Program Evaluation of a Community-Based Door-Through-Door Medical Escort Service

This report summarizes the program evaluation findings of a Boston-based organization’s Medical Escort program. This “door-through-door” service strives to provide medical transportation, physical assistance, and emotional support to elders on their way to the doctor’s office, during medical appointments and on the way back home again. By offering added assistance the program attempts to remove environmental barriers associated with access to health care. This evaluation combines previously collected program statistics with surveys (32) from program volunteers and phone interviews (78) with recipients

Massachusetts State Public Worker Retirees: How Are They Doing?

Although much has been made of the Massachusetts State Retirement System’s funding and abuses, little has been written about the benefits it provides. A retirement system should be judged first on whether it meets its goal of providing for workers in retirement

Massachusetts Senior Legal Assistance Project Needs Evaluation: Current Demand for Legal Services

The Gerontology Institute at the University of Massachusetts Boston was contracted to conduct a statewide needs assessment for the MSLAP. As agreed upon by the MSLAP Advisory Board, the focus of this assessment was to analyze the demand for services Massachusetts legal service providers have experienced recently as a means to understanding the legal needs of Massachusetts elders (age 60 and older). A second needs assessment was conducted by the Massachusetts Executive Office of Elder Affairs. That needs assessment surveyed home care workers and other elder agency personnel to gauge their assessment of elders’ legal needs in Massachusetts. Read together, the two assessments provide some insight into the legal needs of elders in Massachusetts. Client data from the Legal Advocacy and Resource Center (LARC), Greater Boston Legal Services (GBLS), and six other regional legal service programs (MetroWest Legal Services -MWLS, Massachusetts Justice Project -MJP, Merrimack Valley Legal Services - MVLS, Neighborhood Legal Services -NLS, South Coastal Counties Legal Services-SCCLS, and Western Massachusetts Legal Services-WMLS) were combined into one data file. (Data from Legal Assistance Corporation of Central Massachusetts, which services the Worcester area, were not in a readily accessible format; thus, those data are not included in the assessment.) The sample includes all cases of clients 60 years of age and older that were closed in 2010. Full service and brief service cases are included. Not included are calls that were not recorded as cases and therefore not entered into the data base. Data fields used in this report include client characteristics, presenting legal problems, length of service, and case disposition. The combined sample of cases includes 6,713 unique Massachusetts client cases

Prenatal Serum Concentrations of Brominated Flame Retardants and Autism Spectrum Disorder and Intellectual Disability in the Early Markers of Autism Study: A Population-Based Case-Control Study in California.

BackgroundPrior studies suggest neurodevelopmental impacts of polybrominated diphenyl ethers (PBDEs), but few have examined diagnosed developmental disorders.ObjectivesOur aim was to determine whether prenatal exposure to brominated flame retardants (BFRs) is associated with autism spectrum disorder (ASD) or intellectual disability without autism (ID).MethodsWe conducted a population-based case-control study including children with ASD (n=545) and ID (n=181) identified from the California Department of Developmental Services and general population (GP) controls (n=418) from state birth certificates. ASD cases were matched to controls by sex, birth month, and birth year. Concentrations of 10 BFRs were measured in maternal second trimester serum samples stored from routine screening. Logistic regression was used to calculate crude and adjusted odds ratios (AOR) for associations with ASD, and separately for ID, compared with GP controls, by quartiles of analyte concentrations in primary analyses.ResultsGeometric mean concentrations of five of the six congeners with ≥55% of samples above the limit of detection were lower in mothers of children with ASD or ID than in controls. In adjusted analyses, inverse associations with several congeners were found for ASD relative to GP (e.g., quartile 4 vs. 1, BDE-153: AOR=0.56, 95% CI: 0.38, 0.84). When stratified by child sex (including 99 females with ASD, 77 with ID, and 73 with GP), estimates were consistent with overall analyses in boys, but in the opposite direction among girls, particularly for BDE-28 and -47 (AOR=2.58, 95% CI: 0.86, 7.79 and AOR=2.64, 95% CI: 0.97, 7.19, respectively). Similar patterns overall and by sex were observed for ID.ConclusionsContrary to expectation, higher PBDE concentrations were associated with decreased odds of ASD and ID, though not in girls. These findings require confirmation but suggest potential sexual dimorphism in associations with prenatal exposure to BFRs. https://doi.org/10.1289/EHP1079

Syringe Pump

Our team was asked to design a syringe pump that would deliver fluid at a controlled flow rate to cells in a microfluidic device. The design process of our syringe pump proved to be a very dynamic one. The beginning research of both microfluidic devices and existing syringe pumps helped our team get an idea of ways we could implement existing aspects that work into our design. There were many existing devices that resembled the one that we were asked to make closely; however, due to our resources as students, we had to be a bit more creative in figuring out how to afford and assemble each component to the best of our abilities. Developing customer requirements was a huge step in the process of understanding what exactly you as our customer wanted to see delivered in our syringe pump. The main requirements of our pump were that it was able to deliver accurate shear stress values so that they could mimic those found in true physiology, that it was able to deliver an accurate flow rate to the device, that it was easily usable, and that it was compact to both fit in a desired location and have ease of mobility when needed to be moved to or from that location. Next, it was our job as the engineers to turn those requirements into quantitative engineering specifications that our device needed to meet via testing of the device once the prototype was finished. Once we determined what numbers needed to be hit to quantify the requirements set by you, we were able to create a network diagram of tasks in order to organize the design, manufacturing, and testing processes that we had ahead. Our design process then became a series of brainstorming via tools like a conjoint analysis, morphology, and Pugh matrices. We did these exercises in order to compile a multitude of ideas for each component of the pump to determine which combination of these ideas would produce the optimal pump that is attractive to the user and does the best job at meeting the customer specifications. We determined the main functions of our pump were inputting flow rate parameters on the interface, having a power source for the pushing mechanism, the physical pushing mechanism, and lastly the mechanism through which the fluid would be delivered into the tube. Ultimately, through the many exercises as well as iterations due to a multitude of realizations down the road, we settled upon using a stepper motor linear actuator for the pushing mechanism and a screen with buttons for the input from the user, powered by a 24 V DC Power Supply and connected by a needle attachment to the syringe. Next came acquiring the materials and aspects of the pump that were to be purchased from a manufacturer as well as designing the aspects that we were going to manufacture ourselves. The primary component of our design that we purchased was the FUYU stepper motor linear actuator, to which we programmed electrically and designed adapters to fit onto. Our electrical programming revolved around the Arduino UNO and the Sketch coding software. The chassis was our last component to design, and its main purpose was to keep the user safe from any potential harm from the pump and protect the pump from any water or other wear. When we had performed the Hazard Safety Assessment, we determined a lot of the risk involved the user having their hands in the pinch points as well as having the device fall on the user, both of which were mitigated by having a chassis that covered the pinch point and made the device more compact and mobile. Once we had those components designed, we determined how we would both manufacture and assemble the final prototype. These plans were surely dynamic as we changed materials and found new ways to better manufacture each piece. Critical changes included changing the chassis material from acrylic to polycarbonate, and thus changing the manufacturing process from laser jetting to water jetting to using a variety of saws to cut the pieces. Another critical change came after having manufactured the pusher block adapter, as we were sent back to the design process when the adapter did not perform the way we wanted it to. Additionally, the electrical side of our design manufacturing had to be iterated multiple times as we determined what was feasible and still effective for inputting the parameters. Our design changed from a 4 x 4 keypad to two buttons, one increasing the flow rate value and one decreasing the value. Once the prototype had been built, it was time to verify that we had made a device that met the customer specifications. We created protocols for how we would test these specifications and executed each of the four, the most time-consuming ones being the flow rate and shear stress tests. Our testing plans for shear stress included both an analytical COMSOL simulation through the solid model of the microfluidic device as well as physical testing of the velocity of the particles moving via the LabSmith Micro Particle Image Velocimetry microscope. The physical testing was to verify that our analytical model accurately displayed what velocity and thus shear stresses the cells in our microfluidic devices would be experiencing. Next, we tested flow rate via running water through our pump at specified flow rates for a given period of time, measuring the mass acquired on a sensitive scale to back-calculate what flow rate was actually being delivered. Additionally, we used a gauge to measure the displacement of our pusher block over a specified time to first ensure that the correct speed was being programmed to the motor. In terms of surface area testing, we simply used a ruler to measure the dimensions of the bottom of our chassis to verify it would fit in the desired location in the lab. Lastly, our ease of use testing included simply numbering the steps in the operations manual. Ultimately, our data showed that we did in fact create a pump that received an input and delivered a controllable flow rate and shear stress to the cells in the microfluidic devices, all while being compact and easily usable. After inputting a flow rate of 28.8 ml/hr, we measured the delivered flow rate to be 25.5 ml/hr, which was within our target percent error range of 15%. For shear stress, when entering a flow rate of 75.8 uL/hr, our physical testing showed a particle velocity of 295.6 um/s and our COMSOL velocity showed one of 358.91 um/s, putting these within range of our 20% error goal. We measured the bottom surface area of our pump to be 431.85 cm^2, which was well within our specification of 695 cm^2. Lastly, we measured 5 steps to program our device, which was our target specification. There were surely limitations to our data, as when flow rate decreased to smaller and smaller values it was increasingly harder to acquire data, and then additionally extremely difficult to have that data be accurate. Thus, at the flow rate of 0.76 uL/hr, which is the flow rate at which the pump will typically be used at, both the shear stress and flow rate specifications were not met via our testing. There are a multitude of reasons why our data may have been skewed, and we have plans for future testing to discover where errors might be introduced in our pump. Overall, our team learned much about the design process and grew as engineers while designing this syringe pump

Cross-genetic determination of maternal and neonatal immune mediators during pregnancy.

BACKGROUND:The immune system plays a fundamental role in development during pregnancy and early life. Alterations in circulating maternal and neonatal immune mediators have been associated with pregnancy complications as well as susceptibility to autoimmune and neurodevelopmental conditions in later life. Evidence suggests that the immune system in adults not only responds to environmental stimulation but is also under strong genetic control. METHODS:This is the first genetic study of > 700 mother-infant pairs to analyse the circulating levels of 22 maternal mid-gestational serum-derived and 42 neonatal bloodspot-derived immune mediators (cytokines/chemokines) in the context of maternal and fetal genotype. We first estimated the maternal and fetal genome-wide SNP-based heritability (h2g) for each immune molecule and then performed genome-wide association studies (GWAS) to identify specific loci contributing to individual immune mediators. Finally, we assessed the relationship between genetic immune determinants and ASD outcome. RESULTS:We show maternal and neonatal cytokines/chemokines displaying genetic regulation using independent methodologies. We demonstrate that novel fetal loci for immune function independently affect the physiological levels of maternal immune mediators and vice versa. The cross-associated loci are in distinct genomic regions compared with individual-specific immune mediator loci. Finally, we observed an interaction between increased IL-8 levels at birth, autism spectrum disorder (ASD) status, and a specific maternal genotype. CONCLUSIONS:Our results suggest that maternal and fetal genetic variation influences the immune system during pregnancy and at birth via distinct mechanisms and that a better understanding of immune factor determinants in early development may shed light on risk factors for developmental disorders

Accuracy of emergency physicians\u27 self-estimates of CT scan utilization and its potential effect on an audit and feedback intervention: a randomized trial

BACKGROUND: Audit and feedback (AandF) has been used as a strategy to modify clinician behavior with moderate success. Although AandF is theorized to work by improving the accuracy of clinicians\u27 estimates of their own behavior, few interventions have included assessment of clinicians\u27 estimates at baseline to examine whether they account for intervention success or failure. We tested an AandF intervention to reduce computed tomography (CT) ordering by emergency physicians, while also examining the physicians\u27 baseline estimates of their own behavior compared to peers. METHODS: Our study was a prospective, multi-site, 20-month, randomized trial to examine the effect of an AandF intervention on CT ordering rates, overall and by test subtype. From the electronic health record, we obtained 12 months of baseline CT ordering per 100 patients treated for every physician from four emergency departments. Those who were randomized to receive AandF were shown a de-identified graph of the group\u27s baseline CT utilization, asked to estimate wherein the distribution of their own CT order practices fell, and then shown their actual performance. All participants also received a brief educational intervention. CT ordering rates were collected for all physicians for 6 months after the intervention. Pre-post ordering rates were compared using independent and repeated measures t tests. RESULTS: Fifty-one of 52 eligible physicians participated. The mean CT ordering rate increased significantly in both experimental conditions after the intervention (intervention pre = 35.7, post = 40.3, t = 4.13, p \u3c 0.001; control pre = 33.9, post = 38.9, t = 3.94, p = 0.001), with no significant between-group difference observed at follow-up (t = 0.43, p = 0.67). Within the intervention group, physicians had poor accuracy in estimating their own ordering behavior at baseline: most overestimated and all guessed that they were in the upper half of the distribution of their peers. CT ordering increased regardless of self-estimate accuracy. CONCLUSIONS: Our AandF intervention failed to reduce physician CT ordering: our feedback to the physicians showed most of them that they had overestimated their CT ordering behavior, and they were therefore unlikely to reduce it as a result. After audit, it may be prudent to assess baseline clinician awareness of behavior before moving toward a feedback intervention

The Effects of Perspective Taking Implementing Intentions on Employee Evaluations and Hostile Sexism

The current research examined whether gender bias in the workplace could be reduced through perspective taking implementation intentions, which are if–then statements that specify how to accomplish goals (Gollwitzer, 1999). Amazon MTurk participants (N = 180, 53% male) learned they would complete a two-step performance review for a consulting company. Prior to receiving a male or female employee’s record, all participants were given a goal strategy to be fair in their review, with half also receiving an if–then strategy that encouraged perspective taking. Participants rated the employee on three work related dimensions (skillset, performance, and traits), provided an overall promotion recommendation, and completed the Ambivalent Sexism Inventory (Glick & Fiske, 1996). Although we did not find evidence of gender bias on the work measures, we found that the implementation intention strategy resulted in more positive employee evaluations overall and less hostile sexism than a simple goal strategy. We discuss the potential organizational benefits of employing perspective taking implementation intentions

Lithium protects against anaesthesia neurotoxicity in the infant primate brain

Exposure of infant animals, including non-human primates (NHPs), to anaesthetic drugs causes apoptotic death of neurons and oligodendrocytes (oligos) and results in long-term neurodevelopmental impairment (NDI). Moreover, retrospective clinical studies document an association between anaesthesia exposure of human infants and significant increase in NDI. These findings pose a potentially serious dilemma because millions of human infants are exposed to anaesthetic drugs every year as part of routine medical care. Lithium (Li) at clinically established doses is neuroprotective in various cerebral injury models. We therefore investigated whether Li also protects against anaesthesia neurotoxicity in infant NHPs. On postnatal day 6 NHPs were anaesthetized with the widely used anaesthetic isoflurane (ISO) for 5 h employing the same standards as in a human pediatric surgery setting. Co-administration of Li completely prevented the acute ISO-induced neuroapoptosis and significantly reduced ISO-induced apoptosis of oligodendroglia. Our findings are highly encouraging as they suggest that a relatively simple pharmacological manipulation might protect the developing primate brain against the neurotoxic action of anaesthetic drugs while not interfering with the beneficial actions of these drugs. Further research is needed to determine Li’s potential to prevent long-term NDI resulting from ISO anaesthesia, and to establish its safety in human infants

Implications of Visual Social Access on the Welfare and Behavior of Shelter Dogs

Animal shelter environments have many stressful factors that impact the welfare of shelter dogs, such as lack of predictability and control, and social isolation. Social isolation has been found to increase abnormal behavior and lead to poorer adoption outcomes. Providing visual access to shelter dogs is a relatively easy environmental modification that increases social opportunities and allows for more predictability and control over the environment, potentially improving welfare. To investigate the impact of visual access on the behavior of dogs, we used a within-subject design, conducting 5-min focal observations four times weekly before, during, and after visual access was provided by partially removing a barrier between crates at a suburban dog shelter. Our preliminary analysis of 17 subjects using non-parametric Friedman’s Tests (alpha = .05) found no significant difference between phases in regard to anxiety behaviors (χ2 (2) = .50, p = .78), frustration behaviors (χ2 (2) = .51, p = .77), time spent in the front of the crate (χ2 (2) = 4.50, p = .11), self-directed behaviors (χ2 (2) = 1.86, p = .40), resting behaviors (χ2 (2) = 4.59, p = .10), or vocalizations (χ2 (2) = 4.59, p = .10). The absence of an increase in vocalizations during visual access may encourage shelters to implement this change. However, the lack of a decrease in anxiety or frustration behaviors may indicate that visual access alone is insufficient for providing welfare benefits and that shelters should prioritize increasing social contact in dogs through playgroups or group housing