Supported Employment: A Best Practice for People with Psychiatric Disabilities

Over the past several decades, research from a variety of fields has presented powerful evidence of the importance of employment to people with psychiatric disabilities. Many of these people want to work and can successfully participate in the labor market in a variety of competitive jobs. Researchers have also shown how employment can alleviate poverty, reduce hospitalization, and improve quality of life. Society also benefits through taxes paid by workers, goods and services they purchase, and reductions in entitlements and the overall cost of care. However, the 1997 National Health Interview Survey (NHIS) reports employment rates for people with a wide range of mental disorders to be 37.1 percent (Harris et al., 2005; New Freedom Commission on Mental Health, 2003). Employment rates for people with schizophrenia and related disorders are 22 percent (Jans, et al., 2004). Recently, funding agencies and practitioners have begun to move towards evidence-based practice in serving people with psychiatric disabilities. A number of reviews and meta-analyses of single-site, randomized controlled trials of supported employment for this group have found it to be more effective at establishing competitive employment outcomes than prevocational training or non-vocational community care (Crowther et al., 2001; Twamley et al., 2003; Wewiorski & Fabian, 2004). Still in question at the time of this study\u27s funding, however, was the effectiveness of different models of supported employment, operating in a variety of organizational settings, for consumers with diverse demographic characteristics, in different regions of the country. Therefore, the Employment Intervention Demonstration Program (EIDP) was designed as a multi-site randomized controlled trial of the effectiveness of supported employment (SE) for people with psychiatric disabilities in eight locations across the U.S. SE programs use a rapid job search approach to help clients obtain jobs directly (rather than providing lengthy assessment, training, and counseling), and provide them with ongoing support to maintain and improve their earnings after they start work. This policy brief describes the EIDP, presents study findings, and suggests some policy and research implications

Safety Evaluation of Two Commercial Lithium-ion Batteries for Space Applications

Lithium-ion batteries have been used for applications on the Shuttle and Station for the past six years. A majority of the li-ion batteries flown are Commercial-off-the-shelf (COTS) varieties. The COTS batteries and cells were tested under nominal and abusive conditions for performance and safety characterization. Within the past six months two batteries have been certified for flight and use on the Space Station. The first one is a Hand Spring PDA battery that had a single prismatic li-ion cell and the second is an Iridium satellite phone that had a two-cell pack with prismatic li-ion cells

An Instrumental Variable Evaluation of Antidepressant Use on Employment Among HIV-Infected Women Using Highly-Active Antiretroviral Therapy in the United States: 1996-2004

This paper examines the effect of antidepressant use on the likelihood of being employed among HIV-positive women receiving highly active antiretroviral therapy (HAART) in the United States from 1994 to 2004. We use instrumental variables to predict antidepressant use independently of outcomes; thus, addressing potential sources of bias -- more depressed women are more likely to receive antidepressant treatment, but they are also more likely to be unemployed. The results show that antidepressant use has a positive effect on the employment probability of women living with HIV. The proposed instrumental variables can be used to identify antidepressant use in the WIHS population. Among women receiving HAART, and controlling for individual and local area labor market characteristics, the use of antidepressants is associated with a higher probability of being employed.

"Any lady can do this without much trouble ...": class and gender in The dining room (1878)

Macmillan's "Art at Home" series (1876–83) was a collection of domestic advice manuals. Mentioned in every study of the late-nineteenth-century domestic interior, they have often been interpreted, alongside contemporary publications such as Charles Eastlake's Hints on Household Taste (1868), as indicators of late 1870s home furnishing styles. Mrs Loftie's The Dining Room (1878) was the series' fifth book and it considers one of the home's principal (and traditionally masculine) domestic spaces. Recent research on middle-class cultural practices surrounding food has placed The Dining Room within the tradition of Mrs Beeton's Household Management (1861); however, it is not a cookery book and hardly mentions dinners. Drawing upon unpublished archival sources, this paper charts the production and reception of The Dining Room, aiming to unravel its relationships with other contemporary texts and to highlight the difficulties of using it as historical evidence. While it offers fascinating insights into contemporary taste, class and gender, this paper suggests that, as an example of domestic design advice literature, it reveals far more about the often expedient world of nineteenth-century publishing practices

Cultural Competency in Peer-Run Programs: Results of a Web Survey and Implications for Future Practice

Objective: The study explored perceptions of adults with psychiatric disabilities regarding cultural competency of peer-run mental health support groups and programs. Methods: Web survey respondents were recruited via mental health listservs, web sites, newsletters, emails, and word of mouth. A total of 527 peers were surveyed about cultural competency barriers facing peer-run programs; common reasons for not using peer services; and strategies to engage diverse communities. Results: Both multicultural and Caucasian respondents agreed that lack of funding and staff education about diversity were barriers to cultural competency in peer programs. Multicultural respondents were more likely than whites to feel that both the recognition of the need for and interest in attending cultural competency training is lacking in peer programs, as well as information about the diverse composition of peer program memberships. Among those who had never participated in peer support, people of color were more likely than whites to endorse feeling they would not belong and believing their languages would not be spoken in peer programs. Whites, on the other hand, were more likely to cite a preference for professional over peer support, while nearly half of both groups indicated that the main reason for non-attendance is a lack of knowledge about peer programs. Qualitative results highlighted successful outreach and engagement strategies. Conclusions: Study findings informed development of a cultural competency tool that was pilot-tested among peer-run programs. Given the importance of peer support in recovery, these findings suggest the need for additional research on cultural competency in peer programs

Resolving a gender and language problem in women’s leadership:consultancy research in workplace discourse

This article considers the contribution that consultancy research might make to resolving communication problems that women have identified in their leadership practices. Within the intersecting fields of gender and language and workplace discourse, consultancy research-that is, practitioner-commissioned research to resolve work-related, communication problems-is still uncommon. This article presents a study of Monika, a senior leader in an engineering company, who commissioned me to find out why she was experiencing communication problems with her teams. By using interactional sociolinguistic analysis, I was able to show Monika how her authority was being resisted on gendered, linguistic grounds. In making the case for more consultancy research, I discuss how we might use insights from discourse analysis to offer guidance to practitioners seeking our help

Heritability and Tissue Specificity of Expression Quantitative Trait Loci

Variation in gene expression is heritable and has been mapped to the genome in humans and model organisms as expression quantitative trait loci (eQTLs). We applied integrated genome-wide expression profiling and linkage analysis to the regulation of gene expression in fat, kidney, adrenal, and heart tissues using the BXH/HXB panel of rat recombinant inbred strains. Here, we report the influence of heritability and allelic effect of the quantitative trait locus on detection of cis- and trans-acting eQTLs and discuss how these factors operate in a tissue-specific context. We identified several hundred major eQTLs in each tissue and found that cis-acting eQTLs are highly heritable and easier to detect than trans-eQTLs. The proportion of heritable expression traits was similar in all tissues; however, heritability alone was not a reliable predictor of whether an eQTL will be detected. We empirically show how the use of heritability as a filter reduces the ability to discover trans-eQTLs, particularly for eQTLs with small effects. Only 3% of cis- and trans-eQTLs exhibited large allelic effects, explaining more than 40% of the phenotypic variance, suggestive of a highly polygenic control of gene expression. Power calculations indicated that, across tissues, minor differences in genetic effects are expected to have a significant impact on detection of trans-eQTLs. Trans-eQTLs generally show smaller effects than cis-eQTLs and have a higher false discovery rate, particularly in more heterogeneous tissues, suggesting that small biological variability, likely relating to tissue composition, may influence detection of trans-eQTLs in this system. We delineate the effects of genetic architecture on variation in gene expression and show the sensitivity of this experimental design to tissue sampling variability in large-scale eQTL studies

Interleukin-4 activated macrophages mediate immunity to filarial helminth infection by sustaining CCR3-dependent eosinophilia

Eosinophils are effectors in immunity to tissue helminths but also induce allergic immunopathology. Mechanisms of eosinophilia in non-mucosal tissues during infection remain unresolved. Here we identify a pivotal function of tissue macrophages (Mϕ) in eosinophil anti-helminth immunity using a BALB/c mouse intra-peritoneal Brugia malayi filarial infection model. Eosinophilia, via C-C motif chemokine receptor (CCR)3, was necessary for immunity as CCR3 and eosinophil impairments rendered mice susceptible to chronic filarial infection. Post-infection, peritoneal Mϕ populations proliferated and became alternatively-activated (AAMϕ). Filarial AAMϕ development required adaptive immunity and interleukin-4 receptor-alpha. Depletion of Mϕ prior to infection suppressed eosinophilia and facilitated worm survival. Add back of filarial AAMϕ in Mϕ-depleted mice recapitulated a vigorous eosinophilia. Transfer of filarial AAMϕ into Severe-Combined Immune Deficient mice mediated immunological resistance in an eosinophil-dependent manner. Exogenous IL-4 delivery recapitulated tissue AAMϕ expansions, sustained eosinophilia and mediated immunological resistance in Mϕ-intact SCID mice. Co-culturing Brugia with filarial AAMϕ and/or filarial-recruited eosinophils confirmed eosinophils as the larvicidal cell type. Our data demonstrates that IL-4/IL-4Rα activated AAMϕ orchestrate eosinophil immunity to filarial tissue helminth infection