An Alternative to Temporary Staffing: Considerations for Workforce Practitioners

The temporary staffing industry has become a fixture of the US economy in recent decades, and workforce practitioners are increasingly noting the prevalence of temporary jobs in the low-skilled labor market. To ensure that these jobs are a stepping stone for job seekers -- and to tap into additional sources of revenue -- a growing number of social service organizations have launched their own staffing businesses, known as alternative staffing organizations (ASOs)

Tuning In to Local Labor Markets: Findings From the Sectoral Employment Impact Study, Executive Summary

This executive summary highlights the main findings and conclusions from "Tuning In to Local Labor Markets: Findings From the Sectoral Employment Impact Study" -- the first random assignment evaluation of sector-focused training efforts. We studied three nonprofit organizations -- a community-based organization focused on medical and basic office skills in Boston, a social venture focused on information technology in the Bronx, and an employer-union partnership focused on healthcare, manufacturing and construction in Milwaukee -- and found that participants in these programs worked more, had higher earnings and found better jobs (as measured by hourly wages and access to benefits) than members of the control group.The executive summary examines strategies used by the three organizations in the study, describes the people served, and outlines common elements that likely contributed to the programs success

Tuning In to Local Labor Markets: Findings From the Sectoral Employment Impact Study

Over the past two decades, an innovative approach to workforce development known as sectoral employment has emerged, resulting in the creation of industry-specific training programs that prepare unemployed and underskilled workers for skilled positions and connect them with employers seeking to fill such vacancies. In 2003, with funding from the Charles Stewart Mott Foundation, P/PV launched the "Sectoral Employment Impact Study" to rigorously assess whether mature, nonprofit-led sector-focused programs could increase the earnings of disadvantaged workers and job seekers. P/PV selected three organizations to participate in the study -- a community-based organization focused on medical and basic office skills in Boston, a social venture focused on information technology in the Bronx, and an employer-union partnership focused on healthcare, manufacturing and construction in Milwaukee. The study's findings show that program participants earned about $4,500 -- 18 percent -- more than the control group over the course of the study and$4,000 -- 29 percent -- more in the second year alone. Study participants were also more likely to find employment, work more consistently, work in jobs that paid higher wages, and work in jobs that offered benefits. Furthermore, there were earnings gains for each subgroup analyzed, including African Americans, Latinos, immigrants, formerly incarcerated individuals and young adults. Tuning In to Local Labor Markets also examines the strategies employed by the three organizations that took part in the study, as well as the common elements that appeared to be critical to their success. Implications for practice, policy and future research are explored; a forthcoming piece will provide detailed recommendations for policymakers

An Alternative to Temporary Staffing: Considerations for Workforce Practitioners

As the national economy inches toward recovery, risk-averse employers are increasingly turning to temporary workers to fill their hiring gaps. In fact, the temporary staffing industry has been a fixture of the US economy for decades. But the industry added a striking 557,000 jobs from June 2009 to November 2011 — more than half of the jobs created during that period. Growth is likely to continue: A 2011 McKinsey survey of 2,000 firms of differing sizes and across various sectors found that more than a third foresaw their companies increasing their use of temporary workers over the next five years. The bulk of these temporary workers are employed by for-profit temporary staffing firms that recruit and screen candidates for assignments, as well as handle payroll and a few supervisory duties. These firms supply workers for a sizable share of the low- and semi-skilled, entry-level job openings across many diverse sectors, including blue-collar manufacturing, office/clerical, healthcare and IT. Workforce development practitioners — who aim to help those with barriers to employment get and keep jobs — have been struggling to make sense of what this growth in the temporary sector means for their clients. While research examining the effects of temporary jobs on subsequent employment and long-term earnings is mixed, such jobs are likely here to stay. It seems clear that temporary staffing firms will play an increasingly large role in filling the type of job openings that workforce programs often target for their participants. How can program staff navigate this labor market phenomenon? This brief describes the work of “alternative staffing organizations” (ASOs), which seek to mitigate some of the more troubling shortcomings of the temporary employment industry (see “Opportunities, Risks and Dangers of Temporary Jobs” on the next page) with the goal of improving the employment prospects of the most vulnerable job seekers

Impact of e-ASPECTS software on the performance of physicians compared to a consensus ground truth: a multi-reader, multi-case study

BackgroundThe Alberta Stroke Program Early CT Score (ASPECTS) is used to quantify the extent of injury to the brain following acute ischemic stroke (AIS) and to inform treatment decisions. The e-ASPECTS software uses artificial intelligence methods to automatically process non-contrast CT (NCCT) brain scans from patients with AIS affecting the middle cerebral artery (MCA) territory and generate an ASPECTS. This study aimed to evaluate the impact of e-ASPECTS (Brainomix, Oxford, UK) on the performance of US physicians compared to a consensus ground truth.MethodsThe study used a multi-reader, multi-case design. A total of 10 US board-certified physicians (neurologists and neuroradiologists) scored 54 NCCT brain scans of patients with AIS affecting the MCA territory. Each reader scored each scan on two occasions: once with and once without reference to the e-ASPECTS software, in random order. Agreement with a reference standard (expert consensus read with reference to follow-up imaging) was evaluated with and without software support.ResultsA comparison of the area under the curve (AUC) for each reader showed a significant improvement from 0.81 to 0.83 (p = 0.028) with the support of the e-ASPECTS tool. The agreement of reader ASPECTS scoring with the reference standard was improved with e-ASPECTS compared to unassisted reading of scans: Cohen's kappa improved from 0.60 to 0.65, and the case-based weighted Kappa improved from 0.70 to 0.81.ConclusionDecision support with the e-ASPECTS software significantly improves the accuracy of ASPECTS scoring, even by expert US neurologists and neuroradiologists

Morbidity of Returning Travelers Seen in Community Urgent Care Centers throughout Israel

Information regarding post-travel morbidity is usually reported via dedicated post-travel clinics and mainly relates to travelers returning from low–middle-income countries (LMIC), however, the spectrum of morbidity seen within the community setting is scarcely reported. This prospective observational study among visitors to 17 community Urgent Care Centers (UCC) was designed to evaluate the reasons for post-travel community clinic visits and to compare travelers returning from LMIC to high-income countries (HIC). All visitors within one-month post-travel to all destinations were included. A total of 1580 post-travel visits were analyzed during 25 months. Travelers to LMICs were younger (mean 36.8 years old vs. 41.4 in the HIC group) and stayed longer periods abroad (30.1 ± 41.2 vs. 10.0 ± 10.6 in the HIC group) but more of them had pre-travel vaccines (35.5% vs. 6.6%). Travel-related morbidity was significantly more common in the LMIC group 58.3% (253/434) vs. 34.1% (391/1146) in the HIC group, (p p < 0.001). Other common morbidities in the LMIC cohort were respiratory (23.3%), cutaneous (15.8%), and injuries (9.9%). In the HIC group, the common morbidities were respiratory (37.3%), and diarrhea composed only 6.6% of the complaints. Our study group represents a less biased sample of travelers to LMIC as well as HIC, therefore, data from the UCC setting and at the specialized travel clinics complete each other in understanding the true extent of morbidity in travelers

Semantic organization in children with Cochlear Implants: Computational analysis of verbal fluency

Purpose: Cochlear implants (CIs) enable children with severe and profound hearing impairments to perceive the sensation of sound sufficiently to permit oral language acquisition. So far, studies have focused mainly on technological improvements and general outcomes of implantation for speech perception and spoken language development. This study quantitatively explored the semantic networks of children with CIs in comparison to those of age-matched normal hearing (NH) peers.Method: Twenty seven children with CIs and twenty seven age- and IQ-matched NH children ages 7-10 were tested on a timed animal verbal fluency task (Name as many animals as you can). The responses were analyzed using correlation and network methodologies. The structure of the animal category semantic networks for both groups were extracted and compared.Results: Children with CIs appeared to have a less-developed semantic lexicon structure compared to age-matched NH peers. The average shortest path length and the network diameter measures were larger for the NH group compared to the CIs group. This difference was consistent for the analysis of networks derived from animal names generated by each group (sample-matched correlation networks) and for the networks derived from the common animal names generated by both groups (word-matched correlation networks).Conclusions: The main difference between the semantic networks of children with CIs and NH children lies in the network structure. The semantic network of children with CIs is under-developed compared to the semantic network of the age-matched NH children. We discuss the practical and clinical implications of our findings

Endocrine therapy initiation, discontinuation and adherence and breast imaging among 21-gene recurrence score assay-eligible women under age 65

Abstract Background Aside from chemotherapy utilization, limited data are available on the relationship between gene expression profiling (GEP) testing and breast cancer care. We assessed the relationship between GEP testing and additional variables and the outcomes of endocrine therapy initiation, discontinuation and adherence, and breast imaging exams in women under age 65 years. Methods Data from five state cancer registries were linked with claims data and GEP results. We assessed variables associated with survivorship care outcomes in an incident cohort of 5014 commercially insured women under age 65 years, newly diagnosed with stage I or II hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2) non-positive breast cancer from 2006 to 2010. Results Among tested women, those with high Oncotype DX® Breast Recurrence Score® (RS) were significantly less likely to initiate endocrine therapy than women with low RS tumors (OR 0.40 (95% CI 0.20 to 0.81); P = 0.01). Among all test-eligible women, receipt of Oncotype DX testing was associated with a greater likelihood of endocrine therapy initiation (OR 2.48 (95% CI 2.03 to 3.04); P <0.0001). The odds of initiation were also significantly higher for tested vs. untested women among women who did not initiate chemotherapy within six months of diagnosis (OR 3.25 (95% CI 2.53 to 4.16)), with no effect in women who received chemotherapy. Discontinuation and adherence and breast imaging exams were unrelated to tested status or RS. Conclusions Lower endocrine therapy initiation rates among women with high RS tumors and among untested women not receiving chemotherapy are concerning, given its established efficacy. Additional research is needed to suggest mechanisms to close this gap

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Objective This update of a 2008 guideline from the American Academy of Otolaryngology - Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ‰¥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary

The American Academy of Otolaryngology - Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the \ Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).\ To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group