Comparative efficacy and safety of biosimilar infliximab and other biological treatments in ankylosing spondylitis: systematic literature review and meta-analysis.

OBJECTIVES: To compare the efficacy and safety of infliximab-biosimilar with other biological drugs for the treatment of active ankylosing spondylitis (AS). METHODS: Systematic literature review for randomized controlled trials (RCTs) with adalimumab, etanercept, golimumab, infliximab and infliximab-biosimilar in AS was performed and indirect meta-analysis (Bayesian mixed treatment comparison) was carried out. The proportion of patients reaching 20 % improvement by the assessment of Spondyloarthritis International Society response criteria (ASAS20) at weeks 12 and 24 was used as efficacy endpoints, and the occurrence of serious adverse events at week 24 was applied to compare the safety of the biologicals. RESULTS: Altogether, 13 RCTs, identified by the systematic literature search, were included in the analysis. Results on the ASAS20 efficacy endpoint were reported for week 12 in 12 RCTs involving 2,395 patients, and for week 24 in 5 RCTs comprising 1,337 patients. All the five biological agents proved to be significantly superior to placebo. Infliximab showed the highest odds ratio (OR) of 7.2 (95 % CI 3.68-13.19) compared to placebo, followed by infliximab-biosimilar with OR 6.25 (95 % CI 2.55-13.14), both assessed at week 24. No significant difference was found between infliximab-biosimilar and other biological treatments regarding their efficacy and safety. CONCLUSIONS: This is the first study which includes a biosimilar drug in the meta-analysis of biological treatments in AS. The results have proven the similar efficacy and safety profile of infliximab-biosimilar treatment compared to other biologicals.

Factors associated with social work student satisfaction with field placements in child welfare

This study was conducted during the 1994-1995 academic year. Seven social work education programs in the state of Florida, all accredited by the Council on Social Work Education, participated in this study. Graduate and undergraduate social work students in child welfare field placements, and their field instructors, were surveyed during the Spring 1995 semester to assess their satisfaction with field placements in this area and the relationship of this satisfaction to employment interests and field placement recommendations.^ The majority of social work students responding to this survey were generally satisfied with several aspects of their field placements--the learning, field work program, field instructor, child welfare agency, and overall field experience. The field instructors were generally more satisfied than the students, but only statistically different from the students in the areas of satisfaction with the field work program and the child welfare agency. Multiple regression analysis revealed that learning assignment opportunities, field instructor relationship characteristics, placement preference, and pre-placement interview contributed to the prediction of student satisfaction.^ Student satisfaction in field placement was significantly related to the acceptance of employment, if offered, and the recommendation of the field placement to other students. Logistic regression analysis revealed that satisfaction with the child welfare agency was the greatest contributor to the prediction of acceptance of employment, and satisfaction with the field work program was the greatest contributor to the prediction of field placement recommendation. ^

An evaluation of child welfare inservice training: The relative effectiveness of substance abuse content in improving worker knowledge and attitudes

Given the seriousness of substance abuse as a child welfare problem, the purpose of this study was to examine the relative effectiveness of an inservice training curriculum for child welfare workers. The training was designed to improve worker knowledge and attitudes in working with substance abusing families. Seventy (70) child welfare workers from public and private agencies in two south Florida counties participated in a pretest/posttest control group design that also trained and retested the control group. The literature review supports that the general preparedness of child welfare workers for the issues presented by substance abusing families is in question. Confounding this problem is a lack of understanding of substance abuse dynamics, worker biases, and predispositions. The two research hypotheses focused on whether inservice training could increase worker knowledge and improve worker attitudes in working with this population. Training delivery was in the form of a five-day inservice focusing on an array of substance abuse knowledge and attitudinal topics. Separate knowledge and attitude instruments were developed for the research and were administered, before and after training, to a purposive sample of participants that were randomly assigned to the experimental and control groups. The data analysis supported the research hypotheses but raised a question. Specifically, the experimental group demonstrated significant improvement in posttest scores on both instruments after receiving the training; whereas the control group, with training withheld, also demonstrated a significant improvement at posttest, but only on the knowledge instrument. Although the question was unanswered, when examined at a more critical significance level, only the experimental group remained significant. The hypotheses were reconfirmed when, after training and retesting, the control group also displayed significant improvement on both instruments. The findings support the conclusion that this substance abuse inservice was effective in improving worker knowledge and attitudes regarding working with substance abusing families. As an implication for social work practice, it suggests that similar inservice training can be a viable training resource when formal substance abuse training is unavailable. Additional research is suggested regarding to what degree increased substance abuse knowledge and improved worker attitudes correlate with improved practice.

Sales tax enforcement: An empirical analysis of compliance enforcement methodologies and pathologies

Most research on tax evasion has focused on the income tax. Sales tax evasion has been largely ignored and dismissed as immaterial. This paper explored the differences between income tax and sales tax evasion and demonstrated that sales tax enforcement is deserving of and requires the use of different tools to achieve compliance. Specifically, the major enforcement problem with sales tax is not evasion: it is theft perpetrated by companies that act as collection agents for the state. Companies engage in a principal-agent relationship with the state and many retain funds collected as an agent of the state for private use. As such, the act of sales tax theft bears more resemblance to embezzlement than to income tax evasion. It has long been assumed that the sales tax is nearly evasion free, and state revenue departments report voluntary compliance in a manner that perpetuates this myth. Current sales tax compliance enforcement methodologies are similar in form to income tax compliance enforcement methodologies and are based largely on trust. The primary focus is on delinquent filers with a very small percentage of businesses subject to audit. As a result, there is a very large group of noncompliant businesses who file on time and fly below the radar while stealing millions of taxpayer dollars. ^ The author utilized a variety of statistical methods with actual field data derived from operations of the Southern Region Criminal Investigations Unit of the Florida Department of Revenue to evaluate current and proposed sales tax compliance enforcement methodologies in a quasi-experimental, time series research design and to set forth a typology of sales tax evaders. This study showed that current estimates of voluntary compliance in sales tax systems are seriously and significantly overstated and that current enforcement methodologies are inadequate to identify the majority of violators and enforce compliance. Sales tax evasion is modeled using the theory of planned behavior and Cressey’s fraud triangle and it is demonstrated that proactive enforcement activities, characterized by substantial contact with non-delinquent taxpayers, results in superior ability to identify noncompliance and provides a structure through which noncompliant businesses can be rehabilitated.^

Development of local homeland security networks in the state of Florida: A social network analysis approach

How do local homeland security organizations respond to catastrophic events such as hurricanes and acts of terrorism? Among the most important aspects of this response are these organizations ability to adapt to the uncertain nature of these "focusing events" (Birkland 1997). They are often behind the curve, seeing response as a linear process, when in fact it is a complex, multifaceted process that requires understanding the interactions between the fiscal pressures facing local governments, the institutional pressures of working within a new regulatory framework and the political pressures of bringing together different levels of government with different perspectives and agendas. ^ This dissertation has focused on tracing the factors affecting the individuals and institutions planning, preparing, responding and recovering from natural and man-made disasters. Using social network analysis, my study analyzes the interactions between the individuals and institutions that respond to these "focusing events." In practice, it is the combination of budgetary, institutional, and political pressures or constraints interacting with each other which resembles a Complex Adaptive System (CAS). ^ To investigate this system, my study evaluates the evolution of two separate sets of organizations composed of first responders (Fire Chiefs, Emergency Management Coordinators) and community volunteers organized in the state of Florida over the last fifteen years. Using a social network analysis approach, my dissertation analyzes the interactions between Citizen Corps Councils (CCCs) and Community Emergency Response Teams (CERTs) in the state of Florida from 1996–2011. It is the pattern of interconnections that occur over time that are the focus of this study. ^ The social network analysis revealed an increase in the amount and density of connections between these organizations over the last fifteen years. The analysis also exposed the underlying patterns in these connections; that as the networks became more complex they also became more decentralized though not in any uniform manner. The present study brings to light a story of how communities have adapted to the ever changing circumstances that are sine qua non of natural and man-made disasters.^

An analysis of the factors that influence regional economic development cooperation

This dissertation is a comparative case study of regional cooperation in the field of economic development. In the 21st century global economy, proponents of regionalism have put forth fresh arguments for collective action. A regional approach to economic development activity presents a classic social dilemma: How can local officials collectively improve the economic prospects of a region, and remain autonomous to act in the best interest of the local community? This research examines the role of social capital in overcoming this social dilemma. ^ Three (3) comparable Metropolitan Statistical Areas (MSAs) form the empirical basis of this research. The Houston MSA, the Atlanta MSA and the Miami MSA present distinct variations of regionalized economic development activity. This dissertation seeks to explain this disparity in the dependent variable. The hypothesis is that accrued social capital is crucial to obtaining economic development cooperative agreements.^ This qualitative research utilized secondary demographic and economic databases, survey instruments, interviews, field observations, and a review of legislative and administrative decisions to formulate a clear understanding of the factors influencing the current state of regional economic development cooperation within each region. The study concludes that the legislative and executive decisions of state government exert inordinate influence on the capacity of local officials to cooperate regionally for economic development purposes.^

The economic well -being of low -income immigrants in the U.S.: An examination of the impact of the 1996 welfare reform on immigrants

The 1996 welfare reform, for the first time in U.S. history, set a five-year residence requirement for immigrants to be eligible for federal welfare benefits. This dissertation assessed the impact of the 1996 welfare reform, specifically the immigrant provisions, on the economic well-being of low-income immigrants. This dissertation also explored the roles that migration selection theory and social capital theory play in the economic well-being of low-income immigrants. ^ This dissertation was based on an analysis of the March 1995, March 2002, and March 2006 Annual Demographic Supplement Files of the Current Population Survey (CPS). Both logistic regression and multiple regression were used to analyze economic well-being, comparing low-income immigrants with low-income citizens. Economic well-being was measured in the current survey year and the year before on the following variables: employment status, full-time status (35 or more hours per week), the number of weeks worked, and the total annual wage or salary.^ The major findings reported in this dissertation were that low-income immigrants had advantages over low-income citizens in the labor market. This may be due to immigrants' stronger motivation to obtain success, consistent with migration selection theory. Also, this research suggested that immigrant provisions had not ameliorated employment outcomes of low-income immigrants as policymakers may have expected.^ The study also confirmed the role of social capital in advancing the economic well-being of qualified immigrants. Ultimately, this dissertation contributed to our understanding of low-income immigrants in the U.S. The study questioned the claim that immigrants are attracted to the U.S. by welfare benefits. This dissertation suggested that immigrants come to the U.S., to a large extent, to pursue the goal of upward mobility. Consequently, immigrants may employ greater initiative and work harder than native-born Americans.^

Factors associated with social work student satisfaction with field placements in child welfare by Diane Elias Alperin.

This study was conducted during the 1994-1995 academic year. Seven social work education programs in the state of Florida, all accredited by the Council on Social Work Education, participated in this study. Graduate and undergraduate social work students in child welfare field placements, and their field instructors, were surveyed during the Spring 1995 semester to assess their satisfaction with field placements ii this area and the relationship of this satisfaction to employment interests and field placement recommendations. The majority of social work students responding to this survey were generally satisfied with several aspects of their field placements--the learning, field work program, field instructor, child welfare agency, and overall field experience. The field instructors were generally more satisfied than the students, but only statistically different from the students in the areas of satisfaction with the field work program and the child welfare agency. Multiple regression analysis revealed that learning assignment opportunities, field instructor relationship characteristics, placement preference, and pre-placement interview contributed to the prediction of student satisfaction. Student satisfaction in field placement was significantly related to the acceptance of employment, if offered, and the recommendation of the field placement to other students. Logistic regression analysis revealed that satisfaction with the child welfare agency was the greatest contributor to the prediction of acceptance of employment, and satisfaction with the field work program was the greatest contributor to the prediction of field placement recommendation.

Inequality, the Welfare State, and Demographic Change

This dissertation is a three-part analysis examining how the welfare state in advanced Western democracies has responded to recent demographic changes. Specifically, this dissertation investigates two primary relationships, beginning with the influence of government spending on poverty. I analyze two at-risk populations in particular: immigrants and children of single mothers. Next, attention is turned to the influence of individual and environmental traits on preferences for social spending. I focus specifically on religiosity, religious beliefs and religious identity. I pool data from a number of international macro- and micro-data sources including the Luxembourg Income Study (LIS), International Social Survey Program (ISSP), the World Bank Databank, and the OECD Databank. Analyses highlight the power of the welfare state to reduce poverty, but also the effectiveness of specific areas of spending focused on addressing new social risks. While previous research has touted the strength of the welfare state, my analyses highlight the need to consider new social risks and encourage closer attention to how social position affects preferences for the welfare state.

The Olivia Framework:Concepts for Use in Finely-Grained, Integrated Social Policy Analysis (Working Paper 45)

The Olivia framework is a set of concepts and measures that, when mature, will allow users to describe, in a consistent and integrated manner, everything about individuals and institutions that is of potential interest to social policy. The present paper summarizes the current stage of development in achieving this highly ambitious goal. The current version of the framework supports analysis of social trends and policy responses from many perspectives: • The point-in-time, resource-flow perspectives that underlie most traditional, economics-based policy analysis. • Life-course perspectives, including both transitions/trajectories analysis and asset-based analysis. • Spatial perspectives that anchor people in space and history and that provide a link to macro-analysis. • The perspective of the purposes/goals of individuals and institutions, including the objectives of different types of government programming. The concepts of the framework, which are all potentially measurable, provide a language that can support integrated analysis in all these areas at a much finer level of description than is customary. It provides a language that is especially well suited for analysis of the incremental policy changes that are typical of a mature welfare state. It supports both qualitative and quantitative analysis, enabling some integration between the two. It supports citizen-centric as well as a government-centric view of social policy. In its current version, the concepts are most highly developed as they related to social policies as they related to labour markets, equality and social integration, care-giving, immigration, income security, sustainability, and social and economic well-being more generally. However the paper points to likely extensions in the areas of health, justice and safety.

Do Multiculturalism Policies Erode the Welfare State (Working Paper 33)

The past 30 years have witnessed a dramatic change in the way Western democracies deal with ethnic minorities. In the past, ethnic diversity was often seen as a threat to political stability, and minorities were subject to a range of policies intended to assimilate or marginalize them. Today, many Western democracies have adopted a more accommodating approach. This is reflected in the widespread adoption of multiculturalism policies for immigrant groups, the acceptance of territorial autonomy and language rights for national minorities, and the recognition of land claims and selfgovernment rights for indigenous peoples. We refer to these policies as “multiculturalism policies” or MCPs. The adoption of MCPs has been controversial, for two reasons. The first is a philosophical critique, which argues that MCPs are inherently inconsistent with basic liberal-democratic principles. Since the mid-1990s, however, this philosophical debate has been supplemented by a second argument: namely, that MCPs make it more difficult to sustain a robust Welfare State (hereafter WS). Critics worry that such policies erode the interpersonal trust, social solidarity and political coalitions that sustain a strongly redistributive WS. This paper reviews the reasons why critics believe that MCPs weaken political support for redistribution, and then examines empirically whether the adoption of MCPs has, in fact, been associated with erosion of the WS. This examination involves two steps: we develop a taxonomy of MCPs and classify Western democracies as “strong”, “modest” or “weak” in their level of MCPs. We then examine whether the strength of MCPs is associated with the erosion of the WS during the 1980s and 1990s. The evolution of the WS is measured through change in four indicators: social spending as a percentage of GDP; the redistributive impact of taxes and transfers; levels of child poverty; and the level of income inequality. We find no evidence of a consistent relationship between the adoption of MCPs and the erosion of the WS. Our analysis has limits, and we hope it stimulates further research. Nevertheless, the preliminary evidence presented here is clear: the case advanced by critics of MCPs is not supported. The growing ethnic diversity of Western societies has generated pressures for the construction of new and more inclusive forms of citizenship and national identity. The evidence in this paper suggests that debates over the appropriateness of multiculturalism policies as one response to this diversity should not be pre-empted by unsupported fears about their impact on the WS.

A two-step approach for the analysis of hybrids in comparative social policy analysis: a nuanced typology of childcare policies

Typologies have represented an important tool for the development of comparative social policy research and continue to be widely used in spite of growing criticism of their ability to capture the complexity of welfare states and their internal heterogeneity. In particular, debates have focused on the presence of hybrid cases and the existence of distinct cross-national pattern of variation across areas of social policy. There is growing awareness around these issues, but empirical research often still relies on methodologies aimed at classifying countries in a limited number of unambiguous types. This article proposes a two-step approach based on fuzzy-set-ideal-type analysis for the systematic analysis of hybrids at the level of both policies (step 1) and policy configurations or combinations of policies (step 2). This approach is demonstrated by using the case of childcare policies in European economies. In the first step, parental leave policies are analysed using three methods – direct, indirect, and combinatory – to identify and describe specific hybrid forms at the level of policy analysis. In the second step, the analysis focus on the relationship between parental leave and childcare services in order to develop an overall typology of childcare policies, which clearly shows that many countries display characteristics normally associated with different types (hybrids and. Therefore, this two-step approach enhances our ability to account and make sense of hybrid welfare forms produced from tensions and contradictions within and between policies.

Layers of Listening: Qualitative Analysis of the Impact of Early Intervention Services for First-episode Psychosis on Carers' Experiences

Background Early intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice. Aims By analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS. Method Semi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS. Results Our data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking. Conclusions By focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?

Towards a Bourdieusian analysis of the disabled body and practice: embodying negative symbolic capitals and the uneasy experience of hysteresis

Within the last few years, disabled people have become the target of government austerity measures through drastic cuts to welfare justified through the portrayal of benefit claimants as inactive, problem citizens who are wilfully unemployed. For all that is wrong with these cuts, they are one of many aspects of exclusion that disabled people face. Attitudes towards disability are deteriorating (Scope, 2011) and disabled people are devalued and negatively positioned in a myriad of ways, meaning that an understanding of the perceptions and positioning of disability and the power of disabling practices is critical. This thesis will examine how Bourdieu’s theoretical repertoire may be applied to the area of Disability Studies in order to discern how society produces oppressive and exclusionary systems of classification which structures the social position and perceptions of disability. The composite nature of disability and multiple forms of exclusion and inequality associated with it benefits from a multipronged approach which acknowledges personal, embodied and psychological aspects of disability alongside socio-political and cultural conceptualisations. Bourdieu’s approach is one in which the micro and macro aspects of social life are brought together through their meso interplay and provides a thorough analysis of the many aspects of disability.