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Background Drug-resistant minority variants (DRMinVs) detected in patients who recently acquired human immunodeficiency virus type 1 (HIV-1) can be transmitted, generated de novo through virus replication, or technical errors. The first form is likely to persist and result in treatment failure, while the latter two could be stochastic and transient. Methods Ultradeep sequencing of plasma samples from 835 individuals with recent HIV-1 infection in the United Kingdom was performed to detect DRMinVs at a mutation frequency between 2% and 20%. Sequence alignments including >110 000 HIV-1 partial pol consensus sequences from the UK HIV Drug Resistance Database (UK-HDRD), linked to epidemiological and clinical data from the HIV and AIDS Reporting System, were used for transmission cluster analysis. Transmission clusters were identified using Cluster Picker with a clade support of >90% and maximum genetic distances of 4.5% or 1.5%, the latter to limit detection to likely direct transmission events. Results Drug-resistant majority variants (DRMajVs) were detected in 66 (7.9%) and DRMinVs in 84 (10.1%) of the recently infected individuals. High levels of clustering to sequences in UK-HDRD were observed for both DRMajV (n = 48; 72.7%) and DRMinV (n = 63; 75.0%) sequences. Of these, 43 (65.2%) with DRMajVs were in a transmission cluster with sequences that harbored the same DR mutation compared to only 3 (3.6%) sequences with DRMinVs (P <.00001, Fisher exact test). Evidence of likely direct transmission of DRMajVs was observed for 25/66 (37.9%), whereas none were observed for the DRMinVs (P <.00001). Conclusions Using a densely sampled HIV-infected population, we show no evidence of DRMinV transmission among recently infected individuals. [ABSTRACT FROM AUTHOR]

Background: Selection of protease mutations on antiretroviral therapy (ART) including a ritonavir-boosted protease inhibitor (PI) has been reported infrequently. Scarce data exist from long-term cohorts on resistance incidence or mutational patterns emerging to different PIs.Methods: We studied UK patients receiving lopinavir/ritonavir as their first PI, either while naive to ART or having previously received non-PI-based ART. Virological failure was defined as viral load ≥ 400 copies/mL after previous suppression <400 copies/mL, or failure to achieve <400 copies/mL during the first 6 months. pol sequences whilst failing lopinavir or within 30 days after stopping were analysed. Major and minor mutations (IAS-USA 2008-after exclusion of polymorphisms) were considered. Predicted susceptibility was determined using the Stanford HIVdb algorithm.Results: Three thousand and fifty-six patients were followed for a median (IQR) of 14 (6-30) months, of whom 811 (27%) experienced virological failure. Of these, resistance test results were available on 291 (36%). One or more protease mutations were detected in 32 (11%) patients; the most frequent were I54V (n = 12), M46I (n = 11), V82A (n = 7) and L76V (n = 3). No association with viral subtype was evident. Many patients retained virus predicted to be susceptible to lopinavir (14, 44%), tipranavir (26, 81%) and darunavir (27, 84%).Conclusions: This study reflects the experience of patients in routine care. Selection of protease gene mutations by lopinavir/ritonavir occurred at a much higher rate than in clinical trials. The mutations observed showed only partial overlap with those previously identified by structural chemistry models, serial cell culture passage and genotype-phenotype analyses. There remained a low degree of predicted cross-resistance to other widely used PIs. [ABSTRACT FROM AUTHOR]

There is considerable controversy among mental health professionals and the public about the proper role of psychotropic medications in the treatment of youths. Within social work, too, there have been sharp differences of opinion. There have been few studies, however, about the views of practicing clinical social workers on the use of psychiatric drugs in the treatment of youths. This study, a cross-sectional survey of a national sample of social workers, examines their views about medications and the role they may play in the treatment of youths. The findings suggest that social workers hold complex views that recognize both the potential benefits and harms of psychotropic medications, but overall they seem to support their use in a judicious manner. [ABSTRACT FROM AUTHOR]

This study examined the relationship between reputation and productivity among social work researchers. The authors devised a method to gauge reputational standing, using nominations from journal editors, research textbook authors, and heads of research-dedicated social work organizations. Productivity was measured by number of articles, number of books, number of book chapters, and number of citations in lbs social work literature. The study found that productivity rates varied consistently among the three reputational groups (hosed on number of nominations) in the expected direction. Within the high reputation group there were no differences in productivity levels. However, a wide range in productivity was found within each grouping. Various interpretations and implications of the results are offered. [ABSTRACT FROM AUTHOR]

When social workers judge that an antisocially behaving adolescent has a mental disorder, what are the implications of that attribution for other clinical judgments about the youth? Clinical case vignettes that satisfied DSM-IV diagnostic criteria for conduct disorder were presented to 250 MSW students. Based on DSMIV guidelines and on the "harmful dysfunction" analysis of the concept of mental disorder, the context of the symptoms presented in the vignettes was manipulated experimentally to suggest either internal dysfunction or a normal response to a difficult environment as the cause of the youth's antisocial behavior. Students were asked to judge whether the youth had a psychiatric disorder and to assess prognosis, need for professional help, and appropriateness of medication. [ABSTRACT FROM AUTHOR]

The article describes the results of a survey of clinical social workers on the use of the book "Diagnostic and Statistical Manual of Mental Disorders," third edition, by the American Psychiatric Association in the U.S. Social casework's emphasis on diagnosis and treatment has been reinforced by the employment of social workers in psychiatric settings. Mental health has become the most common field of practice. Social work, along with clinical psychology and psychiatric nursing, now is accepted as a partner in the mental health enterprise. Because practice in the mental health field increasingly is interdisciplinary and professional roles often overlap, all disciplines are affected by changes in public policies and by scientific advances. The use of the book is widespread among psychiatrists, psychologists, and social workers employed in a variety of settings. It also is used by insurance companies, government agencies, and psychiatric researchers. Although it is used widely, the way it is used and the effects its use may have on clinicians, clients, and agencies largely are unexplored. There is some evidence, both anecdotal and systematic, that its acceptance is not complete, nor is its use always appropriate.

This article highlights the social work practitioners' legal and ethical problems and the dangers to clients upon their use of the third edition Diagnostic and Statistical Manual of Mental Disorders (DSM-III) issued by the American Psychiatric Association. Although compilers of DSM-III claim that it is a major advance in psycho-diagnosis, there are other reasons why it is so popular. Many public programs require a DSM-III diagnosis before they will provide services. Psychotherapists in private practice must also make diagnoses to obtain payment from insurance programs. Furthermore, payment is limited to certain diagnoses, and some insurers base the amount of reimbursement on the severity of the mental disorder. Certain programs are even more restrictive and pay only for treatment that is specifically related to the qualifying diagnosis. The first issue is whether the social worker had the legal authority to make a diagnosis using DSM-III. In the majority of states, licensing statutes regulate private practice. Customarily, they provide that social workers can engage in psychotherapy, which involves the diagnosis and treatment of patients.

Publication of articles in professional journals is an accepted measure of scholarly productivity and leadership. To assess the intellectual contribution of women in social work, this study examined the authorship of articles in five major social work journals over a period of forty-four years. [ABSTRACT FROM AUTHOR]

The article focuses on a study, which investigated the involvement of social workers in research. Accountability has been the central issue confronting social work during the 1970s. Today, wherever professional social workers turn that is to consumers, to public and private funding bodies, or to their professional colleagues, the request is the same: show that your efforts on behalf of clients are beneficial, that your interventions are effective, that your clients are helped, and that your work makes a difference. These demands that hold professionals accountable for their activities are neither unique to social work nor do they come primarily from outside the profession. The themes of professional conventions and the increasing number of articles being published on such topics as program evaluation and accountability stand as proof that social workers themselves are examining such issues. One way to achieve accountability in practice is to evaluate professional intervention and to have social workers incorporate the resulting knowledge into their practice.

The article focuses on a book forum article in which some central claims made by the books under review about the use of single-system designs and formal assessment instruments in the evaluation of clinical practice were identified. Authors dubbed the use of such designs and instruments the scientist-practitioner model of practice evaluation. Using detailed arguments, they critically assessed the identified claims and concluded that each one was either unproved or false. The authors offer no description of the more flexible approach to single-subject studies to which they allude, but such an approach is likely to have serious problems. The primary reason for using single-subject designs, according to the books we reviewed, is that they allow one to thaw conclusions about causal efficacy of treatment. If one does not adhere to a specific design and instead allows design choices to unfold with treatment, one is unlikely to get the benefit of valid causal inferences.

The article presents a study on the reliability of new manuscript rating scale reviews to know the level of agreement among reviewers for the journal "Social Work Research." The study examined the reviews of 54 consecutively submitted new manuscripts to Social Work Research beginning in 1994. This was approximately a year's worth of submissions. The established manuscript review process was followed. Measures of the percent agreement and one-step agreement were calculated to help describe the extent of agreement between the reviewers' rating. Pearson correlations were used to describe the relationship between the average ratings for each item and the final editorial decision about publication. Modest to low levels of agreement was found among expert reviewers of manuscripts submitted to Social Work Research. For those who assume that manuscripts have an inherent objective quality regarding their contribution to knowledge, these low reliability ratings call into question the diligence of expert reviewers and the procedures used in making editorial decisions because of the frequent failure to identify consistently superior manuscripts.

This article evaluates the scientist-practitioner model that rests on the twin pillars of single-system designs, to structure the therapeutic interaction so as to demonstrate treatment efficacy, and standardized rapid assessment instruments, to monitor symptoms and evaluate outcomes. In analyzing the scientist-practitioner model, researchers do not consider the various other efforts to improve the scientific basis of social work, a goal they certainly share, nor do they dispute the importance of continued research on practice effectiveness. The concept of the scientist-practitioner, in the words of one its earliest proponents, means not only that the same person can both practice and conduct research, but also that he or she can engage in practice and research simultaneously as a set of integrated activities. With the emergence of single-system designs, literally every practitioner has the opportunity to connect systematic and objective evaluation with his or her practice. The art and creativity of practice, and the values and philosophy undergirding practice that make it humane and caring, are combined with the empirical orientation to produce a scientific practitioner.

Nothing is as central to the work lives of social workers or as important to an organization's effective use of personnel as the satisfaction staff derive from their employment. The present - presents a shod (14-item) facet-based, direct measure of job satisfaction that can be used by researchers and administrators. The scale was developed and validated in a series of studies from 1980 to 1991 involving over 600 helping professionals. Across administrations the full Job Satisfaction Scale (JSS) alpha reliabilities ranged between .83 and .91, and reliabilities of the intrinsic and organizational satisfaction subscales ranged from .85 to .90 and .78 to .90, respectively. Factor analyses also suggested a third (two-item) factor dealing with salary, promotion, and benefits. Among findings supporting validity were correlations of lower JSS scores with later-measured depression, burnout, and intention to quit one's job. Two separate studies found job satisfaction or dissatisfaction related to emotional exhaustion or burnout. [ABSTRACT FROM AUTHOR]

Contrary to popular belief, social workers are evaluating their practice, but what they do falls short of the use of quantitative procedures that researchers have promoted. Data obtained from a survey of social workers drawn from the National Association of' Social Workers national member- ship list suggest that the gap between practitioners and clinical researchers may stem in part from different mind-sets as well as from actual differences in the commitment to the importance of clinical evaluation. Moreover in the minds of practitioners there appears to be a sharp distinction between formal single-subject design studies and the general evaluative tasks in which they routinely engage. [ABSTRACT FROM AUTHOR]

This article reviews trends in social work assessment that are likely to shape the future of clinical practice. In contrast to the rich contextual information provided by traditional psychosocial approaches to assessment, classification systems like DSM-III-R can lead to oversimplification and loss of information that is important to intervention planning. The movement toward the use of continuous, dimensional alternatives to categorical classifications will have a significant effect on clinical assessment and treatment monitoring. Technical advances and efforts to conceptualize and operationalize the contextual complexities of clients' lives will be increasingly important in the future. [ABSTRACT FROM AUTHOR]

The article focuses on agencies that provide services to clients. Many who apply to agencies for service do not receive it. To, make service more accessible, changing the behavior patterns of organizations may be as important as changing organizational structure. More than most other professions, social work has concerned itself with the goal of delivering services to all who are in need. At the same time, social workers are acutely aware that the current service system does not adequately meet the needs of many who seek assistance. This system is made up of a variety of loosely linked service organizations. Each of these organizations is dealing with a specific population group or a specific type of human problem. Instead of aid of all kinds being dispensed to all people by the medieval priest and later by the Charity Organization Society or the neighborhood settlement house, there are now many different agencies dealing with such problems as autism, alcoholism, marital conflicts, unemployment, poverty, child abuse, sexual relationships, and mental illness. A basic difficulty with this system is that those seeking assistance from an agency frequently are denied service or are merely referred elsewhere.

Social workers' theoretical assumptions about deviants have important consequences for practice. This article explores four theoretical models of deviant behavior and the circumstances under which people react to nile-violating behavior. [ABSTRACT FROM AUTHOR]

The article deals with a study on the contribution of women faculty to social work journals. The journals studied were Social Work, Social Casework, Social Service Review, Child Welfare, and Smith College Studies in Social Work. Over nine thousand articles by almost thirteen thousand authors and coauthors were reviewed. The study found that from 1934 through 1938, men wrote approximately 33 percent of the articles published in the five journals. To facilitate the comparison of the publication rates of the 1,011 authors who were affiliated with a social work program at a university with known characteristics of social work faculty compiled by CSWE, the examination of the publication records included only those authors who had doctoral or master's degrees and who held appointments as professor, associate professor, assistant professor, instructor, or lecturer in accredited graduate schools of social work. Excluded from this analysis were social work faculty with degrees in medicine or law, faculty holding adjunct, visiting, clinical, or other nontenured-track university appointments, and those faculty not employed by the accredited graduate schools.

Practice literature and experience offer an almost infinite variety of potential interventions, some of which the worker may invent at the moment, and hundreds of relatively discrete interventive techniques that have been empirically evaluated over the past three decades. It is precisely because of the complexity of social work cases and intervention choices that adequate assessment frameworks capable of organizing and integrating complex data are needed. Social work assessment should organize and structure information for selecting or developing an intervention. Theoretical frameworks are then needed to organize these vast databases. Social problems are complex, and unlike some advocates of categorical approaches, researchers believe social workers are capable of learning how to view them in ways and with measures that capture these complexities. In some cases, neural networks have proven more accurate in diagnostic tasks than either general practitioners or medical specialists. Computerized systems often perform as well as or better than human diagnosticians,, particularly in situations in which the data are probabilistic rather than certain and in which clinical misjudgment may distort and reduce predictive power.

Like the telephone and television, journals provide an inexpensive method of sharing information among individuals who are dispersed geographically. Journals also serve a screening function as they select for publication manuscripts of higher quality or potential contribution from many submissions. Journals provide a forum for spirited debate among individuals who rarely would have an opportunity to converse. Finally, journals advance the ideas of authors whose writing they publish. In social work, and in other fields, journal publication by faculty members has been the subject of considerable research. Anyone who has published an article knows the costs and frustrations: hours of reading and thinking; time consumed by collecting and analyzing data; the agonizingly slow process of transforming fuzzy thoughts into acceptable prose. Publishing is one accepted indicator of meritorious performance at most universities. Thus, the third assumption is that on the average, faculty members who publish articles will be treated more favorably in the discretionary salary process than those who do not.

The article focuses on welfare reform in the U.S. to deal with single women with children. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which U.S. president Bill Clinton signed into law on August 22, 1996, is, in large part, a societal response to the imagined threat posed by these women. The act represents the nation's retreat from its commitment to provide a safety net for this most economically vulnerable population. Under this law, the authority to develop and administer welfare programs will be transferred to the states. Specifically, the act includes the provisions: Welfare mothers will be required to work after two years of assistance; Cash payments will be provided for no more than five years during recipients' lives; Unwed mothers under 18 are ineligible for assistance unless they live in the home of an adult relative or in another adult-supervised arrangement. Social work researchers have an important role to play in the process of restructuring welfare.

Presents information on the articles published in this issue of the journal.

The article comments on the views of critic Elizabeth Anello regarding usefulness of the book "Diagnostic and Statistical Manual of Mental Disorders," 3rd ed. in clinical social work. The authors say that the critic has revealed misinformation in many of her statements. Anello had said that only those who use the book daily can have credible responses about it but did not explain it. The authors say the book is valuable work owned by the American Psychiatric Association and has undeniable allure for those who seek financial reimbursement for mental health services.

The article comments on a study which examined the relationship between gender and publication rates in social work, published in the July and August 1987 issue of the journal "Social Work." The methodological issue concerns the quality of the data. Although the authors correctly noted some of the limitations of the data sets used in previous studies, they claim that their data, gathered by the Council on Social Work Education (CSWE), does not contain problems of sampling and response rate. Each school was asked to indicate the number of publications appearing in print during the preceding year for each faculty member. Although this sounds like a simple request, the accuracy of the information received is affected by some of the issues. For example a few deans have access to or can recite from memory accurate lists of faculty publications for a specific time period; for example, few deans can recall whether a specific publication of a year ago was counted in the last CSWE survey or should be counted this year; few deans, knowing that publication rates among schools of social work often are used to rank schools, are not tempted to overestimate, rather than to underestimate, their faculty's publications.

The article focuses on a debate on social work. The development of social work knowledge depends on careful analysis and study. The marketplace of ideas requires open, free discussion. For decades outsiders exercised almost monopolistic control over the presentation of insiders' views. Both theory and research are the poorer when outsiders exclude or ignore the contributions of insiders. The benefits of blacks studying and writing about blacks, of women studying and writing about women, of the handicapped studying and writing about the handicapped, is indisputable. Debate about new research and new ideas is fundamental to the advancement of science. Blind review is in effect at Social Work, Social Work Research and Abstracts and other journals published by the National Association of Social Workers. It is also in effect at all the professional journals published by the American Psychological Association and the American Sociological Association. Few social workers question the value of blind review. It seems the fairest way to select articles.