Findings for the Cleveland Achieve Model: Implementation and Early Impacts of an Employer-Based Approach to Encourage Employment Retention Among Low-Wage Workers

An on-site retention program at long-term nursing care facilities had little effect overall on retention of low-wage employees, aside from a small increase in retention in the short term and among subgroups with particularly high turnover rates

Welfare-to-Work Program Benefits and Costs: A Synthesis of Research

Most welfare programs seek to ensure that poor families have adequate income while at the same time encouraging self-sufficiency. Based on studies of 28 programs involving more than 100,000 sample members, this synthesis compares the costs, benefits, and returns on investment of six welfare program strategies -- from the perspectives of participants, government budgets, and society as a whole

Encouraging Evidence on a Sector-Focused Advancement Strategy: Two-Year Impacts from the WorkAdvance Demonstration

This report summarizes the two-year findings of a rigorous random assignment evaluation of the WorkAdvance model, a sectoral training and advancement initiative. Launched in 2011, WorkAd-vance goes beyond the previous generation of employment programs by introducing demand-driven skills training and a focus on jobs that have career pathways. The model is heavily influenced by the positive findings from the Sectoral Employment Impact Study (SEIS) completed in 2010. A major component of the WorkAdvance model, in common with the programs studied in the SEIS, is formal training offering industry-recognized certifications, reflecting the hypothesis that skills acquisition is necessary for advancement. The model also requires providers to be far more employer-facing than traditional training programs, taking into account multiple employers' changing skill requirements, employee assessment practices, and personnel needs. This report presents the imple-mentation, cost, participation, and two-year economic impacts of WorkAdvance. The economic results are based on unemployment insurance earnings records and a second-year follow-up survey.The WorkAdvance program operations and evaluation are funded through the federal Social Innovation Fund (SIF), a public-private partnership administered by the Corporation for National and Community Service. This SIF project is led by the Mayor's Fund to Advance New York City and the NYC Center for Economic Opportunity in collaboration with MDRC.Key Findings*All providers translated the WorkAdvance model into a set of concrete services, but it took time— more than a year for some components and providers -- and a substantial amount of tech-nical assistance and support. As a result, at some sites, later study enrollees were more likely than earlier ones to experience a fully implemented and "mature" WorkAdvance program.*Overall, WorkAdvance resulted in very large increases in participation in every category of services, as well as in training completion and credential acquisition, compared with what would have happened in the absence of the program. Expenditures for the operation of WorkAdvance fell between $5,200 and$6,700 per participant at the four providers delivering the program.*WorkAdvance providers increased earnings, with variation in results that closely matched the providers' experience in running sector-based programs and the extent to which the services they offered were demand driven. The most experienced sectoral provider, Per Scholas, had large and consistent impacts on both primary and secondary outcomes. Madison Strategies Group and Towards Employment, providers new to sectoral training, had promising but less consistent results that grew stronger for later enrollees. One provider, St. Nicks Alliance, did not produce positive impacts. The results did not differ dramatically across subgroups, though en-couragingly, WorkAdvance was able to increase earnings among the long-term unemployed.The evaluation as a whole provides important information for workforce development providers interested in pursuing a sector strategy. The analysis considers the role played by providers' sector-specific training and preparation and the role played by the nature of the sectors themselves. Future priorities that emerge from the results are (1) understanding how to help the more disadvantaged access the programs and (2) learning how to build service capacity, given how complex the model is to run

Increased hypoglycemia associated with renal failure during continuous intravenous insulin infusion and specialized nutritional support

Objective: To evaluate glycemic control for critically ill, hyperglycemic trauma patients with renal failure who received concurrent intensive insulin therapy and continuous enteral (EN) or parenteral nutrition (PN). Methods: Adult trauma patients with renal failure, who were given EN or PN concurrently with continuous graduated intravenous regular human insulin (RHI) infusion for at least 3 days were evaluated. Our conventional RHI algorithm was modified for those with renal failure by allowing greater changes in blood glucose concentrations (BG) before the infusion rate was escalated. BG was determined every 1-2 hours while receiving the insulin infusion. BG control was evaluated on the day prior to RHI infusion and for a maximum of 7 days while receiving RHI. Target BG during the RHI infusion was 70 to 149 mg/dL (3.9 to 8.3 mmol/L). Glycemic control and incidence of hypoglycemia for those with renal failure were compared to a historical cohort of critically ill, hyperglycemic trauma patients without renal failure given our conventional RHI algorithm. Results: Twenty-one patients with renal failure who received the modified RHI algorithm were evaluated and compared to forty patients without renal failure given our conventional RHI algorithm. Average BG was significantly greater for those with renal failure (133 + 14 mg/dL or 7.3 + 0.7 mmol/L) compared to those without renal failure (122 + 15 mg/dL or 6.8 + 0.8 mmol/L), respectively (p \u3c 0.01). Patients with renal failure experienced worsened glycemic variability with 16.1 + 3.3 hours/day within the target BG range, 6.9 + 3.2 hours/day above the target BG range, and 1.4 + 1.1 hours below the target BG range compared to 19.6 + 4.7 hours/day (p \u3c 0.001), 3.4 + 3.0 hours/day (p \u3c 0.001), and 0.7 + 0.8 hours/day (p \u3c 0.01) for those without renal failure, respectively. Moderate hypoglycemia (\u3c 60 mg/dL or \u3c 3.3 mmol/L) occurred in 76% of patients with renal failure compared to 35% without renal failure (p \u3c 0.005). Severe hypoglycemia (BG \u3c 40 mg/dL or \u3c 2.2 mmol/L) occurred in 29% of patients with renal failure compared to none of those without renal failure (p \u3c 0.001). Conclusion: Despite receiving a modified RHI infusion, critically ill trauma patients with renal failure are at higher risk for developing hypoglycemia and experience more glycemic variability than patients without renal failure

Cerebral Small Vessel Disease burden is increased in Systemic Lupus Erythematosus

BACKGROUND AND PURPOSE—: Systemic lupus erythematosus (SLE) increases stroke risk, but the mechanism is uncertain. This study aimed to determine the association between SLE and features on neuroimaging of cerebral small vessel disease (SVD), a risk factor for stroke. METHODS—: Consecutive patients attending a clinic for SLE were recruited. All patients underwent brain magnetic resonance imaging; had blood samples taken for markers of inflammation, endothelial dysfunction, cholesterol, and autoantibodies; and underwent cognitive and psychiatric testing. The data were compared with sex- and age-matched healthy controls and patients with minor stroke. Features of SVD were measured, a total SVD score calculated, and associations sought with vascular risk factors, cognition, SLE activity, and disease duration. RESULTS—: Fifty-one SLE patients (age: 48.8 years; SD: 14.3 years) had a greater total SVD score compared with healthy controls (1 versus 0; P<0.0001) and stroke patients (1 versus 0; P=0.02). There were higher perivascular spaces and deep white matter hyperintensity scores and more superficial brain atrophy in SLE patients versus healthy controls. Despite fewer vascular risk factors than similarly aged stroke patients, SLE patients had similar or more of some SVD features. The total SVD score was not associated with SLE activity, cognition, disease duration, or any blood measure. CONCLUSIONS—: In this data set, SLE patients had a high burden of SVD features on magnetic resonance imaging, particularly perivascular spaces. A larger longitudinal study is warranted to determine the causes of SVD features in SLE and clinical implications

A Multi-Level Analysis of the Impacts of Services Provided By the UK Employment Retention and Advancement Demonstration

Background: The United Kingdom Employment Retention and Advancement (U.K. ERA) demonstration was the largest and most comprehensive social experiment ever conducted in the United Kingdom. It examined the extent to which a combination of postemployment advisory support and financial incentives could help lone parents on welfare to find sustained employment with prospects for advancement. ERA was experimentally tested across more than 50 public employment service offices and, within each office, individuals were randomly assigned to either a program (or treatment) group (eligible for ERA) or a control group (not eligible). Method: article presents the results of a multilevel nonexperimental analysis that examines the variation in office-level impacts and attempts to understand what services provided in the offices tend to be associated with impacts. Result: The analysis suggests that impacts were greater in offices that emphasized in-work advancement, support while working and financial bonuses for sustained employment, and also in those offices that assigned more caseworkers to ERA participants. Offices that encouraged further education had smaller employment impacts. Conclusion: Plausible results are obtained identifying those particular implementation features that tended to be linked to stronger impacts of ERA. The methodology employed also allows the identification of which services are associated with employment and welfare receipt of control families receiving benefits under the traditional New Deal for Lone Parent program

Social stigma and executive compensation

We document that executives working at firms perceived negatively in light of social norms, such as tobacco, gambling and alcohol, earn a significant compensation premium. The premium compensates for personal costs executives bear due to their employer’s negative public perception and include: (i) a reduced likelihood these CEOs will serve as directors on other firms’ boards, which associates with lower executives’ social status, and (ii) impaired job mobility as employers shun stigmatized executives. The compensation premium is not explained by higher managerial skill required in firms we investigate, higher employment contract risk, political capital, litigation risk, or differences in corporate governance quality, and robust to endogeneity concerns. Our results highlight the significant impact job-related social stigma has on executive compensation

Circulating Biomarkers and Resistance to Endocrine Therapy in Metastatic Breast Cancers: Correlative Results from AZD9496 Oral SERD Phase I Trial.

PURPOSE: Common resistance mechanisms to endocrine therapy (ET) in estrogen receptor (ER)-positive metastatic breast cancers include, among others, ER loss and acquired activating mutations in the ligand-binding domain of the ER gene (ESR1LBDm). ESR1 mutational mediated resistance may be overcome by selective ER degraders (SERD). During the first-in-human study of oral SERD AZD9496, early changes in circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) were explored as potential noninvasive tools, alongside paired tumor biopsies, to assess pharmacodynamics and early efficacy. EXPERIMENTAL DESIGN: CTC were enumerated/phenotyped for ER and Ki67 using CellSearch in serial blood draws. ctDNA was assessed for the most common ESR1LBDm by droplet digital PCR (BioRad). RESULTS: Before starting AZD9496, 11 of 43 (25%) patients had ≥5 CTC/7.5 mL whole blood (WB), none of whom underwent reduction to <5 CTC/7.5 mL WB on C1D15. Five of 11 patients had baseline CTC-ER+, two of whom had CTC-ER+ reduction. CTC-Ki67 status did not change appreciably. Patients with ≥5 CTC/7.5 mL WB before treatment had worse progression-free survival (PFS) than patients with <5 CTC (P = 0.0003). Fourteen of 45 (31%) patients had ESR1LBDm + ctDNA at baseline, five of whom had ≥2 unique mutations. Baseline ESR1LBDm status was not prognostic. Patients with persistently elevated CTC and/or ESR1LBDm + ctDNA at C1D15 had worse PFS than patients who did not (P = 0.0007). CONCLUSIONS: Elevated CTC at baseline was a strong prognostic factor in this cohort. Early on-treatment changes were observed in CTC-ER+ and ESR1LBDm + ctDNA, but not in overall CTC number. Integrating multiple biomarkers in prospective trials may improve outcome prediction and ET resistance mechanisms' identification over a single biomarker

Serial monitoring of genomic alterations in circulating tumor cells of ER-positive/HER2-negative advanced breast cancer: feasibility of precision oncology biomarker detection.

Nearly all estrogen receptor (ER)-positive (POS) metastatic breast cancers become refractory to endocrine (ET) and other therapies, leading to lethal disease presumably due to evolving genomic alterations. Timely monitoring of the molecular events associated with response/progression by serial tissue biopsies is logistically difficult. Use of liquid biopsies, including circulating tumor cells (CTC) and circulating tumor DNA (ctDNA), might provide highly informative, yet easily obtainable, evidence for better precision oncology care. Although ctDNA profiling has been well investigated, the CTC precision oncology genomic landscape and the advantages it may offer over ctDNA in ER-POS breast cancer remain largely unexplored. Whole-blood (WB) specimens were collected at serial time points from patients with advanced ER-POS/HER2-negative (NEG) advanced breast cancer in a phase I trial of AZD9496, an oral selective ER degrader (SERD) ET. Individual CTC were isolated from WB using tandem CellSearch® /DEPArray™ technologies and genomically profiled by targeted single-cell DNA next-generation sequencing (scNGS). High-quality CTC (n = 123) from 12 patients profiled by scNGS showed 100% concordance with ctDNA detection of driver estrogen receptor α (ESR1) mutations. We developed a novel CTC-based framework for precision medicine actionability reporting (MI-CTCseq) that incorporates novel features, such as clonal predominance and zygosity of targetable alterations, both unambiguously identifiable in CTC compared to ctDNA. Thus, we nominated opportunities for targeted therapies in 73% of patients, directed at alterations in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), fibroblast growth factor receptor 2 (FGFR2), and KIT proto-oncogene, receptor tyrosine kinase (KIT). Intrapatient, inter-CTC genomic heterogeneity was observed, at times between time points, in subclonal alterations. Our analysis suggests that serial monitoring of the CTC genome is feasible and should enable real-time tracking of tumor evolution during progression, permitting more combination precision medicine interventions