Accounting for the Decline in AFDC Caseloads: Welfare Reform or Economic Growth?

Nationwide, AFDC caseloads have decreased by about 18 percent since March 1994, while some states, such as Wisconsin, Indiana, and Oregon, have seen declines of 40 percent or more. Two factors are frequently suggested as possible causes: state-level experiments with welfare reform and strong economic growth. In this paper, we use state-level monthly panel data from 1987 to 1996 to assess the importance of each of these factors by estimating a model of AFDC caseloads as a dynamic function of time-dependent state welfare reform variables (welfare waivers) and economic variables such as per capita employment. Our results from the dynamic model suggest that the decline in per capita AFDC caseloads is attributable largely to the economic growth of states and not to waivers from federal welfare policies. In the 26 states experiencing at least a 20 percent decline in per capita AFDC caseloads between 1993 and 1996, we attribute 78 percent of the decline to business-cycle factors and 6 percent to welfare waivers.

Meeting the needs of critical care patients after discharge home: a qualitative exploratory study of patient perspectives

Objectives To describe former critical care patients’ perspectives on the support needed to optimise recovery. Background With improved survival rates in critical care, increasing focus is being placed on survivorship and how best to support patients return to former activity. Little is known about what support patients themselves view as important, and this has implications for efficacy and acceptability of services provided. Study design A qualitative exploratory study of the experiences of support received by critical care survivors. Research Methodology Semi-structured interviews were undertaken with twelve critical care survivors, recruited from a charity and a patient and public involvement group. The interviews were analysed using thematic analysis to describe patterns in the participants’ experiences. Findings Four themes of support were described as: effective management of transfer anxiety; tailored information provision; timely access to services and a supportive social network. Conclusion Survivors of critical care should be equipped with information about their critical care stay, ongoing health issues and recovery; and provided with holistic care at home. Critical care follow-up was an effective way of meeting many of these needs, but needs to be flexible to be useful to attendees. Peer support groups (face-to-face and online) provided information, reassurance, a social network and an avenue for those who had longer-lasting problems than current services provide for. Relevance to Clinical Practice Whilst there are commonalities in the problems faced by critical care survivors, recovery is highly individualised, and current support services do not have sufficient flexibility to cater for this. This study shows that many survivors experience aftereffects of critical care that outlast the support they are given. These longer-term survivors are often excluded from research studies because of fears of recall bias, resulting in poor understanding of their experiences

Randomised controlled trial of specialist nurse intervention in heart failure

<p>Objectives. To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure.</p> <p>Design. Randomised controlled trial.</p> <p>Setting. Acute medical admissions unit in a teaching hospital.</p> <p>Participants. 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year.</p> <p>Main outcome measures. Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure.</p> <p>Results. 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96).Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051).</p> <p>Conclusions. Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.</p&gt

The C. H. Nash Museum at Chucalissa: Community Engagement at an Archaeological Site

This article highlights outreach programs launched by the C. H. Nash Museum to encourage engagement with members of local African-American communities

School distress and the school attendance crisis: a story dominated by neurodivergence and unmet need

BackgroundThe Covid-19 pandemic has brought into sharp focus a school attendance crisis in many countries, although this likely pre-dates the pandemic. Children and young people (CYP) struggling to attend school often display extreme emotional distress before/during/after school. We term this School Distress. Here we sought to elucidate the characteristics of the CYP struggling to attend school in the United Kingdom.MethodsUsing a case–control, concurrent embedded mixed-method research design, 947 parents of CYP with experience of School Distress completed a bespoke online questionnaire (February/March 2022), alongside an age-matched control group (n = 149) and a smaller group of parents who electively home-educate (n = 25).ResultsIn 94.3% of cases, school attendance problems were underpinned by significant emotional distress, with often harrowing accounts of this distress provided by parents. While the mean age of the CYP in this sample was 11.6 years (StDev 3.1 years), their School Distress was evident to parents from a much younger age (7.9 years). Notably, 92.1% of CYP currently experiencing School Distress were described as neurodivergent (ND) and 83.4% as autistic. The Odds Ratio of autistic CYP experiencing School Distress was 46.61 [95% CI (24.67, 88.07)]. Autistic CYP displayed School Distress at a significantly earlier age, and it was significantly more enduring. Multi-modal sensory processing difficulties and ADHD (among other neurodivergent conditions) were also commonly associated with School Distress; with School Distress CYP having an average of 3.62 NDs (StDev 2.68). In addition, clinically significant anxiety symptomology (92.5%) and elevated demand avoidance were also pervasive. Mental health difficulties in the absence of a neurodivergent profile were, however, relatively rare (6.17%). Concerningly, despite the striking levels of emotional distress and disability reported by parents, parents also reported a dearth of meaningful support for their CYP at school.ConclusionWhile not a story of exclusivity relating solely to autism, School Distress is a story dominated by complex neurodivergence and a seemingly systemic failure to meet the needs of these CYP. Given the disproportionate number of disabled CYP impacted, we ask whether the United Kingdom is upholding its responsibility to ensure the “right to an education” for all CYP (Human Rights Act 1998)

Control Technology Needs for Electrified Aircraft Propulsion Systems

Electrified aircraft propulsion (EAP) systems hold potential for the reduction of aircraft fuel burn, emissions, and noise. Currently, NASA and other organizations are actively working to identify and mature technologies necessary to bring EAP designs to reality. This paper specifically focuses on the envisioned control technology challenges associated with EAP designs that include gas turbine technology. Topics discussed include analytical tools for the dynamic modeling and analysis of EAP systems, and control design strategies at the propulsion and component levels. This includes integrated supervisory control facilitating the coordinated operation of turbine and electrical components, control strategies that seek to minimize fuel consumption and lessen the challenges associated with thermal management, and dynamic control to ensure engine operability during system transients. These dynamic control strategies include innovative control approaches that either extract or supply power to engine shafts dependent upon operating phase, which may improve performance and reduced gas turbine engine weight. Finally, a discussion of control architecture design considerations to help alleviate the propulsion/aircraft integration and certification challenges associated with EAP systems is provided