Providers\u27 Perspectives on Women’s Integrated Healthcare: An Exploratory Study

Women of color, low socioeconomic status (SES) women, and other minority groups face healthcare disparities in the U.S. healthcare system, including lower quality care (Cook et al., 2009), dissatisfaction, and barriers to accessing care (Anderson et al., 2001; Avery et al., 2011). In recent years, within the healthcare field, there is an increased interest in integrated healthcare, specifically, the integration of mental health services in primary care. The current study uses a mixed method exploratory approach to investigate providers’ perspectives on women’s healthcare disparities from a relational and systems perspective. We included both psychologists and primary care physicians from three levels of healthcare integration (traditional/coordinated, co-located, and integrated). This study aimed to 1) examine both structural and relational factors that contribute to providers’ experiences at various levels of integration and their perspectives on women’s healthcare; 2) identify interrelationships among structural, relational, and provider factors; 3) explore differences in provider perspectives between provider types and levels of integration; 4) examine predictors of provider beliefs and job satisfaction; and 5) identify themes in narrative data on provider healthcare experiences with diverse women. As we hypothesized, results indicated that providers in integrated settings were the most satisfied with their collaboration with other providers. Providers’ narratives revealed that healthcare integration is promising for improving patient-provider relationships and providers’ knowledge and sensitivity to health disparities and provided insight into areas for further training and intervention. Implications of these findings highlight the need for in-depth understanding of various impact factors, experiences of providers, and potential benefits of integrating care for women of diverse backgrounds

An economic history of five midwestern railroads.

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning; and, (B.S.)--Massachusetts Institute of Technology, Dept. of Mathematics, 1977.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH.Bibliography : p. 86-90.M.C.P.B.S

Synthesis and applications of depolymerizable polyaldehydes

Depolymerizable polymers are stimuli-responsive materials that can be triggered to rapidly and completely depolymerize into their constituting monomers on command. Their applications include use in triggered release, recyclable and restructurable materials, disappearing or transient materials, and many others functions. Polyaldehyde materials were selected as a candidate system for study due to their known ability to depolymerize rapidly; however, they are also known to generally suffer from limited synthetic accessibility and sensitivity toward post-polymerization modification, thus restricting widespread adoption. My research has broadly focused in two areas: Chapters 2-5 focus on the development of a general and scalable cationic polymerization and copolymerization of aldehydes; Chapters 6-7 describe the installation of functional handles for post-polymerization elaboration of polyaldehydes into various nanostructures. Chapter 8 includes more recent work aimed at the preparation of a novel class of sustainable, recyclable, and eco-friendly depolymerizable polyesters. In short, the cationic polymerization of aldehydes was found to be a robust and scalable reaction, and mechanistic analysis of the polymerization has revealed a reversible cyclization process that produces macrocyclic architectures in high yield and with high purity. It was also found that copolymerization of o-phthalaldehyde with substituted benzaldehydes, generally considered unreactive to polymerization, yielded stimuli-responsive polyaldehyde materials that could be further elaborated to generate depolymerizable single-chain polymeric nanoparticles and polymer networks. These and other studies on the preparation and development of depolymerizable materials have advanced the state-in-the-art in polyaldehyde synthesis and paved the way for new applications in triggered depolymerization

Metastable polymer substrate for transient electronics

Transient electronics are designed to operate for programmed life times and then degrade leaving little to no trace behind. The initial work on transient electronics has been focused on biomedical applications in which the electronics are implanted, but eventually degrade and resorb into the body after the treatment is complete [1]. Biomedical transient electronics typically use a water soluble substrate, such as silk that slowly degrades as water diffuses into the substrate. However, the ability to more precisely program the lifetime of electronics and utilize other degradation stimuli would enable new applications in a variety of industries. Essential to this effort is the development of a new class of degradable substrates that can be triggered to degrade by exposure to a variety of environmental stimuli (e.g., mechanical stress, UV light, pH). In this study, we present a photodegradable transient substrate made of cyclic poly(phthalaldehyde) (PPA) doped with a photo-acid generator (PAG). Exposing the substrate to UV light generates acid through reaction of the PAG which then promotes the cleavage of the acetal backbone of PPA, leading to rapid film degradation. We monitored the degradation of the film using dynamic mechanical analysis and Fourier transform infrared spectroscopy. Results demonstrate that the polymer degrades into monomer and that the degradation rate is controlled by varying the concentration of PAG and the intensity of the UV source. In addition, electronic transistors, diodes, and resistors were fabricated from magnesium and silicon nanomembranes using our newly designed substrate. A combination of transfer-printing and electron-beam evaporation were used to demonstrate lithographic compatibility. We demonstrate electronic transience of a Mg resistor in as fast as 20 minutes with substantial physical degradation in 72 hours. REFERENCE [1] Hwang, S.-W., et. al. Science. 2012, 337, 1640

“You Are the Key”: A co-design project to reduce disparities in Black veterans’ communication with healthcare providers

Interventions are needed to overcome a key barrier to patient-provider communication, namely that patients hesitate to participate in clinical conversations because they believe their expected role is to be passive. This expectation is reinforced for veterans, who replicate their experience of military hierarchy in the patient-provider relationship. Black veterans, moreover, encounter structural racism that compounds this power imbalance. This paper describes a co-designed intervention to empower Black veterans to talk with providers, using shared decision-making (SDM) for lung cancer screening (LCS) as an exemplar. We worked with a diverse group of 5 veterans to develop materials that normalize participating in clinical conversations. We then interviewed 10 Black veterans selected from a national sample to assess the booklet’s impact and contextual factors. The co-design team produced a 30-page booklet that includes veteran narratives describing positive clinical interactions, as well as didactic information about SDM and LCS. We identified four themes related to Black veteran participants’ healthcare experience: (1) they want truthful and complete information exchange with providers they know; (2) they often feel their concerns are disregarded; (3) poor communication worsens medical treatment; and (4) they are confused and angry about treatment in clinical encounters that they feel are racist. The booklet was described as interesting and informative. The veteran narratives in the booklet particularly resonated with readers. Assessment of the booklet’s overall impact on planned engagement with providers varied. Co-designed materials that normalize participation in clinical encounters can play a role in reducing disparities in patient-provider communication. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Multi-stimuli-responsive Self-immolative Polymer Assemblies

Self-immolative polymers (SIPs) undergo depolymerization in response to the cleavage of stimuli-responsive end-caps from their termini. Some classes of SIPs, including polycarbamates, have depolymerization rates that depend on environmental factors such as solvent and pH. In previous work, hydrophobic SIPs have been incorporated into amphiphilic block copolymers and used to prepare nanoassemblies. However, stimuli-responsive hydrophilic blocks have not previously been incorporated. In the current work, we synthesized amphiphilic copolymers composed of a hydrophobic polycarbamate SIP block and a hydrophilic poly(2-dimethylaminoethyl methacrylate) (PDMAEMA) block connected by a UV light-responsive linker end-cap. It was hypothesized that after assembly of the block copolymers into nanoparticles, chain collapse of the PDMAEMA above its lower critical solution temperature (LCST) might change the environment of the SIP block, thereby altering its depolymerization rate. Self-assembly of the block copolymers was performed, and the depolymerization of the resulting assemblies was studied by fluorescence spectroscopy, dynamic light scattering, and NMR spectroscopy. At 20 °C, the system exhibited a selective response to the UV light. At 65 °C, above the LCST of PDMAEMA, the systems underwent more rapid depolymerization, suggesting that the increase in rate arising from the higher temperature dominated over environmental effects arising from chain collapse