Cost Should Be No Barrier: An Evaluation of the First Year of Harvard's Financial Aid Initiative

This paper evaluates the first year of Harvard's Financial Aid Initiative, which increased aid and recruiting for students from low income backgrounds. Using rich data from the Census and administrative sources, we estimate family incomes for the vast major of plausible applicants from the U.S. We find that the Initiative had a significant effect almost entirely because it attracted a pool of applicants that was larger and slightly poorer. It appears that very similar standards of admission were used for this group as had been used in previous years. This group, once admitted, enrolled at a rate very similar to that of previous years. Thus, there are a greater number of low income students in the Class of 2009 than in the Class of 2008 simply because more well-qualified, low income students applied. Many apparently qualified students still do not apply, and many of these "missing applicants" come from high schools that have little or no tradition of sending applications to selective private colleges. Targeted outreach to such "one offs" -- that is, students who are one of only a few qualified students from their school in recent years -- may be a way for selective private colleges to increase their income diversity.

Global assessment of impacts on migration and security issues

HELIX - High-End cLimate Impacts and eXtreme

A Middle Palaeolithic to Early Upper Palaeolithic succession from an open air site at Beedings, West Sussex

The collection of flintwork from the site of Beedings, West Sussex (England) contains by far the largest number of stone tools from the earliest Upper Palaeolithic of Britain, and is one of the two largest assemblages of its type in Europe. Despite its obvious importance, its analysis has been hindered by several factors resulting from its early excavation. Chief amongst these is the almost total lack of stratigraphic or contextual information: its Early Upper Palaeolithic attribution has hitherto been made largely on its typological and technological similarity to stratified archaeology elsewhere.\ud \ud New fieldwork in 2007 and 2008 in an area directly adjacent to the original site located further Upper Palaeolithic material, in addition to Middle Palaeolithic and Mesolithic material, situated within a series of fissures. Here we provide an overview of the excavation and details of the archaeological context within which further flint artefacts were found. By extension this work provides the first contextual information for the old, larger collection.\ud \ud The results of OSL analysis accord with an Early Upper Palaeolithic age for the majority of the old lithic collection from the site. Stratigraphic data support this Early Upper Palaeolithic age, and also help to validate the separation of material within the old collection into Middle Palaeolithic, Early Upper Palaeolithic and Mesolithic. These stratigraphic data also suggest that Beedings is the only stratified Middle–Upper Palaeolithic open-air site in Britain. Taphonomic analysis indicates a mechanism for site formation, and accounts for the exceptional preservation of this Palaeolithic archaeology. In the light of this taphonomic analysis the “Sackung” hypothesis of site capture proposed previously for Beedings is upheld and further discussed. Wider implications for the preservation of open-air Palaeolithic sites in the region are also considered

The consequences of micro-discretions and boundaries in the social prescribing link worker role in England: a realist evaluation

Background: Social prescribing addresses non-medical factors affecting health and well-being. Link workers arekey to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprisesector. Funding from the National Health Service means that link workers are becoming a common part of primarycare in England.Objective: To explore and understand the implementation of link workers in primary care in England.Design: A realist evaluation addressed the question – When implementing link workers in primary care to sustainoutcomes – what works, for whom, why and in what circumstances?Setting: Link workers and staff associated with seven primary care sites across England.Methods: Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interactwith patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition,interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterpriserepresentatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patientsand with link workers 9–12 months later. Data were coded and developed into statements to identify how contextaround the link worker triggers mechanisms that lead to intended and unintended outcomes.Results: We found that link workers exercise micro-discretions in their role – actions and advice-giving based onpersonal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlightedthat micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community andsocial enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supporteddelivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries couldplace link workers at risk of overstepping their remit.Limitations: Our research focused on link workers attached to primary care; findings may not be applicable tothose working in other settings. Data were collected around seven link worker cases, who were selected purposivelyfor variation in terms of geographical spread and how/by whom link workers were employed. However, these linkworkers were predominately white females.Conclusions: Enabling link workers to exercise micro-discretions allows for responsiveness to individual patientneeds but can result in uncertainty and to link workers feeling overstretched

AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135987/1/jgs14586_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135987/2/jgs14586.pd

“She’s been a rock”: the function and importance of ‘holding’ by social prescribing link workers in primary care in England: findings from a realist evaluation.

Social prescribing link workers are new roles in English primary care. One of their intended functions is to address the increasing number of patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their non-medical needs. However, our research reveals that link workers provide not only connections, but also what we have described as ‘holding’ for patients who have complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context and its consequences.As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a three-week period. We took field notes and interviewed 61 patients and 93 healthcare professionals. Nine to twelve months later we carried out follow-up interviews with 41 patients, seven link workers and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients’ distress. Holding appears to be a vital, but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become over-burdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support for them should be prioritized to ensure successful implementation and positive outcomes for patients, link workers and primary healthcare

Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review

Objectives Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia. Methods We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise. Results Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons. Conclusions We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia

Proline-rich tyrosine kinase 2 mediates gonadotropin-releasing hormone signaling to a specific extracellularly regulated kinase-sensitive transcriptional locus in the luteinizing hormone beta-subunit gene

G protein-coupled receptor regulation of gene transcription primarily occurs through the phosphorylation of transcription factors by MAPKs. This requires transduction of an activating signal via scaffold proteins that can ultimately determine the outcome by binding signaling kinases and adapter proteins with effects on the target transcription factor and locus of activation. By investigating these mechanisms, we have elucidated how pituitary gonadotrope cells decode an input GnRH signal into coherent transcriptional output from the LH β-subunit gene promoter. We show that GnRH activates c-Src and multiple members of the MAPK family, c-Jun NH(2)-terminal kinase 1/2, p38MAPK, and ERK1/2. Using dominant-negative point mutations and chemical inhibitors, we identified that calcium-dependent proline-rich tyrosine kinase 2 specifically acts as a scaffold for a focal adhesion/cytoskeleton-dependent complex comprised of c-Src, Grb2, and mSos that translocates an ERK-activating signal to the nucleus. The locus of action of ERK was specifically mapped to early growth response-1 (Egr-1) DNA binding sites within the LH β-subunit gene proximal promoter, which was also activated by p38MAPK, but not c-Jun NH(2)-terminal kinase 1/2. Egr-1 was confirmed as the transcription factor target of ERK and p38MAPK by blockade of protein expression, transcriptional activity, and DNA binding. We have identified a novel GnRH-activated proline-rich tyrosine kinase 2-dependent ERK-mediated signal transduction pathway that specifically regulates Egr-1 activation of the LH β-subunit proximal gene promoter, and thus provide insight into the molecular mechanisms required for differential regulation of gonadotropin gene expression