A gene expression-based model predicts outcome in children with intermediate-risk classical Hodgkin lymphoma.

Classical Hodgkin lymphoma (cHL) is a common malignancy in children and adolescents. Although cHL is highly curable, treatment with chemotherapy and radiation often come at the cost of long-term toxicity and morbidity. Effective risk-stratification tools are needed to tailor therapy. Here, we used gene expression profiling (GEP) to investigate tumor microenvironment (TME) biology, to determine molecular correlates of treatment failure, and to develop an outcome model prognostic for pediatric cHL. A total of 246 formalin-fixed, paraffin-embedded tissue biopsies from patients enrolled in the Children's Oncology Group trial AHOD0031 were used for GEP and compared with adult cHL data. Eosinophil, B-cell, and mast cell signatures were enriched in children, whereas macrophage and stromal signatures were more prominent in adults. Concordantly, a previously published model for overall survival prediction in adult cHL did not validate in pediatric cHL. Therefore, we developed a 9-cellular component model reflecting TME composition to predict event-free survival (EFS). In an independent validation cohort, we observed a significant difference in weighted 5-year EFS between high-risk and low-risk groups (75.2% vs 90.3%; log-rank P = .0138) independent of interim response, stage, fever, and albumin. We demonstrate unique disease biology in children and adolescents that can be harnessed for risk-stratification at diagnosis. This trial was registered at www.clinicaltrials.gov as #NCT00025259.

Dynamic altruistic cooperation within breast tumors.

BACKGROUND: Social behaviors such as altruism, where one self-sacrifices for collective benefits, critically influence an organism's survival and responses to the environment. Such behaviors are widely exemplified in nature but have been underexplored in cancer cells which are conventionally seen as selfish competitive players. This multidisciplinary study explores altruism and its mechanism in breast cancer cells and its contribution to chemoresistance. METHODS: MicroRNA profiling was performed on circulating tumor cells collected from the blood of treated breast cancer patients. Cancer cell lines ectopically expressing candidate miRNA were used in co-culture experiments and treated with docetaxel. Ecological parameters like relative survival and relative fitness were assessed using flow cytometry. Functional studies and characterization performed in vitro and in vivo include proliferation, iTRAQ-mass spectrometry, RNA sequencing, inhibition by small molecules and antibodies, siRNA knockdown, CRISPR/dCas9 inhibition and fluorescence imaging of promoter reporter-expressing cells. Mathematical modeling based on evolutionary game theory was performed to simulate spatial organization of cancer cells. RESULTS: Opposing cancer processes underlie altruism: an oncogenic process involving secretion of IGFBP2 and CCL28 by the altruists to induce survival benefits in neighboring cells under taxane exposure, and a self-sacrificial tumor suppressive process impeding proliferation of altruists via cell cycle arrest. Both processes are regulated concurrently in the altruists by miR-125b, via differential NF-κB signaling specifically through IKKß. Altruistic cells persist in the tumor despite their self-sacrifice, as they can regenerate epigenetically from non-altruists via a KLF2/PCAF-mediated mechanism. The altruists maintain a sparse spatial organization by inhibiting surrounding cells from adopting the altruistic fate via a lateral inhibition mechanism involving a GAB1-PI3K-AKT-miR-125b signaling circuit. CONCLUSIONS: Our data reveal molecular mechanisms underlying manifestation, persistence and spatial spread of cancer cell altruism. A minor population behave altruistically at a cost to itself producing a collective benefit for the tumor, suggesting tumors to be dynamic social systems governed by the same rules of cooperation in social organisms. Understanding cancer cell altruism may lead to more holistic models of tumor evolution and drug response, as well as therapeutic paradigms that account for social interactions. Cancer cells constitute tractable experimental models for fields beyond oncology, like evolutionary ecology and game theory.

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists.

BACKGROUND: Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life. OBJECTIVE: The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists. METHODS: One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction. RESULTS: The SMMA model accounted for 49% of the variation in job satisfaction scores (R2 =. 49, f2 = 0.96 [> 0.35], a large effect size). Autonomous motivation to work, work engagement, and organizational commitment were significantly associated with job satisfaction after controlling for the effect of perceived organizational support. CONCLUSIONS: Perceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

Demographic Covariates, Vocational Rehabilitation Services, and Employment Outcomes of Working-Age Adults with Anxiety Disorders: A Multivariate Logistic Regression Analysis.

PURPOSE: This study aimed to investigate the relationships between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of individuals with anxiety disorders. The specific research question for the current study investigate demographic variables and vocational rehabilitation services as predictors of competitive employment outcomes. METHODS: Data for the present study were extracted from the most recent United States Rehabilitation Service Administration 2018 Case Service Report (RSA-911) data. A purposeful selection, multivariate logistic regression analysis was conducted to examine the case service report data of 9266 individuals with anxiety disorders who received vocational rehabilitation services based on their demographic variables and receipt of VR services. RESULTS: The results indicated that African Americans and Latinx, people who have completed high school or more, people who do not receive disability-related benefits, and those who received more vocational rehabilitation services were more likely to be gainfully employed. In addition, receipt of financial support for life crises and occupational credentials (i.e., other services and maintenance services) and vocational rehabilitation counseling and guidance services were significant predictors of employment outcomes. Conversely, receipt of supported employment and transition services were negatively associated with employment outcome. CONCLUSIONS: In the present study, we identified VR services that can improve and risk factors that can impede employment outcomes of people with anxiety disorders. We also identified medical, psychosocial, and vocational interventions that can lessen the effect of anxiety disorders on physical and mental health functioning.

Company Characteristics, Disability Inclusion Practices, and Employment of People with Disabilities in the Post COVID-19 Job Economy: A Cross Sectional Survey Study.

Purpose In the post coronavirus disease 2019 (COVID-19) recession economy, rehabilitation counselors, transition specialists, and other disability service providers must redouble their efforts to connect with employers to create employment opportunities for people with physical and mental impairments. The purpose of the present study was to investigate company characteristics and effective disability inclusion practices that are related to employment of people with disabilities. Methods Four hundred sixty-six employers completed a demographic questionnaire and the Disability Inclusion Profiler. Results Results indicated company characteristics and disability practices were positively related to employment of people with disabilities. Conclusions Findings of the present study can be used by transition specialists, rehabilitation counselors, and other disability service providers to engage and connect with employers to increase employment opportunity for people with disabilities in the post COVID-19 economy. Future research and practice implications are provided.

Validation of the RHL30 digital gene expression assay as a prognostic biomarker for relapsed Hodgkin lymphoma.

Despite continuing improvements in the management of classical Hodgkin lymphoma (cHL), relapse remains associated with a risk of lymphoma-related mortality. The biological composition of relapse tumour biopsies shows interpatient variability, which can be leveraged to design prognostic biomarkers. Here, we validated the RHL30 assay, a previously reported gene expression model in an independent cohort of 41 patients with relapsed cHL. Patients classified as high-risk by the RHL30 assay had inferior failure-free survival (FFS) after autologous stem cell transplantation (2-year FFS 41% vs. 92%, P = 0·035). The RHL30 model is a robust biomarker that risk-stratifies patients considered for autologous stem cell transplantation.

Fine-tuning of FOXO3A in cHL as a survival mechanism and a hallmark of abortive plasma cell differentiation.

We recently found that FOXO1 repression contributes to the oncogenic program of classical Hodgkin lymphoma (cHL). Interestingly, FOXO3A, another member of the FOXO family, was reported to be expressed in the malignant Hodgkin and Reed-Sternberg cells of cHL at higher levels than in non-Hodgkin lymphoma subtypes. We thus aimed to investigate mechanisms responsible for the maintenance of FOXO3A as well as the potential role of FOXO3A in cHL. Here, we show that high FOXO3A levels in cHL reflect a B-cell-differentiation-specific pattern. In B cells, FOXO3A expression increases during the process of centroblast to plasma cell (PC) differentiation. FOXO3A levels in cHL were found higher than in germinal center B cells, but lower than in terminally differentiated PCs. This intermediate FOXO3A expression in cHL might manifest the "abortive PC differentiation" phenotype. This assumption was further corroborated by the finding that overexpression of FOXO3A in cHL cell lines induced activation of the master PC transcription factor PRDM1α. As factors attenuating FOXO3A expression in cHL, we identified MIR155 and constitutive activation of extracellular signal-regulated kinase. Finally, we demonstrate the importance of FOXO3A expression in cHL using an RNA interference approach. We conclude that tightly regulated expression of FOXO3A contributes to the oncogenic program and to the specific phenotype of cHL.

Somatic IL4R mutations in primary mediastinal large B-cell lymphoma lead to constitutive JAK-STAT signaling activation.

Primary mediastinal large B-cell lymphoma (PMBCL) is a distinct subtype of diffuse large B-cell lymphoma thought to arise from thymic medullary B cells. Gene mutations underlying the molecular pathogenesis of the disease are incompletely characterized. Here, we describe novel somatic IL4R mutations in 15 of 62 primary cases of PMBCL (24.2%) and in all PMBCL-derived cell lines tested. The majority of mutations (11/21; 52%) were hotspot single nucleotide variants in exon 8, leading to an I242N amino acid change in the transmembrane domain. Functional analyses establish this mutation as gain of function leading to constitutive activation of the JAK-STAT pathway and upregulation of downstream cytokine expression profiles and B cell-specific antigens. Moreover, expression of I242N mutant IL4R in a mouse xenotransplantation model conferred growth advantage in vivo. The pattern of concurrent mutations within the JAK-STAT signaling pathway suggests additive/synergistic effects of these gene mutations contributing to lymphomagenesis. Our data establish IL4R mutations as novel driver alterations and provide a strong preclinical rationale for therapeutic targeting of JAK-STAT signaling in PMBCL.

Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis.

This study explores the effects of biopsychosocial factors on life satisfaction among persons with serious mental illness. Participants in this study included a convenience sample of 194 adults recruited from Texas and Wisconsin. A path analysis was conducted with psychiatric symptoms as an exogenous variable, and illness insight, social self-efficacy, social support, community integration, and life satisfaction as endogenous variables. Beginning with a hypothesized model, a best model was obtained after removing the paths that were not significant and adding recommended paths supported by theory. In the final model, psychiatric symptoms, social self-efficacy, social support, and community integration were directly associated with life satisfaction. Illness insight did not directly affect life satisfaction but had indirect effects. Psychiatric symptoms may be the most important and direct predictor of life satisfaction; illness insight, social self-efficacy, social support, and community integration buffer the direct of effect of psychiatric symptoms on life satisfaction.

Assessing vocational outcome expectancy in individuals with serious mental illness: a factor-analytic approach.

Background: Self-determination theory (SDT) and self-efficacy theory (SET) can be used to conceptualize self-determined motivation to engage in mental health and vocational rehabilitation (VR) services and to predict recovery. To incorporate SDT and SET as a framework for vocational recovery, developing and validating SDT/SET measures in vocational rehabilitation is warranted. Outcome expectancy is an important SDT/SET variable affecting rehabilitation engagement and recovery.Aims: The purpose of this study was to validate the Vocational Outcome Expectancy Scale (VOES) for use within the SDT/SET vocational recovery framework.Methods: One hundred and twenty-four individuals with serious mental illness (SMI) participated in this study. Measurement structure of the VOES was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).Results: Both EFA and CFA results supported a two-factor structure: (a) positive outcome expectancy, and (b) negative outcome expectancy. The internal consistency reliability coefficients for both factors were acceptable. In addition, positive outcome expectancy correlated stronger than negative outcome expectancy with other SDT/SET constructs in the expected directions.Conclusions: The VOES is a brief, reliable and valid instrument for assessing vocational outcome expectancy in individuals with SMI that can be integrated into SDT/SET as a vocational rehabilitation engagement and recovery model in psychiatric rehabilitation.

Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia.

Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.

Genetic profiling of MYC and BCL2 in diffuse large B-cell lymphoma determines cell-of-origin-specific clinical impact.

The clinical significance of MYC and BCL2 genetic alterations in diffuse large B-cell lymphoma (DLBCL), apart from translocations, has not been comprehensively investigated using high-resolution genetic assays. In this study, we profiled MYC and BCL2 genetic alterations using next-generation sequencing and high-resolution SNP array in 347 de novo DLBCL cases treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) at the British Columbia Cancer Agency. Cell-of-origin (COO) subtype was determined by Lymph2Cx digital gene expression profiling. We showed that the incidence of MYC/BCL2 genetic alterations and their clinical significance were largely dependent on COO subtypes. It is noteworthy that the presence of BCL2 gain/amplification is significantly associated with poor outcome in activated B-cell-like and BCL2 translocation with poor outcome in germinal center B-cell subtypes, respectively. Both have prognostic significance independent of MYC/BCL2 dual expression and the International Prognostic Index (IPI). Furthermore, the combination of BCL2 genetic alterations with IPI identifies markedly worse prognostic groups within individual COO subtypes. Thus, high-resolution genomic assays identify extremely poor prognostic groups within each COO subtype on the basis of BCL2 genetic status in this large, uniformly R-CHOP-treated population-based cohort of DLBCL. These results suggest COO subtype-specific biomarkers based on BCL2 genetic alterations can be used to risk-stratify patients with DLBCL treated with immunochemotherapy.

Novel insights into the disease dynamics of B-cell lymphomas in the Genomics Era.

High-throughput sequencing has significantly contributed to revealing the molecular underpinnings of B-cell lymphomagenesis and disease progression. It is now a widely accepted concept that the diversity of clinical responses to front-line therapy and the development of relapsed/refractory disease are in part explained by 'inter-patient' genetic heterogeneity measurable by individual sets of somatic gene alterations in tumor genomes. Moreover, extensive 'intra-tumor' heterogeneity on the genotypic and phenotypic levels is the product of ongoing tumor evolution and adaptation to various selective pressures during cancer initiation, progression, and therapeutic intervention. As the management of disease progression remains one of the most significant clinical challenges, it is becoming increasingly important to delineate how B-cell lymphomas evolve over time and to develop progression-related biomarker assays. Toward this goal, recent investigations have moved from studying lymphoma biology at initial diagnosis to doing so at multiple time points during the disease course. Profiling progressed tumors, and in particular paired biopsies at initial diagnosis and disease progression of the same patients, has led to novel insights into clonal tumor evolution and tumor microenvironment dynamics. This review discusses the latest findings on genomic alterations and microenvironment biology associated with relapsed/refractory B-cell lymphomas, with a particular emphasis on alterations that are acquired or become more prevalent at disease progression. We also describe overarching tumor evolution patterns, and highlight emerging precision medicine methodologies that can aid in an improved understanding and management of relapsed/refractory disease. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Personal and environmental contextual factors as mediators between functional disability and quality of life in adults with serious mental illness: a cross-sectional analysis.

PURPOSE: To examine personal and environmental contextual factors as mediators of functional disability on quality of life (QOL) in a sample of individuals with serious mental illness (SMI). METHODS: A cross-sectional analysis of 194 individuals with SMI (major depressive disorder = 38.1%; bipolar disorder = 35.6%; schizophrenia spectrum disorder = 25.8%) recruited from four psychosocial rehabilitation clubhouses was undertaken to test a multiple regression model assuming that personal (i.e., resilience, social competence, and disability acceptance) contextual factors and environmental (i.e., family support, support from friends, and support from significant others) contextual factors would mediate the relationship of functional disability on QOL. The bootstrap test for multiple mediators was then used to test for the significance of the indirect effects functional disability on QOL through the mediators. RESULTS: In the simple regression model, functional disability had a strong relationship with QOL; however, after introducing the potential mediators, its effect was significantly reduced indicating partial mediation effects. The final regression model yielded a large effect, accounting for 44% of the variance in QOL. Controlling for all other potential mediating factors, social competence, disability acceptance, family support, and support from friends were found to partially mediate the relationship between functional disability and QOL. Bias-corrected bootstrap procedure results further supported the mediation model. CONCLUSIONS: The findings from the study provide good support for the inclusion of person-environment contextual factors in conceptualizing the relationship between functional disability and QOL for individuals with SMI.

Working Alliance and Stages of Change for Employment: The Intermediary Role of Autonomous Motivation, Outcome Expectancy and Vocational Rehabilitation Engagement.

Purpose Working alliance is one of the most important common factors for successful counseling/psychotherapy outcomes. Based on the empirical literature about working alliance, it seems that self-determination and self-efficacy theory (SDT/SET) can potentially be used as a motivational model to explain the relationship between working alliance and vocational rehabilitation (VR) outcomes. The purpose of this study is to evaluate three primary SDT/SET constructs, autonomous motivation, expectancy and engagement, as mediators for the relationship between working alliance and stages of change (SOC) for employment. Methods A serial multiple mediation analysis (SMMA) was computed to evaluate autonomy, outcome expectancy, and VR engagement as mediators of the relationship between working alliance and SOC for employment in a sample of 277 people with chronic illness and disability (CID) receiving services from state VR agencies in the United States. Results The SMMA results indicated that working alliance was positively associated with SOC for employment (total effect), while the direct effect between working alliance and SOC for employment was not significant after controlling for the effects of the mediators, indicating significant mediation effects. The mediation effects were estimates of the indirect effects for working alliance on SOC for employment through (a) autonomous motivation, (b) outcome expectancy, (c) VR engagement, and (d) autonomous motivation, outcome expectancy and VR engagement together. Conclusions The results indicated that a strong working alliance has the benefit of helping consumers develop autonomous motivation to work and increasing their vocational outcome expectancy and engagement in VR services, leading to employment.

Psychometric evaluation of Turkish version of the Perceived Stress Scale with Turkish college students.

BACKGROUND: The Turkish version of the Perceived Stress Scale (T-PSS-10) measures the extent to which situations in one's life are appraised as stressful. AIMS: The purpose of this study was to evaluate the measurement structure of T-PSS-10. METHOD: Two-hundred and thirty-five Turkish university students (93 men and 142 women) completed the T-PSS-10, the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder 7-Item Scale (GAD-7), and the Inventory of Common Problems (ICP). RESULTS: Confirmatory factor analysis results indicated that a one-factor model did not fit the data, whereas a two-factor correlated model (stress related self-efficacy beliefs, stress related feelings of helplessness) provided a better fit between the model and the data. Significant moderate correlations were found for the stress-related self-efficacy beliefs and stress-related feelings of helplessness factors with depression, anxiety, academic difficulty, relationship problems and health problems. The internal consistency reliability coefficients for the stress-related self-efficacy beliefs and stress-related feelings of helplessness factors were 0.68 and 0.85, respectively. CONCLUSIONS: This study provided support for the reliability and validity of T-PSS-10 suggesting that it can be used as a screening instrument by health professionals working with Turkish college students.

Comparative Ploidy Proteomics of Candida albicans Biofilms Unraveled the Role of the AHP1 Gene in the Biofilm Persistence Against Amphotericin B.

Candida albicans is a major fungal pathogen causing lethal infections in immunocompromised patients. C. albicans forms antifungal tolerant biofilms contributing significantly to therapeutic failure. The recently established haploid C. albicans biofilm model provides a new toolbox to uncover the mechanism governing the higher antifungal tolerance of biofilms. Here, we comprehensively examined the proteomics and antifungal susceptibility of standard diploid (SC5314 and BWP17) and stable haploid (GZY792 and GZY803) strains of C. albicans biofilms. Subsequent downstream analyses identified alkyl hydroperoxide reductase 1 (AHP1) as a critical determinant of C. albicans biofilm's tolerance of amphotericin B. At 32 µg/ml of amphotericin B, GZY803 haploid biofilms showed 0.1% of persister population as compared with 1% of the diploid biofilms. AHP1 expression was found to be lower in GZY803 biofilms, and AHP1 overexpression in GZY803 restored the percentage of persister population. Consistently, deleting AHP1 in the diploid strain BWP17 caused a similar increase in amphotericin B susceptibility. AHP1 expression was also positively correlated with the antioxidant potential. Furthermore, C. albicans ira2Δ/Δ biofilms were susceptible to amphotericin B and had a diminished antioxidant capacity. Interestingly, AHP1 overexpression in the ira2Δ/Δ strain restored the antioxidant potential and enhanced the persister population against amphotericin B, and shutting down the AHP1 expression in ira2Δ/Δ biofilms reversed the effect. In conclusion, we provide evidence that the AHP1 gene critically determines the amphotericin B tolerance of C. albicans biofilms possibly by maintaining the persisters' antioxidant capacity. This finding will open up new avenues for developing therapies targeting the persister population of C. albicans biofilms. The mass spectrometry proteomics data are available via ProteomeXchange with identifier PXD004274.

A Psychometric Validation of the Employers' Stigmatizing Attitudes Toward Cancer Survivors Scale.

Purpose The aim of this study was to evaluate the measurement structure of the Employers' Stigmatizing Attitudes Toward Cancer Survivors Scale (ESATPD-Cancer Scale). Methods A quantitative descriptive design using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). One hundred and seventy-seven Taiwanese human resources (HR) professionals participated in this study. Results EFA revealed a one-factor measurement structure accounting for 50% of the total variance. We conducted a CFA to confirm the one-factor structure; after two pairs of error terms were correlated, the re-specified model was found to fit the data adequately: χ2/df = 1.69, GFI = 0.97, CFI = 0.98, and RMSEA = 0.06. Internal consistency reliability coefficient (Cronbach's alpha) for the ESATPD-Cancer Scale was computed to be 0.80. In addition, stigmatizing attitudes were found to be negatively associated with HR professionals' willingness to hire cancer survivors. Conclusions The results of this study support a one-factor measurement structure for the ESATPD-Cancer Scale in a sample of HR professionals in Taiwan. Findings also support a relationship between ESATPD-Cancer Scale scores and HR professionals' willingness to hire cancer survivors, demonstrating support for the construct validity of the scale.

Employment Outcomes After Vocational Training for People With Chronic Psychiatric Disorders: A Multicenter Study.

People with a chronic psychiatric disorder (CPD) have low employment rates worldwide. This multicenter retrospective cohort study examined the employment outcomes of an innovative in-house vocational training program for people with CPD in Taiwan and explored which program parameters significantly predicted outcomes. Data were retrieved from the records of 323 participants who completed the training program. Satisfactory employment rates were found at 1 (52.9%), 3 (60.4%), and 6 (65.6%) mo posttraining, and 38.7% of participants demonstrated high employment sustainability (employed throughout the first 6 mo posttraining). Three program parameters significantly predicted employment outcomes: (1) occupational therapists' pursuit of additional training or short-term apprenticeship pertinent to clients' job interests, (2) posttraining vocational counseling provided by community-based occupational therapists, and (3) the duration of 6 mo posttraining to allow clients to prepare for competitive employment. Occupational therapist-led in-house vocational training is a promising alternative to traditional vocational training for people with CPD.

Differential vocational rehabilitation service patterns and outcomes for transition-age youth with autism.

BACKGROUND: It is important to investigate receipt of vocational rehabilitation (VR) services, service patterns and outcomes for youth with autism, so that limited public resources can be used more efficiently. METHOD: This study used chi-squared automatic interaction detector, and multivariate logistic regression analysis to investigate relationships between demographic variables, receipt of VR services and employment outcomes for transition-age youth (TAY) with Autism. RESULTS: The results indicate that gender, education level and cash benefits are significant predictors of employment outcomes. After controlling for the effect of demographic variables, several VR services (i.e., job placement, on-the-job support, on-the-job training, maintenance, other services, information referral, and diagnostic and treatment services) were significantly associated with competitive employment. CONCLUSIONS: Overall, the results indicate that job-related services were significantly related to employment outcomes for TAY with Autism; therefore, it is important these youths are provided with more targeted job placements and supported employment services (Wehman et al., ).