Proximity to clinical care and time to resolution following an abnormal cancer screening in an urban setting

Thesis (M.S.)--Boston UniversityBarriers to care have been identified as a major factor in cancer health disparities. Previous research at Boston Medical Center (BMC) found that women referred from community health centers (CHCs) following abnormal breast cancer screening took longer to achieve diagnostic resolution than women referred from a BMC-based practice, consistent with research showing longer delays and worse outcomes for disadvantaged urban populations. It is not known whether this difference relates to the additional distance to BMC. To evaluate the effect of proximity from subjects' residence to the site of clinical care on time to diagnostic resolution in this urban setting we conducted a secondary analysis using data collected as part of the Boston Patient Navigation Research Program (PNRP). The database included all women who had a breast or cervical cancer screening abnormality at six Federally-qualified CHCs from January 2007 to June 2009. Using geocoded home address data captured at the time of registration, we calculated straight-line distances to the location of the diagnostic evaluation, which was the CHC for subjects with a cervical abnormality or BMC for subjects with a breast abnormality, and plotted the time to diagnostic resolution versus distance to site of care. We used proportional hazards regression models to examine the effect of distance to site of care on time to resolution, adjusting for CHC, subject age, race/ethnicity, language, and insurance. Results. We geocoded addresses for 1512 of 1544 subjects (98%). Among the diverse group of subjects with a breast screening abnormality (36% Black, 33% Hispanic; 44% non-English speaking), there was no significant difference in adjusted hazard ratios based on distance to care in 1,000 meter units (adjusted Hazard Ratio 1.00, 95% CI 0.99 -1.01). Similarly, among those with a cervical screening abnormality (22% Black, 21% Hispanic; 15% non-English), there was no significant difference in adjusted hazard ratios based on distance to care in 1,000 meter units (adjusted Hazard Ratio 1.01, 95% CI 1.00- 1.02). Conclusions. Increased distance between residence and clinic alone is not a barrier to diagnostic resolution for this vulnerable urban population receiving care at a CHC who had an abnormal cancer screening exam

The Impact of Medication Use and Medical Morbidity on Symptom Burden in Older Patients

Older patients suffer from a greater number of medical morbidities, consume a greater number of prescribed medications, and report lower levels of quality of life than their younger counterparts. The objectives of this study were to determine whether there is 1) an association between medical morbidity and symptom burden or 2) an association between medication use and symptom burden. This was a cross-sectional study of the symptoms, medical morbidities, and medications reported by 159 community-dwelling male patients 65 years of age or older. Correlations were drawn using linear regression analysis. On average, the participants in this study suffered from 2.56 +/- 1.36 medical morbidities, were prescribed 7.91+/- 2.83 medications, and reported 3.17 symptoms at any severity. The results of this study demonstrated a direct correlation between number of medical morbidities and symptom burden (R2 = 0.94). Our study did not find a significant correlation between medication use and symptom burden (R2 = 0.20). The findings of this study suggest that the number of medical morbidities has a stronger negative impact on symptom burden than the number of medications used. Thus, when attempting to improve quality of life for older patients, physicians should focus on the treatment and alleviations of symptoms associated with medical morbidity

Optimization of Window Positions for Wind-Driven Natural Ventilation Performance

This paper optimizes opening positions on building facades to maximize the natural ventilation’s potential for ventilation and cooling purposes. The paper demonstrates how to apply computational fluid dynamics (CFD) simulation results to architectural design processes, and how the CFD-driven decisions impact ventilation and cooling: (1) background: A CFD helps predict the natural ventilation’s potential, the integration of CFD results into design decision-making has not been actively practiced; (2) methods: Pressure data on building facades were obtained from CFD simulations and mapped into the 3D modeling environment, which were then used to identify optimal positions of two openings of a zone. The effect of the selected opening positions was validated with building energy simulations; (3) results: The cross-comparison study of different window positions based on different geographical locations quantified the impact on natural ventilation effectiveness; and (4) conclusions: The optimized window positions were shown to be effective, and some optimal solutions contradicted the typical cross-ventilation strategy

Slices of the Kerr ergosurface

The intrinsic geometry of the Kerr ergosurface on constant Boyer-Lindquist (BL), Kerr, and Doran time slices is characterized. Unlike the BL slice, which had been previously studied, the other slices (i) do not have conical singularities at the poles (except the Doran slice in the extremal limit), (ii) have finite polar circumference in the extremal limit, and (iii) for sufficiently large spin parameter fail to be isometrically embeddable as a surface of revolution above some latitude. The Doran slice develops an embeddable polar cap for spin parameters greater than about 0.96.Comment: 13 pages, 6 figures; v.2: minor editing for clarification, references added, typos fixed, version published in Classical and Quantum Gravit

Transurethral radiofrequency collagen denaturation for the treatment of women with urinary incontinence

Peer reviewedPublisher PD

Loss of vesicular dopamine release precedes tauopathy in degenerative dopaminergic neurons in a Drosophila model expressing human tau.

While a number of genome-wide association studies have identified microtubule-associated protein tau as a strong risk factor for Parkinson's disease (PD), little is known about the mechanism through which human tau can predispose an individual to this disease. Here, we demonstrate that expression of human wild-type tau is sufficient to disrupt the survival of dopaminergic neurons in a Drosophila model. Tau triggers a synaptic pathology visualized by vesicular monoamine transporter-pHGFP that precedes both the age-dependent formation of tau-containing neurofibrillary tangle-like pathology and the progressive loss of DA neurons, thereby recapitulating the pathological hallmarks of PD. Flies overexpressing tau also exhibit progressive impairments of both motor and learning behaviors. Surprisingly, contrary to common belief that hyperphosphorylated tau could aggravate toxicity, DA neuron degeneration is alleviated by expressing the modified, hyperphosphorylated tau(E14). Together, these results show that impairment of VMAT-containing synaptic vesicle, released to synapses before overt tauopathy may be the underlying mechanism of tau-associated PD and suggest that correction or prevention of this deficit may be appropriate targets for early therapeutic intervention

The genome-scale DNA-binding profile of BarR, a β-alanine responsive transcription factor in the archaeon Sulfolobus acidocaldarius

The DNA-binding domains of S. acidocaldarius BarR and S. solfataricus Ss-LrpB might share a common ancestor. (PDF 198 kb

Recent Insights into Manganese Oxides in Catalyzing Oxygen Reduction Kinetics

The sluggish kinetics of the oxygen reduction reaction (ORR) limit the efficiency of numerous oxygen-based energy conversion devices such as fuel cells and metal-air batteries. Among earth abundant catalysts, manganese-based oxides have the highest activities approaching that of precious metals. In this Review, we summarize and analyze literature findings to highlight key parameters that influence the catalysis of the ORR on manganese-based oxides, including the number of electrons transferred as well as specific and mass activities. These insights can help develop design guides for highly active ORR catalysts and shape future fundamental research to gain new knowledge regarding the molecular mechanism of ORR catalysis.National Science Foundation (U.S.). Materials Research Science and Engineering Centers (Program) (award number DMR- 0819762)Skoltech-MIT CenterNational Science Foundation (U.S.). Graduate Research Fellowship (Grant no. DGE-1122374)United States. Department of Energy. Office of Basic Energy Sciences (contract no. DE-AC02- 98CH10886

Connecting Community to Research: A Training Program to Increase Community Partnerships in Research

Background: Community Engaged Research (CEnR) as a means to address health disparities has emphasized the necessity for community members to partner with researchers. The Boston University CTSI identified the local need to increase the number and diversity of community members ready and willing to engage in the research process. Methods: Connecting Community to Research (CCR) was designed to train community groups interested in improving the health of their community. Trainings were adapted from existing curricula with input from a 12 member advisory panel. The goal was to help trainees understand the various roles they can play along the research process. In a 1-2 hour training, participants were guided through an introduction to CEnR and learned how sharing their stories could inform research. The training concluded with an evaluation survey and opportunities to get connected to loco-regional projects. Results: From December 2015 to November 2016, 100 participants of diverse backgrounds were trained at 7 sessions: 56% identified as White, 35% African American, and 6% other races. Evaluation data indicated: 94% of trainees understood how research could address a community concern, 82% understood how to use their stories to inform research, and 53% intended to participate as an advocate in research. Conclusion: These data suggest trainings like CCR can increase the number and diversity of community members willing to engage in research. While this introductory training generated positive results, additional trainings with varying levels of skill development may be needed to further empower community members to engage as partners in research