Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Child welfare informatics: A proposed subspecialty for social work

Informatics is a term that has been used and applied to data collection, analysis, and information and communication technologies across many disciplines including public health, nursing, medicine, and, more recently, to social work. To date, no collective discussion involving policy makers, practitioners, and researchers in the social work field defining child welfare informatics and its implications to the discipline, including curriculum development has occurred. This paper offers a perspective to begin the dialogue of child welfare informatics and presents a working definition and role specification for those working as child welfare informaticians. Finally, recommendations are made on how to evolve child welfare informatics. These recommendations include highlighting the importance of informatics as a subspecialty in social work, its prospectus for child welfare policyreform, and implications for interdisciplinary, social work curriculum development.Child welfare Informatics Child welfare informatics Information technology Computers in social work Child welfare data collection and analysis

Scholarships and supports available to foster care alumni: A study of 12 programs across the US

Postsecondary education remains unattainable for many foster care alumni. This can be attributed to many factors including inadequate academic preparation, and a lack of financial, housing and supportive services available to college students from foster care. This exploratory study gathers qualitative data from twelve college programs nationwide that provide scholarship and supportive services to foster care alumni attending postsecondary education. Findings illustrate six major themes of youth's unmet needs: academic preparation; housing; financial assistance; the need for emergency assistance; youth's personal challenges; and, the need for advocacy. Program coordinators state the importance of accessibility, advocacy, academic supports in the form of tutoring and mentoring; assistance in finding housing; scholarships; emergency financial assistance; access to health and mental health providers; and, outreach programs to college bound foster youth. Recommendations explore furthering tuition waiver programs and supportive services that address the emotional, financial and housing needs of foster care alumni attending college.Foster youth College Postsecondary education Foster care alumni Supportive services Scholarship Campus based Educational Training Voucher Advocacy Housing Mentoring

Employment outcomes of foster youth: The results from the Midwest Evaluation of the Adult Functioning of Foster Youth

Youth emancipated from the foster care system face challenges in securing steady employment and earning a living wage. Using data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth, this article uses Tobit analyses to test the statistical relationship between multiple factors (demographics, human capital, and independent living services) and yearly income for former foster youth at age 21 years. The findings revealed that race, level of education, histories of drug and alcohol use, and histories of mental illness significantly impact yearly earnings within the sampled population. Equally significant, self-reported receipt of help related to employment did not impact yearly earnings. However, the limitations associated with using a non-experimental design and the challenges associated with the endogeneity of the measures of employment-related help suggest areas for future research on this topic.Foster youth Emancipation Transition to adulthood Independent living Employment services Tobit analysis

"It's not my fault": Acceptance of responsibility as a component of engagement in juvenile residential treatment

Research suggests that client engagement in treatment is related to positive treatment outcomes. Although a large body of literature exists on clients' treatment engagement, literature on engagement in juvenile residential treatment centers is sparse, particularly in the area of who engages in treatment. Practitioners in Residential Treatment Centers (RTCs) have expressed a belief that youths' acknowledgement of problems and acceptance of responsibility is an important first step in the treatment process. Using both qualitative and quantitative data from youths' responses to interview questions during their first month of stay in residence, this paper explores the concept of "attribution of responsibility," including whether these youth accept responsibility for their placement, and examines whether acceptance of responsibility is an important component of engagement in treatment. From these in-depth interviews (n = 125), patterns in youths' attributions did emerge. Youth did make internal or external attributions of responsibility or blame for the activities that led them to residential treatment. Further, differences were found between youth in whether they believed that there was a good reason for their placement. Finally, youths' verbal attributions were significantly related to youths' treatment engagement. Implications of these findings are discussed.