The inducible costimulatory molecule (ICOS) is expressed on activated T cells and participates in a variety of important immunoregulatory functions. After the induction of experimental allergic encephalomyelitis in SJL mice with proteolipid protein (PLP), brain ICOS mRNA and protein were up-regulated on infiltrating CD3+ T cells before disease onset. ICOS blockade during the efferent immune response (9-20 days after immunization) abrogated disease, but blockade during antigen priming (1-10 days after immunization) exacerbated disease. Upon culture with PLP and compared with immunized controls, splenocytes produced either decreased interferon-gamma (IFN-gamma, in efferent blockade) or excessive IFN-gamma (in priming blockade). PLP-specific immunoglobulin G1 was decreased in animals treated with anti-ICOS during antigen priming, but not in other groups.

The findings from this study assist in understanding why the ACT approach is more acceptable to clients deemed by CMHTs as "hard to engage". The key elements of ACT that facilitate client engagement may not be easily replicated within CMHTs due to their larger, varied caseloads.

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A common assumption in public social service organizations is that workload may be positively associated with caseload. However, few empirical studies have examined what specific characteristics of caseload affect caseworkers' workloads in the child welfare system. This study attempts to address this gap by identifying specific individual and regional factors that influence both subjective and objective dimensions of workloads. Survey data were collected from 1,244 caseworkers at one public child welfare agency in a Midwestern state in the United States. The data indicated that both perceptions of unmanageable workloads and self‐reported overtime work were significantly higher when caseworkers had a greater number of cases than the state caseload standard for the investigations units and worked with at least two different types of cases simultaneously (e.g., working with both investigation and ongoing service cases). Additionally, sufficient staffing numbers to meet caseload demands at the regional level significantly decreased the odds ratio of having to do overtime work. The major findings suggest that the objective and subjective dimensions of workload vary by individual‐ and regional‐level variables. Practice implications are discussed for effective and efficient workload management in the public child welfare system.