Social Worker Integrated Care Competencies Scale (SICCS): Assessing Social Worker Clinical Competencies for Health Care Settings

Integrating physical and behavioral health services has the potential to reduce health disparities and service inequities among persons most at risk. However, clinical social workers in integrated health settings must possess relevant knowledge and skills to provide quality care to diverse populations. The Social Worker Integrated Care Competency Scale (SWICCS), developed to complement the Integrated and Culturally Relevant Care (ICRC) field education curriculum, measures students’ self-perceptions of knowledge and skills associated with providing behavioral health care. Three student cohorts (n = 38) completed the SWICCS three times during an integrated care field practicum. Results indicated a statistically significant increase in student knowledge and skills at each time point, with a large effect size (r = −.87). The SWICCS demonstrated utility in measuring and tracking social work student acquisition of knowledge and skills required for practice in integrated care environments

Intra-tumoral production of IL18, but not IL12, by TCR-engineered T cells is non-toxic and counteracts immune evasion of solid tumors

Adoptive therapy with engineered T cells shows promising results in treating patients with malignant disease, but is challenged by incomplete responses and tumor recurrences. Here, we aimed to direct the tumor microenvironment in favor of a successful immune response by local secretion of interleukin (IL-) 12 and IL-18 by sadministered T cells. To this end, we engineered T cells with a melanoma-specific T cell receptor (TCR) and murine IL-12 and/or IL-18 under the control of a nuclear-factor of activated T-cell (NFAT)-sensitive promoter. These T cells produced IL-12 or IL-18, and consequently enhanced levels of IFNγ, following exposure to antigen-positive but not negative tumor cells. Adoptive transfer of T cells with a TCR and inducible (i)IL-12 to melanoma-bearing mice resulted in severe, edema-like toxicity that was accompanied by enhanced levels of IFNγ and TNFα in blood, and reduced numbers of peripheral TCR transgene-positive T cells. In contrast, transfer of T cells expressing a TCR and iIL-18 was without side effects, enhanced the presence of therapeutic CD8+ T cells within tumors, reduced tumor burden and prolonged survival. Notably, treatment with TCR+iIL-12 but not iIL-18 T cells resulted in enhanced intra-tumoral accumulation of macrophages, which was accompanied by a decreased frequency of therapeutic T cells, in particular of the CD8 subset. In addition, when administered to mice, iIL-18 but not iIL-12 demonstrated a favorable profile of T cell co-stimulatory and inhibitory receptors. In conclusion, we observed that treatment with T cells engineered with a TCR and iIL18 T cells is safe and able to skew the tumor microenvironment in favor of an improved anti-tumor T cell response

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A fire in her bones: Autobiographical accounts of women\u27s public evangelism in nineteenth -century America

This dissertation is an interdisciplinary exploration of spiritual autobiography by nineteenth-century American women who engaged in public evangelism. The spiritual autobiographies of Zilpha Elaw, Julia Foote, Margaret Newton Van Cott, and Anna Howard Shaw are examined in order to determine why women entered public evangelism at this point in history and how they garnered the authority to speak and write on spiritual matters. Historical and theological factors enabling women\u27s public evangelism during the nineteenth century included evangelical revivalism, post-revolutionary populism and holiness Methodism. Nevertheless, women\u27s public evangelism was controversial, and women evangelists encountered widespread public disapproval of their ministries. They were forced to justify their actions to the public. Three of the evangelists claimed divine inspiration as the reason and justification for their ministries, while one argued in favor of women\u27s natural rights. The evangelists also employed sophisticated narrative and rhetorical strategies in defense of their public ministries, including womanist biblical hermeneutics, testimonial and documentary support, iconographic self-representation, and the manipulation of generic conventions. My study of these narratives reveals the ways religious discourse was used both to empower and to silence women in the nineteenth century

Anomalous ANITA air shower events and tau decays

Two unusual neutrino events in the Antarctic Impulse Transient Antenna (ANITA) appear to have been generated by air showers from a particle emerging from the Earth at angle similar to 25 degrees 35 degrees above the horizon. We evaluate the effective aperture for ANITA with a simplified detection model to illustrate the features of the angular dependence of expected events for incident standard model tau neutrinos and for sterile neutrinos that mix with tau neutrinos. We apply our sterile neutrino aperture results to a dark matter scenario with long-lived supermassive dark matter that decay to sterile neutrinolike particles. We find that for upgoing air showers from tau decays, from isotropic fluxes of standard model, sterile neutrinos, or other particles that couple to the tau through suppressed weak interaction cross sections cannot be responsible for the unusual events.U.S. Department of Energy (DOE) [DE-SC-0010113, DE-FG02-13ER41976, DE-SC0009913]; National Aeronautics & Space Administration (NASA) [80NSSC18K0246]This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Female Entertainment Workers and Condom Use Negotiation in Post-100% Condom Use Era Cambodia

10.1007/s10508-020-01649-3ARCHIVES OF SEXUAL BEHAVIOR4983065-307