Abstract Objective This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking ...organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and mediating effects of organizational climate and casework services on outcomes. Methods The study applies hierarchical linear models (HLMs) analyses to all 5 waves of the National Survey of Child and Adolescent Well-being (NSCAW) with a US nationwide sample of 1,678 maltreated youth aged 4–16 years and 1,696 caseworkers from 88 child welfare systems. Organizational climate is assessed on 2 dimensions, Engagement and Stress, with scales from the well established measure, Organizational Social Context (OSC); youth outcomes are measured as problems in psychosocial functioning with the Child Behavior Checklist (CBCL); and casework services are assessed with original scales developed for the study and completed by the maltreated youths’ primary caregivers and caseworkers. Results Maltreated youth served by child welfare systems with more engaged organizational climates have significantly better outcomes. Moreover, the quantity and quality of casework services neither mediate nor interact with the effects of organizational climate on youth outcomes. Conclusions Organizational climate is associated with youth outcomes in child welfare systems, but a better understanding is needed of the mechanisms that link organizational climate to outcomes. In addition, there is a need for evidence-based organizational interventions that can improve the organizational climates and effectiveness of child welfare systems.
Background
We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, ...patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes.
Methods
We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant.
Results
There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions (P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions (P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%.
Conclusions
The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.
Living alone is associated with adverse outcomes after acute coronary syndromes (ACS). One potential mediator of the relation between partner status and outcomes after ACS is physical activity. To ...evaluate the association of partner status with physical activity after ACS, data from 107 participants enrolled in the Prescription Use, Lifestyle, and Stress Evaluation (PULSE) study, a prospective observational study of post-ACS patients, were analyzed. Accelerometers were used to measure physical activity after hospital discharge. The primary outcome measure was a maximum 10 hours of daytime activity 1 month after discharge. One month after discharge from ACS hospitalizations, participants without a partner or spouse exhibited 24.4% lower daytime activity than those with a partner or spouse (p = 0.003). After controlling for age, gender, body mass index, Charlson co-morbidity index, and traditional psychosocial and clinical cardiovascular correlates of post-ACS physical activity, partner status remained an independent predictor of post-ACS physical activity (20.5% lower daytime activity among those without a partner or spouse, p = 0.008). In conclusion, in this study of accelerometer-measured physical activity after an ACS hospitalization, those without a partner or spouse exhibit significantly less physical activity than those with a partner or spouse 1 month after discharge from the hospital. Low physical activity may be an important mediator of the prognosis associated with partner status after ACS.
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) typically requires a greater number of stents and longer stent length than non-CTO PCI, placing these patients at greater risk ...for adverse ischemic events. We sought to determine whether the association between high platelet reactivity (HPR) and the risk of ischemic events is stronger after CTO than non-CTO PCI.
Patients undergoing successful PCI in the multicenter ADAPT-DES study were stratified according to whether they underwent PCI of a CTO. HPR was defined as VerifyNow platelet reaction units >208. The study primary endpoint was the 2-year risk target vessel failure (TVF defined as cardiac death, myocardial infarction, or target lesion revascularization).
CTO PCI was performed in 400 of 8448 patients. HPR was present in 34.5% of CTO PCI patients and 43.1% of non-CTO PCI patients (P = .0007). Patients undergoing CTO PCI with versus without HPR had significantly higher 2-year rates of TVF (15.0% versus 8.3%, P = .04) without significant differences in bleeding. HPR was an independent predictor of 2-year TVF (adjusted HR 1.16, 95% CI 1.02-1.34, P = .03) whereas CTO PCI was not (adjusted HR 0.89, 95% CI 0.65-1.22, P = .48). There was a significant interaction between CTO versus non-CTO PCI and PRU as a continuous variable for 2-year TVF (Pinteraction = 0.02).
In ADAPT-DES, HPR was associated with an increased 2-year risk of TVF after PCI, an association that was at least as strong after CTO PCI compared with non-CTO PCI.
We sought to examine the impact of previous failure on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic ...characteristics and procedural outcomes of 1,213 consecutive patients who underwent 1,232 CTO PCIs from 2012 to 2015 at 12 US centers. Mean age was 65 ± 10 years, and 84.8% of patients were men. A previously failed attempt had been performed in 215 patients (17.5%). As compared with patients without previous CTO PCI failure, patients with previous failure had higher Multicenter CTO Registry in Japan CTO score (2.40 ± 1.13 vs 3.28 ± 1.29, p <0.0001) and were more likely to have in-stent restenosis (10.5% vs 28.4%, p <0.0001) and to undergo recanalization attempts using the retrograde approach (41% vs 50%, p = 0.011). Technical (90% vs 88%, p = 0.390) and procedural (89% vs 86%, p = 0.184) success were similar in the 2 study groups; however, median procedure time (125 vs 142 minutes, p = 0.026) and fluoroscopy time (45 vs 55 minutes, p = 0.015) were longer in the previous failure group. In conclusion, a previously failed CTO PCI attempt is associated with higher angiographic complexity, longer procedural duration, and fluoroscopy time, but not with the success and complication rates of subsequent CTO PCI attempts.
This study presents an integrative typology of personality assessment for aggression. In this typology, self-report and conditional reasoning (
L. R. James, 1998
) methodologies are used to assess 2 ...separate, yet often congruent, components of aggressive personalities. Specifically, self-report is used to assess explicit components of aggressive tendencies, such as self-perceived aggression, whereas conditional reasoning is used to assess implicit components, in particular, the unconscious biases in reasoning that are used to justify aggressive acts. These 2 separate components are then integrated to form a new theoretical typology of personality assessment for aggression. Empirical tests of the typology were subsequently conducted using data gathered across 3 samples in laboratory and field settings and reveal that explicit and implicit components of aggression can interact in the prediction of counterproductive, deviant, and prosocial behaviors. These empirical tests also reveal that when either the self-report or conditional reasoning methodology is used in isolation, the resulting assessment of aggression may be incomplete. Implications for personnel selection, team composition, and executive coaching are discussed.
Heart failure hospitalizations occur in older patients who suffer from multiple co-existing conditions, including cognitive impairments. Green says that Dodson et al demonstrated the hazards of ...failure to recognize these cognitive difficulties in the early postdischarge period. Much work remains to be done to optimize the detection of cognitive impairment and other geriatric syndromes in order to support older adults with multimorbidity and ensure maximal benefit from complex medical regimens.
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