a comprehensive review of health risk at the county level. The variables reflected in the maps are an intentionally simplified set of data to assist identification of sites where a rural Veteran suicide prevention program may be most impactful.22.1Maps were created for a total of 49 states (Washington D.C. included in the Maryland map). Alaska was excluded for the current set of maps using county‐level data because the state does not have counties and multiple census boundaries changed as a result of the 2010 Census. Since our suicide data were aggregated from 2005 to 2017, it was not possible to include Alaska at this time CDC, . ImplicaNeed categories were created at the county level considering three factors: percent rural Veteran VHA enrollees, suicide rate, and percent of the population that are Veterans. County‐level data were used instead of state‐level data because (a) states contain a mix of rural and urban locations and this paper aims to identify rural places; (b) Veteran population and adult suicide rates vary substantially by geography within states, so providing state‐level summative data do not help identify locations of need within states, which is the goal of this work.2.2rural or highly rural designated census tracts of all VHA enrollees (which is aggregated up to the county) were sourced from the Current Enrollment Cube provided by the VHA Support Service Center , and rural refers to any areas not defined as urban or highly rural  and categorized as “VA Medical Center” or “Community‐Based and Other Outpatient Clinics”  were provided by the VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC). Original data were captured from the Centers for Disease Control and Prevention (CDC) Wide‐ranging Online Data for Epidemiologic Research (WONDER) Underlying Cause of Death database  do not purport the three variables  to be statically predictive of one another, (b) are not suggesting that county suicide rates are necessarily correlated with Veteran suicide rates, and (c) do not assume that VHA‐enrolled Veterans are representative of all Veterans. While county Veteran‐specific suicide rates would have been preferable to county suicide rates, Veteran suicide rates are suppressed for the majority of rural counties due to small populations resulting counts of <10 for Veteran suicide deaths. Because Veteran suicide rates could not be computed for most rural areas, county adult suicide rates were chosen as a proxy. Rurality data from the VHA enrollee database were used because TWV is a VA ORH‐funded project, and majority rural VHA enrollment is an eligibility criterion for this project.2.4The datasets described above (excluding VA facility data) were used to create four mutually exclusive categories to represent eligibility for the TWV program and increasing levels of county need. The following three measures were used to determine eligibility and need: (a) rurality, considered met if the county had >50% of VHA enrollees residing in rural or very rural census tracts (an eligibility requirement for TWV), (b) suicide rate, considered met if the crude county rate was higher than the state median, and (c) Veteran population, considered met if the percent of Veterans residing in the county was higher than the state median. The latter two criteria were based off the state median instead of the national median so that counties with the highest need could be identified within each state. In order to reflect a more accurate county‐level median, counties with suppressed data (<10 suicide deaths) were given a value of 0 and included in calculating the median.The four categories assigned to each county based on the three measures described above were (a) not eligible for TWV, (b) eligible for TWV and meets no other factors, (c) eligible and meets one factor, and (d) eligible and meets two factors. Choropleth maps using distinct shades of color to depict each county's category classification were created for each state using the eligibility and need factors as one layer with a second layer made up of VHA facilities. The eligibility factors choropleth layer was a monochromatic light‐to‐dark blue layer broken out by county with darker shades of blue applied to counties meeting more criteria.All analyses were done in SAS version 9.4 (SAS Institute), and maps were created using ArcGIS Pro version 2.2.1 Esri, .3A total of 3113 counties were included in the analysis, with 2435 (78.2%) counties eligible to participate in TWV, as a majority of VHA enrollees (greater than 50%) in those counties live in rural areas. A total of 308 counties (9.89%) had suppressed suicide rates. The mean, standard deviation, and range for percent rural Veteran enrollees, percent Veteran population, and suicide rate can be found in Table or the crude suicide rate for the county was greater than the state median). Eight hundred three counties  fell into the highest need category . Washington D.C. and all five Rhode Island counties did not meet rurality criteria.Figure A map for each state was created with descriptive information to provide to partners and stakeholders as a stand‐alone document. Also included with each state map (not shown) was a table with county‐specific values for each measure and whether that value met each criterion. The map created for Utah is included as an example of the final product Figure . In UtahTable 4Using available county‐level VA and CDC data on Veteran populations and suicide rates, we created 49 state maps to facilitate community selection for participation in the Together With Veterans program. The goal of TWV is to implement evidence‐based suicide prevention best practices  in rural communities while taking a Veteran‐driven, collaborative, and community‐centered approach  limit the interpretations that can be drawn from the maps. The planning maps produced must be regarded as tools to aid in decision‐making and not as comprehensive tools to understand or predict county suicide risk. Understanding the background and context of these maps as an answer to community stakeholders’ requests and acknowledging they must be used alongside insights from local stakeholders is necessary to ensure appropriate use.Though attempts were made to limit suppression by including 12 years of data and using crude rates instead of age‐adjusted, 9.89% of the counties were still suppressed as a result of low suicide counts. Due to this suppression, there is a possibility that counties that should be categorized as high need are not captured as such. We created four levels of need in our maps to ensure that counties with a suppressed suicide rate could still show up as higher need if there was a large enough Veteran population to account for this concern. Using crude instead of age‐adjusted rates when populations have varying age structures limits the ability to make meaningful comparisons across them  and relevant community factors  to prioritize counties for participation in a rural Veteran suicide prevention program. Since Alaska was excluded from analyses due to an inequivalent county classification system and change of census boundaries per the 2010 Census, we have reached out to the state and are working to identify a proper substate classification system that would allow us to create an appropriate planning map.Future efforts should focus on expanding the use GIS and spatially referenced data to identify risk and hot spots for Veteran suicide for TWV and other VA programs. For instance, including other information such as distance or travel time from VA hospitals and clinics could add another layer of useful information for prioritizing counties for TWV since VA suicide prevention teams have limited outreach and need to rely more on local non‐VA partners, a strength of TWV. Additional steps may be to account for key social determinants of health that have a known association with suicide (e.g., age, unemployment, social integration, or substance use; Jalles & Andresen, In conclusion, it is critical that researchers and those residing outside of communities of interest do not view GIS as a stand‐alone tool for understanding communities, but as part of a set of tools. Additional tools might focus on evaluating community and organizational readiness, capacity for program sustainability, economic impact, and the impact of using different definitions of rurality (Rural Health Information Hub, 6The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.Table S1Click here for additional data file.


To report on the clinical outcome of patients undergoing combined arthroscopic treatment of labral resection and microfracture at the rim of acetabulum at a minimum 2‐year follow‐up.The retrospective study included 38 patients undergoing hip arthroscopy for irreparable labral injury from 24 February 2014 to 26 February 2018. Thirteen patients were excluded owing to patient refusal of participation and concomitant diseases like synovial chondromatosis and dysplasia hip. The study group consisted of patients undergoing combined arthroscopic labral resection and microfracture at the rim of acetabulum (MICRO Group: 20 patients), arthroscopic labral resection alone (RESEC Group: five patients). Postoperative three‐dimensional (3D) double‐echo steady‐state (DESS) sequence with radial imaging at 3 Tesla were obtained and fluoroscopic image of the involved hip under distraction were used to observe the restoration of vacuum effect. Patient‐reported outcome scores (PROs) including the Harris Hip Score (HHS), Visual Analogue Score (VAS), Hip Outcome Score Activities of Daily Living Subscale (HOS‐ADL), Hip Outcome Score Sport‐Specific Subscale (HOS‐SSS) were collected and compared between two groups.vs 23.9 months, P < 0.05). The 3D DESS imaging demonstrated intermediate signal intensity at the relative area where the labrum resected followed by microfracture at the acetabular rim in MICRO group. Meanwhile, regrowth of labrum‐like tissue was not observed in MRI imaging of the RESEC group. Furthermore, vacuum effect was more apparent in MICRO group compared with RESEC group. All PROs in both groups showed a statistically significant improvement at follow‐up compared with preoperative levels. RESEC group: HHS ; HOS‐ADL ; HOS‐SSS ; VAS . MICRO group: HHS ; HOS‐ADL ; HOS‐SSS ; VAS . One patient of MICRO group had transient neurapraxias of the pudendal nerve that resolved completely by 3 months. There showed no statistically significant difference between groups regarding the preoperative and postoperative PROs.All patients were followed up for at least 6 months. The follow‐up time of RESEC group is longer than MICRO group (46.6 months Compared to labral resection, combined arthroscopic labral resection and microfracture at the rim of acetabulum is able to fulfill the labral defect area with the potential to restore the seal effect of labrum as an effective and safe option for irreparable segmental labral tears. To our knowledge, no relative studies exist about utilizing microfracture as a therapy for irreparable labral tear. Through microfracture, outflowing undifferentiated stem cells is reported to have the capacity of recreating a fibrocartilaginous tissue histologically in the space among capsule, acetabulum and femur. The labrum also deepens the acetabular articular surfaces, which is able to protect the femoral head from dislocating. A labral tear occurs most commonly under the circumstance of fermoroacetabular impingement, which is characteristic by deformity of acetabulum, femoral head or bothThe labrum of hip is a triangular fibrocartilage attached to the acetabular rim almost circumferentially. The labrum's main function is to mainly create a vacuum with a negative pressure that increases the difficulty of dislocating the hip and retains the fluid within the central compartment to lubricate the joint and even the distribution of contact forces across the articular surface, preventing early arthritic wearThe acetabular labrum plays an important role in preventing a healthy hip from premature arthritis. The preservation of the hydraulic seal effect of labrum is closely associated with satisfactory clinical outcomes no matter what kind of surgical treatment is performed. Since the role of the labrum has been supported by evidence, resection of a serious torn labrum may progress to a chondral lesion and premature arthritis and disrupt the role of the labrum in proprioception associated with the mechanical pain. Labral repair is increasingly the favored option for many surgeons as the preservation of the labrum leads to a superior outcome compared with debridement of the labrumDespite the fact that postoperative outcome of labral reconstruction is reported to be good, the possibility of restoring the labral seal effect remains uncertain because of the conversion rate of THA after labral reconstruction. This may raise the controversy over whether labral reconstruction can restore the suction seal effect which is of great importance in preventing premature articular wear. Moreover, current follow‐ups of various research range from short to mid‐term. No long‐term outcome of clinical trials is reported to ensure the role of labral reconstruction. Thus, the current status of treatment of irreparable labral tear remains uncertain.Under these circumstances, we wonder if there is another simple and effective treatment which is easy to operate. To our knowledge, no relative studies exist about utilizing microfracture as a therapy for irreparable labral tear. As the typical kind of marrow stimulation technique, microfracture is considered to be a first line of surgery for chondral defects because of its simplicity, cost‐effectiveness and low patient morbidity. Through penetrating the subchondral plate, the following marrow simulation brings the undifferentiated stem cells into the defect. Then a marrow clot forms at the defect area, which provides an environment for both pluripotential marrow cells and mesenchymal stem cells to differentiate into stable tissue within the base of the lesion. The regrowth tissue is able to replace the damaged cartilage and partially restore its function.Therefore, through microfracture at the rim of acetabulum, outflowing undifferentiated stem cells is reported to have the capacity of recreating a fibrocartilaginous tissue histologically in the space among capsule, acetabulum and femur. Traditionally, the scar formed at the acetabular rim leading to severe postoperative adhesion is considered as the possible cause of recurrent hip pain. However, there exists no research to validate this standpoint. Thus, the functional outcome of labral resection alone was used as a comparison with that of the combined arthroscopic labral resection and microfracture at the rim of acetabulum. We hypothesize that fibrocartilage‐like tissue would grow at the labral defect, function as a gasket seal like labrum and cause no postoperative hip pain. In addition, the short‐term clinical outcome of combined arthroscopic labral resection and microfracture at the rim of acetabulum is expected to be superior to labral resection.The purposes of this study were: (i) to assess the possibility of fibrocartilaginous repair in the labral defect area when performing microfracture at the acetabulum rim; (ii) to make sure the potential of regrowth tissue to restore hydraulic seal effect; and (iii) to find out whether the regrowth tissue is responsible for postoperative hip pain.This is a retrospective case–control study, which was approved by the Ethics Committee of First Affiliated Hospital of Army Medical University. Moreover, the informed consent was obtained from all included patients.Inclusion criteria: (i) patients presented with suspected anterior hip or groin pain with or without concomitant mechanical symptoms including clicking, popping and catching; (ii) the anterior hip or groin pain failed to relieve by conservative treatment for at least 3 month; (iii) magnetic resonance imaging findings of irreparable labral tear confirmed by intraoperative findings; (iv) anterior–posterior pelvis view radiographs showed no severe osteoarthritis ; and (v) patients underwent hip arthroscopy with a minimum of 0.5‐year of follow‐up.Exclusion criteria: (i) patients with concomitant pathology like synovial chondromatosis, dysplasia hip, Perthes disease and acute trauma of hip; (ii) postoperative period less than 0.5 year; and (iii) patients undergoing microfracture of femoral head for severe chondral lesions. Patients who met one of the criteria mentioned above would be excluded.Between 28 February 2014 and 26 February 2018, data on all patients undergoing primary hip arthroscopic surgery with the senior surgeon were retrospectively collected and reviewed. those patients included were diagnosed with fermoroacetabular impingement, among whom there were 17 cases of Pincer type, five cases of Cam type and three cases of mixed type. All hips that underwent arthroscopic labral resection with or without microfracture at the rim of acetabulum for 1 year were included in this study. Thirteen patients were excluded owing to patient refusal of participation and concomitant diseases like synovial chondromatosis or dysplasia hip. Patients were further assessed by radiographic tools preoperatively consisting of anterior–posterior pelvis, frog‐leg lateral view radiographs and magnetic resonance imaging. Irreparable labral tear was determined intraoperatively: severe intra substance damage, labral ossification, or segmental defects treated by either arthroscopic debridement alone or combined arthroscopic labral resection and microfracture at the rim of acetabulum. The total number of included hips were 30 from 25 patients , who were divided into two groups: patients undergoing combined arthroscopic labral resection and microfracture at the rim of acetabulum (MICRO Group: 20 patients/23 hips) and labral resection alone (RESEC Group: five patients/seven hips).Patients were positioned supine on a traction table and placed under combined spinal and epidural anesthesia or general anesthesia. After assessment of hip joint, three portals were established: anterior, anterolateral and posterolateral portal. Anterior portal was placed at the intersection of a vertical line descending from the anterior‐superior iliac spine and a horizontal line from the tip of the greater trochanter. Anterolateral was placed 1 cm anterior and 1 cm superior to the tip of the greater trochanter. Posterolateral portal was placed 1 cm superior and 1 cm posterior to the tip of the greater trochanter.After the portals were established, the labral tear was inspected and carefully probed. The labral tear extent was described using a clock‐face pattern, with 3 o'clock always indicating anterior.If the injured labrum was deemed irreparable, then it was completely debrided followed by the procedure that the acetabular rim was freshened for a bleeding bed, and/or a correction of Pincer deformity was performed if existed. When performing microfracture at the rim of acetabulum, a surgical awl  is used to make multiple small holes (2 mm in diameter) spaced 3–4 mm apart representing a linear shape in the exposed bone of the labral defect. Finally, sufficient marrow bleeding flowing from the small hole is observed after turning off arthroscopic pump  Figs , 2.Iliopsoas releasing was performed if there existed painful internal snapping hip syndrome preoperatively (two cases). Concomitant pathology like severe acetabular chondral lesions were addressed with microfracture, and ligamentum teres tears were treated with debridement (one case). Bony prominence of the femoral neck (cam deformity) was resected using a bur , and any loose bodies observed were removed. The capsule was not closed after interportal capsulotomy was performed.Postoperatively, all patients were instructed to toe‐touching weight bearing for 2 weeks and then transited from partial to full weight bearing for the following 4 weeks. In MICRO group, all patients used a hip brace to maintain slight flexion and external rotation to 0° of the involved hips for 2 weeks with limited motion of hip flexion within 60° in the next 4 weeks. In addition, physical therapy was performed on postoperative day one mainly focusing on straight leg raise training, which is supposed to last 6 weeks.All patients were evaluated with three‐dimensional 3D) double‐echo steady‐state (DESS) reformatted magnetic resonance images (MRI) . Radial reformatted images of axial 3D DESS sequence was reconstructed at 6° slice intervals through the center of the acetabulum perpendicular to the plane across the entire acetabular rim. A clock‐face scheme from 3 o'clock to 9 o'clock was implemented to describe the location of labrum , Visual Analogue Score (VAS), Hip Outcome Score Activities of Daily Living Subscale (HOS‐ADL), Hip Outcome Score Sport‐Specific Subscale (HOS‐SSS) to determine hip function outcome. Moreover, fluoroscopic image of the involved hip under distraction was used to evaluate the vacuum effect.The HHS was used to evaluate postoperative recovery of hip function in an adult population. The HHS score system mainly includes four aspects as pain, function, absence of deformity, and range of motion. The score standard had a maximum of 100 points (best possible outcome). A total score <70 is considered a poor score, 70–80 fair, 80–90 is good and 90–100 excellent.The VAS is a well described pain scale whereby patients report their pain from 0 to 10. A score of 0 would indicate no pain and 10 would indicate the worst pain. The VAS allows patients a simple method of relaying their experience regarding how painful their condition is. Patients are asked to rate their pain on a 0–10 scale. The clinical significance of this is that it allows patients to compare their own pain based on their perception of their own previous pain. It also objectifies the pain level to allow for quantitative analysis. Patients are generally more functional with less pain.The Hip Outcome Score (HOS) was specifically developed for younger more active patients between the ages of 13 and 66 years. The HOS is a patient‐administered tool that was designed to assess self‐reported functional status; therefore, symptoms were not considered part of the functional assessment. The HOS includes two subscales: activities of daily living (ADL) and sports‐specific (SSS). The scoring of the HOS is somewhat complicated since each subscale is scored separately as a percentage score. The ADL subscale has 19 items but only 17 are scored. The items pertaining to sitting and putting on socks and shoes are not included. The sports subscale has nine items. Each item on both scales is scored from 4 to 0, with 4 indicating “no difficulty” and 0 indicating “unable to do.” There is a “not applicable” option as well. The percentage score is calculated by comparing the item total score divided by the highest potential score multiplied by 100. By design the HOS does not represent a true patient‐derived outcome since it does not include items of specific concern to patients such as symptoms and work‐related, social, or emotional issues. It should be considered a well‐designed and evaluated functional outcome measure.P value <0.05 was considered statistically significant. Comparisons of postoperative patient‐reported outcome scores (PROs) and demographic statistics between the labral treatment groups were performed with 2‐tailed Student t tests.All statistical analyses were performed with SPSS software , and a vs 44.6 years), BMI (Body Mass Index) (22.5 vs 22.8) between MICRO and RESEC group .There were no significant differences in comparison of age . One patient in the MICRO group had transient neurapraxias of the pudendal nerve that resolved completely by 3 months. There were no sciatic, femoral, or lateral femoral cutaneous neurapraxias. There were no revision surgeries or conversions or scheduled conversions to resurfacing hip arthroplasty or total hip arthroplasty (THA) in both groups.The DESS MRI provide the compelling evidence that the acetabular rim was covered with regrown tissue in every patient of microfracture group. Comparing with RESEC group, suction seal effect was restored proven by the apparent vacuum effect in all fluoroscopic view of patients from MICRO group. The short‐term clinical outcome of combined arthroscopic labral resection and microfracture at the rim of acetabulum is similar to labral resection.et al. reported four of 47 patients had been converted to THA, three of those had a joint space of <2 mm thus indicated that joint space of <2 mm may be a risk factor for an inferior outcome for labral reconstructionet al. showed that 13 of 131 hips undergoing labral reconstruction progressed to arthritis requiring THA without preoperative joint space of <2 mm and Tönnis Grade ≥2In the case where the labrum is deemed irreparable because of insufficient mass, reconstruction either in open surgery or under arthroscopy is indicated with an autograft or allograft being incised to replace the torn labrum. Despite the fact that postoperative outcome of labral reconstruction is reported to be good, the possibility of restoring the labral seal effect remains uncertain. As far as we are concerned, the conversion rate of THA after labral reconstruction ranges from 0% to 25% reported in various researchet al.As the typical kind of marrow stimulation technique, microfracture is considered to be a first line of surgery for chondral defect because of its simplicity, cost‐effectiveness and low patient morbidity. Through penetrating the subchondral plate, the following marrow simulation brings the undifferentiated stem cells into the defect from the marrow forming a marrow clot, which provides an environment for both pluripotential marrow cells and mesenchymal stem cells to differentiation into stable tissue within the base of the lesionMRI is used for an evaluation for chondrolabral injuries but standard MRI produces both false‐positive results and an underestimation of labral pathology and has only 30% sensitivity and 36% accuracyIt has been pointed out that the association exists between labral lesions and the onset of osteoarthrosis due to the alterations of hip joint biomechanicsLimitations of our study include lack of pathology results in second‐look hip arthroscopy and small sample size of the resection group. As the procedure of microfracture to treat irreparable torn labrum shortly came up, after which labral excision was no longer an option for irreparable labral lesions, the number of patients undergoing labral resection before that is relatively small. The observation of the vacuum effect is a qualitative approach which is not able to define the difference of the restoration of negative pressure between the two groups quantitatively. Whether the unfixed capsule of our patients will have an impact on the restoration of the vacuum effect remains uncertain. Long‐term follow‐up is expected to further explore the clinical outcomes.To sum up, comparing with labral reconstruction, combined arthroscopic treatment of labral resection and microfracture at the rim of acetabulum is an easy, safe and effective procedure which is suitable for segmental irreparable labral tear as partial tissue regrowth could be achieved after marrow stimulation. When faced with the dilemma that labral reconstruction could not be performed, microfracture might be a cost‐effective and efficient option.Through effective marrow stimulation at the acetabular rim, the labral defect is repaired by the regrown tissue. Most importantly, the repaired tissue is able to restore the hydraulic seal effect of the labrum. Further study is needed to determine the long‐term clinical outcomes.


Thus, it is expected that programmes such as the Teen Triple P program  are delivered in any modality . Similarly, targets of the intervention may vary, providing that the parent/carer is defined as a primary rather than secondary target. Intervention targets may include: parent only, parent–adolescent dyads/triads, family‐based interventions or multiple systems approaches .1.3Adolescence is a developmental period that is characterised by significant psychological, social and physical changes that result in attainment of greater autonomy, identity and importance of relationships outside the family  and internationally. Child and adolescent health and/or mental health policies around the world ; the UK's National Health Services' Long Term Plan; the U.S. Department of Health and Human Services Healthy People agenda) emphasise the importance of the adolescent period as a critical transition point in the prevention and treatment of mental health problems and the promotion of health and wellbeing, along with the importance of evidence‐based interventions and the influential role. For example, this review will provide evidence‐based information for the action of “enhancing and promoting resources and mechanisms to support parenting in the middle years and adolescence,” which was identified as a neglected and less‐resourced area but still an influential period of transition where protective parenting has a strong impact on outcomes; and, for “tackling mental health and risky behaviours, such as building social and emotional coping skills in the middle years and during the transitions into adolescence and early adulthood” within the recently released Australian Government's National Action Plan for the Health of Children and Young People (2020–2030). The findings from this review will this support action within identified priority areas for governments across the world.Despite the importance of parents and parenting in the protection and risk for the development of mental health problems in children and adolescents  diagnosis; (b) sociodemographic risk status ; (c) type of caregiver ; (d) geographical location of the study; (e) intervention setting and modality; (f) type of outcome measurement modality ; (g) type of intervention model ; (h) participant age (parent and/or adolescent); and/or (i) participant gender (parent and/or adolescent)? Data permitting, we will fulfil this objective through subgroup analyses.33.13.1.1This review will include randomised controlled trials (RCTs) where participants have been randomly allocated to an intervention or control condition, and cluster‐RCTs where predefined clusters or groups are randomised to different conditions. In these designs, the intervention condition refers to participants who take part in the parenting programme for parents of adolescents. The control group refers to those in a comparison condition involving no intervention, an alternative intervention, service provision or treatment as usual, or waitlist control. In addition, eligible studies may include follow up assessment.3.1.2We define participation in a study to be comprised of two parts: (1) participation in the intervention and (2) the provision of outcome data. This means that participants can be either parents or adolescents. We envision that some studies might include adolescent data and not parent data, but to be included in the review the study must have one or more parent as a programme participant regardless of whether they provide outcome data.Studies will be included if the participants are parents or caregivers who have adolescents aged between 10 and 18 years at the start of the intervention; accordingly, adolescent participants must be aged between 10 and 18 years. Parents or caregivers will be included if they are biological, adoptive, kinship, or foster caregivers. Adolescents may be the primary recipient of the intervention providing there is a substantive parenting component and that a key objective of the intervention is parenting support and capacity building. Where studies include a proportion of adolescents or parents with adolescents outside of the age range, we will contact the study authors to obtain data for participants in the specified age range. When that data is unavailable, we will include the study if at least 80% of the sample falls within the specific age range. If these data are not available, we will exclude the study. We will include studies in any resulting meta‐analyses regardless of whether the sample is comprised entirely of the eligible age group or comprised of at least 80% in the eligible age range. However, we will conduct sensitivity analyses to determine whether the results change by including studies with different proportions of eligible participants.We will exclude parents with an uncontrolled serious mental illness . These parents are arguably a unique category of participants and have been included in other reviews specifically targeted at these populations , family systems theories, relational frame theory/acceptance and commitment therapy and nonviolent resistance theory. Interventions involving an adolescent component  will be included only if the parenting component is primary, not supplementary, and is of equal or greater dosage than the adolescent component.Interventions will be excluded if the sole focus or content of the intervention is related to the psychological functioning, social support, relationships or wellbeing of the parent . We will, however, include studies that have a parenting component alongside this type of content as long as the parenting aspect is of equal or greater dosage. We will exclude interventions that do not have an active psychological focus, such as those that involve peer support or psychoeducation only.3.1.4Studies will be included if the outcomes are measured using questionnaires (self or other report), independent observation, clinician ratings, administrative data or diagnostic interview. The timing of outcome assessment will be categorised as: short‐term (immediately postintervention to 3 months), medium‐term (3–6 months after the intervention) and long‐term (7–12 months vs. >12 months).3.21.Adolescent mental health, including disruptive, oppositional or conduct behaviour problems; anxiety symptoms; and depressive symptoms; as measured by targeted, problem‐specific scales such as the Conners Rating Scales Conners, , Eyberg 2.Adolescent positive development  and negative  dimensions of the relationship and global measures of relationship quality.4.Parenting practices, including effective  and ineffective  dimensions of parenting and parenting styles.Studies with any of the following outcomes will be included in the review:3.3We will include studies with eligible interventions that are delivered in any setting  or via any delivery modality . Included interventions can be of any duration or intensity, and may take a prevention, early intervention or treatment focus. Interventions can also be practitioner‐led or self‐directed . Finally, no restrictions will be placed on the geographical location of the intervention or the study. We recognise the impact that intervention setting and intensity may have on heterogeneity of effect sizes and so will conduct subgroup and sensitivity analyses to explore this heterogeneity (as specified in Section 3.5.8).3.43.4.1Search terms were initially developed by examining similar reviews and eligible studies identified during scoping, following by identification of indexing terms in topic relevant databases. Moreover, a specialist librarian from the authors' academic institution was consulted. Search terms were tested and refined in consultation with the librarian and all authors. No restrictions will be placed on publication date or language. At the searching stage, we will only exclude clearly ineligible document types, if this option is available for the specific search location .The search terms include the following categories: eligible population (adolescents), intervention type (parenting programme) and study design (RCT). Terms will be truncated where applicable . Within the categories, search terms will be combined using the OR Boolean operator and NEAR/2 proximity operator (where available). Categories will then be combined using the AND Boolean operator. The search string will be applied to the title, abstract, keyword and index term fields, where possible, for all search locations. The exact structure of the search will be altered as required in accordance with the functionality of different searching platforms. Where the ideal advanced search cannot be implemented in a particular search location, a simplified version of the search strategy will be used. A search record will be used to record each search, per recommended guidelines )AND((Title OR Abstract OR Keywords: family* NEAR/2 (counselling OR education ORintervention* OR program* OR therapy OR training OR treatment*)) OR  NEAR/2 (course* OR class* OR counselling OR education OR intervention* OR program* OR therapy OR training OR treatment*)) OR (Title OR Abstract OR Keywords: "Family Intervention" OR "Family Therapy" OR "home intervention" OR "home program" OR "Parenting Training" OR "child‐parent Training" OR “parent management training” OR “parent training”))AND)3.4.2To prevent publication bias, both published peer‐reviewed literature and unpublished grey literature will be included by searching key psychological electronic databases, trial registries and grey literature sources.MedLineEmbasePsycINFOCINAHLProQuest Platform: Dissertations and Theses Global, Social Science Databases, Social Services AbstractsWeb of ScienceCochrane and Campbell Collaboration librariesDatabasesOpen Science FrameworkCochrane Central Register of Controlled Trials (CENTRAL)Health Canada Clinical Trial DatabaseSwiss National Clinical Trials PortalPhilippine Health Research RegistrySouth African National Clinical Trials RegisterTanzania Clinical Trial RegistryTrial RegistriesInternational Bibliography of the Social SciencesPsycEXTRAGrey Literature Network ServiceSocial Science Research NetworkAustralian Research Alliance for Children and YouthLifecourse Centre Working Paper SeriesOpenGreyEarly Intervention FoundationCrime SolutionsAustralian Institute for Family StudiesLILACS World Health Organisation Institutional Repository for Information Sharing (WHO IRIS)Australian Institute for Health and Welfare (AIHW)National Technical Reports LibraryAustralian Department of Health and Ageing Mental Health PublicationsBluePrintsCalifornia Evidence‐Based Clearinghouse for Child WelfareGrey Literature sources3.4.3Harvesting references from the reference lists from all included studies.Forward citation searching using GoogleScholar for all included studies. GoogleScholar is the chosen platform for citation searching, as its citation counts include studies that may not be published in peer‐reviewed journals.Hand searching the 12 months prior to the search date in topic relevant journals to identify any published articles that have not yet been indexed in databases. Richards  demonstrContacting the authors of included studies and parenting experts to identify any unpublished studies or studies not captured by the systematic search.We will also conduct the following additional search strategies:3.53.5.1Based on our current understanding of the extant literature, we expect eligible studies to include participants who are adolescents aged 10–18 at the commencement of the parenting intervention, and their parents. We expect participants will be recruited in primarily in community settings , as well as social media and mental health organisations and that outcome measures will include questionnaires (self or other report), observation, clinician ratings, administrative data or diagnostic interview.M = 13.68 years; SD = 1.06 years) and their parents (n = 359) were randomly assigned to receive either the Partners in Parenting (PiP) program—a web‐based parenting intervention—or a control group who received five educational factsheets about adolescent development. Participants were recruited from secondary schools, online networks, social media and mental health organisations . Outcomes included parent‐reported parenting, adolescent‐reported parenting and adolescent depression and anxiety symptoms. Specifically, the following primary outcome measures were used: The Parenting to Reduce Adolescent Depression and Anxiety Scale, Short Mood and Feelings Questionnaire, Spence Children's Anxiety Scale and the secondary outcome: The Parenting to Reduce Adolescent Depression and Anxiety Scale—Adolescent Report. These outcomes were measured at preintervention, postintervention and 12‐months follow‐up.An example of a study that may be included is Yap et al. . In this3.5.2The records captured by the systematic search will be exported to EndNote for the removal of clearly ineligible record types . The remaining records will be imported to SysReview  and/or3.The record does not include any topic related to parenting programmes for parents of adolescents.All unique titles and abstracts remaining will undergo title and abstract screening using the following exclusion criteria:Each record will be initially assessed to determine whether it is a duplicate or ineligible record type. While efforts will be made to exclude duplicate and ineligible document types prior to title and abstract screening, this step will act as a safeguard to prevent the presence of such records during full‐text screening. When records are confirmed to be unique and eligible record types, the third criterion will be applied to remove records that do not relate to parenting programmes for parents of adolescents.Prior to independent screening, all review authors will independently and blindly double screen a test set of the same 25 titles and abstracts to ascertain inter‐rater reliability in screening decisions. The screening results for all review authors will be combined and assessed for consistency, with screening thresholds adjusted and more clearly documented to guide independent screening, where necessary. If required, a subsequent test‐set will be implemented to ensure screening decisions are consistent prior to independent screening. The remaining records will then be derived between review authors for independent screening. However, a random sample of 5% of exclusions from each screener will be cross‐checked and ensure screening consistency for the entire corpus of the search results. If the false negative rate exceeds 5%, additional samples of excluded records will be examined until the false negative rate falls below 5%.Retained records will then progress to a full‐text review, preceded by a literature retrieval stage where the full‐text documents for potentially eligible studies are attached within SysReview to the relevant record. If full‐text versions cannot be located via existing university resources, they will be ordered via university libraries or by contacting document authors.1.Duplicate record;2.Ineligible record type;3.Document does not include topic related to parenting programmes for parents of adolescents;4.Methodological design is not RCT;5.Ineligible participants;6.Ineligible intervention/no intervention and7.Ineligible outcome measure(s).Records retained during the title and abstract screening stage will be screened using the following exclusion criteria:The first three steps of the full‐text screening will be a final check to ensure that duplicates, ineligible record types and records which do not include topics related to parenting programmes for parents of adolescents have not proceeded to the full‐text screening stage.Full text records will be independently screened by two review authors following the exclusion criteria. Any discrepancies in screening decisions will be mediated by a third review author or discussed with the entire review team if an unequivocal decision cannot be made by the third review author.3.5.3SysReview using the coding companion provided in Appendix A. Broadly, the following information will be extracted and coded within the following domains:1.General study characteristics ;2.Participants ;3.Design and methods ;4.Intervention ;5.Outcomes measurement ;6.Effect size data and7.Risk of bias.Eligible documents progressing from the full‐text screening stage will be coded within 3.5.4Two review authors will independently assess risk of bias for all included studies using the Cochrane Risk of Bias Tool 2.0  as the measure of treatment effect. Where studies report baseline and postintervention outcome data, SMDs will be calculated using postintervention outcomes. If eligible studies report binary outcomes, effect sizes will be computed as odds ratios, and then transformed into SMDs for meta‐analyses , which will facilitate taking these issues into account.Multiple study reportsOn occasion, studies may use the same sample of data across reports of a study or may use only a subset of a sample. All reports of an eligible study will be included in the review. However, we will only include one effect size for each conceptually distinct outcome in the meta‐analysis, using the most complete sample or portion of the sample that directly meets the inclusion criteria for the review . We will use all reports of a study to code and assess risk of bias and will state which study report is used for the calculation of effect sizes. In cases where the study characteristics or outcome data differs across study reports, we will contact the study authors to verify the information and will report both the variation in the reports and the information provided by the authors.Multiple conceptually analogous outcomes in one studyPsychological research frequently reports multiple conceptually similar outcome measures within an individual study. If this is identified, we will code all study outcomes, but will combine conceptually equivalent outcomes into a composite effect size using the method described by Borenstein et al. . This wiMultiple time pointsIf studies report multiple outcome measurement time points, we plan to first categorise the postintervention measurements into short‐term (immediately postintervention to 3 months), medium‐term (3–6 months after the intervention) and long‐term (7–12 months and >12 months). Second, we will calculate effect sizes at each of these time points for each outcome category and then conduct separate meta‐analyses for each time point. We acknowledge that not all studies may equivocally fall into these time points and we may need to devise a cohesive categorisation that suits the studies located by the review.Cluster randomised trialsCluster randomised designs overestimate of the precision of study results (higher risk of Type I error) if the analysis conducted by the authors does not account for the dependence within clusters. If the review captures cluster‐randomised trials, they will first be assessed for the use of appropriate analyses to account for the clusters . If study authors analyse participants at the individual‐level and do not account for clustering, we will use the approach recommended by Higgins et al.  to adjusMultiple intervention groups and multiple interventions per individualDue to the nature of the intervention for this review, we do not anticipate locating studies where participants receive multiple interventions . If we locate studies where there are multiple intervention or treatment conditions, we will include and analyse the treatment condition that most closely aligns with the intervention inclusion criteria . Where missing data is identified, we will contact study authors to obtain the data. If after two contact attempts, the missing data cannot be obtained, the approach for dealing with the study will depend on the type of missing data. If the missing data is required for effect size calculation, the study will be excluded from meta‐analyses, but include in the qualitative summary of eligible studies. If the missing data is required for rating risk of bias, the missingness will be reported in the risk of bias summary tables and we will follow the direction of the risk of bias tool to arrive at the level of bias for the relevant domain. If the missing data relates to other characteristics of the study, we will comment on the overall missingness in the data when summarising the studies included in the review.3.5.8I2 statistic, χ2 test and τ2  and conduct random effects inverse variance meta‐analyses for each conceptually distinct outcome category where there is at least two independent studies. The results of the meta‐analyses will be presented in forest plots that also display the mean effect size and their corresponding 95% confidence intervals. All included studies, regardless of their inclusion in the meta‐analyses, will be summarised in narrative text and study summary tables according to key study characteristics .3.5.11If sufficient data is located, we will conduct subgroup analyses to examine whether the impact of the intervention changes according to the following variables: (a) diagnosis; (b) sociodemographic risk status ; (c) type of caregiver ; (d) geographical location of the study; (e) intervention setting and modality; (f) type of outcome measurement modality ; (g) type of intervention model ; (h) participant age (parent and/or adolescent) and/or (i) participant gender (parent and/or adolescent). We will use meta‐regression to conduct subgroup analyses, in order to integrate multiple categorical and continuous moderators. If there are too few studies, which can result in overfitting . Additional exploratory sensitivity analyses may be conducted depending on the studies located by the review, but we will explicitly distinguish between a priori and posthoc analyses in the final review. For example, the categorisation of intervention models or outcome measures. Sensitivity analyses will be summarised in narrative text and tables.3.5.13We do not intend to include or synthesise qualitative research in this review.


Striga hermonthica, causes up to 100% yield loss in maize production in Sub‐Saharan Africa. Developing Striga‐resistant maize cultivars could be a major component of integrated Striga management strategies. This paper presents a comprehensive overview of maize breeding activities related to Striga resistance and its management. Scientific surveys have revealed that conventional breeding strategies have been used more than molecular breeding strategies in maize improvement for Striga resistance. Striga resistance genes are still under study in the International Institute for Tropical Agriculture (IITA) maize breeding programme. There is also a need to discover QTL and molecular markers associated with such genes to improve Striga resistance in maize. Marker Assistance Breeding is expected to increase maize breeding efficiency with complex traits such as resistance towards Striga because of the complex nature of the host‐parasite relationship and its intersection with other environmental factors. Conventional alongside molecular tools and technical controls are promising methods to effectively assess Striga in Sub‐Saharan Africa. These amino acids are toxic to Striga plants but innocuous to maize plants  hormones by up‐regulating gibberellin3β‐dioxygenase 1, which is involved in GA biosynthesis  – VIGS system, Kirigia et al. (2014) have shown that this system works in S. hermonthica and has been proven as a useful system for candidate gene validation either in parasite development or parasitism, for the development of resistant transgenic maize.Other methods for Striga control include biological control using herbicide‐resistant maize variety (Imazapyr treatment), development of Striga‐resistant germplasm, use of fungus Fusarium isolation by applying strigolactones  or after physical contact with the host (postattachment). Preattachment resistance Figure  occurs wStriga hermonthica postattachment resistance in maize has mainly come from its wild‐grass relatives Zea diploperennis .3.3Striga resistance in maize. It is quantitatively inherited with additive gene effects being more important than non‐additive effects. This contributes to regulating the host plant damage syndrome rating and grain yield under Striga infestation  and LBO . In tobacco, the silencing of CCD7 and CCD8 genes has delayed the virus parasite formation in the host, indicating that these two genes are a key in the parasitic life cycle .4Development of Striga‐resistant cultivars has been limited by the lack of dependable screening techniques . Confounding effects of environmental conditions on the polygenic inheritance of traits associated with Striga resistance make field screening indispensable despite the advances made in laboratory and at pot experiments stage.Screen house technique has been used to screen maize genotypes for tolerance / resistance to Striga .5.1Conventional plant breeding aims at increasing the chances of selecting individuals from populations generated from genetic mating designs. Selection has usually been carried out at the whole‐plant level thereby, representing the net result of the interaction between genotype and environment  in 3 years (2014–2017) under Striga infestation . The desire to increase maize yields under marginal growing conditions and a rise in literacy can be the major reasons behind the increase towards the complete adoption of hybrid technology in countries like Zimbabwe, Ghana, Mali and Nigeria . Heterosis of hybrid varieties can be useful in mitigating the effect of Striga on maize productivity. With the increased use of hybrid maize seed in West and Central Africa (WCA), Menkir et al.  have sel5.2Marker‐assisted selection (MAS) is an indirect selection process where a trait of interest is selected based on a marker linked to the trait, rather than on the trait itself . This breeding method allows the performance of a selected phenotype to be predicted based on the use of molecular markers at early generation.Application of molecular markers has provided significant opportunities for breeders to characterize, evaluate and select maize germplasm widely used by public and private sectors. Molecular markers are also used for screening crop genotypes for tolerance to biotic or abiotic stress. Using SSRs and SNPs markers, some elite genotypes for the breeding of Striga resistance are selected and new makers have been identified, which significantly contributed to the differentiation of Striga tolerant and susceptible genotypes . The present challenge is to convert a large amount of available genetic information into a large set of markers useful for Striga resistance breeding in maize and to integrate such markers into a sustainable breeding scheme. Further exploration of closely related QTL gene markers related to Striga will help in the effective trait pyramiding gene actions that can contribute to maize effective production. Some effective molecular docking approaches such as CRISPR/Cas9 genome editing of strigolactone genes, which are responsible for The authors declare that there is no conflict of interests.A.M. Yacoubou, wrote the draft manuscript with the contributions of all the co‐authors.


Cichlids inhabiting the Great Lakes of Africa have radiated extremely rapidly, with Lake Malaŵi harboring some 850 species. This rapid radiation may be linked to the diversity in behaviors, sexual selection, and phenotypic plasticity. To determine the relationships between morphology and behaviors, microcomputed tomography (microCT) was used to observe internal morphological structures. Observed morphological adaptations were linked with observed behavior of cichlids in Lake Malaŵi with respect to the various available food resources. Many of these adaptations have parallels, sometimes into the finest details, in other drainage systems and can thus be considered as variations of how cichlids in general respond to environmental opportunities and challenges. Variations in the structure and teeth of the pharyngeal jaws and the oral jaws allowed for fine tuning of specializations, so that various species can utilize the same source without direct competition. We suggested that high‐resolution X‐ray computed tomography will permit scientists to infer life history and behavior characters of rare or extinct taxa from a detailed examination of morphology and linkages between morphology and behavior found in extant species. We linked observed morphological traits with behavioral observations of fishes from Lake Malawi. We used microcomputed tomography to obtain morphological traits and SCUBA to record behavior. Freshwater lakes with a diverse substrate and inhabited by a varied palette of invertebrate life were most likely present throughout the millennia, and the environmental challenges facing a cichlid in present Lake Malaŵi are expected to be very similar to those faced by its ancestors 50 million years ago. Morphological adaptations that evolved a long time ago are likely stored in every cichlid's genome and under certain circumstances past structural innovations can be “recalled” whenever the environment again requires it.Petrochromis Boulenger, endemic to Lake Tanganyika, and in Petrotilapia Trewavas, endemic to Lake Malaŵi was proven to be convergence on the basis of molecular studies  was based on a single specimen deposited in the British Museum of Natural History (BMNH 1891.12.17.7). High‐resolution X‐ray computed tomography permitted us to examine the internal structure of its head and to determine the various synapomorphies. Furthermore, we can view the internal morphology in increments of 20–35 µm and examine areas that would otherwise be destroyed by dissection. This technology can be applied to similar phenotypes of cichlids found in other lakes, even on different continents. The purpose of this paper is to illustrate how observed behavioral traits of shallow‐water species can be linked with morphological attributes using data collected from selected cichlids from Lake Malaŵi using the aforementioned techniques. Such associations can be used to predict behavior of deep‐water or rare species based on head morphology.The varied morphologies found in cichlids from Malaŵi are best viewed using high‐resolution X‐ray computed tomography (HRCT). The use of such technology is nondestructive, so we can collect data on type specimens from museum collections. For example, the description of 2The specimens referred to herein were collected by SCUBA divers who chased them into a monofilament net. They were anesthetized with clove oil (IACUC 110784), preserved in 10% formalin, and then placed in 70% ethanol for permanent storage in the Penn State University Fish Museum. After preservation, they were scanned on the high‐resolution X‐ray computer system in the Center for Quantitative X‐Ray Imaging (CQI) at Penn State University. Specimens were mounted vertically, the mandibles pinned together to create a standard position, and scanned with target pixel and slice resolutions of approximately 35 µm. Scan data were reconstructed as 16‐bit TIFF images with a 1,024 × 1,024 pixel grid. For each individual, the entire head was scanned. The volumetric image datasets for each fish were used to create a three‐dimensional isosurface reconstruction  prevents it from penetrating the hideaways of the small mbuna, but after having located a site with small fish it slowly drops down onto a rock with its characteristic downward‐projecting snout at the edge of it, above the crevice. Its mottled pattern blends well with the environment while it remains motionless for several minutes stealthily observing the small mbuna hiding in the crack. As soon as one of them comes within reach of the very protractile mouth, it is sucked out of its shelter. When N. linni expands its buccal cavity its protruded mouth functions like the hose of a vacuum cleaner.Aristochromis christyi Trewavas  to correlate with the difference in feeding behavior.Juvenile Genyochromis mento Trewavas ); and another consisting of species with very large, rubbery lips. Placidochromis milomo  from other cichlids . Caprichromis liemi also actively chases mouthbrooding females and feeds on their broods.Apart from some small species that clean parasites from larger fish, Konings, . The AfrLethrinops Regan and similar genera find their food, insects and crustaceans, in the sand. Such prey is normally not visible and must be extracted from the sand by random scooping and sifting , in particular on the head  are attached to the rocks and form the matrix on which other algae, the so‐called “loose aufwuchs,” grow. The loose aufwuchs contains different types of algae strands, but the many short strands of blue–green algae (Cyanobacteria) and the unicellular algae (diatoms) constitute its most nutritious part.Most cichlid species in Lake Malaŵi are herbivores feeding off the rich algal layer that covers rocks—the so‐called aufwuchs—and which is also found on plants and other substrates. The aufwuchs consists of a variety of algae: the tough strands of some filamentous algae . Typically, the lining of the body cavity in herbivores is pitch‐black.Chindongo bellicosus Li, Konings, & Stauffer  neatly fit into each other and have a very strong hold on the algal strands when it bites in the algal mat. While holding tight on the algae, it rapidly shakes its entire body and thus dislodges or tears off the strands. In the very shallow rocky habitat, the algae are also tougher and T. tropheops . The teeth of the outer jaws are situated deep inside the mouth, especially along the sides. As the leaves are scraped, the aufwuchs accumulates in the space between the teeth and the lips.Petrotilapia nigra Marsh , a species who pretends to be dead in order to attract its food: inexperienced juvenile fish that appear to be attracted to the predator's unique color pattern.Besides the many feeding specialists in Lake Malaŵi, there is of course also a group of species that developed behavioral adaptations to increase the efficiency of obtaining available resources. The paedophages discussed above basically belong to this group but also the famous sleeper, Metriaclima and recently by Li et al.  have the firmest grip on the blue–green algae and can thus crop the shortest strands. The algae‐combing herbivores normally have terminal mouths with wide tooth bands in both upper and lower jaws. The bi‐ and tricuspid oral teeth have relatively long tips that act as the tines of a fork or comb, raking the algal matrix collecting the loose strands of algae.The herbivores conversely have a wide lower pharyngeal jaw set with minute teeth with a rounded tip. The precise function of these teeth is unknown, and they do not seem to mechanically alter the algae (Cyanobacteria), which is the main item consumed by all herbivores of Lake Malaŵi. They may, however, concentrate and bundle the various stands of algae before they are swallowed. There are two main types of herbivores, pickers, and combers. The common morphological characteristic of the algae pickers is a short dentary that gives the fish an overbite and closely packed oral teeth each with two or three short tips. It appears that the species with the shortest dentary ; Data curation (supporting); Resources (supporting); Visualization (lead); Writing‐original draft (lead). Joshua Michael Wisor: Data curation ; Formal analysis ; Methodology (supporting); Resources ; Software (lead). Jay Stauffer: Conceptualization ; Funding acquisition ; Methodology ; Resources ; Supervision ; Visualization ; Writing‐review & editing .All fishes were anesthetized with clove oil (IACUC 110784), preserved in 10% formalin, and then placed in 70% ethanol for permanent storage in the Penn State University Fish Museum.