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"Whose streets? Our streets!" This special forum centered on The Streets Belong to Us: Sex, Race, and Police Power from Segregation to Gentrification conjures this popular urban protest chant that may (or may not) be familiar to many readers. While the response—"our streets!"—is forceful, it is far from a clear-cut truism or uncomplicated declaration. Herein, Fischer and five interlocutors discuss the historical and spatial complexities regarding who has a right to define, navigate, and regulate urban spaces. They take up the questions—to whom do the streets belong—by considering regimes of police power at the nexus of sex, moral reform, and so-called "troublesome" terrains in three twentieth-century U.S. cities. They also engage how, as Fischer states, law-enforcement practices of sexual policing decriminalized white womanhood while criminalizing Black womanhood, and thereby expanded police authority, racialized gendered state violence, carceral feminism, gentrification, and spatialized racial and economic inequalities. [ABSTRACT FROM AUTHOR]

This study employs quantitative and qualitative data from a large diverse sample of scientists and professionals active in Greater Boston's environmental and community development movements to pursue two lines of inquiry regarding experts and expertise in social movements. Statistical analysis and supporting qualitative analysis investigate, first, the extent to which expert's professional training and employment predict their mobilization into different social movements (a measure of embodied expertise) and, second, the more specific ways that experts' embeddedness in Boston-area businesses, law firms, and colleges and universities provide distinct mobilization pathways. Finding support for both, our conclusions emphasize the strategic value and heterogeneity of expert activists as a group and the importance of institutional analysis in understanding the dynamics and impacts of expert activism. [ABSTRACT FROM AUTHOR]

Communities of color have been historically excluded and marginalized in the ongoing conversations about climate preparedness and resilience at local, national, and global levels. Using focus groups composed of Boston communities of color (Asian American, Black, Latino, and Native American), this study aimed to understand their perspectives on climate change, providing in-depth knowledge of its impact and their views on preparedness and resilience. Research shows that these communities have long been concerned about climate change and emphasize the urgent need to improve climate preparedness. A multi-pronged approach is crucial: listening to communities of color to leverage local knowledge and leadership, engaging in community organizing, advocating for policy change, redirecting attention to institutional resources, and addressing systemic inequalities that exacerbate vulnerabilities. The findings of this study highlight the need for policy changes driven by collaboration and collective action, which can benefit those most negatively impacted by climate change and the lack of preparedness and resilience in Boston and beyond. [ABSTRACT FROM AUTHOR]

BackgroundPersonal care products are a notable source of exposure to endocrine-disrupting chemicals (EDCs). Racial/ethnic differences in the use of hair products containing EDCs are reported, with women and children of color more commonly using hair products that are hormonally active and contain EDCs than other racial/ethnic groups. There is limited research examining the neighborhood-level social and economic factors that may contribute to these reported disparities.ObjectivesWe aimed to examine the safety of hair products across sociodemographically diverse neighborhoods in Boston, Massachusetts.MethodsEight neighborhoods were identified based on indicators of race/ethnicity and socioeconomic status (SES). We randomly selected 50 stores and collected data on the hair products for sale and their corresponding Environmental Working Group (EWG) Skin Deep hazard score. The association between neighborhood and EWG hazard category (low, moderate, high) was examined using a multinomial logistic regression.ResultsA total of 14,019 hair products were identified in the eight neighborhoods. When considering products with EWG hazard scores, Roxbury, a lower income community of color, and Mission Hill, a lower income community, were reported to have a higher percentage of high-hazard hair products in comparison with Beacon Hill [12.2% (163/1,332), 11.4% (65/571) vs. 7.9% (30/382), respectively]. Differences between the safety of hair products were observed, with Roxbury and Mission Hill reporting more than a 2-fold higher risk ratio (RR) of finding hair products with high vs. low EWG scores in comparison with that of Beacon Hill [RR for Roxbury: 2.3, 95% confidence interval (CI): 1.1, 4.6; RR for Mission Hill: 2.3, 95% CI: 1.0, 5.4]. Other neighborhoods were also observed to have an increased RR in comparison with Beacon Hill, however, with 95% CIs that extended beyond the null.DiscussionRetail stores in neighborhoods with a higher percentage of residents of color and lower SES were found to be more likely to sell products with high hazard scores than stores in a higher SES and predominately non-Hispanic White neighborhood. https://doi.org/10.1289/EHP10653.

Responding to the polarized view of artists either being displaced or co-opted in urban regeneration, this paper unveils a middle ground in which artists also act as partners or co-producers in these processes. We illustrate this intermediary role in property development processes with reference to a case study of the Seaport Innovation District in Boston by drawing upon a survey of resident artists and interviews with artists, planners, architects and economic development specialists. The paper makes two contributions to the literature. It offers a fresh look at the dialectical relationship between cultural and economic modes of production by more fully integrating consideration of artists’ sensibilities and practice with those of a host of built environment disciplinary practices including architects, planners and real estate developers. As a result, it extends extant analysis of urban regeneration-led gentrification from its urban planning, geography and sociology disciplinary roots into the disciplines of architecture and real estate. Our findings lead onto a research agenda centered on consideration of the intermediary roles played by creative and cultural sector actors and how creativity might be captured to positive effect, in the production of the built environment. [ABSTRACT FROM AUTHOR]

The majority of Boston's residents are minorities. These minority residents confront the ongoing effects of racism, including the "hard histories" of enslavement, the civil-rights movement, and community displacement. Some white Bostonians are unaware of these hard histories or see them as an unnecessary and uncomfortable politicizing of the past, while others are aware, but not personally impacted. Public community cultural-resource management archaeological surveys by Boston's City Archaeology Program seek to confront these hard histories through recent surveys in Boston's Chinatown, the Boston Latin School site, and the Malcolm X-Ella Little-Collins House. The hard and often entangled histories encountered at these sites challenge public perceptions of archaeology by seeking extensive public engagement through community archaeology. This article explores the economic and social issues created by the hard histories at these sites through the reflections of individuals both personally and professionally connected to these community archaeological surveys. [ABSTRACT FROM AUTHOR]

It is well known that the increase in coastal flood hazard is expected to continue due primarily to climate change. While, previous studies have advanced probabilistic approaches for estimating future coastal flood hazard, two seminal issues have received little attention: (1) sea level trend projections that arise as a consequence of climate change not being incorporated in nonstationary coastal flood frequency analysis and (2) traditional stationary approaches that estimate return periods are not suited for analysis of nonstationary water levels. In this paper, a regression approach for sea level rise estimation is proposed to detrend water levels. The peak-over-threshold approach is used to analyze the probabilistic behavior of detrended water levels via a generalized Pareto distribution. Two interpretations of return period—the expected waiting time until an exceedance event occurs and the time associated with the expected number of exceedance events equal to one—are elaborated in a nonstationary context. By incorporating the existing sea level trend projections and using two interpretations of return period, flood hazard curves with uncertainty (i.e., water levels vs. return periods) are developed to describe the probabilistic behavior of future coastal flood hazards. Two case studies are conducted: one for Boston, Massachusetts, and one for New York City, New York. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Scoliosis, characterized by the lateral curvature of the spine, impacts the spine's alignment in three dimensions. Braces are commonly employed as a conservative treatment for individuals with scoliosis, particularly those with curves ranging from 20° to 40°. This treatment approach's primary objectives include arresting the deformity's progression, enhancing clinical appearance, alleviating pain, improving overall quality of life, and circumventing the need for surgical intervention. The aim of this study was to compare the effectiveness of Boston and Cheneau braces in individuals with scoliosis. Methods: In this retrospective study, 51 subjects were included and monitored over 2 years. The primary parameters under evaluation encompassed the severity of both primary and secondary curves and compliance with the prescribed treatment. The subjects were classified into 2 groups: those utilizing the Cheneau brace and those employing the Boston brace. Results: The initial mean values of the primary and secondary curves during the first visit were 37.6 (±7.4) and 30.1 (±9.7) degrees, respectively. However, the in-brace curve measurements for the primary and secondary curves were 31.5 (±1.3) and 22.3 (±13.3) degrees, respectively (p-value=.0). The mean compliance values of subjects using Boston and Cheneau braces were 16.8 and 17.3 h per day, respectively (p-value=.1). No significant difference was observed in the correction achieved with the Boston and Cheneau braces during the follow-up period. Conclusions: The results of this study demonstrated a significant reduction in the scoliotic curve while under brace conditions. However, the degree of correction achieved did not significantly differ during the follow-up periods. Additionally, there was no notable variance in the correction obtained between the Boston and Cheneau braces.

In November 1957, a significant milestone in the history of Opus Dei in the United States –which he had started in 1949–, marking the establishment of two distinct circumscriptions: the Chicago region and the Washington region. This article focuses on the formative years of the Washington region, spanning from 1957 to 1961, specifically highlighting the experiences of the male members of Opus Dei. It provides a chronological account, outlines the geographical and demographic aspects, and delves into certain institutional aspects, such as the organization’s relationship with the American hierarchy and its presence in Washington D.C., Boston and Cambridge, and New York.

BACKGROUND: With the expanded indications for telemedicine, there is increased utility for screening methods to determine which patients are likely to progress to surgical intervention, requiring in-person visits. Patient-rated tools such as the Boston Carpal Tunnel Questionnaire (BCTQ) may be one such tool for screening patients with carpal tunnel syndrome (CTS). The aim of the study was to evaluate whether BCTQ scores were predictive of offering conservative treatment or surgical intervention for CTS. METHODS: Patients diagnosed with CTS from January 2017 to February 2020 completed BCTQ questionnaires prior to in-person office visits. Demographics, comorbidities, and highest level of intervention recommended were recorded for each patient as conservative, injection, or surgery. Pearson χ2 and independent-samples t tests were conducted to determine whether BCTQ symptom severity and functional scores were associated with intervention type. RESULTS: A total of 200 patients with CTS were included. Of these, 103 were recommended conservative or injection treatment and 97 were recommended surgery. There were no differences in comorbidities between groups, including other upper extremity pathology (P = .57), previous upper extremity surgery (P = .32), hypertension (P = .17), hypothyroidism (P = .15), rheumatoid arthritis (P = .34), and diabetes (P = .30). Between these groups, there were no differences in BCTQ symptom severity score (symptom severity scale [SSS]; P = .16) or BCTQ functional severity score (functional severity scale [FSS]; P = .96). CONCLUSIONS: There is no correlation between comorbidities and BCTQ SSS or FSS score, and offering surgery for CTS. In an era of minimizing non-essential health care visits, the BCTQ is insufficient in screening patients as potential surgical candidates.

Continuous subzero temperatures and an unrelenting Polar vortex turned the 2014–2015 Boston winter into a compound disaster, causing deaths and roof collapses, shutting down businesses, and paralyzing transportation networks. Little is known about the circumstances, which enhanced community resilience and reduced impacts during this extended disaster. Using original surveys of more than 140 affected community members alongside demographic data from census and ESRI sources and GIS data on bus and rail networks, we investigate the factors that allowed vulnerable communities to overcome the crisis. Through mixed‐methods approaches, including GIS spatial analysis, multiple regression, average treatment effects, and propensity score matching, we illuminate the factors that helped urban residents mitigate the impact of the Boston snowstorms. Controlling for a number of potential confounding variables, including demographic and economic factors and transportation access, we find that bonding social ties served as a significant mitigating force during the crisis. These findings bring with them important public policy findings for residents, NGOs, and decision‐makers alike as we struggle to adapt to extreme weather events amidst increasing urbanization. [ABSTRACT FROM AUTHOR]

It is commonly assumed that urban renewal in the United States following World War II was a home-grown solution applied to cities suffering from the departure of residents, retail, and capital investment as a result of suburbanization led by the White middle class. This essay argues that influences from abroad, particularly from Latin America, were also crucial to how urban renewal evolved over time from the late 1940s into the 1970s. Simultaneously, U.S.-American strategies of urban planning helped shape Latin American cities. The essay focuses on a prominent urban redeveloper of the era, Edward J. Logue, and the circle of like-minded planners with whom he interacted over his long career. As a result of their involvements in the developing world, similar modernist planning schemes and architectural structures appeared on both sides of the U.S. border, until pushback from communities during the 1960s challenged the lack of attention to local cultures and materials and to community participation in planning. Attacks on modernization theory, not least by the dependency theory popularized by Latin Americans, undermined the hegemony of universalistic modernist schemes for a time, until neoliberalism facilitated a resurgence of less regulated and restrained private interests. [ABSTRACT FROM AUTHOR]

Successful climate change mitigation, adaptation, and transformation will require a balance of bottom-up, community-led planning and engagement with top-down resource deployment. While many non-governmental organizations (NGOs), civil society groups, and local agencies argue that they work closely with residents, especially on plans to manage extreme weather events and climate change, the degree to which local, urban-based climate projects engage with coastal communities remains an open question. Using interviews with nearly 20 project managers, local planners, and decision makers along with site visits to and archival research on three core projects in Boston, we evaluate the degree to which residents participate, plan, and engage. Despite being heralded by some observers as truly participatory, we found that none of the projects achieved the highest levels of participation possible seen in other community led projects. Further, none of the projects achieved consistent scores on the three evaluation criteria: equity, efficacy, and efficiency. This gap between rhetoric and reality must be closed if Boston and other vulnerable, coastal cities wish to build more equitable ways of managing challenges like climate change. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel syndrome is a condition caused by the compression of the median nerve within the carpal tunnel, resulting in clinical symptoms in the area innervated by the nerve. The role of electromyography in surgical planning for carpal tunnel syndrome is controversial. The current study aimed to compare the clinical results of patients who underwent carpal tunnel release surgery based on their preoperative electromyography grading. Methods: We examined 102 patients who underwent carpal tunnel release surgery between 2015 and 2018. All patients were evaluated by electromyography preoperatively and 2-year postoperatively and completed the Boston Questionnaire. Based on the Bland classification for electromyography grades, the patients were divided into 2 groups: group 1 (grades 1-3) and group 2 (grades 4-6). Changes in scores were analyzed after carpal tunnel release surgery for each group. Results: When considering the results for all patients irrespective of group, both scores showed significant improvement after surgery. Group 2 exhibited greater improvement in the functional status scale score and electromyography grade compared to group 1, while similar changes were observed in the symptom severity scale scores. Conclusion: Both the symptom severity scale and functional status scale scores improved significantly after surgery for all patients. However, group 1 consistently had lower scores than group 2 across all evaluation periods. The evaluation of the improvement in the electromyography grade (ΔEMG) indicated that group 2 had better improvement than group 1. [ABSTRACT FROM AUTHOR]

This article examines The Boston Document, a documentary photography project that chronicled urban renewal in Boston from 1959–1968. The project was created by a largely unknown yet crucial documenter of Boston, Irene Shwachman (1915–1988). A large portion of the document focuses on the demolition of the West End, a neighborhood home to lower-class and immigrant residents. In the early 1950s, the Boston Redevelopment Authority labeled the neighborhood a slum, and implemented a redevelopment plan. The West End's 'renewal' resulted in the destruction of a vibrant, diverse neighborhood and the displacement of thousands of residents. This article argues that Shwachman reinterprets a documentary photography methodology to incorporate the perspectives and histories of city citizens in her chronicle of urban change. Through this approach, I argue that Shwachman's photographs present a subjective, personal investigation into Boston, centering the perspectives of city residents and underscoring how people shape and activate their urban landscape. In examining The Boston Document in this renewed context, this article reclaims histories and perspectives removed from Boston's landscape through redevelopment. [ABSTRACT FROM AUTHOR]

Rationale & objectivePlasma kidney injury molecule 1 (KIM-1) is a sensitive marker of proximal tubule injury, but its association with risks of adverse clinical outcomes across a spectrum of kidney diseases is unknown.Study designProspective, observational cohort study.Setting & participants524 individuals enrolled into the Boston Kidney Biopsy Cohort (BKBC) Study undergoing clinically indicated native kidney biopsy with biopsy specimens adjudicated for semiquantitative scores of histopathology by 2 kidney pathologists and 3,800 individuals with common forms of chronic kidney disease (CKD) enrolled into the Chronic Renal Insufficiency Cohort (CRIC) Study.ExposureHistopathologic lesions and clinicopathologic diagnosis in cross-sectional analyses, baseline plasma KIM-1 levels in prospective analyses.OutcomesBaseline plasma KIM-1 levels in cross-sectional analyses, kidney failure (defined as initiation of kidney replacement therapy) and death in prospective analyses.Analytical approachMultivariable-adjusted linear regression models tested associations of plasma KIM-1 levels with histopathologic lesions and clinicopathologic diagnoses. Cox proportional hazards models tested associations of plasma KIM-1 levels with future kidney failure and death.ResultsIn the BKBC Study, higher plasma KIM-1 levels were associated with more severe acute tubular injury, tubulointerstitial inflammation, and more severe mesangial expansion after multivariable adjustment. Participants with diabetic nephropathy, glomerulopathies, and tubulointerstitial disease had significantly higher plasma KIM-1 levels after multivariable adjustment. In the BKBC Study, CKD in 124 participants progressed to kidney failure and 85 participants died during a median follow-up time of 5 years. In the CRIC Study, CKD in 1,153 participants progressed to kidney failure and 1,356 participants died during a median follow-up time of 11.5 years. In both cohorts, each doubling of plasma KIM-1 level was associated with an increased risk of kidney failure after multivariable adjustment (hazard ratios of 1.19 [95% CI, 1.03-1.38] and 1.10 [95% CI, 1.06-1.15] for BKBC and CRIC, respectively). There was no statistically significant association of plasma KIM-1 levels with death in either cohort.LimitationsGeneralizability and unmeasured confounding.ConclusionsPlasma KIM-1 is associated with underlying tubulointerstitial and mesangial lesions and progression to kidney failure in 2 cohort studies of individuals with kidney diseases.

AimsGulf War Illness (GWI), a chronic debilitating disorder characterized by fatigue, joint pain, cognitive, gastrointestinal, respiratory, and skin problems, is currently diagnosed by self-reported symptoms. The Boston Biorepository, Recruitment, and Integrative Network (BBRAIN) is the collaborative effort of expert Gulf War Illness (GWI) researchers who are creating objective diagnostic and pathobiological markers and recommend common data elements for GWI research.Main methodsBBRAIN is recruiting 300 GWI cases and 200 GW veteran controls for the prospective study. Key data and biological samples from prior GWI studies are being merged and combined into retrospective datasets. They will be made available for data mining by the BBRAIN network and the GWI research community. Prospective questionnaire data include general health and chronic symptoms, demographics, measures of pain, fatigue, medical conditions, deployment and exposure histories. Available repository biospecimens include blood, plasma, serum, saliva, stool, urine, human induced pluripotent stem cells and cerebrospinal fluid.Key findingsTo date, multiple datasets have been merged and combined from 15 participating study sites. These data and samples have been collated and an online request form for repository requests as well as recommended common data elements have been created. Data and biospecimen sample requests are reviewed by the BBRAIN steering committee members for approval as they are received.SignificanceThe BBRAIN repository network serves as a much needed resource for GWI researchers to utilize for identification and validation of objective diagnostic and pathobiological markers of the illness.

Current scholarship emphasizes the adoption of "zero-tolerance" policies as the cause of the punitive turn in school discipline. The focus on "zero tolerance," however, has obscured how and for what offenses schools most commonly issue suspensions, namely non-attendance and "classroom disruption." Using Boston as case study, this article situates the formation of the contemporary school-prison nexus in the decades following the Supreme Court's decision in Brown v. Board of Education and argues the preservation of educator discretion shaped its structure. Beginning in the decade prior to Boston's court-ordered desegregation, it analyzes how white Bostonians racialized conceptions of safety and crime to sustain segregation and how that rhetoric shaped the city's preparations for and implementation of desegregation. It examines how police conduct combined with educators' disciplining power repurposed the racist logics undergirding segregation to make schools active institutions in spurring carceral expansion and later mass incarceration. [ABSTRACT FROM AUTHOR]

Engagement in HIV care and a high level of antiretroviral therapy (ART) adherence for people living with HIV is crucial to treatment success and can minimize the population burden of the disease. Despite this, there is a critical gap in HIV prevention science around the development of interventions for serodiscordant male couples. This paper reports on the results of a randomized controlled trial to assess the efficacy of Stronger Together, a dyadic counseling intervention aimed at increasing engagement in and optimizing HIV care among serodiscordant male couples in Atlanta, GA, Boston, MA, and Chicago, IL. Between 2014 and 2017, 159 male serodiscordant couples (total N = 318) in Atlanta, GA, Boston, MA, and Chicago, IL were enrolled and equally randomized to either the Stronger Together intervention arm (a three-session dyadic intervention involving HIV testing and adherence counseling) or a standard of care (SOC) control arm. Couples completed individual study assessments via an audio computer assisted self-interviewing (ACASI) system at baseline, 6, 12 and 18 months. Primary outcomes included being prescribed and currently taking ART, and fewer missed doses of ART in the past 30 days; because the trial was not powered to examine viral suppression, we examined this as an exploratory outcome. Longitudinal data analysis was by an intention-to-treat approach. Participants ages ranged from 18 to 69 (mean = 35.9), and are predominantly white (77.5%), and college educated (68.4% earned a college degree or higher). Participants randomized to the Stronger Together arm had a significantly greater odds of being prescribed and currently taking ART over time than those in the SOC arm (at 12 months OR 2.75, 95%CI 1.35-4.67, p-value 0.020, and at 18 months OR 2.91, 95%CI 1.61-4.88, p-value 0.013). Similarly, those in the Stronger Together arm had a significantly lower odds of missing a dose of ART in the past 30 days over time compared to those in the SOC arm (at 12 months OR 0.28, 95%CI 0.09-0.81, p-value 0.019, and at 18 months OR 0.25, 95%CI 0.07-0.82, p-value 0.023). Among male couples in serodiscordant relationships, the Stronger Together intervention resulted in significantly improved HIV treatment outcomes at both 12 and 18 months of follow-up. This trial is the first to date to demonstrate evidence of efficacy for a dyadic counseling intervention and has the potential to fill a critical gap in secondary HIV prevention interventions for serodiscordant male couples.

BackgroundDiet is thought to account for most adult human exposure to per- and polyfluoroalkyl substances (PFAS). Children are particularly vulnerable to adverse health effects of PFAS and may have different eating habits than adults. However, studies of dietary patterns and PFAS in children are limited.MethodsWe studied 548 Boston-area children with food frequency questionnaire data (89 food items) in early childhood (median age 3.3 years) and plasma concentrations of 6 PFAS quantified in mid-childhood (median age 7.7 years). We used univariate linear regression to examine associations between each food item and PFAS, accounting for multiple comparisons. We next used reduced rank regression (RRR) to estimate overall percent variation in PFAS explained by diet and identify dietary patterns most correlated with PFAS. All models were adjusted for race/ethnicity, maternal education, and household income.ResultsIn univariate analyses, 2-(N-methyl-perfluorooctane sulfonamide) acetate (MeFOSAA) plasma concentrations were 17.8% (95% CI: 7.2, 29.5) and 17.0% (95% CI: 6.4, 28.7) higher per SD increment in intake of ice cream and soda, respectively. RRR identified 6 dietary patterns that together explained 18% variation in the plasma concentrations of the 6 PFAS, of which 50% was explained by a dietary pattern consisting of primarily packaged foods (including ice cream and soda) and fish. Children with higher intake of the packaged foods and fish dietary pattern had higher plasma concentrations of all PFAS, particularly MeFOSAA and PFOS.ConclusionsOur analysis examined food intake in association with several PFAS in children and identified dietary determinants that may be sources of PFAS exposure or reflect correlated lifestyle or toxicokinetic factors. Further investigation may help inform measures to modify childhood PFAS exposure.

Background & Objective: Learning about the world's successful educational systems in the field of nursing education can be helpful in planning, especially in the doctoral program, and lead to an increase in the quality of education in this field. Therefore, the present study was conducted with the aim of a descriptive and comparative comparison of the curriculum of nursing doctoral programs in Iran and the University of Massachusetts Boston. Materials & Methods: The present study is a descriptive-comparative study. To compare the doctoral nursing curricula of Iran and Boston Massachusetts, related articles and resources along with library studies based on Bereday's four-stage model, including description, interpretation, proximity, and comparison were analyzed. Results: Integration of the curriculum with a focus on nurse participation in health policies, educational content related to defined roles and more emphasis on educational courses, admission of undergraduate doctoral students, the existence of part-time and full-time courses, and having the practice-focused program alongside Ph.D. were important features of Boston University curriculum. The nursing doctoral curriculum in Iran is done only full time and from master's degree and in a centralized manner. The educational courses do not meet the needs of society and the only nursing doctoral program in Iran is Ph.D. Conclusion: Boston's nursing Ph.D. curriculum has been developed with a comprehensive view of the real perceived needs of the nursing profession and society. The results of the comparison can be useful in revising Iran's nursing Ph.D. curriculum to improve educational quality.

Abstract Objective: To examine associations of household food insecurity with health and obesogenic behaviours among pregnant women enrolled in an obesity prevention programme in the greater Boston area. Design: Cross-sectional evaluation. Data were collected from structured questionnaires that included a validated two-item screener to assess household food insecurity. We used separate multivariable linear and logistic regression models to quantify the association between household food insecurity and maternal health behaviours (daily consumption of fruits and vegetables, sugar-sweetened beverages and fast food, physical activity, screen time, and sleep), mental health outcomes (depression and stress), hyperglycaemia status and gestational weight gain. Setting: Three community health centres that primarily serve low-income and racial/ethnic minority patients in Revere, Chelsea and Dorchester, Massachusetts. Participants: Totally, 858 pregnant women participating in the First 1,000 Days program, a quasi-experimental trial. Results: Approximately 21 % of women reported household food insecurity. In adjusted analysis, household food insecurity was associated with low fruit and vegetable intake (β = −0·31 daily servings; 95 % CI −0·52, −0·10), more screen time (β = 0·32 daily hours; 95 % CI 0·04, 0·61), less sleep (β = −0·32 daily hours; 95 % CI −0·63, −0·01), and greater odds of current (adjusted odds ratio (AOR) 4·42; 95 % CI 2·33, 8·35) or past depression (AOR 3·01; 95 % CI 2·08, 4·35), and high stress (AOR 2·91; 95 % CI 1·98, 4·28). Conclusions: In our sample of mostly low-income, racial/ethnic minority pregnant women, household food insecurity was associated with mental health and behaviours known to increase the likelihood of obesity.

OBJECTIVES: To examine changes in presence of methamphetamine in toxicology testing among outpatients receiving healthcare in Boston, Massachusetts. METHODS: A serial cross-sectional study of oral fluid drug test results over a 6-year period of all patient specimens submitted for testing as part of routine care across an academic medical center in Boston, Massachusetts and affiliated primary care practices which has roughly 48,000 admissions and 500,000 primary care visits per year. All samples were subjected to definitive drug testing by liquid chromatography-tandem mass spectrometry for fentanyl, 6-monoacetylmorphine (6-MAM, metabolite of heroin), benzoylecgonine (metabolite of cocaine), cocaine, and methamphetamine. We compared positive rates and change over time across the same calendar months (February to July) of 6 consecutive years from 2014 to 2019. RESULTS: Total of 17,303 oral fluid samples collected from outpatients receiving routine healthcare across 6 years were analyzed. Samples showing presence of methamphetamine, cocaine, and fentanyl increased over the study period, whereas 6-MAM presence decreased. From 2014 to 2019 samples with methamphetamine present increased from 0.9% to 5.1% and samples with 6-MAM present decreased from 9.5% to 2.8%. Fentanyl was added to the testing panel in 2017. In 2019, 15.7% of samples had fentanyl present. Polysubstance use was common; 44% of samples with methamphetamine also showed cocaine or benzoylecgonine, 25% showed fentanyl, and 3% showed 6-MAM presence. CONCLUSIONS: Presence of methamphetamine in oral fluid toxicology tests increased from 2014 to 2019 across a sample of outpatients receiving healthcare in Boston, Massachusetts. Regions of the country with high rates of opioid overdose may need to integrate harm reduction and addiction treatment resources for stimulant use disorder in addition to opioid use disorder.

BackgroundMen who have sex with men are disproportionately burdened by HIV/AIDS, and the advent of pre-exposure prophylaxis (PrEP) has provided an effective strategy to reduce the risk of HIV transmission. Research has shown that improving one partner's health-promoting behaviors increases the likelihood that their partner adopts healthier behaviors. We examined the longitudinal relationship between favorable HIV treatment outcomes with current PrEP use among HIV serodiscordant male partners.SettingData are from Project Stronger Together, a randomized controlled trial that recruited serodiscordant male couples from Atlanta, GA; Boston, MA; and Chicago, IL.MethodsSerodiscordant couples completed assessments at baseline, 6, 12, 18, and 24 months. We analyzed longitudinal data from 120 HIV serodiscordant male partners to assess the relationship between the HIV-negative partner's current PrEP use and their HIV-positive partner's current ART use, ART adherence, and viral load using generalized estimating equation models.ResultsFewer than half of the HIV-negative partners were on PrEP at baseline and nearly two-thirds of their HIV-positive partners were virally suppressed. HIV-negative male partners who had partners with an undetectable viral load had greater odds of being a current PrEP user than HIV-negative partners with partners with a detectable viral load.ConclusionOur study highlights the need to develop dyad-level interventions to improve HIV medication use/adherence by HIV serodiscordant male couples. Our findings also suggest that dyad-level interventions may be able to leverage our understanding of how partners can influence each other's health-promoting behaviors to develop programs that improve health outcomes for both partners.

Sexual minority men (SMM) face substantial disparities in rates of binge eating compared to heterosexual individuals, underscoring the need to study risk factors for the development of binge eating amongst SMM. One potential explanation for this disparity in binge eating is minority stress theory, which posits that minority groups face stressors, such as discrimination, due to their stigmatized position in society. Additionally, specific domains of discrimination may confer different levels of risk for binge eating. Therefore, the current study examined the association of various forms of discrimination, including appearance-based discrimination, and binge eating in a sample of SMM. A sample of 200 SMM (analytic sample of N = 187) from the greater Boston area completed self-report questionnaires assessing frequency of different forms of perceived discrimination (appearance, sexual orientation, race, etc.) and binge eating. A hierarchical binary logistic regression model was used to examine the association of different forms of discrimination with binge eating. 9% of the sample reported binge eating. Appearance-based discrimination was the most common form of discrimination (47%), and was significantly associated with binge eating, over and above all other forms of discrimination and sociodemographic variables, OR = 1.71, 95% CI = [1.24, 2.35], Wald χ2 (1) = 10.65, p = .001. Findings suggest that appearance-based discrimination may be related to binge eating in SMM. Clinicians may consider assessing appearance-based discrimination among SMM patients.

The study investigates the way local social movements respond to structural transformations in city politics. Drawing from archival research, published scholarship, and 51 in-depth interviews, we characterize the mobilization of experts into social movements in Greater Boston since the 1960s as a long-term shift from "protecting places" to "providing services." Consonant with a shift from centralized to decentralized municipal government, we show how an initially unified resistance to urban renewal morphed into two diverging and opposing movements. One focused on housing affordability and relied on market-driven tactics; the other sought to enhance the "production of nature" through grassroots community organizing. These findings support two contributions to the scholarship on expert activism by showing that: (1) social movement organizations (SMOs) respond to structural shifts epistemologically, as well as organizationally; and (2) expert activism can alter the conditions and context of knowledge production in neighborhoods and the movements that rise in their defense. [ABSTRACT FROM AUTHOR]

The Kearsarge-Warren Avenue and St. Joseph's cemeteries were 19th-century burial grounds located approximately one-third of a mile apart in the Roxbury section of Boston, Massachusetts. Both were used for several decades: Kearsarge from 1818 to 1883 as a Protestant parish and later a city-owned cemetery, and St. Joseph's from ca. 1846 to ca. 1884 as a Catholic parish cemetery. Both were supposedly relocated by the end of the 19th century, but recent archaeological investigations revealed that few of the interred actually had been relocated from either cemetery despite the removal of markers and tombs, the cemeteries' disappearance from city maps, and a collective city memory of their complete relocations. This article examines this phenomenon and its implications for other regional 19th-century urban-cemetery relocations. [ABSTRACT FROM AUTHOR]

ImportanceThe Affordable Care Act (ACA) sought to improve access and affordability of health insurance. Although most ACA policies targeted childless adults, the extent to which these policies also impacted families with children remains unclear.ObjectiveTo examine changes in health care-related financial burden for US families with children before and after the ACA was implemented based on income eligibility for ACA policies.Design, setting, and participantsData used for this cohort study were obtained from the 2000-2017 Medical Expenditure Panel Survey, a nationally representative, population-based survey. Multivariable regression with a difference-in-differences estimator was used to examine changes in family financial burden before and after ACA implementation according to income-based ACA eligibility groups (≤138% [lowest-income], 139%-250% [low-income], 251%-400% [middle-income], and >400% [high-income] federal poverty level). The cohort included 92 165 families with 1 or more children (age ≤18 years) and 1 or more adult parents/guardians.ExposuresIncome-based eligibility groups during post-ACA years (calendar years 2014-2017) vs pre-ACA years (calendar years 2000-2013).Main outcomes and measuresFamily annual out-of-pocket (OOP) health care and premium cost burden relative to income. High OOP burden was determined based on a previously validated algorithm with relative cost thresholds that vary across incomes, and extreme OOP burden was defined as costs exceeding 10% of income. Premiums exceeding 9.5% of income were classified as burdensome and premiums relative to median household income defined an unaffordability index.ResultsCompared with high-income families who experienced a lesser change post-ACA implementation (high OOP burden, 1.1% pre-ACA vs 0.9% post-ACA), the lowest-income families saw the greatest reduction in high OOP burden (35.6% pre-ACA vs 23.7% post-ACA; difference-in-differences: -11.4%; 95% CI, -13.2% to -9.5%) followed by low-income families (24.6% pre-ACA vs 17.3% post-ACA, difference-in-differences: -6.8%; 95% CI, -8.7% to -4.9%) and middle-income families (6.1% pre-ACA vs 4.6% post-ACA, difference-in-differences: -1.2%; 95% CI, -2.3% to -0.01%). Although premiums rose for all groups, premium unaffordability was the least exacerbated for the lowest-, low-, and middle-income families compared with higher-income families.Conclusions and relevanceThe findings of this study suggest that low- and middle-income families with children who were eligible for ACA Medicaid expansions and Marketplace subsidies experienced greater reductions in health care-related financial burden after the ACA was implemented compared with families with higher incomes. However, despite ACA policies, many low- and middle-income families with children appear to continue to face considerable financial burden from premiums and OOP costs.

Purpose: We assessed if young transgender women (YTW) with parents who are supportive of their transgender identity had lower odds of having suicidal ideation compared with YTW with unsupportive parents. Methods: This study analyzed baseline findings from a diverse sample of 297 sexually active, YTW 16-29 years of age who were enrolled in Project LifeSkills, a randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. Bivariate and multivariable logistic regression were used to assess if parental support was associated with a decreased odds of suicidal ideation. Results: Nearly one-fifth (18.9%) of YTW reported suicidal ideation at baseline. In our adjusted multivariable model, YTW with supportive mothers had 0.37 (95% confidence interval = 0.15-0.90) times the odds of having suicidal ideation compared with YTW with unsupportive mothers. Conclusion: This study found that the odds of suicidal ideation were lower among YTW who had mothers who were supportive of their transgender identity. Our results suggest that parent-focused interventions to improve the relationships between YTW and their parents may lower the odds of YTW having suicidal ideation. Clinical Trial Registration Identifier: NCT01575938.

Nowadays, 23% of the world population lives in multi-million cities. In these metropolises, criminal activity is much higher and violent than in either small cities or rural areas. Thus, understanding what factors influence urban crime in big cities is a pressing need. Seminal studies analyse crime records through historical panel data or analysis of historical patterns combined with ecological factor and exploratory mapping. More recently, machine learning methods have provided informed crime prediction over time. However, previous studies have focused on a single city at a time, considering only a limited number of factors (such as socio-economical characteristics) and often at large in a single city. Hence, our understanding of the factors influencing crime across cultures and cities is very limited. Here we propose a Bayesian model to explore how violent and property crimes are related not only to socio-economic factors but also to the built environmental (e.g. land use) and mobility characteristics of neighbourhoods. To that end, we analyse crime at small areas and integrate multiple open data sources with mobile phone traces to compare how the different factors correlate with crime in diverse cities, namely Boston, Bogotá, Los Angeles and Chicago. We find that the combined use of socio-economic conditions, mobility information and physical characteristics of the neighbourhood effectively explain the emergence of crime, and improve the performance of the traditional approaches. However, we show that the socio-ecological factors of neighbourhoods relate to crime very differently from one city to another. Thus there is clearly no one fits all model.

Background: Little research to date has investigated the spectrum of bladder health in women, including both bladder function and well-being. Therefore, we expanded our previous baseline analysis of bladder health in the Boston Area Community Health (BACH) Survey to incorporate several additional measures of bladder-related well-being collected at the 5-year follow-up interview, including one developed specifically for women. Methods: At follow-up, participants reported their frequency of 15 lower urinary tract symptoms (LUTS), degree of life impact from and thought related to urinary symptoms or pelvic/bladder pain/discomfort, and perception of their bladder condition. Prevalence ratios were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. The BACH Survey was approved by the New England Research Institutes Institutional Review Board and all participants provided written informed consent. Results: Generally similar findings were observed in the 5-year cross-sectional analysis as at baseline, irrespective of how we categorized LUTS or measured bladder-related well-being. Approximately one in five women (16.2%-18.0% of 2527 eligible women) reported no LUTS and no diminished bladder-related well-being, the majority (55.8%-65.7%) reported some LUTS and/or diminished well-being, and a further one in five (16.9%-26.6%) reported the maximum frequency, number, or degree of LUTS and/or diminished well-being. Measures of storage function (urinating again after

BackgroundMaternal and neonatal thyroid function is critical for growth and neurodevelopment. Exposure to individual per- and polyfluoroalkyl substances (PFAS) can alter circulating thyroid hormone levels, but few studies have investigated effects of combined exposure to multiple PFAS.ObjectivesEstimate associations of exposure to multiple PFAS during early pregnancy with maternal and neonatal thyroid function.MethodsThe study population consisted of 726 mothers and 465 neonates from Project Viva, a Boston, Massachusetts area longitudinal pre-birth cohort. We measured six PFAS [perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoate (PFNA), perfluorohexane sulfonate (PFHxS), 2-(N-ethyl-perfluorooctane sulfonamido)acetate (EtFOSAA), and 2-(N-methyl-perfluorooctane sulfonamido)acetate (MeFOSAA)] and thyroxine (T4), Free T4 Index (FT4I), and thyroid stimulating hormone (TSH) in maternal plasma samples collected during early pregnancy, and neonatal T4 in postpartum heel sticks. We estimated individual and joint effects of PFAS exposure with thyroid hormone levels using weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR), and evaluated potential non-linearity and interactions among PFAS using BKMR.ResultsHigher concentrations of the PFAS mixture were associated with significantly lower maternal FT4I, with MeFOSAA, EtFOSAA, PFOA, and PFHxS contributing most to the overall mixture effect in BKMR and WQS regression. In infants, higher concentrations of the PFAS mixture were associated with lower T4 levels, primarily in males, with PFHxS and MeFOSAA contributing most in WQS, and PFHxS contributing most in BKMR. The PFAS mixture was not associated with maternal T4 or TSH levels. However, in maternal BKMR analyses, ln-PFOS was positively associated with T4 levels (Δ25th to 75th percentile: 0.21 µg/dL; 95% credible interval: -0.03, 0.47) and ln-PFHxS was associated with a non-linear effect on TSH levels.ConclusionsThese findings support the hypothesis that there may be combined effects of prenatal exposure to multiple PFAS on maternal and neonatal thyroid function, but the direction and magnitude of these effects may vary across individual PFAS.

To develop and evaluate an effective model of patient-centered, high-quality, homeless-focused primary care, our team explored key domains of primary care that may be important to patients. We anchored our conceptual framework in two reports from the Institute of Medicine (IOM) that defined components of primary care and quality of care. Using questions developed from this framework, we conducted semistructured interviews with 36 homeless-experienced individuals with past-year primary care engagement and 24 health care professionals (clinicians and researchers) who serve homeless-experienced patients in the primary care setting. Template analysis revealed factors important to this population. These included stigma, respect, and perspectives on patient control of medical decision-making in regard to both pain and addiction. For patients experiencing homelessness, the results suggest that quality primary care may have different meanings for patients and professionals, and that services should be tailored to meet homeless-specific needs.