Cross-system Comparisons Research Articles

Computed tomography referral guidelines adherence in Europe: insights from a seven-country audit.

Ensuring appropriate computed tomography (CT) utilization optimizes patient care while minimizing radiation exposure. Decision support tools show promise for standardizing appropriateness. In the current study, we aimed to assess CT appropriateness rates using the European Society of Radiology (ESR) iGuide criteria across seven European countries. Additional objectives were to identify factors associated with appropriateness variability and examine recommended alternative exams. As part of the European Commission-funded EU-JUST-CT project, 6734 anonymized CT referrals were audited across 125 centers in Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia. In each country, two blinded radiologists independently scored each exam's appropriateness using the ESR iGuide and noted any recommended alternatives based on presented indications. Arbitration was used in case auditors disagreed. Associations between appropriateness rate and institution type, patient's age and sex, inpatient/outpatient patient status, anatomical area, and referring physician's specialty were statistically examined within each country. The average appropriateness rate was 75%, ranging from 58% in Greece to 86% in Denmark. Higher rates were associated with public hospitals, inpatient settings, and referrals from specialists. Variability in appropriateness existed by country and anatomical area, patient age, and gender. Common alternative exam recommendations included magnetic resonance imaging, X-ray, and ultrasound. This multi-country evaluation found that even when using a standardized imaging guideline, significant variations in CT appropriateness persist, ranging from 58% to 86% across the participating countries. The study provided valuable insights into real-world utilization patterns and identified opportunities to optimize practices and reduce clinical and demographic disparities in CT use. Question Largest multinational study (7 EU countries, 6734 CT referrals) assessed real-world CT appropriateness using ESR iGuide, enabling cross-system comparisons. Findings Significant variability in appropriateness rates across institution type, patient status, age, gender, exam area, and physician specialty, highlighted the opportunities to optimize practices based on local factors. Clinical relevance International collaboration on imaging guidelines and decision support can maximize CT benefits while optimizing radiation exposure; ongoing research is crucial for refining evidence-based guidelines globally.

A unified paradigm for defining elasmobranch aggregations

AbstractElasmobranchs are highly diverse in movement, sensory capacity, and behavioural responses to the environment, leading to differences in the function and nature of associations and interactions between individuals, populations, and species. The term “aggregation” has been widely and variably used to describe co-occurrence across elasmobranch species, but its defining criteria remain vague and indeterminate. The lack of standardized terminology hinders comparisons across studies, species, and systems. It can cause misinterpretation about the drivers of aggregation formation or grouping behaviour and limits the impact of elasmobranch behavioural research. Here, we propose generalizable definitions of aggregation and supporting terms, adapted from more mature socioecological theory in other systems, which can be applied across elasmobranchs. We discuss the drivers and types of elasmobranch aggregations, detail the criteria required to identify an aggregation based on our definition, and offer direction on future methods and reporting to advance the field. These proposed definitions and reporting protocols standardize the study of elasmobranch socioecology, will generate greater understanding of the mechanisms underlying behaviour and distribution across species, and support more cross-system comparisons. Finally, this information can offer greater predictive power into when and how aggregations may form, leading to more proactive management strategies to mitigate anthropogenic threats.

Contact tracing indicators for COVID-19: Rapid scoping review and conceptual framework.

BackgroundContact tracing is one of the key interventions in response to the COVID-19 pandemic but its implementation varies widely across countries. There is little guidance on how to monitor contact tracing performance, and no systematic overview of indicators to assess contact tracing systems or conceptual framework for such indicators exists to date.MethodsWe conducted a rapid scoping review using a systematic literature search strategy in the peer-reviewed and grey literature as well as open source online documents. We developed a conceptual framework to map indicators by type (input, process, output, outcome, impact) and thematic area (human resources, financial resources, case investigation, contact identification, contact testing, contact follow up, case isolation, contact quarantine, transmission chain interruption, incidence reduction).ResultsWe identified a total of 153 contact tracing indicators from 1,555 peer-reviewed studies, 894 studies from grey literature sources, and 15 sources from internet searches. Two-thirds of indicators were process indicators (102; 67%), while 48 (31%) indicators were output indicators. Only three (2%) indicators were input indicators. Indicators covered seven out of ten conceptualized thematic areas, with more than half being related to either case investigation (37; 24%) or contact identification (44; 29%). There were no indicators for the input area “financial resources”, the outcome area “transmission chain interruption”, and the impact area “incidence reduction”.ConclusionsAlmost all identified indicators were either process or output indicators focusing on case investigation, contact identification, case isolation or contact quarantine. We identified important gaps in input, outcome and impact indicators, which constrains evidence-based assessment of contact tracing systems. A universally agreed set of indicators is needed to allow for cross-system comparisons and to improve the performance of contact tracing systems.

Low-Value Care at the Actionable Level of Individual Health Systems

Low-value health care remains prevalent in the US despite decades of work to measure and reduce such care. Efforts have been only modestly effective in part because the measurement of low-value care has largely been restricted to the national or regional level, limiting actionability. To measure and report low-value care use across and within individual health systems and identify system characteristics associated with higher use using Medicare administrative data. This retrospective cohort study of health system-attributed Medicare beneficiaries was conducted among 556 health systems in the Agency for Healthcare Research and Quality Compendium of US Health Systems and included system-attributed beneficiaries who were older than 65 years, continuously enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017, and eligible for specific low-value services. Statistical analysis was conducted from January 26 to July 15, 2021. Use of 41 individual low-value services and a composite measure of the 28 most common services among system-attributed beneficiaries, standardized to distance from the mean value. Measures were based on the Milliman MedInsight Health Waste Calculator and published claims-based definitions. Across 556 health systems serving a total of 11 637 763 beneficiaries, the mean (SD) use of each of the 41 low-value services ranged from 0% (0.01%) to 28% (4%) of eligible beneficiaries. The most common low-value services were preoperative laboratory testing (mean [SD] rate, 28% [4%] of eligible beneficiaries), prostate-specific antigen testing in men older than 70 years (mean [SD] rate, 27% [8%]), and use of antipsychotic medications in patients with dementia (mean [SD] rate, 24% [8%]). In multivariable analysis, the health system characteristics associated with higher use of low-value care were smaller proportion of primary care physicians (adjusted composite score, 0.15 [95% CI, 0.04-0.26] for systems with less than the median percentage of primary care physicians vs -0.16 [95% CI, -0.27 to -0.05] for those with more than the median percentage of primary care physicians; P < .001), no major teaching hospital (adjusted composite, 0.10 [95% CI, -0.01 to 0.20] without a teaching hospital vs -0.18 [95% CI, -0.34 to -0.02] with a teaching hospital; P = .01), larger proportion of non-White patients (adjusted composite, 0.15 [95% CI, -0.02 to 0.32] for systems with >20% of non-White beneficiaries vs -0.06 [95% CI, -0.16 to 0.03] for systems with ≤20% of non-White beneficiaries; P = .04), headquartered in the South or West (adjusted composite, 0.28 [95% CI, 0.14-0.43] for the South and 0.22 [95% CI, 0.02-0.42] for the West compared with -0.09 [95% CI, -0.26 to 0.08] for the Northeast and -0.44 [95% CI, -0.60 to -0.28] for the Midwest; P < .001), and serving areas with more health care spending (adjusted composite, 0.23 [95% CI, 0.11-0.35] for areas above the median level of spending vs -0.24 [95% CI, -0.36 to -0.12] for areas below the median level of spending; P < .001). The findings of this large cohort study suggest that system-level measurement and reporting of specific low-value services is feasible, enables cross-system comparisons, and reveals a broad range of low-value care use.

Validating the predictions of murburn model for oxygenic photosynthesis: Analyses of ligand-binding to protein complexes and cross-system comparisons

In this second half of our treatise on oxygenic photosynthesis, we provide support for the murburn model of the light reaction of photosynthesis and ratify key predictions made in the first part. Molecular docking and visualization of various ligands of quinones/quinols (and their derivatives) with PS II/Cytochrome b 6 f complexes did not support chartered 2e-transport role of quinols. A broad variety of herbicides did not show any affinity/binding-based rationales for inhibition of photosynthesis. We substantiate the proposal that disubstituted phenolics (perceived as protonophores/uncouplers or affinity-based inhibitors in the classical purview) serve as interfacial modulators of diffusible reactive (oxygen) species or DR(O)S. The DRS-based murburn model is evidenced by the identification of multiple ADP-binding sites on the extra-membraneous projection of protein complexes and structure/distribution of the photo/redox catalysts. With a panoramic comparison of the redox metabolic machinery across diverse organellar/cellular systems, we highlight the ubiquitous one-electron murburn facets (cofactors of porphyrin, flavin, FeS, other metal centers and photo/redox active pigments) that enable a facile harnessing of the utility of DRS. In the summative analyses, it is demonstrated that the murburn model of light reaction explains the structures of membrane supercomplexes recently observed in thylakoids and also accounts for several photodynamic experimental observations and evolutionary considerations. In toto, the work provides a new orientation and impetus to photosynthesis research. Communicated by Ramaswamy H. Sarma

Theory of temperature-dependent consumer-resource interactions.

Changes in temperature affect consumer-resource interactions, which underpin the functioning of ecosystems. However, existing studies report contrasting predictions regarding the impacts of warming on biological rates and community dynamics. To improve prediction accuracy and comparability, we develop an approach that combines sensitivity analysis and aggregate parameters. The former determines which biological parameters impact the community most strongly. The use of aggregate parameters (i.e., maximal energetic efficiency, ρ, and interaction strength, κ), that combine multiple biological parameters, increases explanatory power and reduces the complexity of theoretical analyses. We illustrate the approach using empirically derived thermal dependence curves of biological rates and applying it to consumer-resource biomass ratio and community stability. Based on our analyses, we generate four predictions: (1) resource growth rate regulates biomass distributions at mild temperatures, (2) interaction strength alone determines the thermal boundaries of the community, (3) warming destabilises dynamics at low and mild temperatures only and (4) interactions strength must decrease faster than maximal energetic efficiency for warming to stabilise dynamics. We argue for the potential benefits of directly working with the aggregate parameters to increase the accuracy of predictions on warming impacts on food webs and promote cross-system comparisons.

Indocyanine green matching phantom for fluorescence-guided surgery imaging system characterization and performance assessment

.Significance: Expanded use of fluorescence-guided surgery with devices approved for use with indocyanine green (ICG) has led to a range of commercial systems available. There is a compelling need to be able to independently characterize system performance and allow for cross-system comparisons.Aim: The goal of this work is to expand on previous proposed fluorescence imaging standard designs to develop a long-term stable phantom that spectrally matches ICG characteristics and utilizes 3D printing technology for incorporating tissue-equivalent materials.Approach: A batch of test targets was created to assess ICG concentration sensitivity in the 0.3- to 1000-nM range, tissue-equivalent depth sensitivity down to 6 mm, and spatial resolution with a USAF test chart. Comparisons were completed with a range of systems that have significantly different imaging capabilities and applications, including the Li-Cor® Odyssey, Li-Cor® Pearl, PerkinElmer® Solaris, and Stryker® Spy Elite.Results: Imaging of the ICG-matching phantoms with all four commercially available systems showed the ability to benchmark system performance and allow for cross-system comparisons. The fluorescence tests were able to assess differences in the detectable concentrations of ICG with sensitivity differences >10× for preclinical and clinical systems. Furthermore, the tests successfully assessed system differences in the depth-signal decay rate, as well as resolution performance and image artifacts. The manufacturing variations, photostability, and mechanical design of the tests showed promise in providing long-term stable standards for fluorescence imaging.Conclusions: The presented ICG-matching phantom provides a major step toward standardizing performance characterization and cross-system comparisons for devices approved for use with ICG. The developed hybrid manufacturing platform can incorporate long-term stable fluorescing agents with 3D printed tissue-equivalent material. Further, long-term testing of the phantom and refinements to the manufacturing process are necessary for future implementation as a widely adopted fluorescence imaging standard.

Searching for structure in collective systems

From fish schools and bird flocks to biofilms and neural networks, collective systems in nature are made up of many mutually influencing individuals that interact locally to produce large-scale coordinated behavior. Although coordination is central to what it means to behave collectively, measures of large-scale coordination in these systems are ad hoc and system specific. The lack of a common quantitative scale makes broad cross-system comparisons difficult. Here we identify a system-independent measure of coordination based on an information-theoretic measure of multivariate dependence and show it can be used in practice to give a new view of even classic, well-studied collective systems. Moreover, we use this measure to derive a novel method for finding the most coordinated components within a system and demonstrate how this can be used in practice to reveal intrasystem organizational structure.

Species interactions under climate change: connecting kinetic effects of temperature on individuals to community dynamics.

Human-induced climate change, dominated by warming trends, poses a major threat to global biodiversity and ecosystem functioning. Species interactions relay the direct and indirect effects of climate warming on individuals to communities, and detailed understanding across these levels is crucial to predict ecological consequences of climate change. We provide a conceptual framework that links temperature effects on insect physiology and behaviour to altered species interactions and community dynamics. We highlight key features of this framework with recent studies investigating the impacts of warming climate on insects and other ectotherms and identify methodological, taxonomic and geographic biases. While the effects of increased constant temperatures are now well understood, future studies should focus on temperature variation, interactions with other stressors and cross-system comparisons.

Modeling Quantitative Value of Habitats for Marine and Estuarine Populations

Coastal habitats (e.g., seagrass beds, shallow mud, and sand flats) strongly influence survival, growth, and reproduction of marine fish and invertebrate species. Many of these species have declined over the past decades, coincident with widespread degradation of coastal habitats, such that an urgent need exists to model the quantitative value of coastal habitats to their population dynamics. For exploited species, demand for habitat considerations will increase as fisheries management contends with habitat issues in stock assessments andmanagement in generalmoves toward amore ecosystem-based approach. The modeling of habitat function has, to date, been done on a case-by-case basis involving diverse approaches and types of population models, which has made it difficult to generalize about methods for incorporating habitat into population models. In this review, we offer guiding concepts for how habitat effects can be incorporated in population models commonly used to simulate the population dynamics of fish and invertebrate species. Many marine species share a similar life-history strategy as long-lived adults with indeterminate growth, high fecundity, a planktonic larval form, and benthic juveniles and adults using coastal habitats. This suite of life-history traits unites the marine species across the case studies, such that the population models can be adapted for other marine species. We categorize population models based on whether they are static or dynamic representations of population status, and for dynamic, further into unstructured, age/size class structured, and individual-based. We then use examples, with an emphasis on exploited species, to illustrate how habitat has been incorporated, implicitly (correlative) and explicitly(mechanistically), into each of these categories. We describe the methods used and provide details on their implementation and utility to facilitate adaptation of the approaches for other species and systems. We anticipate that our review can serve as a stimulus for more widespread use of population models to quantify the value of coastal habitats, so that their importance can be accurately realized and to facilitate cross-species and cross-system comparisons. Quantitative evaluation of habitat effects in population dynamics will increasingly be needed for traditional stock assessments, ecosystem-based management, conservation of at-risk habitats, and recovery of overexploited stocks that rely on critical coastal habitats during their life cycle.

The One-Sample PARAFAC Approach Reveals Molecular Size Distributions of Fluorescent Components in Dissolved Organic Matter.

Molecular size plays an important role in dissolved organic matter (DOM) biogeochemistry, but its relationship with the fluorescent fraction of DOM (FDOM) remains poorly resolved. Here high-performance size exclusion chromatography (HPSEC) was coupled to fluorescence emission-excitation (EEM) spectroscopy in full spectral (60 emission and 34 excitation wavelengths) and chromatographic resolution (<1 Hz), to enable the mathematical decomposition of fluorescence on an individual sample basis by parallel factor analysis (PARAFAC). The approach allowed cross-system comparisons of molecular size distributions for individual fluorescence components obtained from independent data sets. Spectra extracted from allochthonous DOM were highly similar. Allochthonous and autochthonous DOM shared some spectra, but included unique components. In agreement with the supramolecular assembly hypothesis, molecular size distributions of the fluorescence fractions were broad and chromatographically unresolved, possibly representing reoccurring fluorophores forming noncovalently bound assemblies of varying molecular size. Samples shared underlying fluorescence components that differed in their size distributions but not their spectral properties. Thus, in contrast to absorption measurements, bulk fluorescence is unlikely to reliably indicate the average molecular size of DOM. The one-sample approach enables robust and independent cross-site comparisons without large-scale sampling efforts and introduces new analytical opportunities for elucidating the origins and biogeochemical properties of FDOM.

Species and functional trait re-assembly of ground beetle communities in restored grasslands

Ecosystem restoration provides unique opportunities to study community dynamics under succession and can reveal how consumer communities re-assemble and respond to successional changes. Studying community dynamics from both taxonomic and functional trait perspectives also may provide more robust assessments of restoration progress or success and allow cross-system comparisons. We studied ground beetle (Coleoptera: Carabidae) communities for three years in a restored grassland chronosequence with sites from 0 to 28 years old. We measured traditional community metrics (abundance, richness, Shannon diversity) and functional trait metrics based on species’ body length, wing morphology, activity time, phenology, and diet. Communities had high species richness and abundance in early successional stages, but these declined in later stages to low levels comparable to an adjacent grassland remnant. Species composition also shifted with time, converging with the remnant. Although functional richness, like species richness, declined as succession progressed, functional divergence quickly increased and was maintained over time, suggesting niche differentiation in established communities. Young sites were typified by small, macropterous, phytophagous species, while older sites contained larger species more likely to be flightless and carnivorous. Prescribed burns also affected traits, decreasing prevalence of larger species. This study demonstrates that functionally diverse consumer communities can self-assemble under restoration practices. In a relatively short amount of time both morphological and trophic level diversity are established. However, prescribed fire intended to control non-desirable plants may also shape beetle community functional composition, and restoration managers should consider if plant community benefits of fire outweigh potential declines in consumer function.

The meaning of functional trait composition of food webs for ecosystem functioning.

There is a growing interest in using trait-based approaches to characterize the functional structure of animal communities. Quantitative methods have been derived mostly for plant ecology, but it is now common to characterize the functional composition of various systems such as soils, coral reefs, pelagic food webs or terrestrial vertebrate communities. With the ever-increasing availability of distribution and trait data, a quantitative method to represent the different roles of animals in a community promise to find generalities that will facilitate cross-system comparisons. There is, however, currently no theory relating the functional composition of food webs to their dynamics and properties. The intuitive interpretation that more functional diversity leads to higher resource exploitation and better ecosystem functioning was brought from plant ecology and does not apply readily to food webs. Here we appraise whether there are interpretable metrics to describe the functional composition of food webs that could foster a better understanding of their structure and functioning. We first distinguish the various roles that traits have on food web topology, resource extraction (bottom-up effects), trophic regulation (top-down effects), and the ability to keep energy and materials within the community. We then discuss positive effects of functional trait diversity on food webs, such as niche construction and bottom-up effects. We follow with a discussion on the negative effects of functional diversity, such as enhanced competition (both exploitation and apparent) and top-down control. Our review reveals that most of our current understanding of the impact of functional trait diversity on food web properties and functioning comes from an over-simplistic representation of network structure with well-defined levels. We, therefore, conclude with propositions for new research avenues for both theoreticians and empiricists.

Multiscale benchmarking of drug delivery vectors

Cross-system comparisons of drug delivery vectors are essential to ensure optimal design. An in-vitro experimental protocol is presented that separates the role of the delivery vector from that of its cargo in determining the cell response, thus allowing quantitative comparison of different systems. The technique is validated through benchmarking of the dose–response of human fibroblast cells exposed to the cationic molecule, polyethylene imine (PEI); delivered as a free molecule and as a cargo on the surface of CdSe nanoparticles and Silica microparticles. The exposure metrics are converted to a delivered dose with the transport properties of the different scale systems characterized by a delivery time, τ. The benchmarking highlights an agglomeration of the free PEI molecules into micron sized clusters and identifies the metric determining cell death as the total number of PEI molecules presented to cells, determined by the delivery vector dose and the surface density of the cargo.

Measuring a decade of progress in Text-to-Speech

The Blizzard Challenge offers a unique insight into progress in text-to-speech synthesis over the last decade. By using a very large listening test to compare the performance of a wide range of systems that have been constructed using a common corpus of speech recordings, it is possible to make some direct comparisons between competing techniques. By reviewing over a hundred papers describing all entries to the Challenge since 2005, we can make a useful summary of the most successful techniques adopted by participating teams, as well as drawing some conclusions about where the Blizzard Challenge has succeeded, and where there are still open problems in cross-system comparisons of text-to-speech synthesisers.

Community Living and Participation: Embracing the Complexity and Forging Forward

Community Living and Participation: Embracing the Complexity and Forging Forward

Eddy covariance measurements with a new fast-response, enclosed-path analyzer: Spectral characteristics and cross-system comparisons

A new class of enclosed path gas analyzers suitable for eddy covariance applications combines the advantages of traditional closed-path systems (small density corrections, good performance in poor weather) and open-path systems (good spectral response, low power requirements), and permits estimates of instantaneous gas mixing ratio. Here, the extent to which these advantages are realized in field deployment is assessed, with a focus on the suitability of such an analyzer (the EC155, manufactured by Campbell Scientific) for long-term flux measurements in a new flux monitoring site in the southern Appalachians (NC, USA). The scalar-vertical velocity co-spectra for CO2 fluxes measured with the EC155 were similar to those measured with a co-located open-path system. When humidity was high, attenuation of the EC155 water vapor fluxes for non-dimensional frequencies greater than ∼2 was noted, though results from an ogive analysis suggest that eddies operating on these time scales contributed <2% of the total turbulent flux in this tall forest ecosystem. Inertial sub-range decay of the vertical velocity-scalar co-spectra generally conformed to a -7/3 power law during near-neutral atmospheric stability conditions, supporting the use of an analytical spectral correction approach to the raw measured fluxes. The EC155 fluxes computed directly from instantaneous mixing ratio agreed with will those calculated from mass–density concentration measurements, provided density terms for temperature, water vapor, and pressure were applied. Biases were observed when the EC155 flux records were compared to those measured with the open-path system. These differences were related to wind angle of attack and to an estimate of apparent fluxes related to instrument self-heating, and the biases were minimized after the application of a friction velocity filter. Finally, the EC155 considerably outperformed open-path analyzers during adverse weather conditions favorable to fog development, which occur frequently in the study site.

Green grass and high tides: grazing lawns in terrestrial and aquatic ecosystems (commentary on Burkepile 2013)

Deron Burkepile advances a review of compelling empirical examples arguing that common mechanisms may structure grazing systems in both terrestrial and aquatic biomes. We welcome this synthesis, and on many specific points we concur. In this commentary we further develop the characteristics of grazing systems, grazing lawns in particular, reviewing their prevalence across systems wet and dry. Then, we use studies from terrestrial browsing systems – and their aquatic parallels – to explore major contrasts that are still prominent in cross-system comparisons. We rely heavily on quantitative reviews and meta-analyses to assess the prevalence and generality of the evidence for common mechanisms across grazing ecosystems. Although this approach sacrifices the detail from singular studies, it avoids undue focus on singular exceptions, instead highlighting key similarities and contrasts across biomes.

Cross-system comparisons elucidate disturbance complexities and generalities

Given that ecological effects of disturbance have been extensively studied in many ecosystems, it is surprising that few quantitative syntheses across diverse ecosystems have been conducted. Multi-system studies tend to be qualitative because they focus on disturbance types that are difficult to measure in an ecologically relevant way. In addition, synthesis of existing studies across systems or disturbance types is challenging because sufficient information needed for analysis is not easily available. Theoretical advances and improved predictions can be advanced by generalizations obtained from synthesis activities that include multiple sites, ecosystems, and disturbance events. Building on existing research, we present a conceptual framework and an operational analog to integrate this rich body of knowledge and to promote quantitative comparisons of disturbance effects across different types of ecosystems and disturbances. This framework recognizes individual disturbance events that consist of three quantifiable components: (1) environmental drivers, (2) initial system properties, and (3) physical and biological mechanisms of effect, such as deposition, compaction, and combustion. These components result in biotic and abiotic legacies that can interact with subsequent drivers and successional processes to influence system response. Through time, a coarse-scale quasi-equilibrial state can be reached where variation in drivers interacting with biotic processes and feedbacks internal to the system results in variability in dynamics. At any time, a driver of sufficient magnitude can push the system beyond its realm of natural variability to initiate a new kind of event. We use long-term data from diverse terrestrial ecosystems to illustrate how our approach can facilitate cross-system comparisons, and provide new insights to the role of disturbance in ecological systems. We also provide key disturbance characteristics and measurements needed to promote future quantitative comparisons across ecosystems.

Cross system comparisons of children in treatment foster care: Using agency data to study cross-system child outcomes

This exploratory study matched a set of data from a treatment foster care population served in one Midwestern state during one calendar year with statewide data from public schools and child welfare agencies to create a broader picture of how these children were faring. Despite typical challenges to the quality of agency-level data, a significant proportion of child records could be matched to data from other systems. Important discoveries were made in terms of the attendance patterns of school-aged children and their participation in special education. The stabilizing effect of treatment foster care can be observed by high rates of child welfare involvement up to the point when children were placed in treatment foster care settings after which, they had very little, if any, subsequent child welfare involvement. Recommendations are provided for how treatment foster care agencies might not only enhance the quality of their data to improve their ability to report on their performance but to consider the broader research implications illustrated in the findings presented here.