Overcoming barriers to participation in training : lessons from the home health care workers of 1199/SEIU, New York's Health and Human Services Union

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2002.Includes bibliographical references (leaves 69-72).This thesis explores the barriers to participation in the 1199 Home Care Industry Bill Michelson Education Fund (Home Care Education Fund). The Home Care Education Fund is structured as a Taft-Hartley, joint labor-management training fund to provide skills upgrading opportunities to unionized home care workers. It is the only such fun in the United States devoted exclusively to home care workers. Home care is a growing sector of the health care industry, and home attendants and home health aides are projected to be among the fastest-growing occupations in the following decade, according to the Bureau of Labor Statistics. Home care workers are also some of the most economically disadvantaged workers in the health care sector, earning poverty-level wages and, with the exception of 1199/SEIU members, lacking health insurance and pension benefits. Three sets of stakeholder groups were interviewed for this thesis: home care workers, who participated in a series of focus group meetings and personal interviews; home care agency employers; and Home Care Education Fund and ETJSP staff members. A written survey instrument was implemented to home care agency employers regarding their staffing levels and training benefits to supplement personal interviews. Each group articulated a coherent set of barriers facing home care workers, with unique challenges facing the agency employers and Education Fund staff in meeting the workers' needs. It is argued that shared interests bind these groups together and that a considerable overlap exists between the provision of quality medical care, welfare and job training policies. Further, there is an urgent need to support a frontline, marginalized workforce that is caring for thousands of disabled and elderly clients on a daily basis. The ultimate goal of this thesis is to identify those key barriers that prevent participation in the Home Care Education Fund so that staff and trustees may work together to tailor their services to meet their unique needs. It concludes with supporting recommendations for workforce development policy.by Hilary Sharpless Chapman.M.C.P

Pile capacity testing

As there is still uncertainty in accurately predicting the performance of piled foundations based upon design calculations there remains a need to test piles. Several methods of pile testing are available some of which have been in common usage for many years, while others are relatively recent developments. Static pile testing is a well understood and simple test technique that has been in use for many years. This approach has the benefit of directly producing test results but is hindered by the increasing size of associated testing infrastructure as pile capacity increases. A recent variation of classic top-down static testing is bi-directional testing which relies on the incorporation of a specialised loading jack or jacks in the pile shaft at some depth below ground surface. This technique has the ability to apply test loads that greatly exceed those possible in other pile test types by effectively using one portion of the pile capacity to test against the other or others. Alternative pile testing techniques come in the form of rapid and dynamic load tests that have the benefit of quick testing and reduced testing infrastructure but require more complicated analysis and interpretation techniques due to the rapid/dynamic nature of the tests

Economic analysis of the health impacts of housing improvement studies: a systematic review

Background: Economic evaluation of public policies has been advocated but rarely performed. Studies from a systematic review of the health impacts of housing improvement included data on costs and some economic analysis. Examination of these data provides an opportunity to explore the difficulties and the potential for economic evaluation of housing. Methods: Data were extracted from all studies included in the systematic review of housing improvement which had reported costs and economic analysis (n=29/45). The reported data were assessed for their suitability to economic evaluation. Where an economic analysis was reported the analysis was described according to pre-set definitions of various types of economic analysis used in the field of health economics. Results: 25 studies reported cost data on the intervention and/or benefits to the recipients. Of these, 11 studies reported data which was considered amenable to economic evaluation. A further four studies reported conducting an economic evaluation. Three of these studies presented a hybrid ‘balance sheet’ approach and indicated a net economic benefit associated with the intervention. One cost-effectiveness evaluation was identified but the data were unclearly reported; the cost-effectiveness plane suggested that the intervention was more costly and less effective than the status quo. Conclusions: Future studies planning an economic evaluation need to (i) make best use of available data and (ii) ensure that all relevant data are collected. To facilitate this, economic evaluations should be planned alongside the intervention with input from health economists from the outset of the study. When undertaken appropriately, economic evaluation provides the potential to make significant contributions to housing policy

Deficits in metacognitive monitoring in mathematics assessments in learners with autism spectrum disorder

Children and adults with autism spectrum disorder have been found to have deficits in metacognition that could impact upon their learning. This study explored metacognitive monitoring in 28 (23 males and 5 females) participants with autism spectrum disorder and 56 (16 males and 40 females) typically developing controls who were being educated at the same level. Participants were asked a series of mathematics questions. Based upon previous research, after each question they were asked two metacognitive questions: (1) whether they thought they had got the answer correct or not (or ‘don’t know’) and (2) whether they meant to get the answer correct or not (or ‘don’t know’). Participants with autism spectrum disorder were significantly more likely than the typically developing group to erroneously think that they had got an incorrect answer correct. Having made an error, those with autism spectrum disorder were also significantly more likely to report that they had meant to make the error. Different patterns in the types of errors made were also identified between the two groups. Deficits in metacognition were identified for the autism spectrum disorder group in the learning of mathematics. This is consistent with metacognitive research from different contexts and the implications for supporting learning in autism spectrum disorder are discussed. </jats:p

Evaluation of Heart Rate Assessment Timing, Communication, Accuracy, and Clinical Decision-Making during High Fidelity Simulation of Neonatal Resuscitation

Objective. Accurate heart rate (HR) determination during neonatal resuscitation (NR) informs subsequent NR actions. This study’s objective was to evaluate HR determination timeliness, communication, and accuracy during high fidelity NR simulations that house officers completed during neonatal intensive care unit (NICU) rotations. Methods. In 2010, house officers in NICU rotations completed high fidelity NR simulation. We reviewed 80 house officers’ videotaped performance on their initial high fidelity simulation session, prior to training and performance debriefing. We calculated the proportion of cases congruent with NR guidelines, using chi square analysis to evaluate performance across HR ranges relevant to NR decision-making: <60, 60–99, and ≥100 beats per minute (bpm). Results. 87% used umbilical cord palpation, 57% initiated HR assessment within 30 seconds, 70% were accurate, and 74% were communicated appropriately. HR determination accuracy varied significantly across HR ranges, with 87%, 57%, and 68% for HR <60, 60–99, and ≥100 bpm, respectively (P<0.001). Conclusions. Timeliness, communication, and accuracy of house officers’ HR determination are suboptimal, particularly for HR 60–100 bpm, which might lead to inappropriate decision-making and NR care. Training implications include emphasizing more accurate HR determination methods, better communication, and improved HR interpretation during NR

Identifying and prioritising unanswered research questions for people with hyperacusis: James Lind Alliance Hyperacusis Priority Setting Partnership

Objective To determine research priorities in hyperacusis that key stakeholders agree are the most important. Design/setting A priority setting partnership using two international surveys, and a UK prioritisation workshop, adhering to the six-staged methodology outlined by the James Lind Alliance. Participants People with lived experience of hyperacusis, parents/carers, family and friends, educational professionals and healthcare professionals who support and/or treat adults and children who experience hyperacusis, including but not limited to surgeons, audiologists, psychologists and hearing therapists. Methods The priority setting partnership was conducted from August 2017 to July 2018. An international identification survey asked respondents to submit any questions/uncertainties about hyperacusis. Uncertainties were categorised, refined and rephrased into representative indicative questions using thematic analysis techniques. These questions were verified as ‘unanswered’ through searches of current evidence. A second international survey asked respondents to vote for their top 10 priority questions. A shortlist of questions that represented votes from all stakeholder groups was prioritised into a top 10 at the final prioritisation workshop (UK). Results In the identification survey, 312 respondents submitted 2730 uncertainties. Of those uncertainties, 593 were removed as out of scope, and the remaining were refined into 85 indicative questions. None of the indicative questions had already been answered in research. The second survey collected votes from 327 respondents, which resulted in a shortlist of 28 representative questions for the final workshop. Consensus was reached on the top 10 priorities for future research, including identifying causes and underlying mechanisms, effective management and training for healthcare professionals. Conclusions These priorities were identified and shaped by people with lived experience, parents/carers and healthcare professionals, and as such are an essential resource for directing future research in hyperacusis. Researchers and funders should focus on addressing these priorities.Additional co-authors: Tracey Pollard, Helen Henshaw, Toto A Gronlund, Derek J Hoar

Sequencing of Culex quinquefasciatus establishes a platform for mosquito comparative genomics

Culex quinquefasciatus (the southern house mosquito) is an important mosquito vector of viruses such as West Nile virus and St. Louis encephalitis virus, as well as of nematodes that cause lymphatic filariasis. C. quinquefasciatus is one species within the Culex pipiens species complex and can be found throughout tropical and temperate climates of the world. The ability of C. quinquefasciatus to take blood meals from birds, livestock, and humans contributes to its ability to vector pathogens between species. Here, we describe the genomic sequence of C. quinquefasciatus: Its repertoire of 18,883 protein-coding genes is 22% larger than that of Aedes aegypti and 52% larger than that of Anopheles gambiae with multiple gene-family expansions, including olfactory and gustatory receptors, salivary gland genes, and genes associated with xenobiotic detoxification

Cortisol regulates the paracrine action of macrophages by inducing vasoactive gene expression in endometrial cells

The human endometrium undergoes inflammation and tissue repair during menstruation. We hypothesized that the local availability of bioactive glucocorticoids plays an important role in immune cell–vascular cell interactions in endometrium during tissue repair at menstruation, acting either directly or indirectly via tissue resident macrophages. We sought to determine whether endometrial macrophages are direct targets for glucocorticoids; whether cortisol-treated macrophages have a paracrine effect on angiogenic gene expression by endometrial endothelial cells; and whether endometrial macrophages express angiogenic factors. Human endometrium (n = 41) was collected with ethical approval and subject consent. Donor peripheral blood monocyte-derived macrophages were treated with estradiol, progesterone, or cortisol. The effect of peripheral blood monocyte-derived macrophage secretory products on the expression of angiogenic RNAs by endothelial cells was examined. Immunofluorescence was used to examine localization in macrophages and other endometrial cell types across the menstrual cycle. Endometrial macrophages express the glucocorticoid receptor. In vitro culture with supernatants from cortisol-treated peripheral blood monocyte-derived macrophages resulted in altered endometrial endothelial cell expression of the angiogenic genes, CXCL2, CXCL8, CTGF, and VEGFC. These data highlight the importance of local cortisol in regulating paracrine actions of macrophages in the endometrium. CXCL2 and CXCL8 were detected in endometrial macrophages in situ. The expression of these factors was highest in the endometrium during the menstrual phase, consistent with these factors having a role in endometrial repair. Our data have indicated that activation of macrophages with glucocorticoids might have paracrine effects by increasing angiogenic factor expression by endometrial endothelial cells. This might reflect possible roles for macrophages in endometrial repair of the vascular bed after menstruation