The potential of socially assistive robots during infectious disease outbreaks.

Robots have a role in addressing the secondary impacts of infectious disease outbreaks by helping us sustain social distancing, monitoring and improving mental health, supporting education, and aiding in economic recovery.

Project Nova: A Combination HIV Prevention and Microfinance Intervention for Women Who Engage in Sex Work and Use Drugs in Kazakhstan.

Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.

Living as a person using a lower-limb prosthesis in Nepal.

PURPOSE: The purpose of this study is to explore experiences of persons in Nepal using lower-limb prostheses, in relation to specific articles in the Convention on the Rights of Persons with Disabilities that consider mobility, education, health, rehabilitation, and work and employment. METHOD: Qualitative interviews were conducted with 16 persons using lower limb prostheses. Content analysis was applied to the data. RESULTS: Six themes emerged: The lower-limb prosthesis is essential for mobility and daily life; Limited mobility in challenging terrain and request for reduced pain when using prosthesis; Difficulties in finding and sustaining employment emphasized the importance of vocational training; Appreciation of comprehensive rehabilitation together with other persons with amputations, but covering related costs is a struggle; Satisfied with health care, but concerned that it creates debt and dependence upon others; and finally, Limited ability creates negative self-image and varied attitudes in other people. CONCLUSION: Persons with lower-limb amputations were restricted by poverty and wanted increased independence. Rehabilitation and prosthetic services in Nepal need to increase proportionally as they contribute to enabling those persons to a better daily life. Prostheses were essential but more advanced technology was requested. Access to education and vocational training has the potential to improve the socio-economic status of those with lower-limb amputations due lack of employment not requiring physical effort. Implications for rehabilitation To increase access for persons with lower-limb amputations in Nepal to rehabilitation services, these services need to increase proportionally, and the policy for financial compensation to enable those persons to afford transportation to the rehabilitation center should be implemented. The design and manufacture of the low-cost polypropylene technology for prostheses used in Nepal needs to be improved, directed towards increasing the ability to ambulate on uneven surfaces and hilly terrain, and the ability to walk long distances. Adjustments of employment for persons with physical disabilities in Nepal have the potential to strengthen their socio-economic status. Vocational training programs and educational opportunities for persons with physical disabilities have the potential to improve income-generating employment and need to increase proportionally in Nepal. The policies developed in accordance with the Convention on the Rights of Persons with Disabilities need to be further implemented to decrease existing barriers to access to general health care and rehabilitation and prosthetic services for persons with disabilities in Nepal.

Employment effects of active labor market programs for sick-listed workers.

We use register data of 88,948 sick-listed workers in Denmark over the period 2008-2011 to investigate the effect of active labor market programs on the duration until returning to non-subsidized employment and the duration of this employment. To identify causal treatment effects, we exploit over-time variation in the use of active labor market programs in 98 job centers and time-to- event. We find that ordinary education and subsidized job training have significant positive employment effects. Subsidized job training has a large, positive effect on the transition into employment but no effect on the subsequent employment duration. In contrast, ordinary education has a positive effect on employment duration but no effect on the transition into employment. The latter effect is the result of two opposing effects, a large positive effect of having completed education and a large negative lock-in effect, with low re-employment chances during program participation.

The Mohs histotechnician: a review of training and practice within 29 centres in the UK.

BACKGROUND: Although various assessments pertaining to the surgical aspect of Mohs micrographic surgery (MMS) have been performed, the pivotal role played by the MMS histotechnician (MH) has not previously been addressed in the UK. AIM: To undertake a review of the training and practice of MHs in all centres performing MMS within the National Health Service (NHS) in the UK. METHODS: NHS dermatology departments performing MMS in the UK were identified and contacted by telephone between November 2011 and January 2012. MMS practice data pertaining to the role of the MH in tissue processing was collected by speaking directly to a histotechnician in each department. RESULTS: In total, 29 centres were identified. The number of MHs at each centre varied from 1 to 13 (median 3). All MHs had undergraduate degrees in biomedical science. Most (85%) MHs worked full-time under the directorate of their local pathology department. In 19 centres (66%), the Mohs surgeon reviewed the slides, and in the remaining 10 centres (34%), a consultant histopathologist reviewed the slides, either alone or in partnership with the Mohs surgeon. There was significant variation in tissue handling and processing techniques across the centres. All centres used MMS to treat primarily high-risk basal cell carcinomas, with over half (55%) also treating squamous cell carcinomas. MHs from all centres had learned about the specifics of MMS tissue processing 'on the job', with a minority having received formal training by attending a larger MMS centre or an MMS course. CONCLUSIONS: Significant variation in MMS tissue-processing techniques exists across the UK. A standard of practice should perhaps be considered, as this has risk-management, quality-control and possible medicolegal implications.

Preliminary assessment of the behavioral activation model in Japanese undergraduate students.

Many studies have reported that behavioral activation is an effective intervention for depression. The behavioral activation model is based on several formulations. For example, depressive mood leads to avoidant behaviors, avoidance negatively affects social contacts, decreased socialization lessens opportunities for positive reinforcement, and a decrease in positive reinforcement results in more depressive mood. The purpose of this study was to examine relationships among avoidant behavior, social contact, frequency of positive reinforcement, and depressive mood by using structural equation modeling to assess support for aspects of this behavioral activation model. Participants were 630 Japanese undergraduate students and vocational school students. Results provided preliminary support for the model. Treating both avoidance and activating behavior might contribute to decreased impairment.

Developing a model to estimate the potential impact of municipal investment on city health.

This article summarizes a process which exemplifies the potential impact of municipal investment on the burden of cardiovascular disease (CVD) in city populations. We report on Developing an evidence-based approach to city public health planning and investment in Europe (DECiPHEr), a project part funded by the European Union. It had twin objectives: first, to develop and validate a vocational educational training package for policy makers and political decision takers; second, to use this opportunity to iterate a robust and user-friendly investment tool for maximizing the public health impact of 'mainstream' municipal policies, programs and investments. There were seven stages in the development process shared by an academic team from Sheffield Hallam University and partners from four cities drawn from the WHO European Healthy Cities Network. There were five iterations of the model resulting from this process. The initial focus was CVD as the biggest cause of death and disability in Europe. Our original prototype 'cost offset' model was confined to proximal determinants of CVD, utilizing modified 'Framingham' equations to estimate the impact of population level cardiovascular risk factor reduction on future demand for acute hospital admissions. The DECiPHEr iterations first extended the scope of the model to distal determinants and then focused progressively on practical interventions. Six key domains of local influence on population health were introduced into the model by the development process: education, housing, environment, public health, economy and security. Deploying a realist synthesis methodology, the model then connected distal with proximal determinants of CVD. Existing scientific evidence and cities' experiential knowledge were 'plugged-in' or 'triangulated' to elaborate the causal pathways from domain interventions to public health impacts. A key product is an enhanced version of the cost offset model, named Sheffield Health Effectiveness Framework Tool, incorporating both proximal and distal determinants in estimating the cost benefits of domain interventions. A key message is that the insights of the policy community are essential in developing and then utilising such a predictive tool.

[Time budget, progress, and adaptation in school-university profile class pupils].

The paper considers the hygienic aspects of optimization of daily and weekly time budgets, the formation of healthy lifestyle choices in 10th-to-11th-form pupils from the vocational guidance classes of comprehensive secondary schools during intensified school lessons and adaptation of first-year students.

Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.

CONTEXT: National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment. METHODS: We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months. Participants were interviewed semiannually, paid employment was tracked weekly, and vocational and clinical services were measured monthly. Mixed-effects random regression analysis was used to predict the likelihood of competitive employment, working 40 or more hours in a given month, and monthly earnings. RESULTS: Cumulative results during 24 months show that experimental group participants (359/648 [55%]) were more likely than those in the comparison programs (210/625 [34%]) to achieve competitive employment (chi(2) = 61.17; P<.001). Similarly, patients in experimental group programs (330/648 [51%]) were more likely than those in comparison programs (245/625 [39%]) to work 40 or more hours in a given month (chi(2) = 17.66; P<.001). Finally, participants in experimental group programs had significantly higher monthly earnings than those in the comparison programs (mean, US 122 dollars/mo [n=639] vs US 99 dollars/mo [n=622]); t(1259) = -2.04; P<.05). In the multivariate longitudinal analysis, experimental condition subjects were more likely than comparison group subjects to be competitively employed, work 40 or more hours in a given month, and have higher earnings, despite controlling for demographic, clinical, work history, disability beneficiary status, and study site confounders. Moreover, the advantage of experimental over comparison group participants increased during the 24-month study period. CONCLUSION: The SE models tailored by integrating clinical and vocational services were more effective than services as usual or unenhanced services.

Vocational assessment and intervention for people with epilepsy.

Employment restrictions have been experienced by many people with epilepsy. In many cases, the restrictions are unjustified and based on stigma or a stereotypical image of the person with epilepsy. Unjustifiable restrictions are a form of discrimination and lead to unemployment and underemployment. Unfortunately, much of the research in this area has been difficult to interpret because of differences in the definition of "people with epilepsy" and differences in the definition of "employment restrictions or problems." I report on an attempt to develop a classification structure and examine some survey results collected by the IBE Employment Commission from professionals and people with epilepsy concerning the sources of employment restrictions and possible methods to overcome these restrictions.

Programming for efficiency: the effects of motion economy on vocational tasks for adults with severe and profound mental retardation.

Principles of motion economy were assessed with two vocational tasks for two adults with severe to profound mental retardation. Study 1 assessed task acquisition by comparing two tasks (collating three pages, bagging three ribbons), one task trained using the standard job site task analysis, the other trained using a motion economy-based task analysis (requiring less total distance movement to task completion) in two alternating treatments designs. Study 2 assessed task fluency by examining the effects of the motion economy-based task analysis on collating and bagging separately across the same two adults in four reversal designs. Neither task analysis was superior overall in acquisition (Study 1), but once each task was mastered, the motion economy-based task analysis enhanced fluency across both tasks for both participants (Study 2). The use of distance movement as a parameter of response efficiency is discussed when targeting job performance, productivity, and preference.

Models of vocational assessment of handicapped students.

During the last twenty years, increasing emphasis has been placed upon the provision of comprehensive vocational assessment to disabled and disadvantaged persons to assist them in obtaining employment. Vocational evaluation programs have proliferated in rehabilitation facilities, manpower programs, vocational-technical schools and public schools. An increasing body of literature and research has delineated service-delivery models and competencies needed by vocational evaluation specialists. Increasing numbers of universities have implemented graduate training programs in vocational evaluation; and a national professional certification process has been developed. Most of this activity has been centered at rehabilitation facilities at the same time that public schools are becoming the norm for educating disabled students. As vocational assessment for disabled students moves into this relatively new setting, it is being modified. This article explores models of vocational assessment for disabled students which incorporate modifications to suit the special needs of the public school setting.

A team approach to prevocational services.

This paper presents a chronology of legislative mandates for vocational rehabilitation, discusses their impact on occupational therapy, and describes relationships between special educators and vocational agencies. The Career Training Workshop, a prevocational program developed and used successfully by a North Carolina school district, is described here as an example of one effort to prepare students with disabilities for employment.

[Vocational aptitude and inclination--aspects of their assessment and evaluation in rehabilitation]. / Berufliche Eignung und Neigung--Gesichtspunkte ihrer Erfassung und Bewertung in der Rehabilitation.

The task of appraising aptitudes and inclinations accompanies a rehabilitee and the rehabilitation workers involved for the entire duration of an occupationally-focussed rehabilitation measure. Explicitly so in vocational guidance measures, it aims at obtaining a sound basis for decision-making in view of vocational reorientation. Responsibility for this decision in the last analysis rests with the rehabilitee himself, an aspect that abolishes any strict separation of aptitude and inclination in predicting outcome in the context of occupational perspectives. Being the decision-making agent, the rehabilitee must therefore be offered typical situational fragments of a possible educational and vocational future, intended on the one hand to inform him of occupational alternatives and, on the other, to provide initial experience. The rehabilitation worker's role in this process requires a client-centered stance in terms of information provider and trusted agent, which is to help avoid an adverse exams climate evolve in this momentous decision-making phase. Psychological testing, from this angle, should be used merely as a supplementary means. The approach outlined for appraisal of individual potentials requires intensive teamwork, not least also in view of verifying individual capacity.