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Children learning two languages (Dual Language Learners; DLLs) represent a rapidly growing population in the United States. DLLs are disproportionately more likely to live in families of low socioeconomic status (SES), which places many of them at risk for poor dual-language outcomes. To date, most studies on SES and dual language development have relied on static measures of vocabulary and syntactic skills, without examining the language learning processes -- children's ability to acquire new language items. The current study used a newly developed language measure, the Quick Interactive Language Screener: English and Spanish (QUILS:ES), to assess 3- through 5-year-old Spanish-English DLLs' language learning processes. We also examined the association between SES (as measured by primary caregivers' education) and language learning processes, and further explored mechanisms underlying the association. DLLs from higher-SES families showed better language learning skills than those from lower-SES families. The size of the gap did not vary by child age. Home literacy environment (i.e., access to books, book-reading frequency) and children's existing knowledge (i.e., vocabulary and syntactic knowledge) mediated the SES effect. Together, these findings highlight the need to better prepare DLLs from low-SES families for learning from a dual-language environment. Supporting DLLs' language environment and knowledge through learning materials and language and literacy activities in both languages is crucial for ameliorating the SES gap in language learning processes.

The harms that occur to patients in the hospital are relatively well documented. In contrast, less information is available about the harms that occur to outpatients, even though the amount of health care being delivered in outpatient settings and the complexity of that care are increasing. This article describes the frequency and types of harm that occurred at 11 outpatient sites in Massachusetts during 1 year. Visual Abstract. The Safety of Outpatient Health Care: The harms that occur to patients in the hospital are relatively well documented. In contrast, less information is available about the harms that occur to outpatients, even though the amount of health care being delivered in outpatient settings and the complexity of that care are increasing. This article describes the frequency and types of harm that occurred at 11 outpatient sites in Massachusetts during 1 year. Background: Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited. Objective: To measure AEs in the outpatient setting. Design: Retrospective review of the electronic health record (EHR). Setting: 11 outpatient sites in Massachusetts in 2018. Patients: 3103 patients who received outpatient care. Measurements: Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites. Results: The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care–associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, −0.05 [CI, −0.09 to −0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially. Limitation: Retrospective EHR review may miss AEs. Conclusion: Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed. Primary Funding Source: Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions. [ABSTRACT FROM AUTHOR]

Extant research has highlighted the importance of multiple characteristics of housing but has not comprehensively assessed a broad range of housing characteristics and their relative contributions to children's well-being. Using a representative, longitudinal sample of low-income children and adolescents from low-income urban neighborhoods (N = 2,437, ages 2-21 years) from the "Three-City Study", this study assessed housing quality, stability, type (i.e., ownership status and subsidy status), and cost simultaneously to delineate their unique associations with children's development. Hierarchical linear models found that poor housing quality was most consistently associated with children's and adolescents' development, including worse emotional and behavioral functioning and lower cognitive skills. These associations operated in part through mothers' psychological functioning. Residential instability showed mixed links with functioning, whereas housing cost and type were not consistently predictive. Results suggest that housing contexts are associated with functioning across the developmental span from early childhood through late adolescence, with some differences in patterns by child age.

This study assessed whether previous findings linking early maternal employment to lower cognitive and behavioral skills among middle-class and White children generalized to other groups. Using a representative sample of urban, low-income, predominantly African American and Hispanic families ("n" = 444), ordinary least squares regression and propensity score matching models assessed links between maternal employment in the 2 years after childbearing and children's functioning at age 7. Children whose mothers were employed early, particularly in their first 8 months, showed enhanced socioemotional functioning compared to peers whose mothers remained nonemployed. Protective associations emerged for both part-time and full-time employment, and were driven by African American children, with neutral effects for Hispanics. Informal home-based child care also heightened positive links. (Contains 5 tables.)

Research Findings: Using longitudinal survey data from the Welfare, Children, and Families Study: A Three-City Study ("n" = 135), this study examines how congruence in maternal and child care provider sensitivities contributes to young children's social, emotional, and academic outcomes among low-income minority families. Congruence groups were created based on levels of high and low maternal and child care provider sensitivity. Children with high maternal sensitivity and low child care provider sensitivity had lower scores on measures of social competence and applied problems compared to children with high maternal and child care provider sensitivity. Children with low maternal sensitivity but high child care provider sensitivity displayed higher emotional competence than children with low maternal and child care sensitivity, implying an important protective benefit of child care. Practice or Policy: Current state and federal policy climates, including recently awarded Early Learning Challenge grants focused on social and personal development and the Academic, Social, and Emotional Learning Act, reflect an important emphasis on social and emotional learning. Given this, the findings from this study implicate the role of families and child care providers as important components in any policy or program focused on shaping children's early social and emotional outcomes.

Bradford College, located 35 miles north of Boston in Haverhill, Massachusetts, was exactly the type of institution in greatest jeopardy of closing. It was too small, with an enrollment that never exceeded five hundred students. Such institutions tend to have high attrition rates because they have limited numbers of courses, majors, facilities, faculty, and social possibilities. Bradford was also not selective in admissions. Such colleges are more susceptible to declines in the college-aged population and economic downturns than others. Bradford College additionally had a small endowment, only a few million dollars. Low-endowment colleges are highly enrollment dependent and have little in the way of a safety net when interest rates or the stock market or giving declines. They are less able to respond when there are unexpected expenses such as a roof replacement or shortfalls in enrollment or the other routine calamities most colleges face. They have fewer dollars to invest in new programs, facilities, and the like. In addition, Bradford was a private college. Such institutions are far more expensive to attend than the community colleges and regional public universities they compete with for students. To compete against comparable public or private institutions, they must offer significant tuition discounts. To compete against more selective institutions, they must provide merit scholarships. These discounts come directly out of operating revenues. On top of this, Bradford College was located in New England, an area with one of the highest ratios of colleges to college-age population in the country. In short, the supply of colleges in the region was high and the relative student demand was low, making competition for students even more difficult and necessitating that colleges seek students from other regions of the country and around the world. Finally, the mission and character of Bradford was in flux. This article is about the closure of Bradford College, where the author had been president from 1982 to 1989. The story of Bradford College is the story of many colleges that served well, in this case for almost two hundred years, but borrowing funds for buildings never filled by anticipated enrollment increases led to insurmountable debt.

The present study investigated the association of mothers' marriage and changes in young adolescents' cognitive and socioemotional development and changes in family processes. Analyses employed longitudinal data from the "Three-City Study" to track maternal partnerships for 860 low-income adolescents (10-14 years-old in Wave 1) across a 16 month period. No short-term benefits or risks emerged for youth when mothers entered marriage, with few changes in family or maternal functioning linked with marriage formation as well. In contrast, adolescents in stably married families experienced improved academic, behavioral, and psychological well-being compared to youth in stable cohabiting or single-parent families. Stable marriage was similarly linked to improvements across multiple domains of home and mothers' functioning. These patterns were not moderated by the male partner's identity (biological father or stepfather). Results support the benefits of stable marriage on youth development, but suggest that policies supporting movements into new marriages may not result in improved adolescent or family functioning, at least in the short term. (Contains 5 tables.)

Increasing numbers of low-income children are receiving regular nonparental care, yet knowledge is limited regarding whether child care settings meet the needs of low-income children and their parents. Using a sample of low-income, predominantly African-American and Hispanic children and families from low-income neighborhoods in Boston, Chicago, and San Antonio ("n" = 238), the present study provides a descriptive view of the child care experiences of children (ages 2-5) and families. Results indicate that most children attend Head Start centers, other centers, or relative care, provided either within or outside of the child's home. Head Start programs were rated higher in overall developmental quality than all other types of care. Though unregulated home care settings scored lower on ratings of developmental quality, such settings appeared to be the types in which mothers felt most comfortable, and that best met family needs.

In 1993, the state of Massachusetts implemented comprehensive reforms that included increased state aid to local school districts. This study presents empirical evidence on whether these reforms actually increased educational spending and, if so, in what functional areas. These evaluations are based on relatively detailed annual financial data from the unified school districts in Massachusetts and two neighboring states over the 1990-1996 period. The results indicate that the reforms did increase state aid to and spending by those districts that spent the least prior to the reforms. Furthermore, most of the new spending in these low-spending districts was directed towards student instruction and capital investments.

Background: Patients with limited English proficiency (LEP) experience lower quality end-of-life (EOL) care. This inequity may have been exacerbated during the COVID-19 pandemic. Objective: Compare health care utilization, EOL, and palliative care outcomes between COVID-19 decedents with and without LEP during the pandemic's first wave in Massachusetts. Methods: Retrospective cohort study of adult inpatients who died from COVID-19 between February 18, 2020 and May 18, 2020 at two academic and four community hospitals within a greater Boston health care system. We performed multivariable regression adjusting for patient sociodemographic variables and hospital characteristics. Primary outcome was place of death (intensive care unit [ICU] vs. non-ICU). Secondary outcomes included hospital and ICU length of stay and time to initial palliative care consultation. Results: Among 337 patients, 89 (26.4%) had LEP and 248 (73.6%) were English proficient. Patients with LEP were less often white (24 [27.0%] vs. 193 [77.8%]; p < 0.001); were more often Hispanic or Latinx (40 [45.0%] vs. 13 [5.2%]; p < 0.001); and less often had a medical order for life-sustaining treatment (MOLST) on admission (15 [16.9%] vs. 120 [48.4%]; p < 0.001) versus patients with English proficiency. In the multivariable analyses, LEP was not independently associated with ICU death, ICU length of stay, or time to palliative care consultation, but was independently associated with increased hospital length of stay (mean difference 4.12 days; 95% CI, 1.72–6.53; p < 0.001). Conclusions: Inpatient COVID-19 decedents with LEP were not at increased risk of an ICU death, but were associated with an increased hospital length of stay versus inpatient COVID-19 decedents with English proficiency. [ABSTRACT FROM AUTHOR]

During the COVID‐19 pandemic, frontline nursing home staff faced extraordinary stressors including high infection and mortality rates and ever‐changing and sometimes conflicting federal and state regulations. To support nursing homes in evidence‐based infection control practices, the Massachusetts Senior Care Association and Hebrew SeniorLife partnered with the Agency for Healthcare Research and Quality AHRQ ECHO National Nursing Home COVID‐19 Action Network (the network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes, grouped into nine cohorts of 30–33 nursing homes. Eighty‐three percent of eligible nursing homes in Massachusetts participated in the Network, and Hebrew SeniorLife's Training Center served the vast majority. Each cohort was led by geriatrics clinicians and nursing home leaders, and coaches trained in quality improvement. The interactive sessions provided timely updates on COVID‐19 infection control best practices to improve care and also created a peer‐to‐peer learning community to share ongoing challenges and potential solutions. The weekly Network meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and well‐being for nursing home staff. [ABSTRACT FROM AUTHOR]

Background: Uncertainty surrounding COVID-19 regarding rapid progression to acute respiratory distress syndrome and unusual clinical characteristics make discharge from a monitored setting challenging. A clinical risk score to predict 14-day occurrence of hypoxia, ICU admission, and death is unavailable. Objective: Derive and validate a risk score to predict suitability for discharge from a monitored setting among an early cohort of patients with COVID-19. Design: Model derivation and validation in a retrospective cohort. We built a manual forward stepwise logistic regression model to identify variables associated with suitability for discharge and assigned points to each variable. Event-free patients were included after at least 14 days of follow-up. Participants: All adult patients with a COVID-19 diagnosis between March 1, 2020, and April 12, 2020, in 10 hospitals in Massachusetts, USA. Main Measures: Fourteen-day composite predicting hypoxia, ICU admission, and death. We calculated a risk score for each patient as a predictor of suitability for discharge evaluated by area under the curve. Key Results: Of 2059 patients with COVID-19, 1326 met inclusion. The 1014-patient training cohort had a mean age of 58 years, was 56% female, and 65% had at least one comorbidity. A total of 255 (25%) patients were suitable for discharge. Variables associated with suitability for discharge were age, oxygen saturation, and albumin level, yielding a risk score between 0 and 55. At a cut point of 30, the score had a sensitivity of 83% and specificity of 82%. The respective c-statistic for the derivation and validation cohorts were 0.8939 (95% CI, 0.8687 to 0.9192) and 0.8685 (95% CI, 0.8095 to 0.9275). The score performed similarly for inpatients and emergency department patients. Conclusions: A 3-item risk score for patients with COVID-19 consisting of age, oxygen saturation, and an acute phase reactant (albumin) using point of care data predicts suitability for discharge and may optimize scarce resources. [ABSTRACT FROM AUTHOR]

The article discusses the maintenance of a flexible operating room (OR) schedule during the coronavirus disease 2019 (COVID-19) pandemic as of October 2020. It states that the Massachusetts General Hospital (MGH) OR continues to run 58 rooms daily and completes an average of 750 surgical cases a week, which represents a full schedule in pre-pandemic times. Also noted is its multidisciplinary focus on safe and quick alignment of patients, clinicians, OR space and equipment.

Massachusetts General Hospital (MGH) manages a large inventory of surgical equipment which must be delivered to operating rooms on-time, efficiently, and according to a set of quality standards and regulatory guidelines. In recent years, flexible scope management has become a topic of interest for many hospitals, as they face pressure to reduce costs, prevent infections that can result from mismanagement, and are under increased regulatory oversight. This work conducted at MGH proposes a novel method for surgical equipment management in a hospital. The proposed solution uses a real-time locating system to track flexible scopes, a semantic reasoning engine to determine the state of each scope, and a user interface to inform staff about necessary interventions to avoid scope expirations while maximizing efficiency. This study aimed to accomplish three primary goals. First, the study sought to improve the hospital's compliance to quality standards in order to reduce risks of infection due to expired scopes. Second, the study aimed to improve the cost-efficiency of scope disinfecting processes through more efficient inventory management. Finally, the study served as an opportunity for the hospital to establish best practices for working with the newly installed real-time locating system. The system proposed in this work was implemented at MGH on a subset of the hospital's flexible scopes. The study results demonstrated a quality compliance increase from 88.9% to 94.5%. The study also showed an estimated $17,350 annual cost savings due to more efficient scope management. Finally, the study demonstrated the feasibility, increase in regulatory compliance, and cost savings that would make this technology valuable when scaled across the hospital to other types of scopes and medical devices. [ABSTRACT FROM AUTHOR]

Introduction: Warfarin is a potent anticoagulant used for the prevention and treatment of venous and arterial thrombosis. Occasionally, patients require emergent warfarin reversal due to active bleeding, supratherapeutic international normalized ratio, or emergent diagnostic or therapeutic interventions. Various agents can be used for emergent warfarin reversal, including fresh frozen plasma (FFP) and 4-factor prothrombin complex concentrate (4F-PCC). Both FFP and 4F-PCC are generally considered safe; however, both agents contain coagulation factors and have the potential to provoke a thromboembolic event. Although clinical trials have compared the efficacy and safety of FFP and 4F-PCC, data are limited comparing the risk of thromboembolism between the two agents. Methods: A retrospective chart review was performed at a single, urban, academic medical center comparing the incidence of thromboembolism with FFP or 4F-PCC for warfarin reversal during a three-year period in the emergency department (ED) at Massachusetts General Hospital. Patients were included in the study if they were at least 18 years of age and were on warfarin per electronic health records. Patients were excluded if they had received both FFP and 4F-PCC during the same visit. The primary outcome was the frequency of thromboembolism within 30 days of 4F-PCC or FFP. Secondary outcomes included time to thromboembolic event and in-hospital mortality. Results: Three hundred and thirty-six patients met the inclusion criteria. Thromboembolic events within 30 days of therapy occurred in seven patients (2.7%) in the FFP group and 14 patients (17.7%) in the 4F-PCC group (p=<0.001). Death occurred in 39 patients (15.2%) who received FFP and 18 patients (22.8%) who received 4F-PCC (p=0.115). Since the 4F-PCC group was treated disproportionately for central nervous system (CNS) bleeding, a subgroup analysis was performed including patients requiring reversal due to CNS bleeds that received vitamin K. The primary outcome remained statistically significant, occurring in four patients (4.1%) in the FFP group and nine patients (14.1%) in the 4F-PCC group (p=0.02). Conclusion: Our study found a significantly higher risk of thromboembolic events in patients receiving 4F-PCC compared to FFP for urgent warfarin reversal. This difference remained statistically significant when controlled for CNS bleeds and administration of vitamin K. [ABSTRACT FROM AUTHOR]

I Background: i Lyme disease is the most common vector-borne disease in the United States, and it is hyperendemic in the Northeast ([1]). Results of immunohistochemical testing for I Anaplasma phagocytophilum i and I Babesia i species on heart tissue from the Massachusetts patient and on heart, spleen, and liver tissue from the Vermont patient were negative. [Extracted from the article]

BACKGROUND Many patients who survive an intensive care unit admission develop post--intensive care syndrome and face significant long-term physical, cognitive, and mental health impairments. The intensive care unit diary is a reality-sorting tool that is effective in aiding patients to connect their flashbacks and delusional memories to actual events. OBJECTIVES To describe implementation of an intensive care unit diary in the cardiac intensive care unit and to describe the patient's perspective of the diary. METHODS Consent for participation in the study was given by the patient health care proxy or a family member. The study consisted of 3 phases: writing in the diary about the patient's events in the cardiac intensive care unit, a follow-up visit with the patient within 1 week of cardiac intensive care unit transfer, and a follow-up telephone call 2 months after hospital discharge. RESULTS Of 26 patients, 13 completed all phases of the study. Four themes were identified from the transcripts of the patients' responses: (1) The diary allowed patients to correlate memories to actual events, (2) it enabled patients to read about their families' experiences during their critical illness, (3) recovery was an emotional process that affected the patient's readiness to read the diary, and (4) patients expressed a desire for more entries by caregivers. CONCLUSIONS The intensive care unit diary can help patients gain clarity of their time in the cardiac intensive care unit. Additional research on the use of the diary and long-term patient follow-up is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Rheumatic mitral stenosis (MS) is a progressive disease, and risk of death may persist despite relief of the obstruction. Net atrioventricular compliance (Cn) modulates the overall haemodynamic burden of the MS and may be useful in predicting cardiovascular death after percutaneous mitral valvuloplasty (PMV).Methods: A total of 427 patients (mean age 50±16 years, 84% female) with severe MS undergoing PMV were enrolled. Doppler-derived Cn was estimated at baseline using a previously validated equation. The primary endpoint was late cardiovascular death, and the secondary endpoint was a composite of all-cause mortality, mitral valve (MV) replacement or repeat PMV over a median follow-up of 31 months (IQR: 7.8-49.2 months).Results: At baseline, 209 patients (49%) were in New York Heart Association (NYHA) functional class III or IV. During follow-up, 49 patients died (41 cardiovascular deaths), 50 underwent MV replacement and 12 required repeat PMV, with an overall incidence of cardiac mortality and adverse events of 4.1 deaths and 11.1 events per 100 patient-years, respectively. Low baseline Cn was a strong predictor of both cardiac death (adjusted HR 0.70, 95% CI 0.49 to 0.86) and composite endpoint (adjusted HR 0.81, 95% CI 0.67 to 0.91) after adjusting for clinical factors, baseline pulmonary artery pressure, tricuspid regurgitation severity, right ventricular function and immediate procedural haemodynamic data. The inclusion of Cn in a model with conventional parameters resulted in improvement in 5-year cardiovascular mortality risk prediction.Conclusions: Baseline Cn is a strong predictor of cardiovascular death in patients with MS undergoing PMV, independent of other prognostic markers of decreased survival in MS, including baseline patient characteristics and postprocedural data. Cn assessment therefore has potential value in evaluation of cardiovascular mortality risk in the setting of MS. [ABSTRACT FROM AUTHOR]

Date Presented 04/22/2023 This study surveyed families in early intervention (EI) to identify perceived barriers to accessing EI services. By supporting parents in overcoming these barriers, OTs can support child health outcomes and health equity. Primary Author and Speaker: Cathy Leslie Additional Authors and Speakers: Stefanie Johnston Contributing Authors: Kris Martone-Levine, Amirra Johnson [ABSTRACT FROM AUTHOR]

From town halls to public forums, disadvantaged neighborhoods appear more "participatory" than ever. Yet increased participation has not necessarily resulted in increased influence. This article, drawing on a four-year ethnographic study of redevelopment politics in Boston, presents an explanation for the decoupling of participation from the promise of democratic decision-making. I find that poor urban residents gain the appearance of power and status by invoking and policing membership in "the community"--a boundary sometimes, though not always, implicitly defined by race. But this appearance of power is largely an illusion. In public meetings, government officials can reinforce their authority and disempower residents by exploiting the fact that the boundary demarcating "the community" lacks a standardized definition. When officials laud "the community" as an abstract ideal rather than a specific group of people, they reduce "the community process" to a bureaucratic procedure. Residents appear empowered, while officials retain ultimate decision-making authority. I use the tools of cultural sociology to make sense of these findings and conclude with implications for the study of participatory governance and urban inequality. [ABSTRACT FROM AUTHOR]

In April 2016, Massachusetts General Hospital (MGH) went live with the Epic electronic health records (EHR) system, replacing a variety of EHRs that previously existed in different departments throughout the hospital. At the time of implementation, the Vocera® Badge Communication System, a wireless hands-free communication device distributed to perioperative team members, had increased perioperative communication flow and efficiency. As a quality improvement effort to better understand communication patterns during an EHR go-live, we monitored our Vocera call volume and user volume before, during and after our go-live. We noticed that call volume and user volume significantly increased during our immediate go-live period and quickly returned to baseline levels. We also noticed that call volume increased during periods of unplanned EHR downtime long after our immediate go-live period. When planning the implementation of a new EHR, leadership must plan for and support this critical communication need at the time of the go-live and must also be aware of these needs during unplanned downtime. [ABSTRACT FROM AUTHOR]

In an era of public-private partnerships, what role do nonprofit community-based organizations (CBOs) play in urban governance? Drawing on ethnographic fieldwork in Boston, this article presents a new way to understand CBOs' political role in poor neighborhoods: CBOs as nonelected neighborhood representatives. Over the course of four years, I followed nine CBOs in six Boston neighborhoods as they planned community development projects. The CBOs in my study superseded elected politicians as the legitimate representatives of poor urban neighborhoods. Private funders and government agencies legitimated CBO leaders' claims and treated them as the preferred representatives of neighborhoods' interests. Elected district representatives, by contrast, exhibited limited influence over resources and were rarely involved in community development decision-making. By reconsidering CBOs' political role in urban neighborhoods, this study uncovers a consequential realignment of urban political representation. It also identifies an important tradeoff between the urban poor's access to resources and the ability to hold their leaders democratically accountable--a tradeoff that will remain so long as governments continue to rely on private actors in public governance. [ABSTRACT FROM AUTHOR]

Objectives. To determine whether HIV preexposure prophylaxis (PrEP) use is associated with use of non–HIV-related health care. Methods. We conducted a cross-sectional study of potential PrEP candidates at a Boston, Massachusetts, community health clinic during 2012 to 2016, comparing the proportion of PrEP users and non-PrEP users receiving primary care. Results. Of 5857 PrEP candidates, 2047 (35%) were prescribed PrEP. After adjustment for demographics and number of visits, more PrEP users received influenza vaccination (prevalence ratio [PR] = 1.28; 95% confidence interval [CI] = 1.20, 1.37), tobacco screening (PR = 1.06; 95% CI = 1.02, 1.09), and depression screening (PR = 1.07; 95% CI = 1.04, 1.11) compared with non-PrEP users. After additional adjustment for diabetes, hypertension, and overweight or obesity, more PrEP users received glucose testing (PR = 1.64; 95% CI = 1.56, 1.72) but fewer received hemoglobin A1c testing (PR = 0.81; 95% CI = 0.71, 0.93) compared with non-PrEP users. Conclusions. PrEP use was associated with receipt of influenza vaccination, tobacco and depression screening, and glucose but not hemoglobin A1c testing. Among PrEP users receiving routine care, the benefits of PrEP may extend to behavioral health, mental health, and prevention and treatment of other infectious and chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Patients with treatment-resistant advanced cancer rarely benefit from cardiopulmonary resuscitation (CPR) but infrequently discuss end-of-life care with physicians until hospitalized. Admitting resident physicians may conduct initial code status discussions, but may elicit patients' preferences without providing necessary guidance. Objective: We surveyed residents' approach to code status discussions to identify barriers hindering informed decision making. Methods: We developed an online case-based survey and enrolled subjects via e-mail requests to program directors. U.S. internal medicine residents ( n=358; response rate 22.0%) from 19 programs participated. We measured respondents' likelihood of discussing prognosis and benefit of CPR, likelihood of offering code status recommendations, preference for discussing code status independent of attending physicians, and satisfaction with end-of-life discussions. Results: Nearly all residents felt CPR would be unhelpful. Yet fewer than half (46.7%) were likely to discuss an estimate of prognosis and the value of CPR with the patient. Only 30% were likely to offer a recommendation on CPR. A majority (69%) of residents who were unwilling to offer a recommendation stated that deference to patient autonomy prevented them from providing guidance. Residents preferred to discuss code status independent of attendings, primarily due to a sense of responsibility. Ultimately, only a minority was satisfied with end-of-life discussions. Conclusion: U.S. internal medicine resident physicians are unlikely to discuss prognosis or offer recommendations on CPR in treatment-refractory cancer principally because of a conflict with their concept of patient autonomy. Given the futility associated with CPR in this setting, these data define an unmet need in training and practice. [ABSTRACT FROM AUTHOR]

The article focuses on risk and burden of delivering end-of-life care for patients with COVID-19 may prohibit patients from dying at home and the data suggest that most patients with COVID-19 die in the hospital. Topics include the end-of-life care by place of death among COVID-19 decedents at Mass General Brigham (MGB).

Web-based learning methods are being used increasingly to teach core curriculum in medical school clerkships, but few studies have compared the effectiveness of online methods with that of live lectures in teaching the same topics to students. Boston University School of Medicine has implemented an online, case-based, interactive curriculum using videos and text to teach delirium to fourth-year medical students during their required 1-month Geriatrics and Home Medical Care clerkship. A control group of 56 students who received a 1-hour live delirium lecture only was compared with 111 intervention group students who completed the online delirium curriculum only. Evaluation consisted of a short-answer test with two cases given as a pre- and posttest to both groups. The total possible maximum test score was 34 points, and the lowest possible score was −8 points. Mean pre- and posttest scores were 10.5 ± 4.0 and 12.7 ± 4.4, respectively, in the intervention group and 9.9 ± 3.5 and 11.2 ± 4.5, respectively, in the control group. The intervention group had statistically significant improvement between the pre- and posttest scores (2.21-point difference; P < .001), as did the control group (1.36-point difference; P = .03); the difference in test score improvement between the two groups was not statistically significant. An interactive case-based online curriculum in delirium is as effective as a live lecture in teaching delirium, although neither of these educational methods alone produces robust increases in knowledge. [ABSTRACT FROM AUTHOR]

Although scholars and policy makers herald the promotive influence of fathers’ parenting involvement, limited research has carefully delineated effects of fathers’ parenting on low-income children’s development and whether early contributions from fathers confer long-term protective effects. Using data from the Three-City Study (N = 261), analyses assessed whether fathers’ parenting practices during early childhood showed long-term links with low-income children’s cognitive skills through middle childhood. Results found that fathers’ warm and stimulating parenting predicted enhanced reading and math skills for children in middle childhood, whereas fathers’ restrictive discipline predicted lower reading and math skills. These links were independent of mothers’ parenting and emerged controlling for a range of child and family characteristics. Associations between fathers’ parenting and children’s cognitive skills were similar across both resident and nonresident fathers and across African American and Hispanic families. [ABSTRACT FROM PUBLISHER]

The article presents a study on the evaluation of the benefits of second-trimester fetal echocardiography for diabetic women whose fetuses had no congenital heart disease (CHD). It says that CHD occurs about 0.8% in humans in which maternal diabetes mellitus (MDM) is known to add the chance of fetal CHD. A review of fetal echocardiograms at Children's Hospital in Boston, Massachusetts in 2000-2005 was made. Results showed that fetal echocardiography adds little to the care of diabetic women.

Objectives. We evaluated a real-time ambulatory care-based syndromic surveillance system in four metropolitan areas of the United States. Methods. Health-care organizations and health departments in California, Massachusetts, Minnesota, and Texas participated during 2007-2008. Syndromes were defined using International Classification of Diseases, Ninth Revision diagnostic codes in electronic medical records. Health-care organizations transmitted daily counts of new episodes of illness by syndrome, date, and patient zip code. A space-time permutation scan statistic was used to detect unusual clustering. Health departments followed up on e-mailed alerts. Distinct sets of related alerts ("signals") were compared with known outbreaks or clusters found using traditional surveillance. Results. The 62 alerts generated corresponded to 17 distinct signals of a potential outbreak. The signals had a median of eight cases (range: 3-106), seven zip code areas (range: 1-88), and seven days (range: 3-14). Two signals resulted from true clusters of varicella; six were plausible but unconfirmed indications of disease clusters, six were considered spurious, and three were not investigated. The median investigation time per signal by health departments was 50 minutes (range: 0-8 hours). Traditional surveillance picked up 124 clusters of illness in the same period, with a median of six ill per cluster (range: 2-75). None was related to syndromic signals. Conclusions. The system was able to detect two true clusters of illness, but none was of public health interest. Possibly due to limited population coverage, the system did not detect any of 124 known clusters, many of which were small. The number of false alarms was reasonable. [ABSTRACT FROM AUTHOR]

The article discusses the constitutionality of Massachusetts's reimbursement statute. The article starts with a narration by the author wherein after successfully defending indigents in court, the judge ordered a fee for the author's legal services. Contrary to what he learned, Gideon v. Wainwright does not guarantee an indigent defendant free counsel. In essence, Gideon gives the defendant the right to have a lawyer and if the state will provide counsel for defendant, he will have to repay the state for the privilege of asserting this constitutional guarantee. In Massachusetts, the indigent defendant is mandated to pay the state back $150 for counsel appointed by the court for his defense. Under this system, an indigent defendant is not free until he has reimbursed the state.

Presents several abstracts of research on specimen mineralogy that were presented at the 30th Rochester Mineralogical Symposium. "Mineralogy of the Kimberlites From New York State," by M. Lupulescu; "Mineralogy of the Hiddenite and Emerald Vein Assemblage, Hiddenite, North Carolina," M. A. Wise, A. J. Anderson and R. L. Isaac; "Diopside From the Atwater Quarry Area, Westfield, Massachusetts," by W. Shelton, G. W. Robinson, D. Burgess and D. Levine.

Presents Case 8-1989 of a 46-year-old woman admitted to the hospital because of cognitive impairment and cerebrospinal fluid pleocytosis. Differential diagnosis; Clinical diagnosis; Dr. David N. Levine's diagnosis; Anatomical diagnosis.

Herbert Gutman often prefaced his arguments by pointing out that "little is known" about the particular subject at hand. This certainly was true of women's history during his lifetime. Gutman's work and his presence in the historical profession contributed enormously to altering that fact. Gutman's approach to history did more than any particular study or article to inform and invigorate the field of women's history. The questions he posed, how he posed them, and the way he used sources opened new areas to historical study and freed us to consider the history of those who left no state papers, no archives, and no published documents. With a basically humanistic approach; Gutman considered history part science and part literature. He combined numbers from the census with poems written by slaves and workers. The implications of Gutman's approach proved critical for women's history. By probing sources in a new way, he opened the possibility of new questions as well. Arenas of life previously considered impossible to scrutinize from an historical perspective suddenly became important arenas of investigation. Gutman included women in his vision, not as appendages but on the stage of American life.

Examines the use of oral methoxsalen photochemotherapy on the treatment of psoriasis and mycosis fungoides by researchers from Boston, Massachusetts. Utilization of non-ionizing electromagnetic radiation in combination with a drug to produce a beneficial effect; Identification of a family of naturally occurring tricyclic furocoumarins; Assessment on the safety and efficacy of oral methoxsalen photochemotherapy.

A case study of a neighborhood crimewatch illustrates the interactive recreation of community from the fragmentation and alienation of contemporary urban life. Organizing an intensive walking watch program in response to a serious neighborhood crime-wave in Cambridge, Massachusetts emphasized a ‘working it out’ strategy that attempted to reconcile and draw from the different approaches and talents of oldtimer working-class and newcomer middle-class residents. Empowerment ultimately expanded into municipal and ward politics, disarmament, and civilian review board programs. A participant-observation, intersubjective methodology, as part of the organizing, provided a validational context for observation, interview and drawing community and organizing histories. The results suggested that community re-creation increases empowerment, social control, and sense of community (McMillan & Chavis, 1986) and develops a complementary mix of social problems and opportunity reduction approaches. Citizen participation and control and an active role for the community psychologist are recommended to facilitate democracy and empowerment in fragmented communities. [ABSTRACT FROM AUTHOR]

Background. This article looks at the role that arts, culture, and creativity play in promoting social cohesion and community well-being. It presents research on the role that a community arts center plays in an ethnic enclave that is under stress of immigration and gentrification. Method. An academic–community research partnership conducted this research. A mixed-methods approach was used. Twenty-four interviews were conducted with stakeholders (including community leaders, neighborhood residents, and business owners). Surveys (n = 102) were done of community members and those who participate in the Center activities. Results. Interviewees and survey respondents point to the importance of the ethnic enclave as a close-knot community that helps to foster a sense of belonging, security, and cultural identity. Arts, culture, and creativity plays a role in maintaining this sense of social cohesion, despite the threat of gentrification. Engagement in the arts and creative practice are important for buffering the stress of immigration. Discussion. The center has an important role as a critical cultural, civic, and creative space for the neighborhood and the broader community who sees the ethnic enclave as their cultural home. [ABSTRACT FROM AUTHOR]

Being the economic powerhouses of most large medical centers, operating rooms (ORs) require the highest levels of teamwork, communication, and efficiency in order to optimize patient safety and reduce hospital waste. A major component of OR waste comes from unused surgical instrumentation; instruments that are frequently prepared for procedures but are never touched by the surgical team still require a full reprocessing cycle at the conclusion of the case. Based on our own previous successes in the perioperative domain, in this work we detail an initiative that reduces surgical instrumentation waste of video-assisted thoracoscopic surgery (VATS) procedures by placing thoracotomy conversion instrumentation in a standby location and designing a specific instrument kit to be used solely for VATS cases. Our estimates suggest that this initiative will reduce at least 91,800 pounds of unnecessary surgical instrumentation from cycling through our ORs and reprocessing department annually, resulting in increased OR team communication without sacrificing the highest standard of patient safety. [ABSTRACT FROM AUTHOR]

The Massachusetts General Hospital (MGH) is merging its older endoscope processing facilities into a single new facility that will enable high-level disinfection of endoscopes for both the ORs and Endoscopy Suite, leveraging economies of scale for improved patient care and optimal use of resources. Finalized resource planning was necessary for the merging of facilities to optimize staffing and make final equipment selections to support the nearly 33,000 annual endoscopy cases. To accomplish this, we employed operations management methodologies, analyzing the physical process flow of scopes throughout the existing Endoscopy Suite and ORs and mapping the future state capacity of the new reprocessing facility. Further, our analysis required the incorporation of historical case and reprocessing volumes in a multi-server queuing model to identify any potential wait times as a result of the new reprocessing cycle. We also performed sensitivity analysis to understand the impact of future case volume growth. We found that our future-state reprocessing facility, given planned capital expenditures for automated endoscope reprocessors (AERs) and pre-processing sinks, could easily accommodate current scope volume well within the necessary pre-cleaning-to-sink reprocessing time limit recommended by manufacturers. Further, in its current planned state, our model suggested that the future endoscope reprocessing suite at MGH could support an increase in volume of at least 90% over the next several years. Our work suggests that with simple mathematical analysis of historic case data, significant changes to a complex perioperative environment can be made with ease while keeping patient safety as the top priority. [ABSTRACT FROM AUTHOR]

Background The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results Between 2005 and 2015, 19 232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0% were black, and 6.1% were Latino. Almost half had documented self-report of identifying as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, BSTI diagnoses increased more than 8-fold. In 2015, of 1319 men who were diagnosed with at least 1 BSTI; 291 were diagnosed with syphilis, 554 with gonorrhea (51.4% rectal, 31.0% urogenital), and 679 with chlamydia (69.1% rectal, 34.3% urogenital). In 2015, 22.7% of BSTIs were diagnosed among HIV-infected patients (15.4% of the clinic population), and 32.8% of BSTIs were diagnosed among HIV-uninfected patients using pre-exposure prophylaxis (PrEP; 10.1% of all men in care). In multivariable analyses, age 18 to 24 years, being HIV-infected, using PrEP, being nonwhite, or reporting Medicaid or not reporting having private insurance or Medicare were independently associated with being diagnosed with a new BSTI. Conclusions Over the past decade, BSTI diagnosis rates increased in HIV-infected and uninfected MSM, with disproportionate increases in PrEP users, racial and ethnic minority MSM, those aged 25 to 34 years, and those without stable health insurance, warranting focused education, screening, and accessible services for these key subpopulations. [ABSTRACT FROM AUTHOR]

Focuses on a study which analyzed the bacterioplankton community composition in the waters of the Ipswich River Watershed in Massachusetts. Effects of development on a watershed; Collection of water samples; Results and conclusion.