Policy and Practice: Customer Service in Illinois Department of Human Services Local Offices

In a single month, as many as 6,400 to 12,500 people visit each of the busiest of the Illinois Department of Human Services (IDHS) local offices. Since welfare reform in 1996, TANF caseloads in Illinois have declined precipitously. In the midst of the current economic recession with its attendant high levels of unemployment, Illinois ranks first in the United States with a reduction in its TANF caseload of 39.5% for period March 2001 to March 2003. 1 However, reductions in TANF caseload do not mean that the number of eligible families in need of assistance is declining.2 Nor do they mean that the workload of local offices has been decreasing at the same rate as TANF caseloads. On the contrary, welfare reform policies have made the management of the remaining TANF caseload a time consuming and labor intensive process. As of August 2003 for the five local offices in this study, caseworker staffing was 23.7% less than the allocated level and supervisor staffing was 28.6% less than allocated. These staff reductions resulting in caseloads in Cook County offices as high as 700 to 1,200 per caseworker negatively impact the kind of service that families encounter when they try to apply for and retain benefits. Commenting on the critical shortage of staff, one Cook County Local Office Administrator said, "I've been around a long time and it's very bad now. There are long lines and long waits. The volume is very detrimental to providing efficient services." Over the past two years, members of community-based organizations and advocacy groups have expressed concern about the increasing number of reports of problems facing people who go to Chicago area IDHS offices for public benefits such as Food Stamps, Medicaid, and TANF. For example, the volume of calls to the Public Benefits Hotline has increased from 7,054 calls for the period August 2001 through July 2002 to 8,418 calls for the period of August 2002 through July 2003. During 2003, call volume has continued to expand, with 43% more calls in August 2003 than in January 2003. In response to the need for current data about customer service in IDHS offices, CIR collaborated with community human services agencies and advocacy organizations in conducting a one-day survey to document the experiences of customers in five of the busiest local IDHS offices in Cook County. IDHS assisted with logistics, instructing local offices to allow CIR to conduct the survey in the waiting areas. Working group members conferred on research design and survey development, attended training in survey administration, and participated in administering the survey. Working group members also participated in discussions to interpret research findings and develop policy recommendations. Although the scope of the survey is limited -- information about 199 customers in 5 offices on one day in July 2003 -- the findings offer important indicators of strengths and weaknesses in service delivery. These findings are being used to inform stakeholders such as elected officials, state agencies, community leaders and organizations, and the media about the quality of service delivery

Money Management by Low-Income Households: Earning, Spending, Saving, and Accessing Financial Services

Opening and maintaining a checking or savings account at a credit union or bank are crucial steps for establishing the kinds of relationships with financial institutions that lead to qualifying for credit and developing assets. An estimated 22.2 million households or 56 million adults in the U.S. did not have a bank account in 2002. The lack of a bank account is more pervasive among low -income families than higher income families: 83% of families without bank accounts earn less than $25,000 per year. Furthermore, as many as 22$25,000 -- do not have a checking or savings account. Families in the lowest income group are even less likely to have accounts. An estimated 29.1% of families with incomes in the lowest twentieth percentile ($10,300 or less) are without accounts, which is more than three times the median of 9.1$25,000 had bank accounts in 2001, 53.4% of this income group reported having saved in the previous year. For households in the lowest income quintile ($10,300 or less), the savings rate is 30.0%. Furthermore, the reasons for saving differ among income levels, with families at lower income levels saving for more immediate expenditures such as rent and holiday gifts, compared with the longer timeframe of savings by higher income groups for future expenditures such as children's education and retirement

Medicare Reform: Widespread Confusion, Uncertain Benefits

This report presents the data from CIR's 2004 survey of 600 Medicare recipients about their health care options, ability to access services, and choices about health care spending in the wake of Medicare reform. The findings of this report will assist policy makers and community-based organizations to advocate for programs that will best serve the needs of Medicare recipients

Wherever I Can Lay My Head: Homeless Youth on Homelessness

Research about the issue of homelessness largely has focused on understanding the characteristics and addressing the needs of homeless adults and families in our communities. Much less research has been conducted to document the characteristics and needs of homeless youth. In recent years, a number of studies have come out in Illinois that address the situation of homeless adults and families as well as youth. Yet there remains a lack of data documenting the perspective of homeless youth concerning their own needs. Providing services that youth report they need can serve as a gateway to other needed services. In the summer of 2003, the Chicago Department of Health sponsored a symposium on the needs of LGBTQ homeless youth. Discussions during this meeting made it clear that assessing the needs of homeless youth would require looking beyond those who were living in shelters, and that the needs of subgroups within the homeless youth population were likely to vary considerably. In response to this need for more information about homeless youths' needs, the City's Department of Children and Youth Services (CYS) partnered with the Night Ministry, an agency with a history of addressing the needs of marginalized youth, to commission the Center for Impact Research (CIR) to conduct a study of the needs of homeless youth in the City of Chicago. The purpose of this study was to learn what the youth themselves identify as their needs, and to understand the differences in these needs among a variety of subgroups-those experiencing their first episode of homelessness, those cycling in and out of homelessness, and those experiencing chronic homelessness. Both the non -profit service providers and the City hope that identifying and meeting these needs not only will act as a gateway to other needed services, but also will expedite resolution of problems that result in homelessness and lead to the establishment of permanent, stable, and safe living situations. With guidance from the Homeless Youth Task Group of the Chicago Continuum of Care 3 and an advisory group composed of government policy makers and program personnel and non-profit agency directors,4 CIR conducted a survey of homeless youth in Chicago between the ages of 14 and 21 during April and May 2004. Twelve youth, nine of whom were homeless, were recruited and trained to interview homeless youth for the project. They conducted 400 interviews with homeless youth throughout Chicago -- at bus stops, fairs and festivals, on trains, streets, and basketball courts, in parks, shelters, schools, homes, drop -in centers, churches, and restaurants. In addition to conducting the survey, CIR interviewed homeless youth service providers, advocates, and public policy personnel working at public and private agencies. These interviews provide further information about the needs of homeless youth and the resources currently available to them, as well as ways that the various systems serving homeless youth might be improved

The Costs and Benefits of School Health Centers: A Fact Sheet Prepared for the Illinois Coalition for School Health

This fact sheet describes the costs and estimates the benefits to the state of Illinois that accrue from thirty-eight School Health Centers that receive partial funding from the Illinois Department of Human Services. The study focuses on benefits from reduced asthma hospitalizations, reduced emergency room visits, and increased immunizations provided for Illinois school-age children

Mechanistic and structural basis for the actions of the antibacterial gepotidacin against Staphylococcus aureus gyrase

Gepotidacin is a first-in-class triazaacenaphthylene novel bacterial topoisomerase inhibitor (NBTI). The compound has successfully completed phase II trials for the treatment of acute bacterial skin/skin structure infections and for the treatment of uncomplicated urogenital gonorrhea. It also displays robust in vitro activity against a range of wild-type and fluoroquinolone-resistant bacteria. Due to the clinical promise of gepotidacin, a detailed understanding of its interactions with its antibacterial targets is essential. Thus, we characterized the mechanism of action of gepotidacin against Staphylococcus aureus gyrase. Gepotidacin was a potent inhibitor of gyrase-catalyzed DNA supercoiling (IC50 ≈ 0.047 µM) and relaxation of positively supercoiled substrates (IC50 ≈ 0.6 µM). Unlike fluoroquinolones, which induce primarily double-stranded DNA breaks, gepotidacin induced high levels of gyrase-mediated single-stranded breaks. No double-stranded breaks were observed even at high gepotidacin concentration, long cleavage times, or in the presence of ATP. Moreover, gepotidacin suppressed the formation of double-stranded breaks. Gepotidacin formed gyrase-DNA cleavage complexes that were stable for >4 h. In vitro competition suggests that gyrase binding by gepotidacin and fluoroquinolones are mutually exclusive. Finally, we determined crystal structures of gepotidacin with the S. aureus gyrase core fusion truncate with nicked (2.31 Å resolution) or with intact (uncleaved) DNA (2.37 Å resolution). In both cases, a single gepotidacin molecule was bound midway between the two scissile DNA bonds and in a pocket between the two GyrA subunits. A comparison of the two structures demonstrates conformational flexibility within the central linker of gepotidacin, which may contribute to the activity of the compound

Clinical and Translational Significance of Basophils in Patients with Cancer

Despite comprising a very small proportion of circulating blood leukocytes, basophils are potent immune effector cells. The high-affinity receptor for IgE (FcɛRI) is expressed on the basophil cell surface and powerful inflammatory mediators such as histamine, granzyme B, and cytokines are stored in dense cytoplasmic granules, ready to be secreted in response to a range of immune stimuli. Basophils play key roles in eliciting potent effector functions in allergic diseases and type 1 hypersensitivity. Beyond allergies, basophils can be recruited to tissues in chronic and auto-immune inflammation, and in response to parasitic, bacterial, and viral infections. While their activation states and functions can be influenced by Th2-biased inflammatory signals, which are also known features of several tumor types, basophils have received little attention in cancer. Here, we discuss the presence and functional significance of basophils in the circulation of cancer patients and in the tumor microenvironment (TME). Interrogating publicly available datasets, we conduct gene expression analyses to explore basophil signatures and associations with clinical outcomes in several cancers. Furthermore, we assess how basophils can be harnessed to predict hypersensi-tivity to cancer treatments and to monitor the desensitization of patients to oncology drugs, using assays such as the basophil activation test (BAT)

Dual Roles of Fer Kinase Are Required for Proper Hematopoiesis and Vascular Endothelium Organization during Zebrafish Development

Fer kinase, a protein involved in the regulation of cell-cell adhesion and proliferation, has been shown to be required during invertebrate development and has been implicated in leukemia, gastric cancer, and liver cancer. However, in vivo roles for Fer during vertebrate development have remained elusive. In this study, we bridge the gap between the invertebrate and vertebrate realms by showing that Fer kinase is required during zebrafish embryogenesis for normal hematopoiesis and vascular organization with distinct kinase dependent and independent functions. In situ hybridization, quantitative PCR and fluorescence activated cell sorting (FACS) analyses revealed an increase in both erythrocyte numbers and gene expression patterns as well as a decrease in the organization of vasculature endothelial cells. Furthermore, rescue experiments have shown that the regulation of hematopoietic proliferation is dependent on Fer kinase activity, while vascular organizing events only require Fer in a kinase-independent manner. Our data suggest a model in which separate kinase dependent and independent functions of Fer act in conjunction with Notch activity in a divergent manner for hematopoietic determination and vascular tissue organization

Sleep Health Issues for Children with FASD: Clinical Considerations

This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research

The cancer patient and cardiology

Advances in cancer treatments have improved clinical outcomes, leading to an increasing population of cancer survivors. However, this success is associated with high rates of short- and long-term cardiovascular (CV) toxicities. The number and variety of cancer drugs and CV toxicity types make long-term care a complex undertaking. This requires a multidisciplinary approach that includes expertise in oncology, cardiology and other related specialties, and has led to the development of the cardio-oncology subspecialty. This paper aims to provide an overview of the main adverse events, risk assessment and risk mitigation strategies, early diagnosis, medical and complementary strategies for prevention and management, and long-term follow-up strategies for patients at risk of cancer therapy-related cardiotoxicities. Research to better define strategies for early identification, follow-up and management is highly necessary. Although the academic cardio-oncology community may be the best vehicle to foster awareness and research in this field, additional stakeholders (industry, government agencies and patient organizations) must be involved to facilitate cross-discipline interactions and help in the design and funding of cardio-oncology trials. The overarching goals of cardio-oncology are to assist clinicians in providing optimal care for patients with cancer and cancer survivors, to provide insight into future areas of research and to search for collaborations with industry, funding bodies and patient advocates. However, many unmet needs remain. This document is the product of brainstorming presentations and active discussions held at the Cardiovascular Round Table workshop organized in January 2020 by the European Society of Cardiology.</p