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Shape Up Under 5 (SUU5) was a two-year early childhood obesity prevention pilot study in Somerville, Massachusetts (2015–2017) designed to test a novel conceptual framework called Stakeholder-driven Community Diffusion. For whole-of-community interventions, this framework posits that diffusion of stakeholders’ knowledge about and engagement with childhood obesity prevention efforts through their social networks will improve the implementation of health-promoting policy and practice changes intended to reduce obesity risk. SUU5 used systems science methods (agent-based modeling, group model building, social network analysis) to design, facilitate, and evaluate the work of 16 multisector stakeholders (‘the Committee’). In this paper, we describe the design and methods of SUU5 using the conceptual framework: the approach to data collection, and methods and rationale for study inputs, activities and evaluation, which together may further our understanding of the hypothesized processes within Stakeholder-driven Community Diffusion. We also present a generalizable conceptual framework for addressing childhood obesity and similar complex public health issues through whole-of-community interventions. [ABSTRACT FROM AUTHOR]

We analyzed data from across five decades of passerine bird banding at Manomet in Plymouth, Massachusetts, USA. This included 172,609 captures during spring migration and 253,265 during fall migration, from 1969 to 2015. Migration counts are prone to large interannual variation and trends are often difficult to interpret, but have the advantage of sampling many breeding populations in a single locale. We employed a Bayesian state-space modeling approach to estimate patterns in abundance over time while accounting for observation error, and a hierarchical clustering method to identify species groups with similar trends over time. Although continent-wide there has been an overall decrease in landbird populations over the past 40 years, we found a variety of patterns in abundance over time. Consistent with other studies, we found an overall decline in numbers of birds in the aggregate, with most species showing significant net declines in migratory cohort size in spring, fall, or both (49/73 species evaluated). Other species, however, exhibited different patterns, including abundance increases (10 species). Even among increasing and declining species, the specific trends varied in shape over time, forming seven distinct clusters in fall and ten in spring. The remaining species followed largely independent and irregular pathways. Overall, life-history traits (dependence on open habitat, nesting on or near the ground, migratory strategy, human commensal, spruce budworm specialists) did a poor job of predicting species groupings of abundance patterns in both spring and fall, but median date of passage was a good predictor of abundance trends during spring (but not fall) migration. This suggests that some species with very similar patterns of abundance were unlikely to be responding to the same environmental forces. Changes in abundance at this banding station were generally consistent with BBS trend data for the same geographic region. [ABSTRACT FROM AUTHOR]

Dolphin stranding events occur frequently in Florida and Massachusetts. Dolphins are an excellent sentinel species for toxin exposures in the marine environment. In this report we examine whether cyanobacterial neurotoxin, β-methylamino-L-alanine (BMAA), is present in stranded dolphins. BMAA has been shown to bioaccumulate in the marine food web, including in the muscles and fins of sharks. Dietary exposure to BMAA is associated with the occurrence of neurofibrillary tangles and β-amyloid plaques in nonhuman primates. The findings of protein-bound BMAA in brain tissues from patients with Alzheimer's disease has advanced the hypothesis that BMAA may be linked to dementia. Since dolphins are apex predators and consume prey containing high amounts of BMAA, we examined necropsy specimens to determine if dietary and environmental exposures may result in the accumulation of BMAA in the brains of dolphins. To test this hypothesis, we measured BMAA in a series of brains collected from dolphins stranded in Florida and Massachusetts using two orthogonal analytical methods: 1) high performance liquid chromatography, and 2) ultra-performance liquid chromatography with tandem mass spectrometry. We detected high levels of BMAA (20–748 μg/g) in the brains of 13 of 14 dolphins. To correlate neuropathological changes with toxin exposure, gross and microscopic examinations were performed on cortical brain regions responsible for acoustico-motor navigation. We observed increased numbers of β-amyloid+ plaques and dystrophic neurites in the auditory cortex compared to the visual cortex and brainstem. The presence of BMAA and neuropathological changes in the stranded dolphin brain may help to further our understanding of cyanotoxin exposure and its potential impact on human health. [ABSTRACT FROM AUTHOR]

Purpose: Safety-net health systems, which serve a disproportionate share of patients at high risk for hepatitis C virus (HCV) infection, may use revenue generated by the federal drug discount pricing program, known as 340B, to support multidisciplinary care. Budgetary impacts of repealing the drug-pricing program are unknown. Our objective was to conduct a budgetary impact analysis of a multidisciplinary primary care-based HCV treatment program, with and without 340B support. Methods: We conducted a budgetary impact analysis from the perspective of a large safety-net medical center in Boston, Massachusetts. Participants included 302 HCV-infected patients (mean age 45, 75% male, 53% white, 77% Medicaid) referred to the primary care-based HCV treatment program from 2015–2016. Main measures included costs and revenues associated with the treatment program. Our main outcomes were net cost with and without 340B Drug Pricing support. Results: Total program costs were $942,770, while revenues totaled $1.2 million. With the 340B Drug Pricing Program the hospital received a net revenue of $930 per patient referred to the HCV treatment program. In the absence of the 340B program, the hospital would lose $370 per patient referred. Ninety-seven percent (68/70) of patients who initiated treatment in the program achieved a sustained virologic response (SVR) at a net cost of $4,150 each, among this patient subset. Conclusions: The 340B Drug Pricing Program enabled a safety-net hospital to deliver effective primary care-based HCV treatment using a multidisciplinary care team. Efforts to sustain the 340B program could enable dissemination of similar HCV treatment models elsewhere. [ABSTRACT FROM AUTHOR]

Incarcerated people remain a priority group in efforts to control and reverse the HIV epidemic. Following release, social instability and reengagement in key transmission risk behaviors increase the risk of secondary transmission of HIV. Targeted programs have been developed to facilitate reengagement in care on reentry. Evaluation of the impact of these initiatives requires a systematic, confidential, framework for assessment of linkage to care for persons released from corrections. By linking HIV viral load surveillance data to corrections release data, the time to the first laboratory monitoring service in the community as well as the virologic status can be assessed. Using this method, we linked release data for sentenced individuals released from Massachusetts state correctional facilities in 2012 to HIV surveillance data from the Massachusetts HIV/AIDS Surveillance Program (MHASP) for the years 2012–2013. We identified 41 individuals with HIV released in 2012. Ninety-one percent had identified virologic assessments post release, 41% within 30 days. Thirty-three percent did not have a viral load assessed for more than 90 days and 31% had detectable virus at the time of their initial assessment. Persons with longer incarcerations (> 180 days) were more likely to have suppressed viral load at the time of follow-up (p = 0.05). This work demonstrates the important value of HIV laboratory surveillance data and correctional release data as a tool to assess linkage to care following release from corrections. We encourage jurisdictions to explore utilizing similar methodology to evaluate the effectiveness of the linkage to HIV care after release from incarceration. [ABSTRACT FROM AUTHOR]

Various studies have reported the physical and mental health benefits from exposure to “green” neighborhoods, such as proximity to neighborhoods with trees and vegetation. However, no studies have explicitly assessed the association between exposure to “green” surroundings and cognitive function in terms of student academic performance. This study investigated the association between the “greenness” of the area surrounding a Massachusetts public elementary school and the academic achievement of the school’s student body based on standardized tests with an ecological setting. Researchers used the composite school-based performance scores generated by the Massachusetts Comprehensive Assessment System (MCAS) to measure the percentage of 3rd-grade students (the first year of standardized testing for 8–9 years-old children in public school), who scored “Above Proficient” (AP) in English and Mathematics tests (Note: Individual student scores are not publically available). The MCAS results are comparable year to year thanks to an equating process. Researchers included test results from 2006 through 2012 in 905 public schools and adjusted for differences between schools in the final analysis according to race, gender, English as a second language (proxy for ethnicity and language facility), parent income, student-teacher ratio, and school attendance. Surrounding greenness of each school was measured using satellite images converted into the Normalized Difference Vegetation Index (NDVI) in March, July and October of each year according to a 250-meter, 500-meter, 1,000-meter, and 2000-meter circular buffer around each school. Spatial Generalized Linear Mixed Models (GLMMs) estimated the impacts of surrounding greenness on school-based performance. Overall the study results supported a relationship between the “greenness” of the school area and the school-wide academic performance. Interestingly, the results showed a consistently positive significant association between the greenness of the school in the Spring (when most Massachusetts students take the MCAS tests) and school-wide performance on both English and Math tests, even after adjustment for socio-economic factors and urban residency. [ABSTRACT FROM AUTHOR]

Many species of mature forest-nesting birds (“forest birds”) undergo a pronounced shift in habitat use during the post-fledging period and move from their forest nesting sites into areas of early-successional vegetation. Mortality is high during this period, thus understanding the resource requirements of post-fledging birds has implications for conservation. Efforts to identify predictors of abundance of forest birds in patches of early-successional habitats have so far been equivocal, yet these previous studies have primarily focused on contiguously forested landscapes and the potential for landscape-scale influences in more fragmented and modified landscapes is largely unknown. Landscape composition can have a strong influence on the abundance and productivity of forest birds during the nesting period, and could therefore affect the number of forest birds in the landscape available to colonize early-successional habitats during the post-fledging period. Therefore, the inclusion of landscape characteristics should increase the explanatory power of models of forest bird abundance in early-successional habitat patches during the post-fledging period. We examined forest bird abundance and body condition in relation to landscape and habitat characteristics of 15 early-successional sites during the post-fledging season in Massachusetts. The abundance of forest birds was influenced by within-patch habitat characteristics, however the explanatory power of these models was significantly increased by the inclusion of landscape fragmentation and the abundance of forest birds in adjacent forest during the nesting period for some species and age groups. Our findings show that including factors beyond the patch scale can explain additional variation in the abundance of forest birds in early-successional habitats during the post-fledging period. We conclude that landscape composition should be considered when siting early-successional habitat to maximize its benefit to forest birds during the post-fledging period, and should also be included in future investigations of post-fledging habitat use by forest birds. [ABSTRACT FROM AUTHOR]