Developing the Welfare-to-Work Participation and Employability Appraisal Screening: A Retrospective Study

CalWORKs recipients, unless exempt, are required to participate in welfare-to-work (WTW) program activities as a condition of receiving cash aid. A number of clients, however, may have issues that impede successful engagement in WTW program activities, such as substance abuse, mental health concerns, or domestic violence issues. The Riverside County (California) Department of Mental Health (RCDMH) and the Department of Public Social Services (DPSS) sought to develop a structured case management system to help ensure early identification of WTW customers with barriers to employment and, if necessary, to help facilitate quicker engagement in services to address those barriers and move customers into successful employment. A key component of the structured case management system is an actuarial appraisal screening to help identify those customers most in need of support to make a successful transition to self-sufficiency. This report describes the study conducted by Childrenas Research Center (CRC) to develop an appraisal screening that classifies customers by the likelihood of subsequent WTW program participation and employment. Employment counselors can complete the screening assessment soon after WTW assignment to help identify which customers are in greatest need of additional support and engagement to increase the likelihood of successful program participation

Developing an Actuarial Risk Assessment to Inform the Decisions Made by Adult Protective Service Workers

In 2008, the New Hampshire Department of Health and Human Services Bureau of Elderly and Adult Services (BEAS) and the National Council on Crime and Delinquency (NCCD), with funding provided by the National Institute of Justice (NIJ), collaborated to construct an actuarial risk assessment to classify BEAS clients by their likelihood of elder maltreatment and/or self-neglect in the future. Studies in adult and juvenile corrections and child welfare have demonstrated that active service intervention with high risk clients can reduce criminal recidivism and the recurrence of child maltreatment (Wagner, Hull, & Luttrell, 1995; Eisenberg & Markley, 1987; Baird, Heinz, & Bemus, 1981). The purpose of this research was to examine a large set of individual and referral characteristics, determine their relationship to subsequent elder self-neglect and/or maltreatment, and develop an actuarial risk assessment for BEAS workers to complete at the end of an investigation to inform their case decisions.BEAS and NCCD pursued development of an actuarial risk assessment with the goal of reducing subsequent maltreatment of elderly and vulnerable adults who have been involved in an incident of self-neglect or maltreatment by another person (i.e., abuse, exploitation, or neglect). The actuarial risk assessment described in this report provides BEAS workers with a method to more accurately identify high risk clients and therefore more effectively target service interventions in an effort to protect their most vulnerable clients

Depression in Husbands of Breast Cancer Patients: Relationships to Coping and Social Support

PURPOSE: The purpose of the present study was to examine depression in husbands of women with breast cancer, as depression is typically as high in husbands as in patients, and impacts functioning in both. METHODS: We compared husbands of patients to husbands of women without chronic illness on depressive symptoms with the Center for Epidemiological Studies Depression Scale, social support with the Interpersonal Support Evaluation List, and coping with the Ways of Coping Questionnaire. Using the stress and coping model, we examined whether coping mediated social support and depression differently by group, as has been found in the literature. RESULTS: Husbands of patients reported higher scores on the measure of depression and lower use of problem-focused coping, while groups reported equivalent social support. Escape-avoidance coping emerged as a full mediator between social support and depression in husbands of patients, but only a partial mediator in comparison husbands. Accepting responsibility coping partially mediated social support and depression in both groups. Low social support appears particularly detrimental in husbands of patients as it is associated with ineffective coping and depression. CONCLUSIONS: Findings suggest that among husbands of patients, social support relates to depression only through its relationship with coping, indicating healthcare providers should direct attention and intervention to the coping strategies employed by husbands with low social support

Venous Thromboembolic Disease in Trauma and Surveillance Ultrasonography

Background. The literature reports a wide variation in the incidence of venous thromboembolic (VTE) disease in trauma patients. The performance of routine surveillance venous duplex ultrasound of bilateral lower extremities is controversial. Furthermore, recent examinations of the national trauma databank registry have suggested that routine duplex surveillance is associated with higher deep venous thrombosis (DVT) detection rates. Materials and Methods. We examined the incidence and risk factors for VTE disease in 2827 trauma patients admitted over a 2-y period to a state-verified level I trauma center. Detailed chart review was carried out for patients with VTE disease. We then evaluated the effects of a routine bilateral lower extremity duplex surveillance guideline on VTE detection in the subset of injury patients admitted to the trauma service. Results. We found an approximately 2% incidence of venous thromboembolic disease in a mostly blunt trauma population. Amongst patients with VTE disease, the most common risk factors were obesity and significant head injury. We then evaluated the 998 patients with injury who were admitted to the trauma service 1 y before and after surveillance guideline implementation. Despite a nearly 5-fold increase in the number of duplex scans, with a substantial increase in cost, we found no significant difference in the incidence of DVT. Conclusions. Our preliminary data argue against the use of routine duplex surveillance of lower extremities for DVT in trauma patients. A larger, prospective analysis is necessary to confirm these findings

The Lantern Vol. 40, No. 1, Fall 1973

• I, The Poet • Observation • Haiku • Smile and Lift Me Up • The Sacrifice • Prints in the Snow • Eric • Ode to a Possum • The Flower • Yamato • You, Sisyphus • The Love Song • Goodbyes • Living High With Gary Rutledge in Markevitch\u27s Cucumber and Gourd Patch: Grabbing Lightning Bugs and Stuffing Them in My Hellmann\u27s Mayonnaise Jar!https://digitalcommons.ursinus.edu/lantern/1103/thumbnail.jp

Mortality and comorbidities in patients with multiple sclerosis compared with a population without multiple sclerosis: An observational study using the US Department of Defense administrative claims database

AbstractBackgroundData are limited for mortality and comorbidities in patients with multiple sclerosis (MS).ObjectivesCompare mortality rates and event rates for comorbidities in MS (n=15,684) and non-MS (n=78,420) cohorts from the US Department of Defense (DoD) database.MethodsComorbidities and all-cause mortality were assessed using the database. Causes of death (CoDs) were assessed through linkage with the National Death Index. Cohorts were compared using mortality (MRR) and event (ERR) rate ratios.ResultsAll-cause mortality was 2.9-fold higher in the MS versus non-MS cohort (MRR, 95% confidence interval [CI]: 2.9, 2.7–3.2). Frequent CoDs in the MS versus non-MS cohort were infectious diseases (6.2, 4.2–9.4), diseases of the nervous (5.8, 3.7–9.0), respiratory (5.0, 3.9–6.4) and circulatory (2.1, 1.7–2.7) systems and suicide (2.6, 1.3–5.2). Comorbidities including sepsis (ERR, 95% CI: 5.7, 5.1–6.3), ischemic stroke (3.8, 3.5–4.2), attempted suicide (2.4, 1.3–4.5) and ulcerative colitis (2.0, 1.7–2.3), were higher in the MS versus non-MS cohort. The rate of cancers was also higher in the MS versus the non-MS cohort, including lymphoproliferative disorders (2.2, 1.9–2.6) and melanoma (1.7, 1.4–2.0).ConclusionsRates of mortality and several comorbidities are higher in the MS versus non-MS cohort. Early recognition and management of comorbidities may reduce premature mortality and improve quality of life in patients with MS

Central memory phenotype drives success of checkpoint inhibition in combination with CAR T cells

The immunosuppressive microenvironment in solid tumors is thought to form a barrier to the entry and efficacy of cell-based therapies such as chimeric antigen receptor (CAR) T cells. Combining CAR T cell therapy with checkpoint inhibitors has been demonstrated to oppose immune escape mechanisms in solid tumors and augment antitumor efficacy. We evaluated PD-1/PD-L1 signaling capacity and the impact of an inhibitor of this checkpoint axis in an in vitro system for cancer cell challenge, the coculture of L1CAM-specific CAR T cells with neuroblastoma cell lines. Fluorescence-activated cell sorting-based analyses and luciferase reporter assays were used to assess PD-1/PD-L1 expression on CAR T and tumor cells as well as CAR T cell ability to kill neuroblastoma cells. Coculturing neuroblastoma cell lines with L1CAM-CAR T cells upregulated PD-L1 expression on neuroblastoma cells, confirming adaptive immune resistance. Exposure to neuroblastoma cells also upregulated the expression of the PD-1/PD-L1 axis in CAR T cells. The checkpoint inhibitor, nivolumab, enhanced L1CAM-CAR T cell-directed killing. However, nivolumab-enhanced L1CAM-CAR T cell killing did not strictly correlate with PD-L1 expression on neuroblastoma cells. In fact, checkpoint inhibitor success relied on strong PD-1/PD-L1 axis expression in the CAR T cells, which in turn depended on costimulatory domains within the CAR construct, and more importantly, on the subset of T cells selected for CAR T cell generation. Thus, T cell subset selection for CAR T cell generation and CAR T cell prescreening for PD-1/PD-L1 expression could help determine when combination therapy with checkpoint inhibitors could improve treatment efficacy

Bacteria Total Maximum Daily Load Task Force Final Report

In September 2006, the Texas Commission on Environmental Quality (TCEQ) and Texas State Soil and Water Conservation Board (TSSWCB) charged a seven-person Bacteria Total Maximum Daily Load (TMDL) Task Force with: * examining approaches that other states use to develop and implement bacteria TMDLs, * recommending cost-effective and time-efficient methods for developing TMDLs, * recommending effective approaches for developing TMDL Implementation Plans (I-Plans), * evaluating a variety of models and bacteria source tracking (BST) methods available for developing TMDLs and I-Plans, and recommending under what conditions certain methods are more appropriate, and * developing a roadmap for further scientific research needed to reduce uncertainty about how bacteria behave under different water conditions in Texas. The Task Force, assisted by an Expert Advisory Group of approximately 50 stakeholders and agency staff, held two two-hour meetings/teleconferences and developed two drafts of the report. These drafts were shared by e-mail and on a Web site and feedback received from the Expert Advisory Group was also made available on the Web site. The Task Force report describes the characteristics, as well as some of the strengths and weaknesses of several models that have been used and/or are under development to assist bacteria TMDL and I-Plan analysis. These include: * load duration curves (LDC), * spatially explicit statistical models, including Arc Hydro, SPARROW and SELECT, * the mass balance models BLEST and BIT, and * the mechanistic hydrologic/water quality models HSPF, SWAT, SWMM and WASP. The Task Force report also describes and makes recommendations for effective use of BST methods that have been used in Texas and elsewhere for TMDL development. These include ERIC-PCR, Ribotyping, PFGE, KB-ARA, CSU and Bacteroidales PCR. Based on recent experience in Texas and elsewhere, the Task Force recommends using library-independent methods like Bacteriodales PCR for preliminary qualitative analyses and more expensive and time-consuming library-dependent methods if more quantitative data are required for TMDL or I-Plan development. Based on the discussions of bacteria models and source tracking, as well as extensive input from the Expert Advisory Group, the Task Force recommends a three-tier approach to implementing bacteria TMDLs and I-Plans. Tier 1 is a one-year process that includes the formation of a representative stakeholder group, development of a comprehensive geographic information system (GIS) of the watershed, a survey of potential bacterial sources, calculation of load duration curves from existing monitoring data and analysis by agency personnel and stakeholders of data collected for Tier 1. After reviewing information from Tier 1, the group may choose to complete and submit a draft TMDL for agency approval, request an evaluation of the designated use of the water body (an use attainability analysis) or proceed to Tier 2. Tier 2 is a one-to-two-year effort designed to collect targeted monitoring data to fill gaps in previously collected data, conduct qualitative library-independent BST data to determine whether humans and/or a few major classes of animals are sources and develop simple spatially explicit or mass balance models of bacteria in the watershed. After analysis of Tier 1 and Tier 2 data, the group may chose to complete and submit the draft TMDL (or I-Plan if a TMDL was developed after Tier 1), request an evaluation of the designated use (an use attainability analysis), or initiate a “phased TMDL” and proceed with Tier 3 analysis. Tier 3 is a two-to-three-year process designed to continue strong stakeholder involvement, implement more extensive targeted monitoring, conduct quantitative library-dependent BST analysis and develop a detailed hydrologic/water quality model for the watershed. Tier 3 should be implemented only when this level of detailed analysis is needed for I-Plan development or for TMDL development for particularly complex watersheds for which consensus cannot be reached after Tier 2. The Task Force emphasizes that the agencies and stakeholders may choose to deviate from these recommendations if they reach consensus that a more time- and cost-effective approach is feasible. The Task Force concludes its report by summarizing a number of research activities needed to strengthen the scientific tools available for TMDL and I-Plan development. The needed research falls into the following categories: characterization of sources, characterization of kinetic rates and transport mechanisms, enhancements to bacteria fate and transport models and bacteria source tracking, determination of effectiveness of control mechanisms and quantification of uncertainty and risk