The Economic Status of Older Women in Massachusetts

This report presents a list of current state legislative initiatives which directly or indirectly, affect older women in Massachusetts. Despite the progress made by the Commonwealth in the area of elder services, a significant portion of this population continues to live in dire need. It is important that State Legislators, State Administrators, policymakers and community leaders understand the needs of this population and work to increase the financial resources and enhance the dignity of older women in the Commonwealth

Feedback control design for subsonic cavity flows

A benchmark problem in active aerodynamic flow control, suppression of strong pressure oscillations induced by flow over a shallow cavity, is addressed in this paper. Proper orthogonal decomposition and Galerkin projection techniques are used to obtain a reduced-order model of the flow dynamics from experimental data. The model is made amenable to control design by means of a control separation technique, which makes the control input appear explicitly in the equations. A prediction model based on quadratic stochastic estimation correlates flow field data with surface pressure measurements, so that the latter can be used to reconstruct the state of the model in real time. The focus of this paper is on the controller design and implementation. A linear-quadratic optimal controller is designed on the basis of the reduced-order model to suppress the cavity flow resonance. To account for the limitation on the magnitude of the control signal imposed by the actuator, the control action is modified by a scaling factor, which plays the role of a bifurcation parameter for the closed-loop system. Experimental results, in qualitative agreement with the theoretical analysis, show that the controller achieves a significant attenuation of the resonant tone with a redistribution of the energy into other frequencies, and exhibits a certain degree of robustness when operating in off-design conditions

The detection of anti-dengue virus IgM in urine in participants enrolled in an acute febrile illness study in Puerto Rico.

BACKGROUND:Dengue is an important arboviral disease with about 100 million dengue cases per year, of which, ~5% result in severe disease. Clinical differentiation of dengue from other acute febrile illnesses (AFI) is difficult, and diagnostic blood tests are costly. We evaluated the utility of anti-DENV IgM in urine to identify dengue cases among AFI patients enrolled in a clinical study. METHODS:Between May 2012-March 2013, 1538 study participants with fever for ≤7 days were enrolled, a medical history was obtained, and serum and urine specimens were collected. Serum was tested for DENV RNA and anti-DENV IgM. Urine was tested for anti-DENV IgM, and its sensitivity and specificity to detect sera laboratory-positive dengue cases were calculated. We evaluated if urine anti-DENV IgM positivity early (≤5 days post-illness onset [DPO]) and late (6-14 DPO) in the clinical course was associated with dengue severity. RESULTS:Urine anti-DENV IgM sensitivity and specificity were 47.4% and 98.5%, respectively, when compared with serum anti-DENV IgM ELISA results, and 29.7% and 91.1% when compared with serum rRT-PCR results. There was no correlation between urine anti-DENV IgM positivity and patient sex or pre-existing chronic disease. Early in the clinical course, a significantly higher proportion of those who developed dengue with warning signs had anti-DENV IgM in their urine when compared to those without warning signs (20.4% vs. 4.3%). There was no difference in the proportion with urine anti-DENV IgM positivity between severity groups late in the clinical course. CONCLUSION:While detection of urine anti-DENV IgM lacked adequate diagnostic sensitivity, it is a highly specific marker for laboratory-positive dengue, and its presence early in the clinical course may distinguish those with more severe disease. Further assessment of urine anti-DENV IgM by DPO is warranted to determine its utility as an early diagnostic (and possibly prognostic) marker for dengue

Use of Household Cluster Investigations to Identify Factors Associated with Chikungunya Virus Infection and Frequency of Case Reporting in Puerto Rico

<div><p>Background</p><p>Chikungunya virus (CHIKV) is transmitted by <i>Aedes</i> species mosquitoes and is the cause of an acute febrile illness characterized by potentially debilitating arthralgia. After emerging in the Caribbean in late 2013, the first locally-acquired case reported to public health authorities in Puerto Rico occurred in May 2014. During June–August 2014, household-based cluster investigations were conducted to identify factors associated with infection, development of disease, and case reporting.</p><p>Methodology/Principal Findings</p><p>Residents of households within a 50-meter radius of the residence of laboratory-positive chikungunya cases that had been reported to Puerto Rico Department of Health (PRDH) were offered participation in the investigation. Participants provided a serum specimen and answered a questionnaire that collected information on demographic factors, household characteristics, recent illnesses, healthcare seeking behaviors, and clinical diagnoses. Current CHIKV infection was identified by rRT-PCR, and recent CHIKV infection was defined by detection of either anti-CHIKV IgM or IgG antibody. Among 250 participants, 74 (30%) had evidence of CHIKV infection, including 12 (5%) with current and 62 (25%) with recent CHIKV infection. All specimens from patients with CHIKV infection that were collected within four days, two weeks, and three weeks of illness onset were positive by RT-PCR, IgM ELISA, and IgG ELISA, respectively. Reporting an acute illness in the prior three months was strongly associated with CHIKV infection (adjusted odds ratio [aOR] = 21.6, 95% confidence interval [CI]: 9.24–50.3). Use of air conditioning (aOR = 0.50, 95% CI = 0.3–0.9) and citronella candles (aOR = 0.4, 95% CI = 0.1–0.9) were associated with protection from CHIKV infection. Multivariable analysis indicated that arthralgia (aOR = 51.8, 95% CI = 3.8–700.8) and skin rash (aOR = 14.2, 95% CI = 2.4–84.7) were strongly associated with CHIKV infection. Hierarchical cluster analysis of signs and symptoms reported by CHIKV-infected participants demonstrated that fever, arthralgia, myalgia, headache, and chills tended to occur simultaneously. Rate of symptomatic CHIKV infection (defined by arthralgia with fever or skin rash) was 62.5%. Excluding index case-patients, 22 (63%) participants with symptomatic CHIKV infection sought medical care, of which 5 (23%) were diagnosed with chikungunya and 2 (9%) were reported to PRDH.</p><p>Conclusions/Significance</p><p>This investigation revealed high rates of CHIKV infection among household members and neighbors of chikungunya patients, and that behavioral interventions such as use of air conditioning were associated with prevention of CHIKV infection. Nearly two-thirds of patients with symptomatic CHIKV infection sought medical care, of which less than one-quarter were reportedly diagnosed with chikungunya and one-in-ten were reported to public health authorities. These findings emphasize the need for point-of-care rapid diagnostic tests to optimize identification and reporting of chikungunya patients.</p></div

Reemergence of Dengue in Southern Texas, 2013

During a dengue epidemic in northern Mexico, enhanced surveillance identified 53 laboratory-positive cases in southern Texas; 26 (49%) patients acquired the infection locally, and 29 (55%) were hospitalized. Of 83 patient specimens that were initially IgM negative according to ELISA performed at a commercial laboratory, 14 (17%) were dengue virus positive by real-time reverse transcription PCR performed at the Centers for Disease Control and Prevention. Dengue virus types 1 and 3 were identified, and molecular phylogenetic analysis demonstrated close identity with viruses that had recently circulated in Mexico and Central America. Of 51 household members of 22 dengue case-patients who participated in household investigations, 6 (12%) had been recently infected with a dengue virus and reported no recent travel, suggesting intrahousehold transmission. One household member reported having a recent illness consistent with dengue. This outbreak reinforces emergence of dengue in southern Texas, particularly when incidence is high in northern Mexico

Dendrogram of hierarchical cluster analysis of symptoms among household-based cluster investigation participants that reported an acute illness in the previous three months, Puerto Rico, 2014

<p>Dendrogram of hierarchical cluster analysis of symptoms among household-based cluster investigation participants that reported an acute illness in the previous three months, Puerto Rico, 2014</p

Demographics, pre-existing medical conditions, household characteristics, and mosquito avoidance behaviors associated with chikungunya virus infection among household-based cluster investigations participants in Puerto Rico, 2014 (N = 250).

<p>Demographics, pre-existing medical conditions, household characteristics, and mosquito avoidance behaviors associated with chikungunya virus infection among household-based cluster investigations participants in Puerto Rico, 2014 (N = 250).</p

Illness and health care seeking behaviors of household-based cluster investigation participants that reported an acute illness in the previous three months, Puerto Rico, 2014.

<p>Illness and health care seeking behaviors of household-based cluster investigation participants that reported an acute illness in the previous three months, Puerto Rico, 2014.</p

Duration of detection of diagnostic markers of chikungunya virus infection by test and time of specimen collection post-illness-onset.

<p>Duration of detection of diagnostic markers of chikungunya virus infection by test and time of specimen collection post-illness-onset.</p