Boston University School of Public Health

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Student PracticumAbstracts

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Fall 2015

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BUSPH Student Practica Fall 2015

The BUSPH Office of Public Health Practice is pleased to present the Fall 2015 Student Practicum Abstract Book featuring

students’ practicum experiences. Our office would like to congratulate this semester’s practicum students for their

accomplishments and express our appreciation to the agencies and organizations for their commitment to the BUSPH practicum program and for providing our students with valuable, hands-on

public health experience.

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Table of Contents

Biostatistics………………………………………………7

Environmental Health…………………………………...9

Epidemiology …………………………………………..11

Global Health……………………………………………..19

Health Law, Bioethics, & Human Rights……………….29

Health Policy & Management …………………………..31

Maternal & Child Health ………………………………...41

Social & Behavioral Sciences ……………………….....45

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Biostatistics

Name: Chen, YutingPracticum Site: Boston University Goldman School of Dental MedicineLocation: Boston, MA United StatesTitle: Data Research Intern

Introduction: The practicum organization, The Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD) ‘s site is in the department of Health Policy & Health Services Research of Boston University School of Dental Medicine. CREEDD’s mission is to improve oral, dental and craniofacial health through research, research training, and the dissemination of health information, with a focus on the elimination of oral health disparities between lower and middle SES classes. The project focuses on analyzing social networks of low-socioeconomic status (SES) public housing women at childbearing age. The objective is to utilize the outcome of the analysis to design oral health interventions targeted at this community and decrease oral health disparities between this community and middle to upper classes.Methods: The project involved first interviewing the subjects to obtain information from Egos and Alters and then utilize the Microsoft ACCESS to conduct double data entry. SAS programming was then used to find and address data entry errors; SAS macro file are created to conduct the data cleaning. After the data preparation, a preliminary analysis will begin.Results/Outcomes: The double data entry for egos interview forms are almost done and validation is going on simultaneously the same time. Overall, analytic data preparation for egos is almost complete.

Name: Fortu, KarenPracticum Site: Boston University School of Public Health (BUSPH) - Data Coordinating CenterLocation: Boston, MA United StatesTitle: Research Assistant

Introduction: The Data Coordinating Center (DCC) supports investigators in their research endeavors from data management and database systems development to statistical programming and analysis with the aim of generating the highest quality of data. As a data management resource center, the DCC’s experience is reflected in the various projects and initiatives it has been and is currently involved in. As a research assistant at the DCC, I worked as part of a larger team and supported data management of ongoing projects including the Center for Chronic Traumatic Encephalopathy (CTE), the Narcan Program, and the Longitudinal Health Survey of the Fort Devens Cohort of Gulf War Veterans.Methods: I assisted in the audit of the data from the Boston University Alzheimer’s Disease Center (BU ADC). Also, I heavily supported the adjudication of the Fort Devens Survey data using Research Electronic Data Capture (REDCap) software. I also assisted in verifying data collection forms of the Narcan Program.Results/Projected Outcomes: The successful audit of the BU ADC data assures data integrity as well as quality data for analysis. The Fort Devens Survey data adjudication resolved discrepancies in the double data entry system, producing a merged dataset that is standardized based upon the investigators’ specified criteria. Regular verification of the Narcan Program data collection forms ensures an updated database system and allows the data and project managers to communicate issues to the research sites in real-time for resolution.

Name: Kulics, MilanPracticum Site: Silver Pine Medical GroupLocation: Sterling Heights, MI United StatesTitle: Intern at Silver Pine Medical Group

Introduction: Silver Pine Medical Group is a patient-centered medical home (PCMH) in Sterling Heights, MI that serves a large population with chronic illnesses. One group of interest was the diabetic population and their access to quality care in a PCMH setting. The evaluation of the use of electronic medical record (EMR) technology in providing care to the diabetic population at Silver Pine Medical Group, as well as general effectiveness of such technologies in a PCMH setting, were the main objectives of this practicum.Methods: A literature-based review of PCMH structure and guidelines for technology integration was conducted in the first few weeks of the practicum. Next, an assessment of the current technologies at Silver Pine (Phreesia tablets and Allscripts EMR) was conducted. Interviews with physicians and nurses at the practicum site were conducted to gain insight into the practicality of the EMR program and its use in everyday work. Several managerial meetings were attended to learn about the management of a PCMH and how actions taken by both physicians and staff contribute to patient wellness.Results/Projected Outcomes: EMR technology seems to have been utilized to a fair degree, based on standards set forth by the NCQA and BCBSM, and access to records or other services via the EMR have made the quality of diabetic patient care somewhat higher. Despite this, costs of implementing and maintaining such technology have left little room for additional improvements in care, such as a patient registry or clinical decision support features.

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BiostatisticsConcentration: BiostatisticsName: Rusli, EmellyPracticum Site: Beacon Health OptionsLocation: Boston, MA United StatesTitle: Summer Graduate Associate - Corporate Strategy and Development

Introduction: My position at Beacon Health Options (Beacon) was Analyst/Strategist for their Product Innovation team, which was under the Corporate Strategy and Development department. A main project on which I worked on was a self-managed, mood-tracking App implementation strategy to the U.S. Coast Guard. Suicide associated with depression and workplace distress has been a major concern for the U.S. Coast Guard, which drives the need of a mood-tracking tool. Moreover, I was also working with the Marketing team to write about Beacon’s telehealth solution, a video- based counseling between member and provider.Methods: My roles on those projects were: 1) identifying meaningful outcome measures for implementation of a mood- tracking App to the U.S. Coast Guard, and 2) creating a product sheet for Beacon’s telehealth service. From the mood-tracking App project, I was able to apply my Biostatistics background into a program evaluation design. Additionally, I could also combine my public health and Marketing background to communicate the emerging use of telehealth to enhance behavioral health service delivery regardless of geographical limitations and/or behavioral health provider shortage.Results/Outcomes: I presented to client the list of outcome measures for evaluating this mood tracking App, and the list was positively received. Some measures I used revolved around member’s clinical outcomes, their engagement to Beacon’s EAP services, as well as response rate with the App itself. The telehealth product sheet has been produced and will be presented during poster presentation.

Name: Rusli, EmellyPracticum Site: Boston University School of Dental MedicineLocation: Boston, MA United StatesTitle: Research Data Intern

Introduction: My position at BU School of Dental Medicine served as a Research Data Intern within the Health Policy and Health Services department. I worked on a research project to examine the effect of social network to people’s dental health and their access to dental health service. Study population is women age 18-55 years old who live in Boston public housing. Information about each participant (called "Ego") was collected, as well as her social network (called "Alter"). One "Ego" can have more than one "Alters." The “Ego” data will be entered into an Access database twice to reduce error.Methods: During the practicum, my roles were: 1) to enter “Ego” data from a paper into an Access database, 2) to perform data cleaning and validation using SAS, and 3) to run a preliminary analysis once all “Ego” data have been double-entered using SAS from this experience, I was able to learn about data management (coding, entry, etc.) as well as the importance of cleaning the data prior to analysis. I specifically learned how to use SAS to perform data cleaning (e.g., “proc compare” to compare doubly-entered data), which was essential in my future Biostatistics career.Results/Outcomes: I aim to present the preliminary analysis about the “Ego” by the end of practicum. I will also show the SAS procedure used to perform data cleaning and validation.

Name: Straitz, SamanthaPracticum Site: World Health OrganizationLocation: Geneva 27, SwitzerlandTitle: 2015 Global Survey on Health Technology Assessment by National Authorities

Introduction: Health technologies vary widely in availability and complexity and country leaders face difficult decisions when choosing which technologies to fund that best address their population’s priority health needs. In response to World Health Assembly Resolution 67.23, the WHO 2015 Global Survey on Health Technology Assessment (HTA) was administered to all WHO Member States between February 24 and August 31, 2015. The survey evaluated HTA utilization in public sector decision-making, scope and availability of HTA guidelines, institutional capacity supporting HTA, governance of the HTA process and requirements for strengthening HTA capacity at the government and national institute level. Methods: In June 2015, I wrote and sent a letter to over 100 WHO in- country representatives and Ambassadors of Permanent Missions to the United Nations to ensure completion of the Global Survey and nomination of an in-country health technology focal point. Throughout June-August 2015, I corresponded with these representatives to assist with survey completion. In August 2015, I cleaned all survey response data and submitted this information for analysis and publication.Results/Outcomes: The WHO Health Systems and Innovation Cluster determined that HTA-related organizations play an advisory role in policy decisions, HTA focuses on safety and clinical effectiveness and two in three countries rely on national HTA organizations/departments/committees to analyze and evaluate health technologies and their impact. Additionally, findings show public health professionals and civil society representatives support national health bodies in initiating HTA and a lack of qualified human resources and in-country training programs pose primary barriers to producing and using HTA.

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Environmental HealthName: Cunningham, AmparitoPracticum Site: Harvard Legal AidLocation: Cambridge, MA United StatesTitle: Chronic dampness in homes and health related outcomes for legal testimony

Introduction: The purpose of this practicum was to identify the appearance of chronic dampness in 11 homes as defined in the MA Housing Code (MAHC) 105 CMR 410.020, 410.500, 410.750 (k) and link the presence of chronic dampness to health outcomes in order to use these as legal testimony for negotiations, settlements and educate attorneys and court personnel.Methods: This practicum involved comprehensive literature review around mold, chronic dampness and respiratory conditions. It also included assisting during thorough home inspections. The MAHC was the tool used to assess housing characteristics and conditions, for this practicum the presence of chronic dampness. Medical record review for the cases was also conducted when possible. Attendance to trials in court also happened when feasible.Results/Outcomes: Out of 11 homes, 9 had violations of the housing code 105 CMR 410 under sections 410.500 and/or 410.750(k). In 5 of the homes with violations falling under both sections of the code there were one or more occupants of the home who self-reported suffered from respiratory diseases (asthma). Only in one case the attorney wanted to use the medical history for testimony. Most cases settled without going to trial. There is a long way to go between the legal system and public health in order to make of environmental justice a broader and more comprehensive tool for the health of the families in the homes.

Name: Desanto, JeffreyPracticum Site: Peabody Health DepartmentLocation: Peabody, MA United StatesTitle: North Shore Health Departments of Massachusetts Public Health Accreditation Review

Introduction: The Public Health Accreditation Board (PHAB) is a nonprofit organization dedicated to advancing the quality and performance of tribal, state, local, and territorial public health departments. There are seven steps that must be completed before a public health department receives accreditation. PHAB offers a “readiness checklist,” to assist in preparations for accreditation. For this practicum, I completed a readiness analysis for the eight communities on the North Shore of Massachusetts (Peabody, Danvers, Lynn, Salem, Beverly, Marblehead, Swampscott, and Topsfield). Methods: The first step was research into the twelve goals that must be completed for the accreditation process. Next, two online surveys were created to collect information pertaining to achievements in each goal for each of the eight communities. The first survey focused on goals two and three. Goal two pertains to the investigation of health problems and environmental public health hazards to protect the community, and goal three relates to documentation that informs and educates citizens about public health issues. The second survey focused on goals six and eight. Goal six includes documentation on the enforcing of health laws, while goal eight deals with documentation pertaining to maintenance of a competent public health workforce.Results/Outcomes: Results of the first survey revealed more than 75% of the proper documentation could be located for goal two and more than 60% for goal three. Results of the second survey showed that more than 60% of the proper documentation could be located for goal six and less than 30% for goal eight.

Name: Fresta, ChristinaPracticum Site: Boston University School of Public HealthLocation: Boston, MA United StatesTitle: East Boston Ambient Noise Exposure Assessment

Introduction: Existing literature suggests that exposure to aircraft noise is associated with adverse cardiovascular health. However, the noise metrics primarily used to assess these relationships—the A-weighted decibel—severely discounts infra (0–20 Hz) and low frequency (20–500 Hz) sound. The objective of this study is to investigate the prevalence of infrasound and low frequency noise stemming from aircraft, conducted an exposure assessment in the East Boston community of Boston, MA.Methods: Noise monitoring took place at 52 sites in East Boston, where infra, low, mid, and high frequency noise was collected using an infrasound meter provided by Acentech Inc. Sampling was conducted during the day (7am-7pm) and night (7pm-7am) as well as weekday (Monday- Friday) and weekend (Saturday – Sunday). Additional onsite data collected included meteorological conditions and counts of episodic noise events such as plane, train, and traffic counts and any other audible sounds. ANOVA will be conducted to test for statistically significant differences in mean noise levels. Spearman and Pearson correlations will be used to assess associations between noise metrics and transportation, episodic noise event counts, as well as meteorological and land use variables. Ongoing updates on sampling and analyses are provided to East Boston residents via social media.Results/Projected Outcomes: We anticipate noise in each metric to vary by time of day and day of week for each East Boston neighborhood (Eagle Hill, Jefferies Point, and Orient Heights), which each vary uniquely in distance from Logan International Airport, land use, and elevation. Results of this study will be disseminated to East Boston residents via a report and presentation.

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Environmental Health

Name: Huang, CassiePracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Children's HealthWatch Practicum Student

Introduction: Housing and shelter is an environmental factor that most people take for granted. Over 600,000 people were homeless on a single night in 2013, and one-quarter of these people were children under 18 years old. Poor housing conditions a vulnerable period of a child’s development can contribute to many adverse health effects including increased rate of hospitalizations, impaired cognitive development, and poor growth. Children’s HealthWatch is a network of doctors and researchers whose goal is to improve children’s health in America. They collect data in hospitals on infants and toddlers of families experiencing economic hardship. The interview contains environmental components, including questions regarding access to shelter and provision of heat and food.Methods: (1) Comprehensive literature review conducted to synthesize current research on the impacts of governmental assistance programs for families in need. (2) Analysis of cross-sectional data collected in urban hospitals from interviews on household demographics and maternal and child health status, including prenatal and postnatal housing situation, and birth weight and gestational age.Results/Outcomes: (1) Analysis yielded that access to food programs promoted healthier eating overall and influence non-participants through availability of WIC foods in stores. SNAP and WIC have a positive impact on maternal and child physical and mental health. CACFP improves nutrition in care facilities. Mobile vouchers for housing opportunities lead to improved family heath and growth, fewer monetary tradeoffs, and better school functioning in children. (2) Odds of homeless families having adverse child and maternal health outcomes, and household hardships are higher.

Name: Jump, EmilyPracticum Site: Boston Bikes, City of BostonLocation: Boston, MA United StatesTitle: Bike Equity Program Assistant, Boston Bikes

Introduction: The City of Boston recognizes that bicycle commutes provide health benefits to riders and result in lower levels of urban air pollution. Through an innovative collaboration with the Boston Medical Center (BMC), Boston Bikes seeks to increase bike access and use among low income Bostonians, a population with low rates of bike use. The Prescribe-a- Bike program leverages a network of BMC physicians trained to offer low income Bostonians “prescriptions” for $ 5 annual bikeshare memberships.Methods: I focused on expanding Prescribe-a-Bike’s scope, reach, and visibility with the goal of increasing bike use among low-income Boston residents. I conducted a review of existing literature on bikeshare programs, held interviews with prescribing physicians to identify gaps/barriers to prescribing and patient uptake, provided training to physicians and other caregivers on using EPIC to write digital “prescriptions”, and increased program visibility through a campus-wide media outreach strategy. Through our networks, we identified and met with leaders at two Community Health Centers in order to expand the Prescribe- a-Bike model beyond BMC.Results/Projected Outcomes: Throughout Prescribe-a- Bike’s second season, I 1) continued outreach to primary care physicians and extended training to nurses, physician’s assistants, nutritionists, and physical therapists; 2) coordinated outreach through BMC’s media and communications team, Transcomm, the BMC Food Pantry, Test Kitchen and WIC program offices; and 3) helped expand the Prescribe-a- bike model to Boston’s South End and Upham’s Corner Community Health Centers.

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ENVIRONMENTAL HEALTH

Epidemiology

Name: Alkhulaif, FatimaPracticum Site: Boston University School of Public Health (BUSPH) – Data Coordinating Center Location: Boston, United StatesTitle: Research Assistant

Introduction: As a research assistant at the Data Coordinating Center (DCC) at Boston University School of Public Health, I worked on the study Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH). The goal of the URBAN ARCH study is to examine alcohol use and consequences in people with HIV infection affected by multiple substances and to mitigate its harm by developing interventions to reduce alcohol use. The URBAN ARCH was conducted at multiple sites: Boston, Uganda, and Russia. The purpose of this practicum is to assist the research team of URBAN ARCH in the set of the data collection tools, data management and data verification in a cohort and randomized clinical trial in RussiaMethods: I worked with the research team of ARCH Russia: 1) to help in maintaining project documentation; 2) to assist in testing electronic forms; 3) to verify data collected utilizing the TELEForms scannable data collection system; 4) write and/or modify a SAS program to call in and check data quality; and 5) to attend weekly study meetings.Results/Outcomes: The writing and modification of a SAS code to create reports on URBAN ARCH and perform periodic data quality assessment, the verification and auditing of TELEForms and other data quality checks.

Name: Armstrong, BrettPracticum Site: Brookline Department of Public HealthLocation: Brookline, MA United StatesTitle: Youth Risk Behavior Survey Data Analysis Intern

Introduction: The Brookline Department of Public Health’s (BDPH) mission is to monitor and improve the health and quality of life of people living and/or working in Brookline, MA through environmental, community, and clinical initiatives. The Brookline Substance Abuse and Violence Prevention Program, a division of BDPH, is tasked with implementing the Youth Risk Behavior Survey (YRBS). The YRBS, a biannual survey that assesses Brookline High School and Middle School students’ participation in various risk behaviors, was administered in the spring of 2015. My practicum project encompassed its data analysis and reporting of results.Methods: The Youth Risk Behavior Survey, which included one dataset of responses from 1,571 high school students and one dataset of responses from 946 middle school students, was analyzed using Excel and SPSS. The BDPH director, division director, and I met regularly to assess the progress of the analysis, from data cleaning and determining prevalence of risk behaviors to the writing of the report.Results/Outcomes: The Survey results were analyzed for the overall prevalence of risk behaviors. The behaviors were also stratified by grade level, gender, and race. The findings, including Brookline results from previous years and 2013 Massachusetts and U.S. results, form the basis of the report. I constructed over one hundred charts and graphs to display recent trends, stratified prevalences, and comparisons with state and national data. The report is close to completion and the final step of the project is a presentation to Brookline stakeholders, including the High School’s Wellness Committee in December 2015.

Name: Ciccolo, GiaPracticum Site: Brookline Sister City OrganizationLocation: Brookline, MA United StatesTitle: Follow up Study of Chronic Kidney Disease epidemic in Rural Nicaragua

Introduction: In 2008, an initial population-based prevalence study was done identifying those with Chronic Kidney Disease (CKD) in the municipal of Quezalguaque, Nicaragua (O’Donell et al. 2010). The results suggested a high prevalence of the disease, like many others yet none had studied the same population over time to evaluate a cumulative incidence of CKD.Methods: Under the instruction of Dr. Brooks (PhD) Dr. Amador (MD) and Dr. Ramirez (PhD, MD) my team and I began the follow up study in May 2015. Prior to arrival I worked on the study preparation including construction and translation of questionnaires and documents as well as ascertainment of IRB approval. In the field, with help of community leaders we organized clinics or visited homes of the pre-determined subset of the cases and controls from the 2008 study. We conducted interviews, took blood pressure and collected urine, saliva, and blood samples from each participant. Additionally, I categorized the preliminary data into both de -identified and master data sets. I also engaged in preliminary validation analyses to compare the creatinine levels measured by the stat sensors versus intravenous blood results.Results/Outcomes: The results are currently undergoing analysis and will hopefully provide a better understanding of the CKD epidemic in rural Nicaragua over the 7-year time period, allowing a greater understanding of its scope, incidence, causes and morbidity in the population. The information will hopefully directly serve the communities affected in getting one step closer to identifying the causal mechanism for and eventually ending this epidemic.

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EPIDEMIOLOGY

Epidemiology

Name: Cikesh, BryannaPracticum Site: Massachusetts Department of Public HealthLocation: Boston, MA United StatesTitle: Intern

Introduction: Injuries are a serious public health problem in Massachusetts. While the overall percentage of assault-related gunshot and stab wounds is small, such injuries impact our communities disproportionately. WRISS (Weapons Related Injury Surveillance System) is a passive surveillance system, in which hospitals report cases of injury from gunshot or sharp instrument to the Massachusetts Public Health Department. WRISS allows the Department to assess current trends in assault-related gun and sharp instrument related injuries.Methods: I worked with the program coordinator to 1) Enter case reports into the WRISS system. 2) To clean the WRISS data from previous years. 3) Find trends of Weapon related Injuries from 1994 to 2013 using Statistical Software. 4) Find groups at risk for being cases of assault-related gun and sharp instrument related injuries using 2012 data.Results / Outcomes: Our results found over all weapon related injuries for all intentions decreases after 1994. The crude rate of weapon related injuries for 2012 was 29 cases per 100,000 people, with a majority of them being from sharp instrument wounds. Those who were male Caucasian and between 15-24 years of age, accounted for rate of cases in assault-related gun and sharp instrument related injuries. Male African Americans between the 15-24 years of age were found to account for the second highest rate of cases assault- related gun and sharp instrument related injuries. With weapon related injuries having a heavy toll on Massachusetts residents, this data can be used for policy decisions and future prevention measures.

Name: Corpuz, KathrynaPracticum Site: PalladiumLocation: Washington, DC United StatesTitle: Research Assistant Intern for Stigma and Discrimination Project

Introduction: Palladium is a global health consulting firm that has worked in development and international health for over 50 years. In collaboration with Persons Marginalized and Aggrieved (PEMA) Kenya, a Mombasa-based NGO, Palladium has begun to implement the Department of State’s Global Equality Fund project: Facing Our Fears. This project aims to strengthen LGBT human rights in Kenya through the sensitization and training of religious leaders on issues affecting gender and sexual minorities.Methods : I virtually collaborated with the team from Palladium to provide research and project management support through these activities: 1) collected demographics about practiced religions in Kenya; 2) reviewed PEMA’s original curriculum and provided comments to assist with initial revisions; 3) identified potential stakeholders; 4) searched for resources on existing curricula about LGBT human rights and religions; 5) mapped out writings of African theologians on gender and sexual diversity; 6) reviewed the project proposal and monitoring plan to determine strategies for program evaluation.Results/Outcomes: From my research, I produced two information sheets about practiced religions and potential stakeholders from local organizations in Kenya. I also developed an extensive annotated bibliography on African theological writings and an accompanying report on major themes to guide conversations of religious leaders on issues related to gender and sexual diversity. Lastly, I created a draft of an evaluation plan to support project implementation.

Name: DiBella, JacquelinePracticum Site: Boston University School of MedicineLocation: Boston, MA United StatesTitle: Research Assistant

Introduction: Asthma is a chronic lung disease that causes the airways to become inflamed. Researchers recognize that asthma is a genetic disorder, but are beginning to examine how genetics and environmental factors interact to fully understand the disease. The children enrolled have been participants since 2004. The children are seen annually in clinic for various testing, questionnaires, and biological sample collection. Throughout the study, the researchers have collected environmental data including dust samples from the participants’ home. The primary purpose of the URECA study is to determine the wheezing and asthma phenotypes in minority children growing up in urban neighborhoods as they develop from birth to adolescence.Methods: I worked with the researchers in the ICAC studies to 1.) Assist in the transition from one data management system to a new system and help with data-entry into both; 2.) Attend clinic with participants and take measurements as well as collect, label, and store samples from each child; 3.) Assist with other administrative activities like preparing and breaking down binders, filing forms from clinic and phone questionnaires, and recruitment.Results/Outcomes: It is important for researchers to have a reliable and easy way to record data while in clinic. The new data-management system will help the team record relevant information that can assist in collecting data for each participant. The ICAC team is hopeful that information on the wheezing and asthma phenotypes in inner-city children will help in understanding how asthma works and why there is a greater prevalence in urban environments.

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EpidemiologyName: Farmer, AshaPracticum Site: Centers for Disease Control and Prevention (CDC)Location: Atlanta, GA United StatesTitle: Graduate Student Data Analyst - PLAY-MH

Introduction: Project to Learn about Youth Mental Health (PLAY-MH) is a study that collects screening data on school- aged children from teachers, and diagnostic interview data from parents and the children themselves. The current data is of adolescents in grades ranging from kindergarten to twelfth grade from the states South Carolina and Colorado. The study tests the prevalence of many different mental health disorders. This section focused on tic disorder symptoms and Tourette’s disorder.Methods: I worked closely with the lead Biostatistician of the project to transfer the questionnaire to match the new DSM-V code for tic disorders. We worked in SAS throughout my practicum to continuously run new codes and develop new questionnaire transferred from the previous DSM-IV manual.Results/Outcomes: I developed a scoring algorithm for a measure designed to identify children who meet criteria for tic disorders that was newly developed for this project and used collected data to test the scoring algorithm on SAS.

Name: Frohlich, LillianPracticum Site: Boston Children's HospitalLocation: Boston, MA United StatesTitle: Clinical Research Coordinator - Testicular Torsion Study

Introduction: In my role as a Research Coordinator at Boston Children’s Hospital in the Emergency Department (ED), I assisted with a study addressing the effectiveness of a clinical tool used to diagnose Testicular Torsion (TT) in males. The objective of this study is to identify clinical variables associated with TT and elaborate a scoring system for prediction and diagnosis of torsion applicable for general practitioners. The use of a scoring system to help non-specialists diagnose TT could decrease the time spent with testicular ischemia, which would decrease the likelihood of testicular non-viability and reduce the cost of treatment for patients presenting with acute scrotal pain. The purpose of my practicum was to aid in participant enrollment and to determine the use of urinalysis in the evaluation of males presenting with acute scrotal pain.Methods: My responsibilities included: 1) enrolling participants into the study; 2) assessing the recruitment rates for the manuscript; 3) conducting a chart review for participants to determine the use of urinalysis, urine culture, ultrasound, STI testing, and Urology consultations. Results/Outcomes: My projected results include: 1) A drafted “Figure 1” including all patients presenting to the ED with testicular pain/swelling, numbers of who was excluded and who was missed, and the proportion of those enrolled who were diagnosed with TT; 2) Assessment of the utilization and results of urinalysis for the population enrolled, stratified by diagnosis.

Name: General, KevinPracticum Site: Slone Epidemiology CenterLocation: Boston, MA United StatesTitle: Research Assistant

Introduction: Larger than recommended doses (>4g/day) of acetaminophen (APAP) can result in potentially adverse reactions. Understanding the trends in APAP use and nonuse is essential in identification of potential violators (those who use >4g/day of APAP). The Slone Epidemiology Center (SEC) is involved in a long term program of behavioral surveillance of APAP users and non-users. The SEC assists in the development of survey protocols and instruments and the analysis of subsequent data.Methods: Developed codes and codebook with specified indicators to make open-ended questionnaire data more user friendly and to aid in qualitative data analyses. Manipulated, cleaned, and extracted necessary survey data using Microsoft Access and Excel in preparation for quantitative analyses. Completed summary measures related to physician prescriptions and violators compared to non-violators.Projected Outcomes: Data analyses are ongoing. Results from the analyses will help provide measures of attitudes, knowledge, and behaviors relative to APAP use and provide methods to track changes in these measures. Understanding trends in APAP utilization will help to determine the focus and potential impact of consumer product education initiatives.

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Name: Hall, JuliaPracticum Site: National Institute of EpidemiologyLocation: Madrid, SpainTitle: Research Intern

Introduction: Working for the National Surveillance Network at that National Institute of Epidemiology (INE) in Madrid I have learned how a disease surveillance network works, from the reporting of diseases through automated computer programs, to managing compliance of all of the representative areas of a country in order for the whole system to work. I was given the lead on two very different studies investigating data previously collected from the INE.Methods: The first study is a temporal and spatial cluster analysis of potential outbreaks of Shigellosis in Spain from 2008 until 2013 using SATSCAN. The second study is a time- series analysis using a negative binomial regression model, in order to detect associations between the seasonality of Influenza and Meningococcal Disease (MD).Results: In the investigation of Shigellosis outbreaks, there were 13 significant (P<0.05) spatial-temporal clusters detected in comparison to 45 registered outbreaks during this period, which had a correlation of Rho=0.64. Soon we will complete the analysis of environmental risk factors on registered outbreaks. While in the second study, seasons from 2000 until 2014 were investigated and the peaks of MD and influenza were correlated with a Rho=0.80 (P=0.0007), while the negative binomial model resulted in a relative risk of 1.0014, meaning with every 1 case of Influenza the chance that a MD case will occur increases by 1.0014. The projected outcomes for my two projects are articles in order to shed light on significant relationships between occurrence of two diseases and between environmental factors and outbreaks of Shigellosis.

Name: Hollender, KathleenPracticum Site: Cambridge Health AllianceLocation: Cambridge, MA United StatesTitle: ICH Data Analysis Intern

Introduction: The Learning, Engaging, and Advocating with Peers Project sought to improve the health of people living with HIV/AIDS by providing comprehensive support from crisis to stability and self-sufficiency. The program connects high-risk, HIV-positive US and foreign-born women, MSM, and IDUs to HIV medical care. The purpose of the practicum was to identify the demographic characteristics as well as evaluate the overall success of the program through the analyses.Methods: Data was collected and combined from multiple data sources as well as analyzed using SAS computer software. Demographic characteristics of all participants were recorded as well as baseline information on characteristics such as housing stability, mental health (using the Kessler score), viral load, and CD4 count; information was also taken at 6 months, 12 months, and 18 months after baseline information was recorded.Results/Projected Outcomes: It is important for program supervisors to have information on the success of the program through the evaluation of how clients changed on key baseline characteristics and follow-up assessments. It is also essential for public health practitioners to be able to analyze and interpret the success of a program through the collection and evaluation of data taken from various data sources. At the conclusion of the practicum, program supervisors will have the analyzed data in order to determine the degree of success of the LEAP program.

Name: Hu, JensenPracticum Site: University of California, Los AngelesLocation: Los Angeles, CA United StatesTitle: Public Health/Statistical Support Intern

Introduction: As a research intern at UCLA’s Crump Institute of Molecular Imaging, my role was to assist with the computational aspects of understanding the skin microbiome’s role in the etiology of acne vulgaris. The research was split into two hypotheses: (1) Whether the skin microbiome of related individuals living in the same household are more similar compared to the skin microbiome of unrelated individuals and (2) Can the nose be used as a representative site for sampling the facial skin microbiome in acne vs. healthy individuals?Methods: After meeting with the investigator, I performed bioinformatics analyses from the raw DNA sequencing data using an open-source pipeline, Quantitative Insights into Microbial Ecology (QIIME). After this, I assisted in conducting student t-tests and other relevant statistical analyses to study beta-diversity between multiple facial site microbiomes. Lastly, I created plotted visuals of the data and presented my findings to the members of the Li Lab.Results/Projected Results: The skin microbiome of related individuals living in the same household was more similar [Avg. Unifrac=0.313097 (0.30824)] than unrelated individuals [Avg. Unifrac=0.368287(0.320331)] living in the same household. Comparing multiple facial sites, we found that forehead samples among different individuals had the greatest dissimilarity between skin microbiome communities (0.240042±0.207883), the chin samples had the most similar (0.053034±0.066313), and the nose samples among different individuals were slightly less similar than the chin samples, but with greater stability (0.152636 ±0.043936). Performing a t-test comparing the similarity metric, we found that chin samples were significantly different than nose samples (p-value<.05).

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EPIDEMIOLOGY

EPIDEMIOLOGYName: Ng, WinniePracticum Site: Massachusetts Department of Public HealthLocation: Boston, MA United StatesTitle: Research Associate for MA DPH Division of Global Populations and Infectious Disease Prevention

Introduction: Massachusetts is one of six states that mandate reporting of Latent TB Infection (LTBI). The purpose of my practicum was to perform descriptive analysis on current LTBI reporting patterns in Massachusetts to inform future policy changes and identify best practices.Methods: The 2014 LTBI surveillance dataset was used to obtain demographic (age, gender, race, birth country, residence town) and provider variables (health care facility). The data were cleaned and errors were corrected using Excel and SAS 9.3. A profile of LTBI risk in Massachusetts was created. ArcMap 10.0 was used to illustrate the geographic distribution of high volume LTBI health care reporters in Massachusetts. Results/Outcomes: In 2014, a total of 10,129 LTBI cases were reported in Massachusetts. Based on available reports, the rate of LTBI was 27 times higher for foreign-born persons than U.S.-born persons (95% CI: 24.91 – 28.26). Mapping showed that facilities with high LTBI reporting were located in towns with larger refugee and immigrant populations. Blank entries on the case reporting form were frequent: age (2.1%), sex (8.3%), race (50.8%), birth country (34.5%), and health care facility (58.0%). The data collected will be utilized to inform policy and encourage health care providers to report all LTBI cases in a timely, accurate and complete manner. Higher completion rates of reported LTBI data will provide a more robust dataset for analysis and resource distribution.

Name: Sewalk, KaraPracticum Site: Massachusetts Department of Public HealthLocation: Boston, MA United StatesTitle: PRECEPT Student - Adolescent Health Intern

Introduction: The Massachusetts Personal Responsibility Education Program (PREP) is a state-funded collaborative project between the Massachusetts Department of Public Health (MDPH) and the Massachusetts Department of Elementary and Secondary Education (DESE) that funds 7 community-based agencies and 4 school districts. PREP provides evidence- based curricula that cover topics related to sexually transmitted infections, healthy relationships, birth control methods and use and other related health issues that young adults face. The overall aim of the program is to decrease the teen birth rate in Massachusetts’s communities with high teen birth rates.Methods: Throughout my internship as an Adolescent Health Intern, I assisted in evaluating results from both pre- and post-surveys from the PREP program in the Department of Adolescent Health within the Family Planning Division. My responsibilities included: performing SAS analyses for 7 community-based organizations that participate in the PREP program for fiscal years 2014 and 2015; merging SAS files for pre- and post-surveys for a more concise data set to draw from; generating reports for each site on background characteristics and sexual health behaviors, and comparing each site to the total results of all organizations.Results/Outcomes: Reports for fiscal years 2014 and 2015 were generated for each community-based organization that participates in PREP for agency’s use at annual site visits. We found positive impacts of the PREP program from pre- to post-surveys, such as an increased intention to use condoms and other birth control methods at next sexual intercourse. The SAS code and report templates created will be used for future fiscal year analyses for the PREP program.

Name: Shah, KrutiPracticum Site: Boston Public Health CommissionLocation: Boston, MA United StatesTitle: Intern

Introduction: As a research assistant, my primary responsibility was to perform literature review for states for HIV care continuum. The main objectives were a) To compare US states HIV counting methodologies and data collectionb) To explore how each jurisdiction define their stages of carec) To compare levels of engagement and viral suppression rates of jurisdiction. d) Understand demographics of PLWH (People living with HIV) across jurisdictionMethods: The website of the U.S. Department of Health and Human (DHHS) was used to identify the HIV continuum cascade of every state. HIV surveillance and needs assessment reports of 15 states were used to gather information on methods for data collection on PLWH. Epidemiology profile of each state was reviewed to collect their demographic report. Also, approximately 10 peer reviewed articles were reviewed to understand the complexities of each jurisdiction cascades and to derive conclusions. Literature review helped to identify the reason behind the use of specific methodologies.Results/Outcomes: Our findings indicate that a total of 1.2 million PLWH were present in US in 2012. Moreover, 18% was completely unaware that they were affected by HIV. This signifies that there is an incomplete awareness amongst the population which can be harmful as it can transmit easily amongst the society. We conclude that almost all states had HIV diagnosed cases rate over 80% and national viral suppression rate was 25%.

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EPIDEMIOLOGY

Name: Sullivan, PhilipPracticum Site: Johns Hopkins UniversityLocation: Laurel, MD United StatesTitle: Internship

Introduction: Recent advances in human genetic analysis and the availability of variant databases have created large data stores of genotypes and penetrance data for Mendelian diseases. This project is focused on using open databases to model and predict disease occurrence with allele frequencies ≤1% for a simulated Air Force population.Methods: Hemochromatosis was chosen as the disease model due to its multiple disease states and clinically actionable results, while not precluding individuals from Air Force service. Databases of allele frequencies in ethnic populations included 1000 Genomes and ExAC. OMIM, dbSNP, ClinVar, and ClinGen databases provided information on allele and disease relation. Classification of ethnic populations varied between databases and was standardized to match the Air Force’s classification method. Allele frequencies were recalculated based on new ethnic sorting definitions and sex. Identified SNPs used were: rs1799945, rs1800730, and rs1800562. Carrier status for alleles was determined because of the impact on disease state. The total project population was fit to the Air Force’s reported metrics from 2013.Results: The Air Force population was set to match the 2013 report with a total number of individuals at 326,573, and 81.1% Male. Ethnic groups were divided into 5 categories: African decent (14.2%), European decent (73.0%), and Asian decent (East and South Asian, 4.1%), and Other (8.7%). Estimated cases spanned the range of low penetrance (1%) at 3 cases up to high penetrance (50%) at 156 cases. This is an incidence estimate up to 3.55 times the US general population (based on 2013 census data).

Name: Tobin, CatherinePracticum Site: Boston University School of Public HealthLocation: , United StatesTitle: Epidemiologic Research of Infectious Disease in Boston Homeless Persons / Research Assistant

Introduction This practicum focused on evaluating drug-resistant bacterial carriage and infection among urban homeless populations in high-income countries. I participated in enrollment of subjects as part of a study led by Jessica Leibler of the Environmental Health department of BUSPH on nasal carriage of Methicillin-resistant Staphylococcus aureus (MRSA), a strain of Staphylococcus aureus bacterium resistant to commonly used antibiotics, among urban homeless in Boston. I also conducted a comprehensive literature review exploring bacterial infection prevalence, risk factors, and antibiotic usage among high-income country homeless populations to help inform future research on the subject.Methods I interviewed homeless patients and swabbed for nasal samples at Boston Health Care For The Homeless Program in July 2015 as part of enrollment for a study on nasal carriage of MRSA headed by Jessica Leibler. Using well-known databases of scholarly life sciences and biomedical research including PubMed, Web of Science, and Google Scholar, I conducted extensive research around bacterial infections, risk factors, and antibiotic usage among homeless populations in high-income countries, using a narrative synthesis approach to provide information on existing literature on bacterial infections in this population. Results/Projected Outcomes The literature review I conducted provides an outline of current published literature on bacterial infections, risk factors, and antibiotic usage among homeless populations in high-income countries that can be used to inform future research and possible interventions. My participation in study enrollment helped to complete recruitment for a new study that will evaluate prevalence and risk factors for MRSA nasal carriage in the urban homeless.

Name: Wang, WendyPracticum Site: Dana Farber Medical InstituteLocation: Boston, MA United StatesTitle: Financial Management Intern

Introduction: Dana Farber Cancer Institute was founded in 1947 and is a world-renowned cancer treatment and research center that provides care for both adult and pediatric patients. They are committed in providing patients of all ages with the best treatment available today while working on developing future cures through cutting-edge research.Methods: As the financial management intern, I create requisitions, process various transactions, and track invoice payments. I work with a partner IT department on automating the TIMC (Tumor Imaging Metrics Core) billing process. I ensured that nocturnal hospitalists at partnering hospitals are getting billed correctly and worked on RVU (relative value unit) productivity. As the hospital has switched over to EPIC, I’ve been working through sorting and processing a large number of raw data (300,000 rows on average) to create 19 monthly med fee reports for each department using the appropriate med fee schedule for more than ten departments across various institutes. I worked closely with the Clinical Trials Business Office in Research Administration on the quarterly clinical trial salary reports and provide feedback to my direct supervisor, as well as other internal stakeholders. Results/Outcomes: Through my time at Dana Farber, I have become the point of contact for various reports and have been able to contribute to numerous departments. As a result, I have been able to gain insight into the Medical Oncology department and clinical related financial operations.

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EPIDEMIOLOGY

Name: Emily WelchPracticum Site: Boston University School of Public HealthLocation: Boston, United StatesTitle: Evaluation of Streptococcus pneumoniae and non-typeable Haemophilus influenzae co-colonization over a 5-year period following the introduction of PCV13

Introduction: Pneumococcal vaccination of young children has substantially reduced vaccine-serotype pneumococcal disease as well as prevalence of vaccine-serotypes found in the nasopharynx. We examined trends in S. pneumoniae (SP) and non-typeable H. influenzae (NTHi) co -colonization in young children attending primary care at Boston Medical Center following the introduction of 13-valent pneumococcal vaccination in this population.Methods: Data for this study came from a large on-going surveillance study of nasopharyngeal colonization among children <5 years from July 2010 – March 2015. I conducted extensive data cleaning of demographic, clinical, and microbiologic data, generating a final data set for analysis. I calculated summary statistics to describe the study population, SP, NTHi, and SP- NTHi co-colonization overall and stratified by patient characteristics and calendar time. Logistic regression was used to estimate the association between NTHi and SP colonization, adjusting for confounders.Results: Overall, 17.8% of the study population was colonized with SP only, 4.8% was colonized with NTHi only, and 3.2% was colonized with both simultaneously. During the 5-year study period SP and NTHi colonization both declined (relative decline of 50.2% and 67.8%, respectively); this decline was observed for all age groups. Univariate analyses demonstrated that nasopharyngeal colonization with one bacteria was positively associated with colonization by the other bacteria: NTHi-colonized children were 2.1 times as likely to be co- colonized with SP compared to NTHi-negative children, and SP-colonized children were 2.5 times as likely to be co-colonized with NTHi compared to SP-negative children. This association was attenuated after controlling for age, recent respiratory tract infection, recent antibiotic use, daycare attendance, and calendar time.

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GLOBAL HEALTH

Global Health

Name: Ajayi, GracePracticum Site: Global Health Fellows Program IILocation: Washington, DC, United StatesTitle: PEPFAR HIV and AIDS Care and Treatment Data Analysis for Targeted Impact

Introduction: The Office of HIV/AIDS Technical, Leadership, and Research division provides technical guidance to advance USAID’s PEPFAR efforts. PEPFAR 3.0 has refocused its vision to include data driven targeting of key geographical areas and programs servicing PLHIV to improve HIV incidence rates. The division plays a critical role in this pivot by providing technical assistance and leading research efforts to improve partner countries’ HIV services across the continuum of care (COC).Methods: My activities included (1) data analysis of 36 country and site - level FY2014-2015 PEPFAR care and treatment indicators reported by PEPFAR partners (2) an abstract creation based on a literature review of evidence-based ART adherence interventions to achieve virologic re - suppression for PLHIV in low and middle income countries (3) assisting with Phase I implementation and evaluation protocol development of USAID’s first Test and Treat Pilot Study in Senegal through an in-county site visit, development meetings with stakeholders and partners, and interviews with key populations.Results/Outcomes: PEPFAR 3.0’s goal of achieving sustainable epidemic control of HIV is dependent on sound data for greater impact. Analysis of PEPFAR country HTC outputs helped to identify shortcomings for service targets across the COC and assisted the TLR division with prioritization of TA needs in 27 countries for the upcoming year; furthermore, analytic research results will provide the Care and Treatment team with evidence- based interventions to be considered for implementation in the field and test and treatment feasibility study results will identify efficient and effective intervention strategies for ART eligibility expansion in resource limited settings.

Name: Bhaloo, JennaPracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Research Assistant for Treating Comorbid Depression during Care Transitions Using Relational Agents

Introduction: Depression is a strong risk factor for avoidable 30-day re-admissions into the hospital post-discharge and is often associated with poorer clinical outcomes. Despite being a treatable condition, few people with chronic pain and comorbid depression receive effective treatment because of limited insurance coverage and the difficulty of finding a psychologist or psychiatrist. Cognitive Behavior Therapy (CBT) is an effective way of treating depression. CBT helps patients to understand how thoughts and feelings can influence their behavior and teaches them how to transform their negative thoughts into more positive actions.Methods: For my practicum, I participated in a research study at Boston Medical Center to develop a relational agent system, designed to deliver CBT treatment to patients with chronic pain and comorbid depression following hospital discharge. I worked with the principle investigator and a licensed mental health clinician to develop the scripts for the relational agent named Sophie. Sophie has been designed to teach core CBT topics in a six-module system that will be delivered to patients’ post- discharge on a tablet. The modules consist of 1) an introduction to depression and CBT 2) thought-feeling connections 3) transforming thoughts 4) behavioral activation 5) stress and pain management and 6) self- management and maintenance.Results/Projected Outcomes: The CBT module scripts were finalized and sent to our coding team at Northeastern University who will create an application that will run the program on a tablet. The projected start date for the pilot test of the program is November 2015.

Name: Breegi, DannyPracticum Site: Breegi Scientific, Inc.Location: Woburn, MA United StatesTitle: Researcher

Introduction: Every year, over fifteen million babies are born pre-term and more than one-million infants die from easily treatable complications such as hypothermia, infection, respiratory issues and jaundice. More than 90% of these babies are born in Asia and Africa, in improvised and low-resource settings. Breegi Scientific Inc. seeks to test the capabilities of a portable infant incubator as a contained, modular clinical enclosure for infant treatment while also being cost-effective enough to perform various neonatal treatments without the prohibitive costs associated with current incubators and or the lack of functionality from partial solutions. This proposal will outline our proof-of-concept testing strategy in rural Honduras. A preliminary testing proposal was created by integrating a needs assessment that was taken in Honduras in September of 2015 by our CEO, Dr. Wisam Breegi with a group of Honduran health officials along with current health research from Honduras and similar low-resource settings.Methods: I worked with the CEO of the company to complete a proposal for field testing a medical device, including: 1.) an introduction for our proposal; 2.) an updated situation analysis; 3.) a gap analysis; 4.) a data gathering strategy; 5.) logistical priorities 6.) a monitoring and evaluation plan; 7.) an access framework.Projected Outcome: Complete the core components of a medical device testing proposal to inform potential partners and our own research and development team.

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Name: Choudhury, NandiniPracticum Site: Harvard School of Public Health Location: Boston, MA Title: Intern for Disaster Resilience and Response Program, FXB Center for Health and Human Rights, Harvard SPH

Introduction: Natural disasters are highly detrimental to public health in both the immediate aftermath of a disaster, and in the ensuing longer-term recovery. Asia is the world’s most disaster prone region with factors like urbanization and infrastructure compounding its geographical vulnerabilities. As part of its Disaster Resilience and Response Program, the Harvard FXB Center for Health and Human Rights is developing a suite of five detailed case studies focusing on disasters in Asia. The goal of these case studies is to simulate a creative learning experience that imparts lessons learned and best practices for response to future disasters. I was responsible for helping develop a case study on the earthquakes that occurred earlier this year in Nepal.Methods: I conducted desk- based research and a thorough review of the scientific and grey literature concerning the pre-existing preparedness and vulnerabilities in Nepal, earthquake events and the response that followed. I also interviewed stakeholders who were involved in the response, drafted the written case study and worked closely with project team members to help plan its translation into an e-Learning format. Results/Projected Outcomes: The final product of the case study “On Shaky Ground: Disaster Preparedness and Response in Nepal”, accompanied by the e- Learning module, will be used by MPH programs at the Chinese University of Hong Kong (CUHK) and Hong Kong University (HKU) to train students in disaster preparedness and response.

Name: Clarke, ChelseaPracticum Site: SwastiLocation: Karnataka, IndiaTitle: M&E intern, Avahan Project

Introduction: The Avahan Initiative is a Bill and Melinda Gates Foundation project that was created in 2003 to prevent and reduce HIV infections among at-risk populations in India including female sex workers, transgendered people, and men who have sex with men. Swasti Health Resource center has been monitoring the key activities, outputs, outcomes, and impact of the project since 2012 and has begun conducting an internal evaluation at the outcome level to test the effectiveness of the combined strategy (of crisis response, reducing social and economic vulnerabilities, and strong community organizations) to achieving the impact of sustained HIV prevention among India.Methods: My activities included 1. Creating quantitative and qualitative monitoring tools including the MECT (Member Engagement Community Questionnaire) to measure impact and outcomes 2. Revising the state, district, and regional level dashboard 3. Creating a Community Organization performance tracking system as well as a monthly progress report for programmatic feedback and training manual 4. Making improvements to the COPI (Community Ownership and Preparedness Index) and developing an analytical framework for MECT 5. Helped pilot a mobile health application to be used in the feld by community health workers.Results/Outcomes: The evaluation is ongoing and is expected to conclude by fall 2017. As this project has lasted many years, the work I completed is important for understanding whether the context of the program is changing and how this will affect the performance of the intervention. I gained a better understanding of what’s needed to support large-scale global health programs while interning at Swasti.

Name: Dawson, MaryPracticum Site: Boston UniversityLocation: Boston, MA United StatesTitle: Co-Investigator, National Review of Protocols on Identification of Human Trafficking

Introduction: Most human trafficking survivors access the health care system at least once while trafficked. Health providers are uniquely positioned to identify survivors, yet most have no formal training on human trafficking, believe their patient population is not affected, or lack confidence in their ability to identify survivors. This is a meta-analysis of current medical institutions’ procedures for identifying and treating survivors.Methods: Protocols (N=30) were selected through convenience sampling. Protocols were defined as any document which outlines identification and/or treatment of human trafficking survivors, including those drawn from other sources that are used at the institution (i.e., doesn’t have to be original). When multiple documents were received from an institution, they were coded together as one protocol. Investigators developed a coding scheme, independently coded, compared results, and discrepancies were settled until a conclusion was reached. Inter-rater reliability was 94.5%. Results/Outcomes: Most protocols were limited scope; for example, 80% did not specify screening accompanying friends, or primarily focused on children (30%) or sex trafficking (27%). While most defined human trafficking, few identified local prevalence or risk factors for victimization (e.g., homeless, runaway, or LGBTQ youth). Guidance on screening, reporting, referral to services, and follow-up is summarized. In addition, “red flag” indicators of human trafficking (e.g., exploitation, communication, appearance, housing, physical and mental health indicators) are also provided. Results provide guidance on important components of protocols for institutions where no procedures are in place.

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GLOBAL HEALTH

Global HealthName: Desrochers, ChelseaPracticum Site: The Batey FoundationLocation: Bethlehem, NH United StatesTitle: Community Needs Assessment: Batey Naranjo, Santo Domingo, Dominican Republic

Introduction: They Batey Foundation has been working in the Bateyes of the Dominican Republic for 15 years and has focused its efforts mainly on education and infrastructure projects, until recently where they expressed interest in expanding their outreach to include public health programs. This practicum focused on completing a community needs assessment in Batey Naranjo to determine the current health situation and to guide the organization towards designing programs to target these needs. Methods: To complete this assessment 1) met with key-stakeholders and community leaders to develop a situation analysis; 2) created a 4-page questionnaire consisting of 30 questions; 3) 460 interviews were conducted including 1690 individuals; 4) inputted data and analyzed; and 5) created a report to outline the health needs and concerns of Batey Naranjo and presented to the Board of Directors and community. Results: The top health concerns that were reported in the community were hypertension, diabetes, parasites and asthma. Of the 1,690 individuals included in the assessment preliminary data reveals that 4.3% (n=73) reported to be diagnosed with hypertension, .8% (n=14) reported being diagnosed with diabetes, 2.4% (n=40) reported having parasites within the past 3 months and 1% reported having asthma (n=16). In addition, there were also alarming rates of sugar and salt consumption of an average of 2lbs of salt and 5 lbs of sugar being consumed by families weekly. Presently, the results of this assessment are being used to develop a community based prevention and education intervention that target reduction in salt consumption.

Name: Donahoe, KateriPracticum Site: Pulitzer Center on Crisis Reporting Location: Washington, DCTitle: Global Health Reporting Fellow, “Female Genital Cutting in Mali: What Keeps the Practice Going and What’s Being Done to Stop It”

Introduction: The Pulitzer Center on Crisis Reporting is a non-profit, journalistic organization that sponsors international reporting trips and projects that provide an analysis of previously underreported issues. As one of their Student Fellows in the summer of 2015, I traveled to Mali to collect research and conduct interviews on the topic of female genital mutilation for the purposes of creating a comprehensive and compelling project that conveys the multifaceted nature of this issue and tells stories that would go unheard under normal circumstances.Methods: Prior to departing for Mali, I worked at the Pulitzer Center in D.C. for two weeks, preparing for my trip, compiling essential information and contacts, and participating in workshops/meetings with Pulitzer Center staff and journalists on topics such as international reporting, ethics, and social media. In Mali, I arranged to work with a fxer/translator and set up over 30 separate interviews and meetings, including travel to a village outside of Bamako, observing a community workshop on the topic, and visits with traditional sexual guides and practitioners of FGC. I recorded nearly every interview and took dozens of photographs.Results/Project Outcomes: As part of my fellowship contract, I created two personal profiles, a long-form written piece, a photo essay, and an audio slideshow. These pieces are in the process of being published on the Pulitzer Center website, with the possibility of publication in other journalistic outlets. It is my hope that these stories will be seen by key stakeholders and help spread awareness about this issue in Mali.

Name: Douglass, EmilyPracticum Site: The PURE Initiative: Point-of-care Ultrasound in Resource-limited Environments Location: Malvern, PA United StatesTitle: The PURE Initiative: Ramping up Trauma Management at MRRH

Introduction: Evidence of the need for emergency care in sub-Saharan Africa is apparent from the high morbidity and mortality burden resulting from traumatic injuries. I joined a hospital- based study designed to evaluate the impact of an ultrasound training program in basic trauma management at Mbarara Regional Referral Hospital in southwestern Uganda.Methods: This aim of this observational, case-control study is to determine the impact of an ultrasound- based trauma training program on patient management and outcomes of a pre- and post-intervention analysis. We launched baseline data collection in November which will run through January, at which time we will launch the post- training data collection. Our sample size of 1000 subjects will be enrolled from 7:30 am to 11 pm, 7 days a week. As the Research Manager for the program, I traveled to Mbarara to launch and manage the baseline analysis of current practices in trauma evaluation and management. My objectives were to 1. train local nurses as Research Assistants to observe and record patient management in real time; 2. build a database for collection and analysis; and 3. manage the regulatory and administrative components of the study.Results/Outcomes: After 2 weeks of live collection, we have enrolled over 100 patients. Daily follow- up will track patient outcomes and care for 30 days after initial presentation. The ongoing baseline data period will evaluate the current state of management, and distinguish areas which need specific focus in preparation for the interventional training in January.

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Global HealthName: Fadden, MirandaPracticum Site: Sneha Caritable TrustLocation: Tamil Nadu, IndiaTitle: Developing and Implementing Essential Tools for a Comprehensive Approach to Children Living with HIV

Introduction: Snehagram, in partnership with Sneha Care Home, collectively make up the international organization, Sneha Charitable Trust (SCT). Overall, SCT focuses on providing healthcare and support for orphaned and vulnerable children living with HIV in India. Snehagram specifically provides services such as education, vocational training, psychosocial support, and healthcare for adolescents aged 12 -18. At Snehagram, I developed and implemented a template for the electronic medical record system (EMR) and the pharmacy inventory system to better track the usage of supplies and medicines. Lastly, I taught English and Life Skills to emphasize the importance of education in striving for a better, more productive future. Methods: While developing the EMR system, I used Excel to create the template. The template was designed to streamline the health information, such as height, weight, ART status, etc., for all students at Snehagram. After template completion, data from the paper copies were input into the template. Also using Excel, I developed the pharmacy inventory system. The Excel file was designed to track what medicines/supplies are available, being used, and remaining. The third major project was teaching English and Life Skills classes to students who were preparing to study for their national standard exams. Skills such as problem solving, teamwork, leadership, and decision-making were important building blocks for the students’ future.Results/Outcomes: After completion of each project, I made two major observations: all staff at Snehagram should undergo training to understand how the EMR operates and students in all classes need to focus more on conversational English.

Name: Gillespie, CaitlinPracticum Site: Ruma Women's DevelopmentLocation: Boston, United StatesTitle: MCH & Field Assistant: Ruma Women's Development

Introduction: Ruma Women’s Development addresses educational and health needs of mothers and children near Ruma village in western Kenya. The NGO consists of roughly ten Kenyan employees working in a small central office in Ruma and many field visits. The AIDS Orphan Support Program comprises most of their activities and includes financial support for school tuition for orphans, home visits, and counseling. RWD also helped construct Maternal Health Nutrition Units at 2 health facilities. Pregnant women and new mothers come for weight check-ins, nutrition education, and immunizations here. I contributed to daily operations of the AIDS Orphan Support Program and MCH care at these facilities. Methods: I worked with 2 social workers and CHWs to conduct home visits with AIDS orphans. We inspected the home’s structural integrity, adequacy of food and medicine, and psychological well-being. I also visited the Maternal Health Nutrition Units three times weekly to instruct on nutrition and water/sanitation, immunize young infants, issue food supplements to children with Severe Acute Malnutrition, and conduct weigh-ins with children and mothers. Finally, I conducted a self- directed review of summary documents on the previous nutrition project to determine strengths and weaknesses of its implementation and evaluation.Results/Outcomes: After reviewing data from the previous nutrition project research, I issued recommendations to improve data quality and smoothness of operations for the next project in rural development. The community learned more about at- home health practices such as balanced diets and was able to receive higher quantities of treatment and health monitoring from my participation.

Name: Griffin, AjaPracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Infectious Diseases Data Specialist Intern

Introduction: The STD Clinic within the Center for Infectious Diseases at Boston Medical Center provides free HIV and STI testing and counseling for everyone. I used the MPDH Electronic Library Reporting and Communication Provider Portal to observe and enter of STI lab results for patients tested at the clinic. I also developed an independent project, observing treatment and support resources for HIV positive immigrants in Boston. Ultimately, I want to assess how citizenship status affects healthcare seeking behavior for HIV.Methods: I assessed patients' electronic medical records to ensure the correct information was reported, such as insurance information, whether or not he or she saw a nurse, and what medications may have been received at that visit. I then notified the clinic counselors and nurses of the patients' lab results to help determine if they needed to return to the clinic for treatment. I also reported any positive STI cases to the MDPH. For my independent project, I reviewed medical records to compare HIV treatment and resource-seeking behavior of immigrants and US citizens. I also conducted a questionnaire with the STD clinic’s case managers for an in-depth perspective into some of the legal, social, and other issues immigrants face when trying to treat the virus.Results/Outcomes: I predict that there will be an extended amount of issues that immigrants endure compared to US citizens. I presume that these problems are not only legal or socioeconomic, but include cultural aspects, affecting an immigrant’s healthcare and resource-seeking behavior to treat HIV.

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Global HealthName: Hashey, KathrynPracticum Site: Gavi-Global Alliance for Vaccines and ImmunizationLocation: 1202 Geneva, SwitzerlandTitle: Intern/Policy and Market-Shaping Team

Practicum Title: Increasing Vaccine Access and Equity through PolicyIntroduction: Gavi, The Vaccine Alliance was founded in 2000 as a public-private partnership to increase access to new and underused vaccines in the poorest countries around the world. The organization uses a co-financing model to develop long -term sustainability of national immunization programs, with the goal of countries transitioning away from Gavi support as gross national income (GNI) increases. The main objectives of the practicum were to review a sub-policy on product switch grants within the larger Co-financing policy framework; and to conduct a literature review on gender and immunization to inform Gavi's Gender policy. Methods: I worked with the Policy Team to: 1.) review the current switch grant policy through documentation of historic scenarios and consultations within the Gavi Secretariat; 2.) conduct an annual literature review to systematically survey recent literature to identify subpopulations and countries where gender discrimination and gender barriers exist, preventing equity in vaccine access. Results/Projected Outcomes: Revised policy recommendations were drafted to increase clarity and effectiveness of switch grants for countries, as well as Gavi and its partners. Recommendations will be reviewed at the Policy and Performance Committee in December. The literature review found no differences in immunization coverage between boys and girls on an aggregate level. However, in countries were women are of lower status; children are equally less likely to be immunized. Relevant studies will be circulated to key teams within the Secretariat to inform vaccine program implementation and management to ensure accessible and equitable coverage.

Name: Jadhav, MeenaPracticum Site: Rajiv Gandhi Mahila Vikas PariyojanaLocation: Raebareli, IndiaTitle: InternIntroduction: Rajiv Gandhi Charitable Trust helps poor women organize into microfinance based Self-Help Groups (SHGs) and further into SHG federations. The trust is implementing the Uttar Pradesh Community Mobilization Project that delivers a package of family health interventions using the behavior change management approach, through the SHG platforms. It also links mothers and children to health services and other entitlements provided by the government.Methods: I designed and executed a qualitative assessment to gain field insights and conceptualize a model bringing together the economic entrepreneurship of SHGs and government service delivery platforms for child nutrition. Group discussions with 3 SHGs and 4 SHG federations, in-depth interviews with 5 community health workers and 5 health officers from the government, were conducted. Local health facilities and community based service delivery sites with specific focus on child health and nutrition interventions were visited.Results/Outcome: Motivated village leadership, open community meetings, community health workers being members of SHGs, and three-tiered structure of the SHGs parallel to the government health structure were factors favoring the linkages. Time constraints, SHG women working on voluntary basis, attitude of health workers, lack of data sharing between stakeholders, caste, class, politically patronized government health workers, and corruption were the factors undermining the linkage strategy. The social entrepreneurship model developed provides conceptual landscape for designing interventions linking SHGs with nutritional interventions.

Name: Janota, AndreaPracticum Site: Revere on the Move, Local Food Assessment-Department of Healthy Community Initiatives Location: Revere, MA Title: Accessing Locally Sourced Foods: The City of RevereIntroduction: As part of a collective effort to promote a community-driven environment conducive to healthy behaviors, Revere on the Move (ROTM) was founded by the Revere CARES Coalition through the Center for Community Health Improvement at MGH and is co-managed with the City of Revere. The team works to promote healthy eating and active living through policies, systems, environmental, and programmatic changes. The purpose of this practicum was to investigate the city’s food system and research alternative procurement options with the ultimate goal to understand the feasibility of locally sourcing more farm-fresh produce. Methods: I worked with the manager of the Department of Healthy Community Initiatives to 1.) interview local market owners about their buying practices in order to understand how and from where produce was sourced 2.) begin planning of a regional Small Business Association to utilize collective buying power for local store owners and 3.) to build a Community Supported Agriculture program (CSA) in coordination with a local Massachusetts farmer. Results/Projected Outcomes: Eleven participants were recruited to the Fall CSA, which lasted 10 weeks and provided special subsidies to low-income families and individuals, particularly seniors. The nine markets participating in the ROTM Healthy Markets programs were contacted about their procurement strategies. The information collected was compiled into a final report that will inform the formation of the Small Business Association in the future.

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Global HealthName: Jonnalagadda, SivaniPracticum Site: Boston Children's HospitalLocation: Boston, MA United StatesTitle: Investigating A Novel Treatment for Chronic Low Back Pain in ChildrenIntroduction: The Pain Treatment Service at Boston Children’s Hospital is the most academically and clinically active program in the world for management of acute and chronic pain in children. A strong focus of the work at the Pain Treatment Service involves the clinical outcomes of children and adolescents with chronic pain of several types, including those with spine problems and pain due to abnormal nerve activity known as complex regional pain syndrome type 1. The objective of this project was to conduct a retrospective medical record review on the clinical outcomes of lumbar medial branch blocks (facet joint injections) for pediatric chronic low back pain. Specifically, the effect of lumbar medial branch blocks on pain scores, functional disability and behavioral changes pre and post procedure were of interest. Methods: In order to gain a deeper understanding of research conducted by the Department of Anesthesiology and Perioperative Medicine I attended weekly research meetings, and observed medical procedures in a clinical setting. I developed an IRB protocol for a retrospective medical record review and prospective follow-up, and wrote a statistical analysis plan as well. Results: I gained experience in database development, data management, and statistical design and a better understanding of clinical research, statistical computing and data analysis in a professional public health setting. The Pain Treatment Service is currently implementing the IRB protocol. Results of the study will strengthen the evidence base of treatment methods for chronic low back pain among the pediatric population.

Name: Kwankam, DelphinePracticum Site: Clinton Health Access InitiativeLocation: YaoundéTitle: Zonan Coordinator, eMTCT

Introduction: The Clinton Health Access Initiative (CHAI) is supporting the Government of Cameroon in its policy of eliminating mother to child transmission of HIV (eMTCT). CHAI is as a major implementing partner to the National AIDS Control Committee (NACC) in expanding eMTCT program in the Center region. The goal of the practicum is to support the Regional Delegation of Public Health in the extension of PMTCT services to all health facilities in zone six which comprises of; Djoungolo, Sa’a, Ntui and Yoko health districts.Methods: Baseline assessment, training in PMTCT option B+, site level visits and support in data rendering. Results/Outcomes:96 baseline assessments completed in three districts; Djoungolo, Sa’a and Ntui.Data from the surveys were entered into Epi-data for analysis. This baseline helped identify existing PMTCT sites and gaps in reproductive health services in general in the zone. Based on existing and potential PMTCT sites identified from the baseline, providers were identified for PMTCT option B+ training. Provide technical and logistic support to trainers and participants during trainings. Administer pre and post-test to assess the aptitude of trainees. Five PMTCT option B+ trainings organized in three health districts and a total of 143 providers trained from 101 health facilities. Conducted 57 site level visits to supervise trained providers in the use of new monitoring and evaluation tools and ensure knowledge sharing among providers between services. I attended five district coordination meetings to collect PMTCT reports from sites, and districts.

Name: Samarakoon, Sajeewani Practicum Site: Institute for Health Policy Location: Colombo 2, Sri LankaTitle: Student Intern

Introduction: Childhood malnutrition remains a significant problem in Sri Lanka. Stunting and underweight reduced by 50% and 25% respectively from 1987 to 2006, but progress has stalled recently. At the Institute for Health Policy I examined the current state of malnutrition in children under-five years, and the policies and programs implemented within the last 15 years to identify the policy, programmatic and research gaps that has hindered recent progress. The endeavor culminated in Review of Child Nutrition Policies and Programs in Sri Lanka and Nutrition Policy Brief compiled for UNICEF, Sri Lanka.Methods: A review of literature, nutrition policies and programs, data on child nutrition, and fve key informant interviews were conducted. Results: Undernutrition remains high despite significant improvements in average living standards, breast feeding, infant mortality and numerous interventions. Amongst children under five, 10% are stunted, 20% are wasted, 25% are underweight, 20% have low birth weight and 33% are iron deficient. Residents of tea estates, the urban poor and resettled populations are the most nutritionally vulnerable populations. Ten factors which inhibit progress in reducing child malnutrition were identified, including: household food insecurity, poor complementary feeding practices, poor nutrition education, lack of monitoring and evaluation of nutrition programs, and absence of nutrition surveillance data. The Way Forward: Three policy and programmatic changes were proposed to improve the nutritional outcomes: establish a conducive multi-sectoral environment for planning and intervention; re-focus nutrition policy on prevalent and growing nutrition problems; and programmatic emphasis on superior targeting of vulnerable populations.

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Global HealthName: Sanfratello, NataliePracticum Site: Brookline Department of Public Health Location: Brookline, MA Title: Public Health Intern

Introduction: Using a ‘train the trainer’ approach, the Division of Youth Substance Abuse and Violence Prevention creates educational programs for Brookline High School Student Peer Leaders. Utilizing knowledge gained from these programs, the Peer Leaders then create and present workshops for high school students, middle school students, and parents in Brookline about various public health issues relevant to teens; like substance use, relationship violence, and mental health. The Division also develops youth-driven programs to present and enact warrant articles restricting the sale and use of tobacco in Brookline. Methods: For my practicum, I worked in the Peer Leader training program. I created presentations, including discussion and contemplation components, for the Peer Leaders, to both educate and provide an environment for open exploration of substance abuse, violence, and mental health. Furthermore, I helped Peer Leaders to design their own education programs and improve their presentation skills. Additionally, I applied for and received a grant from the 84 group to engage with stakeholders and write a warrant article to pass legislation concerning a flavored tobacco ban and minimum cigar pricing in Brookline. Results/Projected Outcomes: During the rest of the year, I will continue to assist the Peer Leaders in their design of education programs. Additionally, I, along with students, will make presentations to various stakeholders and complete the writing of the warrant article prohibiting the sale of flavored tobacco, marketed towards teens, in under- 21 establishments. I expect this policy will reduce the accessibility of flavored tobacco to teens in Brookline.

Name: Shepherd, JulianaPracticum Site: Boston University School of MedicineLocation: Boston, United StatesTitle: Research Assistant

Introduction: Tuberculosis (TB) is an infectious bacterial disease most commonly affecting the lungs. In 2014, TB claimed the lives of 1.5 million people and 1 in 3 HIV deaths were due to TB. Emerging evidence suggests a relationship between a host's nutritional state and disease susceptibility, severity, and outcome. The goal of my practicum was to do an in-depth literature review on the association between nutritional state and disease susceptibility, severity, and outcome for the Principal Investigators (PI) at the Tuberculosis Clinical Diagnostics Research Consortium at the BU School of Medicine.Methods: As an intern at the TBCDRC I performed a literature review on nutrition and TB disease, filling out an excel master document with concise, relevant information from 40 studies, some of which I was given and some I found through PubMed. The studies ranged from assessing nutrition by measuring metabolic hormones in the blood to BMI measurements and actual nutrient intake. I therefore also sorted the studies by theme to make it easier in the future for PIs to find specific information. I also joined the bi- weekly department TB interest meetings to expand my understanding of tuberculosis and learn about research studies the department is conducting. Results/Outcomes: I assisted the PI in drafting the background for a grant application using information from the literature review. The findings discussed in the literature review suggest a relationship between nutritional state and disease outcome though studies were inconclusive and further research is needed.

Name: Sivalogan, KasthuriPracticum Site: VeAhavta Grace Care CenterLocation: Trincomalee, Sri LankaTitle: Evaluating Psychosocial Therapy in Girls at Grace Care Center

Introduction: During the twenty-six-year civil war in Sri Lanka and 2004 tsunami, tens of thousands of Sri Lankan civilians were killed leaving thousands of orphan children without families to care for them. Grace Home provides a safe and nurturing environment for thirty-three girls and provides psychiatric treatment for eight girls diagnosed with PTSD beginning in December 2014. Methods: A pilot evaluation was conducted six months after the initiation of treatment to establish whether psychosocial therapy would improve the girl’s psychosocial health and behavior. The pilot evaluation included a demographic survey to identify and understand each participant and the risks and resources map activity to qualitatively assess their concerns and progress. The largest component of the evaluation involved using the child version of the Sri Lankan Index of Psychosocial Status (SLIPSS-C) to assess the psychosocial status of each participant using a forty-nine item qualitative tool that assess subdomains of psychosocial distress. Results: The results validate the study intent - that providing psychosocial therapy with the assistance of a trained counselor has been positive in providing a safe environment for the girls to address their struggles and difficulties after experiencing immeasurable loss, grief and struggle. Deeper analysis of the results of the SLIPSS-C survey indicate that despite making progress, the girls are struggling to identify their own self-worth, to deal with internal stress, to focus in school, to make health friendships with other girls at school and to find another individual to share concerns or points of significance.

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Global Health

Name: Thomas,ShirlyPracticum Site: Sneha Caritable TrustLocation: Tamil Nadu, IndiaTitle: Snehagram: A Case for Holistic HIV Care in Adolescents

Introduction: Snehagram is an organization in the consortium of the Sneha Charitable Trust focused on helping people who are living with HIV. The institution is a home for adolescents, aged 13 -19 who are HIV infected and HIV affected. Snehagram takes a unique approach to adolescent HIV care by concentrating on a holistic method which comprises of medical, physical, and psycho-social support.Methods: My time with Snehagram was focused on three main activities: introducing an electronic medical system, organizing a pharmacy inventory system, and teaching classes on life skills and English. The EMR system was completed by collecting information from the students’ existing paper medical records, creating an electronic template focused on monitoring HIV health indicators, and transcribing the information into the electronic format. The pharmacy inventory system was organized from existing paper inventory to an electronic system through an Excel format that keeps track of current stock and provides alerts in case of low inventory. I also taught classes to groups of 15 -20 students, in life skills and English by designing lesson plans on key areas of personality development, such as team building, listening, public speaking, problem solving, and decision making.Results: By the end of my time, the Excel-based EMR had over 200 students entered and will be used by both the Snehagram Health Clinic and its sister organization Sneha Care Home. The pharmacy inventory system was up and running and staff had been trained to continually update stock. Lastly, I had successfully designed and implemented a teaching curriculum and left Snehagram with a compilation of teaching resources to be utilized in the future.

Name: Uwase, MalysePracticum Site: Breast Cancer Initiative East Africa Inc. Location: Houston, TX United StatesTitle: Summer Intern

Introduction: The burden of non-communicable diseases such as breast cancer is increasing in low-income countries and there are limited resources to address them. In Rwanda, Breast Cancer Initiative East Africa (BCIEA) is a non- profit organization that raises awareness on breast cancer and provides support to breast cancer patients. BCIEA conducts educational workshops--to promote early detection and reduce the stigma attached to the disease-- and helps patients navigate the referral system to access care. The purpose of this practicum was to provide support to the educational program, identify grant opportunities, and help improve data collection for the organization.Methods: I worked with the Program Coordinator under the supervision of the Executive Director 1) to plan and lead educational workshops; 2) to create entrance and exit forms for BCIEA clients; 3) to write and submit grants; 4) to help patients get the right referrals and conduct support visits for the sickest patients. Results/Outcomes: Entrance and exit forms, two grant proposals and a facilitator guide for the educational workshops.

Name: Villas, EmilyPracticum Site: Desmond Tutu TB Centre/ Stellenbosch University Location: Cape Town, South AfricaTitle: Increase Access to HIV Care in Cape Town

Introduction: The Community HIV Prevention Project (COMAPP) is an HIV prevention project that addresses the challenge of reducing the number of new HIV infections through a community HIV counseling and testing (HCT) model based on behavioral and biomedical interventions. The project targets those who do not typically access clinic services and those deemed vulnerable to HIV risk.Methods:The primary scope of my work focused on analyzing quantitative data collected during the randomized implementation of CD4 count tests into the HCT model. Field visits and collaboration with nurses supplemented the analysis. I investigated whether administering a CD4 count to patients who test HIV+ affects the time they take to access referral care. Additionally, I observed counselor performance during site visits and analyzed quarterly evaluations encompassing 2013 – 2014. This was to show the continuous improvement and consistency of care across two sites, and highlight communication areas needing improvement. Results/Outcomes: Statistical t and chi square tests showed there was no significant difference (p=.65) between the two groups in time taken to access healthcare services; or when stratified by days to care (p=.16) or count level of HIV+ clients (p=.24). Proposals for further accurate data collection were presented at the government partners meeting. Counselor evaluations showed a decrease in performance errors across both sites. The top issue was counselors neglecting to demonstrate condom usage and issue condoms; 44% of total errors. Counselor and site manager feedback substantiated

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recommendations to include correct condom and testing kit protocol in future training sessions.

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Global HealthName: Williams, JoannaPracticum Site: Mildmay UgandaLocation: Lweza, UgandaTitle: Strengthening PEPFAR supported HIV/AIDS health systems in Uganda

Introduction: Mildmay Uganda is a non-governmental organization that deals in “modeling quality and sustainable prevention, care and treatment of HIV/AIDS and other health priorities, using a family centered approach; together with training, education and research". One HIV/AIDS health systems strengthening program, supported mainly by PEPFAR, has many dimensions including outreaches to hard-to-reach areas and contacting various vulnerable and most-at-risk populations (MARPS).Methods: I visited three hard-to-reach MARPS islands and three remote districts, and gave health education on prevention of HIV/AIDS, opportunistic infections and antiretroviral drug adherence. I worked with different MARPS including commercial sex workers, fisher folks and their families. During the outreach, I made visits home by home and also met with people in their communities. With commercial sex workers on the islands, we discussed challenges to devise acceptable solutions in a bid to curb further spread of HIV. I also worked on monitoring and evaluating the quality and performance of HIV/AIDS health services rendered at Mildmay Uganda associated health centers. I used the standardized PEPFAR Site Improvement through Monitoring System (SIMS) tool to find gaps and devise possible solutions to improve service delivery and/or access.Results/Outcomes: Findings indicated that many people on the islands did not have access to care due to constraints such as transport to facilities. Sex workers felt stigmatized and were reluctant to receive care. Finally, data entry on HIV/AIDS treatment and follow- up was lacking at some facilities. A report of findings was presented to the Mildmay Quality Improvement and Training departments, which will be used to improve service delivery.

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Name: Ann CashellPracticum Site: Health Law Advocates, Inc.Location: Boston, United StatesTitle: Evaluation Research Assistant

Introduction: Health Law Advocates Inc. commenced on their three-year pilot project, Juvenile Mental Health Advocacy Project (JMHAP), in February 2015 to address the unmet mental health needs of youth involved in the court system. To determine whether project continuation or expansion is viable, BUSPH is subsequently carrying out an evaluation process to determine whether outcomes improve for participating youth and whether the project is advantageous financially.Methods: To determine outcomes of JMHAP, I helped write questionnaires, which are being given to involved youth and their parents at several marks: beginning work with a mental health advocate, six months, and the one-year mark. The questionnaires include verified surveys, as well as questions to get at the outcomes and benchmarks the JHMAP is trying to accomplish, including attitudes, services received, relationships, and activities. Alongside these interviews the Health Law Advocates will complete a questionnaire for each case to ensure the sample size is representative and to determine facilitators or barriers for the project. Information gathered will be entered into forms I created in StudyTrax, where a data analyst can compare individuals as well as measure the trajectory of youth involved with a mental health advocate can be compared to the trajectory of court involved youth nationally.Results/Outcomes: Baseline surveys have been given to the majority of already enrolled youth, and the six-month follow-up questionnaires are set to take place soon. Although a change in outcomes cannot yet be determined, some personal anecdotes have articulated positive changes among some involved youth.

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Health LAW, BIOETHICS, & HUMAN RIGHTS

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Name: Abraham, ReshmaPracticum Site: Steward Health Care System - Carney HospitalLocation: Boston, MA United StatesTitle: Project Lead-Community Health Needs Assessment Project

Introduction: Carney Hospital is a member of Steward Health Care System, the largest fully-integrated community care organization in New England. Carney’s service area includes North Dorchester, South Dorchester, Mattapan, Hyde Park, and Milton. The objective of the project was to prepare a community health needs assessment report for the Director of Marketing and Communication, that provides an insight on the health conditions and social factors affecting the people living in the neighborhoods surrounding Carney and propose recommendations to improve quality and access of care.Methods: (1) Extensive public data was collected and analyzed using U.S. Census reports, Department of Public Health statistical reports and the Massachusetts Community Health Information Profile. (2) An online provider survey was distributed to Carney’s Community Benefits Advisory Board and local organizations to ensure that the health needs of Carney’s service area population are being met. (3) A focus group was conducted to capture community data on perceived health issues and barriers to health resources.Results/Outcomes: The report indicated that mortality rates of heart disease, cancer and substance abuse, along with sexually transmitted diseases are substantially higher in Carney’s service areas compared to the city of Boston. Providing group counseling sessions for diabetic and obese patients, training primary care practitioners to team with mental health workers to assess behavioral disorders, instituting a patient navigator to link individuals with substance abuse issues to clinical services, as well as primary care, and mental health services in the community were some of the recommended

Name: Chidsey, LaurenPracticum Site: World Health OrganizationLocation: Geneva, SwitzerlandTitle: WHO Substance Abuse Intern/Consultant

Introduction: As an intern and consultant for the Management of Substance Abuse department at the World Health Organization, I assisted two technical officers with various policy initiatives related to controlled substances. I worked initially on the launch of new opioid overdose treatment guidelines and also on a publication on the latest research on harms due to cannabis.Methods: For the launch of the opioid overdose guidelines, which promoted availability of overdose reversal drugs to the general public, I organized the launch, edited the guidelines, invited and corresponded with the participants, and attended the UN press release. The cannabis publication first involved an expert meeting in Sweden, for which I was the reporter. I then used the information from these papers and presentations to co-write the sixty-page cannabis report for publication on the website, along with leading researchers from Canada and Australia.Results and Projected Outcomes: The guidelines for overdose management were launched and hopefully countries respond by enabling citizens to use life - saving drugs to prevent more deaths in this epidemic. The cannabis publication which will go live on the website in December of this year should be groundbreaking, as the first official WHO cannabis publication since the 1990’s, and should influence policy globally. It should also educate people about some of the serious dangers of the drug, which are currently overlooked.

Name: Edelberg, RebeccaPracticum Site: Boston Medical Center Pediatrics DepartmentLocation: Boston, MA United StatesTitle: Evaluating the Feasibility of an Intervention to Prevent Vaccine-Induced Presyncope

Introduction: This practicum is based on ongoing research within the Division of General Pediatrics and Pediatric Infectious Disease at Boston Medical Center (BMC). The original research study seeks to determine whether drinking water prior to vaccination impacts rates of post-vaccination presyncope among patients ages 11-21 years. The practicum study evaluates the feasibility of implementing the hydration intervention, should it prove to be effective.Methods: Physician, staff and key stakeholder interviews were conducted. Interview questions focused on the five "domains" of effective implementation identified by the Consolidated Framework for Implementation Research (CFIR).Projected Outcomes: Two barriers to implementation have been identified from interviews completed to date. The first is lack of a water bubbler in the pediatric clinic; the second is lack of space for patients during the post-vaccination observation. Methods of overcoming these barriers were also identified during interviews. At present, it appears feasible to implement the hydration intervention so long as aforementioned barriers were addressed.

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Health Policy & Management

Name: Gwynn, KendrickPracticum Site: Office of Disease Prevention and Health PromotionLocation: Rockville, MD United StatesTitle: Preventive Medicine Resident

Introduction: The Centers for Disease Control and Prevention estimate that only 57% of Americans are up to date on colorectal cancer screening. [1] Shared decision making may help increase the uptake of colorectal cancer screening. Additionally, health care is shifting to team-based care involving the patient and various care team members. As part of a pilot module for medical student, resident and health care professional training, we developed a framework for a team- based, shared decision making conversation model to incorporate into wellness visits.Methods: Colorectal cancer screening modalities follow the 2008 United States Preventive Services Task Force (USPSTF) recommendations. The conversation framework was outlined using the Agency for Healthcare Research and Quality (AHRQ) SHARE Approach for shared decision making. The Framework was reviewed and revised based upon input from collaborators at Virginia Commonwealth University School of Medicine, who will pilot test the framework.Results/Projected Outcomes: The tool, informed by the Health Literate Care Model, will be used as the core of a training module that focuses on improving the provider’s ability to engage in productive interactions with patients regarding clinical preventive services. Our conversation framework offers a new approach for learners. If the pilot proves successful, the framework will be scaled up into an interactive eLearning lesson for health care professionals.

Name: Hotard, MeggiePracticum Site: Biogen IdecLocation: Cambridge, MA United StatesTitle: Biogen Public Policy and Government Affairs Intern

Introduction: Biogen’s Public Policy and Government Affairs office provides legislators and policy makers with both policy and political assistance on topics of importance to patients and the pharmaceutical industry. Topics of importance include drug reimbursement policies, intellectual property laws, and regulatory policies. As part of the Public Policy and Government Affairs team, I assisted with conducting research and analysis on key policy issues, such as the replacement of the Sustainable Growth Rate (SGR) for Medicare physician payment. I also conducted research to help assist the strategic plan for the Alzheimer’s product, aducanumab, in Biogen’s drug pipeline.Methods: I worked directly with the Senior Director for Public Policy and Government Affairs. My responsibilities included organizing and conducting research for the preparation of an upcoming meeting with the Veterans Health Administration about Alzheimer’s disease. Additional responsibilities included a report on Alzheimer’s disease current quality measures and an unrelated, outside policy position paper about the replacement of the Sustainable Growth Rate and the potential impact on biotechnology products and the care of their patients.Results/Projected Outcomes: Biogen’s pipeline product, aducanumab, is at the very early stages of development. However, preliminary research about impact on potential policies and engagement with government agencies is important in early years of product development. I prepared a research report and formal presentation in front of senior staff and outside consultants on Veterans Health Administration’s long-term care services for Alzheimer’s disease, and their reimbursement policies for MRI and PET scans for Alzheimer’s neuroimaging in clinical trials.

Name: Lai, JustinPracticum Site: Kaiser PermanenteLocation: Milpitas, CA United StatesTitle: Demand Forecasting Graduate Intern

Introduction:Kaiser Permanente is making significant efforts to stay competitive in the digital health realm while also providing high quality care. The organization has observed a 20% increase in enrolled members in the past year, and with the increased use of digital health services such as telehealth and secured messaging, Kaiser Permanente hopes to create a methodology to predict demand on its six national data centers by observing trends in the digital health landscape. As part of this effort, the Business Demand Forecasting team at Kaiser Permanente shifted its methodology and created a new process to monitor both internal and external healthcare trends to forecast IT demand.Methods:The Business Demand Forecasting team worked to create a methodology to predict the demand of server usage, networking services, and storage space based on emerging trends in healthcare. The key variables analyzed were care delivery channels, condition mix, membership volume, administrative delivery change, employee mix, regulations/external events, and care treatment method. The team then collected metrics pertaining to these variables, navigating through various databases and communicating with various subject matter experts who created and handled the data. Results/Outcomes: A list of over 300 digital and clinical metrics pertaining to digital health volume was successfully established at Kaiser Permanente. These metrics were then handed off to the data scientists on the Business Demand Forecasting team, who are working to publish the forecast of digital health infrastructure demand by the end of 2015.

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Health Policy & Management

Health Policy & ManagementName: Marling, RyanPracticum Site: Massachusetts Medical SocietyLocation: Waltham, MA United StatesTitle: Intern in Department of Practice Solutions and Policy Research

Introduction: The Massachusetts Medical Society is the state's professional association for physicians, and is the oldest active physician society in America. Their mission is to be dedicated to educating and advocating for the patients and physicians of Massachusetts.Methods: Working within the department of Practice Solutions & Research, our goal was to provide value to member practices via practice consulting services, annual research studies, and educational resources on health care topics that are impacting practices in the area and nationwide. Our team of five attains information via surveys of our 25,000-plus member physicians, hosting events with area thought-leaders as keynotes, networking and attending area conferences, reaching out to relevant subject authorities, and manual online research. Our inspiration for research topics stem from our physician helpdesk hotline, on which physicians can call when in need of any sort of guidance in handling a practice related issue. After analyzing the subject of these requests, we get a good idea of what informational resources are in demand.Results/Outcomes: During my time within the Practice Solutions & Research department I have contributed to multiple informational resources, research publications, practice consulting projects, and a half day conference of 3 speakers on disruptive innovations in healthcare. Our educational resources ranged in topics from considerations before joining an ACO, to practical use of tele-medicine, value-based care delivery, and retail clinic penetration in the state.

Name: McCarron, ChelseaPracticum Site: East Boston Neighborhood Health CenterLocation: Boston, MA United StatesTitle: Program Evaluator, Youth and Young Adult Pathways HiSET Initiative

Introduction: The East Boston Neighborhood Health Center (EBNHC) serves East Boston and surrounding communities, providing access to health care and community programs addressing a variety of public health concerns. In 2014, clinicians identified only 58% of East Boston High’s seniors graduated from high school, of the non-graduates, 2.4% earned a GED and 17.5% dropped out. The population of East Boston High is 62% Hispanic, 76% low-income, and 35% designated English- language learners. Research has linked education with better health outcomes and reduced crime within a neighborhood and community.Methods: The project required collaboration with EBNHC’s Clinical Project Manager and Education & Training Institute to design, implement and evaluate an integrated high school equivalency preparation program for youth patients of EBNHC. The work included 1) literature reviews of current programs 2) design and execution of a focus group 3) development of a policy and procedures manual 4) evaluation of performance data 5) summary report of outcomes and recommendations.Results/Outcomes: Retention rate was 100% (n=12) during the pilot’s 10-week semester. 50% received their high school equivalency, 25% completed 80% of the requirements, and 25% still needed to complete 40% or more the requirements. Of students with outstanding testing, 66% reenrolled in the fall semester. 100% of students who received their high school equivalency are enrolled in an internship, apprenticeship, or job placement program for fall of 2015. Enrollment required engagement with primary care providers and future objectives are aimed at tracking health outcomes of students who complete the program.

Name: Michael, MariamPracticum Site: Boston Public Health Commission Location: Boston, MA United StatesTitle: PWTF Asthma Intern

Introduction: The Prevention and Wellness Trust Fund was established for the prevention and management of elderly falls, hypertension, and pediatric asthma. The pediatric asthma project aims to coordinate care for asthmatic students between community health centers and schools through the implementation of E-Referral Gateway.Methods: Activities revolving around year-2 pilot included gathering data, required deliverables, and business agreements from the partners (fve community centers, Boston Public Schools, Head Start). Each deliverable, such as PDSAs and workflows, was reviewed for compliance with recommendations and feasibility. Additional activities included preparing presentations for the Department of Public Health on overall pilot evolution, attending asthma work- group meeting, preparing relevant materials to present during those meetings, and coordinating communication between partners and with BPHC. Extensive time and effort were invested in collaborating on a work-plan for each disease to manage the expectations and requirements for partners and the BPHC for year-2. Once work- plans were developed, scorecards for each disease were created to assess progress.Projected outcomes: Each partner will self-evaluate using scorecards and financial incentives will be awarded based on relative performance. Moreover, the pilot is set to expand to include two additional community health clinics beginning January 2016

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Health Policy & ManagementName: Moreno, SamadhiPracticum Site: Upstate Medical UniversityLocation: Syracuse , NY United StatesTitle: Samadhi Moreno – Presidential Scholars Intern in the Hospital Administration Department at Upstate Medical University – University Hospital

Introduction: SUNY Upstate Medical Center (Upstate) is the lead academic medical center in the area of Syracuse, NY. In the 2013 Medicare Utilization Report the state of NY was ranked 49 out of 51 in terms of hospice utilization with 29.7%. The rates in Onondaga county where Upstate is located were lower, 20.9%. Patients who qualify for hospice but do not receive the services tend to have higher LOS and longer ICU visits while adding to the increasing healthcare costs. The project’s goal for the summer was to examine the contributing factors to low hospice utilization in the NYS and in CNY and develop a strategic plan to increase referrals to hospice from Upstate’s standpoint.Methods: Part of the internship involved comprehensive research literature reviews and stakeholder interviews. In order to understand the contributors thoroughly health professionals at the hospital, the hospice agency that serves the county of Onondaga and patients who received care from both organizations were interviewed.Results/Outcomes: Two of the biggest barriers patients experience in hospice enrollment are the lack of a 24/7 caregiver and the financial ability to cover the cost related to end of life care. Four recommendations were developed for potential implementation at the SUNY Upstate in order to streamline the hospice referral process and increase referrals in the area. One of the recommendations was for Upstate to amend their existing contract with the local hospice agency to provide routine home level care at the hospital to overcome barriers to care.

Name: Nanavati, SonalPracticum Site: Edith Nourse Rogers Memorial (Bedford) VA Hospital Location: Bedford, MA United StatesTitle: Telehealth Specialist

Introduction: Telehealth Scheduling System (TSS) is a new system to be launched by Veterans Administration (VA) to improve the scheduling of Telehealth appointments and coordination between different VA facilities bound with Telehealth Service Agreements. The value VA derives from Telehealth is not in the implementation of Telehealth technologies but in the way how they use health informatics, disease management, care management and Telehealth technologies to facilitate access to care.Methods: The project involved - i) taking the telehealth courses, ii) completing virtual online training program for data entry in TSS, iii) collaborating work with the Telehealth staff , iv) entering the various components of the data needed to schedule a telehealth service activity - Master Telehealth Service Agreements, Telehealth Service Agreements (TSA), site of the telehealth clinics, details of the users – providers and telepresenters, facility information, clinic names, resource information, and the emergency contact numbers at the different telehealth sites, and v) attending weekly online meetings of TSS.Outcomes/Results: The roll out of TSS will enable veterans to get appointments with providers in VA facilities who have TSA’s between the facilities. The increased efficiency of the system will allow enhanced access for the veterans to providers and specialists for routine or specialty care. Through the combined clinical, business and technical processes safe, appropriate and cost effective support for the delivery of care will be provided.

Name: Ni, HuaPracticum Site: Veterans Affairs Boston Healthcare SystemsLocation: Boston, United StatesTitle: Director's Office student intern, VA Boston Healthcare system

Introduction: Veterans Affairs Boston Healthcare System (VABHS) has been committed to providing timely and high quality care for veterans. The clinical video Telehealth into Chelsea Soldiers’ Home (CSH) is a VABHS initiative which aims to provide more timely care by utilizing Telehealth to shorten state veterans' long commute time to the VA facilities.Methods: The project involved working as a project manager and cooperating with the Telehealth facility coordinator, physician team, telehealth technologists and Soldiers’ Home staff by using a few distinctive methods: the frst one is a need assessment. Through observing current VA telehealth procedure and having an onsite visit to Soldier’s Home, patients’ needs can be identified and matched with facility capability. The second one is the installation of software and hardware. The core method of initiating clinical encounter is to combine IP to home software with the already established medical equipment in the VA. After all the technical parts are ready, further evaluation and continuous improvement will be conducted.Results/Outcomes: A list of patients' information has been obtained and analyzed from CSH; a current telehealth process map within the VA facility is created; more than half of the primary care and specialty care physicians have received Telehealth training as well as the access to the software and hardware. The next step will be an on-site visit to the Soldier’s Home to learn more about their infrastructure, patient demographics and services. In addition, an emergency procedure between VABHS and CSH will be developed.

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Health Policy & ManagementName: Olunwa, JosephPracticum Site: Boston University School of Public HealthLocation: , United StatesTitle: Research assistant/Coordinator

Introduction: Chronic pain affects millions of racially diverse Americans. Evidence suggests that group medical visits are effective for treating chronic pain; similarly, a number of studies demonstrate the effectiveness of certain evidence-based complementary therapies in managing pain. The primary aim of this study is to evaluate the feasibility of the integrative medical group visit (IMGV) care model in a group setting of Latino patients with chronic pain attending BMC outpatient clinic. IMGV combines patient- centered, non-pharmacologic strategies and principles of mindfulness-based stress reduction with a group medical visit to reduce pain and associated symptoms.Methods: We surveyed patients pre and would survey post an 8 session IMGV program to evaluate changes in pain in the last week (0-10 point scale) and co-morbid symptoms including depression (Patient Health Questionnaire-8[PHQ-8], perceives stress and anxiety. We conducted a mid-point survey at the 5th week to get feedback on participants’ thoughts about the group visit experience, barriers to participation, main benefits of the group visits, home practice of concepts learned during group visits and suggestions for improving the curriculum.Results/Outcomes: Nineteen patients enrolled in the study. While the group visits are still ongoing, we expect to determine the mean difference in pain level for all the patients between baseline and 8 weeks, Mean difference in PHQ-8 depression score for all patients between baseline and 8 weeks and also a qualitative analysis of participants’ experience of the group visits.

Name: Parekh, KhushbooPracticum Site: Shire PharmaceuticalsLocation: Lexington, MA United StatesTitle: Clinical Trial Transparency Associate

Introduction: Headquartered in Ireland, Shire specializes in rare diseases. I worked within the Clinical data management and Clinical Trials Transparency (CTT) teams as a Summer Intern. The CTT team was chartered to fulfill Shire’s public commitment to responsible and ethical approach to trial disclosure and transparency beyond the regulations.Methods: My responsibility was to support the effort of the CTT team with the 1)Ongoing registration of Shire sponsored studies and disclosure of study results in US and EU registries, 2) User Acceptance Testing (UAT) for Sylogent deployment to comply with legal and regulatory requirements, 3) Designing a customized SharePoint site for the team, 4) Submitting periodic Key Performance Indicator updates for R&D compliance index and 5) Benchmarking competitors using clinicaltrials.gov to determine Shire’s participation in public data sharing as part of leadership’s global growth strategy; developing Excel database and PPT presentation as part of business case.Results/Outcomes: As a result of the project activities undertaken, centralizing and streamlining of the disclosure procedure with technological solutions was made possible. It helped standardize and automate data compilation and extraction of registration, results and safety data of the study and also aided in developing product/study specific inspection readiness checklists to help prepare for audits and inspections. UAT helped in the effective and successful migration of the disclosure data onto the new system while ensuring quality and uniformity of data and automating the data approval and review process to ensure compliant submissions to all mandatory global registries.

Name: Prabhala, SripriyaPracticum Site: Dana Farber Cancer Institute Location: Boston, MA United StatesTitle: Global Health Initiative Intern

Introduction: As part of the Global Health Initiative (GHI) program at Dana Farber/Boston Children’s Cancer and Blood Disorders Center, the practicum project required M&E of global pediatric oncology programs. The GHI’s vision is for all children with cancer and blood disorders worldwide to receive the highest quality care leading to an improvement in their lives. The GHI is trying to build twinning partnerships with sites in low and middle-income countries mainly focusing on three main objectives: program building; education; and research. This is a research project that the GHI started in June 2015 in order to explore ways to evaluate specifically the global pediatric oncology programs and other global health programs in general; and also to define an outcome measurement strategy.Methods: Conducted thorough literature survey on: Various global health organizations working on program M&E; Logic models pertaining to global health programs; Annual reports of organizations that have awarded funding for global health programs and/or M&E programs; and WHO core health indicators. Created a list of indicators that could be applicable to the GHI programs. Drafted a GHI logic model to understand and describe the various phases of GHI as a program. Results/Outcomes: A checklist of program measures was created using the methods above that Program Leaders at the GHI can use to conduct M&E of specifically pediatric oncology and hematology programs and other global health programs in low and middle-income countries (LMICs).

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Health Policy & ManagementGlobal Health

Name: Rahman, NilufarPracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Baby Steps Follow-Up Quality Improvement Project

Introduction: Baby Steps at Boston Medical Center (BMC) provides developmental evaluations and nutritional assessments of former premature infants or term infants born at BMC with Neonatal Abstinence Syndrome (NAS) and other complicated newborn courses due to opioid exposure in utero. A developmental and behavioral pediatrician, dietitian, occupational therapists, and two family outreach advocates staff the clinic. Under the supervision of the Department leadership, interns are attempting to increase percentage of infants treated for NAS who attend a post discharge visit in Baby Steps. The objectives to be accomplished include scheduling Baby Steps appointments for infants treated for NAS within 14 days from inpatient discharge as well as increasing attendance of Baby Steps appointments to 80%. This PDSA will be tested from June-Sept 2015. Methods: Interns created a new charter that identified changes, including generating business cards for Baby Steps staff, updating existing program brochure, having a Baby Steps representative discuss program to guardians before baby’s discharge and sending a reminder call about the upcoming Baby Steps appointments. Additionally, interns were encouraged to attend quality improvement sessions instructed by Director of Quality Improvement. Results/Projected Results: It is anticipated that in-person meetings with families on the Pediatric Inpatient Unit and additional reminders via phone calls/written notes will help improve attendance rates in Baby Steps. However, further interventions are needed. Currently, infants treated for NAS who attend a post discharge visit in the Baby Steps program is at 50%. Close follow-up is essential for infants with NAS who may experience long-term health or developmental outcomes.

Name: Roberts, MurielPracticum Site: Boston Medical CenterLocation: Boston, United StatesTitle: Intern

Introduction: Physician rounds are a means for physicians to assess a patient’s current condition and create a treatment plan to remedy any ailments. Rounds give medical students and interns the opportunity to learn and teach one another. However, this process at Boston Medical Center has been shown to take an excessive amount of time, leading Resident Interns and medical students to miss other educational formats and increases the possibility that the medical staff works longer than their allotted work day. The goal of this project is to improve rounds in order to increase the educational yield as well as reduce the possibility of overtime medical professionals put in.Methods: Through observational study of two medical teams round on more than twenty different patients, the inefficiencies in the process were apparent. As a result of these observations a process map was created, which displayed redundancies and inefficiencies. Subsequently, conclusions were drawn and recommendations were drafted based on witnessed events. Then, a root cause analysis was shaped based on the known barriers the stakeholders in rounds experience.Results: With these deliverables a set of recommendations will be crafted for BMC to consider as they move forward. These recommendations will be directed at reducing the length of time the medical staff spends on rounds and increasing a standard structure for the process.

Name: Robertson, NicolePracticum Site: City of BostonLocation: Boston, United StatesTitle: Lead Paint Initiative Intern

Introduction: Familial status housing discrimination based on the presence of lead paint is prevalent in Boston. The Boston Lead Paint Initiative (BLPI) formed in October 2014 as an interdepartmental effort to address Boston’s high number of lead- poisoned children and discrimination complaints. The BLPI Project Coordinator role is to support the goal of creating a lead-safe Boston. BLPI efforts include: updating lead-related legislation, convening a Lead Paint Work Group to provide recommendations to the Department of Housing and Urban Development (HUD), developing a community survey gauging knowledge and perceptions of housing discrimination in Boston, and producing quarterly BLPI progress reports for the Mayor’s office. Methods: Project tasks: (1) supporting Lead Paint Work Group through agenda organization, and generating a comprehensive research paper for HUD, (2) developing RfP language and collaborating with contracted survey vendor to ensure successful dissemination of community survey, (3) developing lead-related educational materials tailored to Massachusetts legislators and Boston residents, (4) collecting and compiling lead data into quarterly reports, and (5) creating presentations, including one for the 2015 American Public Health Association (APHA) annual meeting. Results/Projected Outcomes: BLPI efforts are ongoing. Lead Work Group and community survey are being used to develop recommendations to further address housing discrimination throughout Boston. To date, educational material has reached 1,000+ Boston residents. Legislative materials are intended to make proposed lead bill a Massachusetts law. Quarterly reports and APHA presentation will secure future funding and inform the local/national public health community of Boston efforts.

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Health Policy & Management

Name: Salloum, ValeriePracticum Site: Boston Medical Center Pediatrics Department Location: Boston, MA United StatesTitle: bWell Center Project Coordinator - Department of Pediatrics - BMC

Introduction: The bWell Center offers an innovative approach to educate and support families of the Boston Medical Center Pediatrics Department. The center aims to improve patients' health and wellness by providing free health and community resources along with engaging and enriching programs. The practicum required managing the operations and evaluation of bWell's programs as well as ensuring the registration, follow up and tracking process of 550 participants.Methods: This practicum had on several components: 1) Collecting and analyzing patients' data using Excel and R; 2) Assisting with quality improvement projects and new process implementation in the center; 3) Training 40 volunteers of bWell's procedures and protocols; 4) Developing monthly reports and presentation for providers; 5) Collaborating with multidisciplinary teams to evaluate the projects, assess physicians' engagement in the program and implement changes.Results/Outcomes: The implementation of new programs and tracking processes in the bWell Center improved families' access to the resources/activates provided and enhanced patients' health and wellness. We noticed a 40% increase in the number of patients' visits and registration and received positive feedbacks from families about programs' effectiveness. The programs' evaluation enabled us to identify some areas of improvement: more providers' referrals to bWell are needed; incentives to engage, empower and retain patients are required to have effective and sustainable programs.

Name: Sethi, AnuradhaPracticum Site: Guthrie Medical Group/Robert Packer Hospital Location: Sayre, PA United StatesTitle: Intern at the Guthrie Research Foundation

Introduction: Guthrie is a not-for-profit, integrated health care organization located across Northeastern Pennsylvania and the Southern Tier of New York State. A majority of Guthrie's patients originate from rural communities. As a clinical research intern, my projects involved being part of the new Learning Management System (LMS), Global Health Initiatives (GHI) team and Clinical Research Department (CRD).Methods: The design and implementation of the LMS from scratch involved collaboration with Directors, Coordinators, Chief Residents and Fellows. The GHI involved partnership with the GHI team to organize 6 weekly seminars for physicians and healthcare staff. The other projects involved observing a site initiation visit (SIV), attending a SIV training for a Phase III clinical trial and attending a kick-off meeting for a baseline water supply grant with USGS. The projects at the Clinical Research Department involved conducting statistical analysis for investigator initiated research projects, reviewing journals and presentations for Journal Club, and conducting presentations on statistical analysis. Results/Outcomes:(1) A completed LMS with all the learning materials up and running for the for the 4 residencies and fellowship programs (2) Compilation of ways to use global and regional health policies and initiatives to improve health care in rural areas through the GHI seminars (3) Conducted 2 presentations on statistical analysis (4) Conducted 4 statistical analysis on white paper - 1 for the Program Director, 2 for physicians and 1 for resident. (5) 3 successful Journal Club presentations.

Name: Small, ArthurPracticum Site: New England Quality Care Alliance Location: Braintree, MA United StatesTitle: Medical Home Support Analyst

Introduction: As a medical home support analyst I was responsible for supporting the practice consultants in the collection and documentation of practice specific data and workflows for Primary and Pediatric practices working towards Patient Centered Medical Home recognition through NCQA. Ever since the passing of the HITECH Act, a greater emphasis has been placed on the use of EHRs as form of patient proprietary information, PCMH is a quality measurement program that corresponds with that direction in health care. In my role, I was working hands- on in over thirty practices to help each practice gain PCMH recognition. Methods: Through the documentation of practice workflows, monitoring of Meaningful Use measures that correspond with PCMH measures, and an active role conducting check-ins on previously recognized practices, I have been able to actively participate in the quality assurance of over thirty primary and pediatric practices in Massachusetts.Results/Outcomes: Our team has helped almost 90 practices with over 300 physicians reach PCMH recognition in 2015, while also ensuring that practices remain compliant with the essential message patient- centered care behind PCMH through the check- in process, even after recognition has been reached.

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Health Policy & ManagementGlobal Health

Name: Sonnathi, SindhuraPracticum Site: Health Leads NationalLocation: Boston, MA United StatesTitle: Institute Fellow, Health Leads Boston

Introduction: This practicum took place at Health Leads, a Boston-based organization that integrates patient resource screening into care delivery at hospitals across the country. By creating a comprehensive competitive landscape analysis, the organization was able to determine Health Leads’ position in the healthcare space. Additionally, work was done with the Institute team to strategize its next steps as it moved forward into a Learning Network, evolving a more low-touch approach as it introduced its tech platform in new hospital systems. The purpose of this practicum was to help Health Leads understand its role in comparison to its competitors, as it established its Learning Network model.Methods: This practicum involved working with one of the core members of the Institute team to 1) develop a management plan for the landscape analysis project 2) to establish Health Leads’ areas of expertise and knowledge buckets 3) to do extensive research on competitors 4) to organize results into an excel database 5) to create concise competitor profiles.Results/Outcomes: A sustainable database to keep track of competitors, a list of recommendations for knowledge management practices surrounding this database, competitor profile documents for internal and external consumption, a presentation to the entire staff about Health Leads in the space.

Name: Sridhar, Deepti AnanyaPracticum Site: Biogen IdecLocation: Cambridge, MA United StatesTitle: Business Process Analyst Intern

Introduction: Reference Safety Information (RSI) is an aggregation of key safety information created by Biogen in order to communicate important safety information about Biogen products (investigational and post-marketing) to key stakeholders (i.e., internal Biogen groups, Investigators, patients, Health Care Providers, Regulators, etc.). In order to communicate meaningful, consistent safety data, it is imperative for all processes and uses of the RSI be clear, concise and in line with corporate and regulatory authority policies. RSI is required, at all stages of a product life cycle. Not supplying RSI in a consistent manner poses a safety concern to patients using Biogen’s products. Methods: The activities undertaken were aimed at developing clear, consistent cross-functional processes for all aspects of RSI to streamline operations and improve quality and compliance. These activities were: i) Documenting Current Stage Operations ii) Creating current state Process Maps iii) Establishing Process Improvement Project Plans iv) Align GxP Processes with a Process Owner Framework to improve ownership and accountability of core processes v) Assist with the efforts of the Business Process Excellence Team to inculcate a process oriented cultural shift within the organization to help teams integrate process improvement into their daily activities. Results/Outcomes: The projected outcome of this project is i) Finalization of future state maps and integration with other sub process areas ii) Significant improvement in quality and compliance for regulatory fling deliverables in the Safety and Beneft Risk Management team.

Name: Tam, AlisonPracticum Site: Massachusetts Department of Mental Health Location: Tewksbury, MA United StatesTitle: Integrated Metabolic Syndrome Assessment Tool and Treatment Plan

Introduction: Tewksbury Hospital is a 350 -bed hospital jointly run by the Department of Public Health and the Department of Mental Health. The objective for this practicum is to improve the treatment of patients on the psychiatric units by increasing awareness, monitoring, and treatment of metabolic syndrome, which has been linked to the development of atherosclerotic cardiovascular disease and type 2 diabetes mellitus (Grundy, et al., 2005). Patients who are taking atypical antipsychotic medications are at increased risk for developing hypertension, obesity, diabetes, and dyslipidemia which make up metabolic syndrome. Methods: A pilot study was launched to evaluate metabolic risk monitoring on a 28-patient medically-enhanced inpatient psychiatric unit at Tewksbury Hospital. It was introduced at a medical staff meeting and protocols of the project were reviewed with the attending psychiatrist and the consulting medical internist of the unit. A chart review of all of the patients on the unit was conducted to collect information about assessment of vital signs and labs, recommendations for diet and physical activity, treatment planning, and patient education and informed consent. Results: Using pre- established criteria, it was determined that five of the patients met criteria for metabolic syndrome; monitoring of blood glucose, weight, and blood pressure were done fairly regularly but not monitoring of lipid levels; recommendations for diet, physical activity, and pharmacological management were all documented separately in the medical records; discussions about the risks and benefits of treatment were occurring, though not well documented.

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Health Policy & Management

Name: Tran, AnhPracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Pediatric Primary Care Quality Improvement Intern

Introduction: Reach Out and Read (ROR) was carried out in the Neonatal Intensive Care Unit at Boston Medical Center with the purpose of encouraging parents to read to their children from an early age. Among premature infants, language delay is common and reading is one of the methods to increase language exposure for these babies. Children whose families enrolled in ROR are more likely to possess large vocabularies and strong language skills.Methods: Baseline data for eligible babies from November 2014 until July 2015 were collected to examine parents’ demographics, primary language, and visitation patterns prior to ROR implementation. Eligible babies are those who have length of stay equal to or greater than 7 days and have a gestational age of less than 37 weeks. These data were collected from the hospital’s EMR. After the program has been implemented, similar data continued to be collected for current and newly admitted babies. Run charts were generated in Excel to allow for analysis of changes in average parent-infant interaction per week prior to and after participating in ROR. Data for eligible babies are recorded each month and are integrated onto run charts to monitor visitation trends.Results/Outcomes: Preceding ROR, visitation trends were low and did not show signs of increasing over time. Following ROR implementation, run charts have shown significant increases in parent visitation and interaction in the NICU. Infants continued to be read to at least once a day whether it was by a parent or a staff.

Name: Vivar, CristinaPracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Primary Care Department Intern

Introduction: Working at the Boston Medical Center’s (BMC) Primary Care Department two projects were conducted: (1) finding an ideal and possible proposal to move forward with the forms and faxes system (2) making the bins in each suite consistent and efficient to make employees lives easier. BMC’s primary care department is divided into 6 suites and each of them handles their forms, form requests, faxes, and bins differently. The projects required working closely with a practice manager.Methods: The first project included conducting gemba walks, shadowing the forms and faxes coordinators, interviewing all staff involved in the process, and creating process maps of each entry point in which the primary care department receives forms and form requests from patients and agencies. The project then involved focusing on inefficiencies that could be potentially revised and narrowed it down to targeting a very important form called a 485 that was being handled differently in each suite. The second project involved data collections on excel spreadsheets, interviews with project managers, nurses, and medical assistants, and shadowing forms and faxes coordinators.Results/Outcomes: The creation of the process maps and excel spread sheets provided a sense of what is wasteful and what has value to the department. The new process flow map allowed the implementation of a new way of managing the 485’s by shifting this job to distinctive staff and the results are still ongoing.

Name: Walker, RobinPracticum Site: Center for Medicare & Medicaid Services Location: Boston, MA United StatesTitle: Student Trainee Intern (Administration)

Introduction: The Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is a federal agency that administers Medicare and partners with states to administer Medicaid and State Children’s Health Insurance Programs. Under the Consortium for Medicare Health Plans Operations, the primary objective of this practicum was to review, update and prepare materials for the Train the Trainer workshop that took place September 1 -2nd. Train the Trainer is a CMS National Training Program that hosts workshops geared toward training State Health Insurance Assistance Program counselors to help Medicare beneficiaries make informed healthcare decisions. The secondary objective included evaluating the New Employee Orientation (NEO) 30, 60, 90 day Resources Folder and providing feedback to the Department of Medicare Health Plans Operations (DMHPO) Professional Development & Employee Recognition Committee (PDERC).Methods: This practicum involved assisting the Lead Health Insurance Specialist for Train the Trainer: 1) to update and prepare materials on Medicare issues; 2) research Train the Trainer registrant inquiries; 3) schedule and help plan a local abbreviated version of Train the Trainer in Charlton, MA; 4) and review the New Employee Resources folder.Results/Outcomes: By the conclusion of the practicum, Train the Trainer attendants were provided with updated Medicare materials, Train the Trainer registrants received responses to their inquiries, useful feedback for New Employee Orientation resources was provided, and a desktop phishing sign promoted Consortium wide was developed.

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Health Policy & Management

Name: Welsh, MeredithPracticum Site: Massachusetts Health Quality PartnersLocation: Watertown, MA United StatesTitle: Project Coordinator supporting MHQP’s Patient Engagement Workgroup

Introduction: Massachusetts Health Quality Partners (MHQP) is a non-profit organization dedicated to driving measureable improvements in health care quality, patient’s experiences, and use of resources through patient and public engagement and broad-based collaboration among health care stakeholders. As a part of this ongoing mission, MHQP convened a strategic workgroup during summer 2015, to develop a plan to improve and measure patient engagement in Massachusetts.Methods: The project involved a literature search, which highlighted 27 articles about improving and measuring patient engagement. This research informed the development of a landscape of current patient engagement activities and best practices, which was further strengthened by information gathered during discussions with stakeholders focused on improving patient engagement in their organizations. The resulting landscape showed that there is not yet a common understanding of what patient engagement means and how to identify best practices in patient engagement across the health care system. The strategic workgroup met three times between July and September 2015 to review the landscape and develop a plan for facilitating better statewide patient engagement.Results/Outcomes: The workgroup used the landscape to develop a working definition of patient engagement to guide MHQP’s future work. The final product was a strategic recommendation for MHQP to identify ways to share best practices and measure patient engagement in ambulatory care settings. MHQP’s Board reviewed and approved the recommendation in October 2015 and in the coming months MHQP will use this recommendation to develop an implementation plan.

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Maternal and Child HealthName: Abe, HitomiPracticum Site: Boston Medical CenterLocation: Boston, MA United StatesTitle: Boston Healthy Start Initiative Fellow

Introduction: As part of the Teen and Tot Clinic in the Department of Pediatrics at Boston Medical Center (BMC), I assisted in a project aimed to increase pregnant adolescents' awareness regarding long acting reversible contraceptive (LARC) options. LARC options include intrauterine device (IUD) and the birth control implant such as Implanon and Nexplanon. LARC is completely reversible if a patient decides she wants to become pregnant, and can be removed at any time. The purpose of the practicum was to find how much patients know about LARC.Methods: I worked with the Teen and Tot physicians, health educators, family partners, and contraceptive counselors: 1. to learn quality improvement theories and strategies using the IHI Model for Improvement; 2. to learn LARC methods by attending a LARC training and shadowing contraceptive counselor; 2. to design and develop a questionnaire for patients to complete during their appointments asking about their knowledge of LARC.Results/Projected Outcomes: A total of 8 women in their 3rd trimester completed the initial pre questionnaire. Of these women, only 3 knew about LARC, its options, and benefits. 5 women said they would be interested in contraception method postpartum. Results do not permit generalization because of the small sample, but suggest that the majority of women do not know about LARC. It would be beneficial to follow up with the women post-appointment to see whether their knowledge of LARC changed after their appointments. This may help providers see if they need to make changes to their approach in discussing contraception.

Name: Clausen, KristianPracticum Site: MA Department of Public HealthLocation: Boston, United StatesTitle: Chronic Disease Epidemiology Intern

Introduction: As a Chronic Disease Epidemiology Intern with the Massachusetts Department of Public Health (MDPH), I assisted with developing an evaluation plan for two statewide initiatives (Mass in Motion and an additional grant from CDC) which aim to prevent obesity, diabetes, heart disease, and stroke via several mutually reinforcing strategies. The programs share common multi-faceted approaches that encompass 1) environmental changes (such as passing Complete Streets policies), 2) improvement of linkages between clinical settings and community-based, evidence-based services, and 3) improvement of clinical outcomes using health information technology (such as implementing EMR-related quality improvement initiatives to increase the identification of undiagnosed hypertensive patients).Methods: I collected baseline data regarding residents’ age, sex, race, poverty, and health insurance from U.S. Census data for each Mass in Motion community, then created relevant data displays (charts, etc.) to be used in progress reports and presentations. Using ArcGIS, I developed maps of each community presenting average poverty level and insurance status by census tract to identify areas of highest need. These maps will be used to target interventions for priority populations.Results: The development of the data displays and maps will be used to provide baseline data and inform program evaluation plans. In particular, side-by-side comparisons of MA communities will allow project staff to determine risk and need across demographically different regions. Synthesizing this data is necessary to track program progress. Additionally, it supports MDPH’s efforts to secure future funding and provides clear evidence to lawmakers of the need for chronic disease prevention.

Name: Jackson, ClarkPracticum Site: Illinois Department of Public HealthLocation: Chicago, IL United StatesTitle: Title V Needs Assessment Action Plan, Office of Women's Health and Family Services, IDPH

Introduction: The objective of this project was to assist in the development of the 2015 Title V Action Plan for the Illinois Department of Public Health. I worked the Office of Women’s Health and Family Services to further describe Title V priorities from the 2015 Needs Assessment in a health transformation context, and assist in the development of a systems-based approach for moving forward in the changing healthcare environment. Methods: Secondary data on healthcare access, utilization, quality, and assessment related to the Title V priorities were identified and compiled in order to summarize health service metrics for each priority. Working with staff and external stakeholders, I generated health transformation-focused action plans for each of the identified priority areas. Using data on the health status of Illinois women, public health theory, and research on other successful health transformation programs from across the nation, I developed action plans that focused on closing gaps in health equity and reducing disparities, as well as reaching underserved populations.Outcomes: A final report outlining best practices and recommendations for supporting women’s health and birth outcomes was created for the department. The action plans and final report will be used by the OWHFS staff in the development of the final Title V Action Plan to help guide program development, evaluation, and transformation over the next five years.

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Maternal and Child Health

Name: Lamb, AprilPracticum Site: Boston Public Health CommissionLocation: Boston, United StatesTitle: Boston Healthy Start Initiative/BPHC Fellowship

Introduction: The Boston Healthy Start Initiative (BHSI) is a federally funded program administered through the Boston Public Health Commission that targets health disparities in perinatal outcomes. In an effort to increase preconception care, and potentially impact perinatal health, the Boston Public Health Commission launched a media campaign of the Oregon-based “One Key Question.” The purpose of this practicum was to assist the campaign efforts and study the impact of the campaign.Methods: Initial activities included composing an introductory letter to clinical health care sites, gathering contact information for key stakeholders at these sites, sending the letter, and creating a list of referral sites for the Mayor’s Health Line. Activities after the campaign launch included constructing a survey tool, using the tool to collect qualitative data, and analyzing collected data.Results/Outcomes: Campaign posters were put up at local bus shelters as well as in several BHSI sites. Qualitative data revealed mixed responses and reactions to the campaign and several lessons were learned.

Name: Levine, AdelePracticum Site: The Fenway InstituteLocation: Boston, United StatesTitle: Racial Equity and LGBTQ Youth Health Promotion

Introduction: Across the U.S., LGBTQ youth experience high rates of victimization, suicidality, substance abuse, housing insecurity, and HIV infection compared to heterosexual and cisgender youth. The Fenway Institute, in partnership with youth-serving organizations and community advisory boards, implemented the Our Health Matters survey of approximately 300 LGBTQ youth of color in the Greater Boston Area in order to better understand their physical and mental health needs, as well as their expectations for building successful lives. As a research assistant, I analyzed data from the community survey and contributed to the development of recommendations for policy and public health practice.Methods: I conducted literature reviews of (1) the health impacts of discrimination on the basis of race, sexual orientation, gender expression and SES and (2) best practices for youth economic development. In addition, I analyzed data from the community survey pertaining to racism, discrimination, racial/ethnic pride, SES, and substance use. Lastly, I collaborated with the project team to develop recommendations for policy and practice to promote resiliency, empowerment, and economic opportunity among LGBTQ youth of color.Results/Projected Outcomes: These data present a unique opportunity to develop an intersectional analysis of mental health, risk, and resiliency among urban LGBTQ youth of color. In addition to a survey report, the project team is developing a manuscript detailing a conceptual framework of economic opportunity and positive youth development for LGBTQ youth of color. These findings expand the scope of LGBTQ youth research and advocacy to be more inclusive of race and SES.

Name: Melnick, AnnaPracticum Site: Boston University School of Public HealthLocation: Boston, MA United StatesTitle: Via Christi Human Trafficking Protocol Evaluation

Introduction: Human trafficking is a national and global problem. Hospitals provide a unique opportunity for providers to identify and assist victims of human trafficking, yet there are few resources to specifically help providers accomplish this goal. Via Christi is the largest healthcare provider in Kansas, and recently developed and employed a human trafficking protocol. The purpose of the practicum is to evaluate the planning, training, and enacting of a human trafficking protocol for broadly applicable lessons.Methods: The practicum consisted of key informant phone interviews with persons who identified the need for a protocol, researched components to a successful protocol and the nature of human trafficking, planned and conducted training, and currently utilize the protocol. From these interviews, salient ‘themes’ were noted as points integral to a successful protocol planning and implementation regardless of hospital setting. Results/Project Outcomes: Via Christi is at the forefront of large hospital healthcare providers by having this protocol for victims of human trafficking. As human trafficking gains recognition as a nation-wide issue, other hospitals will seek guidance for creating their own protocols, or established protocols that they can adapt to their needs. Our six major themes address individual, hospital, and community-wide aspects of a successful protocol. The result of this practicum is a set of guiding themes and accompanying discussion that would assist a hospital on their own path to implementing a successful human trafficking victim identification and assistance protocol.

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Maternal and Child Health

Name: Morris, MolliePracticum Site: Massachusetts Alliance on Teen PregnancyLocation: Boston, MA United StatesTitle: Patient-Provider Interactions and Relationships: a needs assessment of adolescent and emerging adult prenatal care in Boston

Introduction: The purpose of this needs assessment was to learn more about interactions and relationships between pregnant young women (ages 16-24) and their prenatal care providers. The primary aim of this project was to develop a survey to answer the question “Are adolescents and emerging adults in Boston satisfied with their prenatal health care provider interactions?” Satisfaction was measured via the Adolescent Patient Provider Interaction Scale (APPIS). The APPIS scale assesses information exchange and feelings of support and control within patient-provider relationships. The goal of the study is to identify common themes in young people’s provider interactions and generate suggestions for a local non- profit organization, the Massachusetts Alliance on Teen Pregnancy (MATP). Ultimately, recommendations from the needs assessment and survey will identify best practices for both patients and providers to improve teens’ and emerging adults’ satisfaction with prenatal care.Methods: In generating a needs assessment for MATP around the issue of prenatal patient satisfaction, I conducted a literature review and a secondary data summary. I also compiled surveys related to the target population, including components from the APPIS scale, the Illinois Caucus for Reproductive Health Birth Justice survey, and the Listening to Mothers survey.Results/Outcomes: I developed a survey designed to measure levels of satisfaction with prenatal care among teens and emerging adults. Young mothers (twenty-four or younger when they last received prenatal care) involved in Boston teen parent-serving organizations were asked to participate in an anonymous survey about their last prenatal care provider experience. Data from the survey are still being collected.

Name: Pahn, MollyPracticum Site: Independent ProjectLocation: Boston, MA United StatesTitle: Effects of policy barriers to welfare on low-income Americans

Introduction: In order to understand the impact of poverty in America and the role of public health work to the issue, I interviewed and video-documented 6 people who were facing poverty and/or homelessness and 3 people whom I considered to be experts on this field of study. By assessing the scope of the government systems in place to support low-income individual's lives, I was able to discuss with experts the systemic barriers in place that require intervention and reform in order to better serve this population, and turn these results into a film.Methods: 1) I researched and reached out to organizations in two different regions of the country in order to find subjects to interview. 2) I interviewed subjects about their experiences with poverty, the programs that they must utilize in order to receive government support, and discussed their future aspirations. 3) I interviewed representatives from nonprofit organizations, academia, and state government to best understand the tasks each entity faced and perceived comprehension of the issue from each side. 4) I did outside research in order to support the excerpts that I would take from each interview with factual information. 5) Edited the footage into a short film to present my findings. Results/Outcomes: 30-minute film that can be used to promote advocacy and awareness around homelessness and policy in regards to poverty.

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Social and Behavioral Sciences

Name: Brody, MiriamPracticum Site: Boston University School of Public HealthLocation: Boston, MA United StatesTitle: Implementation Assistant

Introduction: The New England Regional Spinal Cord Injury Center (NERSCIC) through the Boston University School of Public Health aims to provide health-related support and resources to individuals with spinal cord injuries (SCI) throughout the Northeast. Currently underway, one of their primary research studies, My Care My Call (MCMC), is using telehealth to connect Peer Health Coaches (PHC) with individuals with SCI in an effort to empower people in managing and advocating for their primary healthcare needs.Methods: I worked directly with the NERSCIC research team under the supervision of the MCMC intervention’s head Peer Health Coach. With their guidance, I created a manual for the MCMC program and PHC Toolkit, the primary tool that PHCs use when interacting with study participants. My responsibilities included: 1) Adapting study documents into usable teaching tools for training and 2) organizing and restructuring these materials into an MCMC Program Manual and a PHC Training Toolkit.Results/Outcomes: If proven effective, NERSCIC plans to market the MCMC program to local and national SCI peer organizations. Upon adoption, these organizations will use the MCMC Program Manual and PHC Training Toolkit developed in the training of PHCs who will be administering the program in their communities. The randomized controlled trial of My Care My Call is schedule to end in March of 2016, upon which dissemination of result and marketing of the program will begin.

Name: DeYoung, ElisePracticum Site: Boston Medical Center Pediatrics DepartmentLocation: Boston, MA United StatesTitle: Intern at BMC Pediatrics

Introduction: The Teen and Tots Clinic, an adolescent pregnancy and parenting program at Boston Medical Center, has seen a 50% decrease in teens utilizing its services. In 2014, an electronic medical record review revealed that of the 77 pregnant teens that received prenatal care at BMC, 33 received care at Teen and Tots and 44 received care from the OB clinic. The Teen and Tots Clinic provides tailored care to pregnant teens 21 and under, such as support groups, access to social workers, family planning, ongoing case management, primary care for mother and child, home visits, etc. The focus of this practicum was to increase referral rates to the clinic.Methods: The chief strategy to increase referral rates was to mobilize gatekeepers in the emergency departments at BMC. Information gathering meetings were held with the associate director of nursing in the pediatric emergency department, the health promotion advocate, and the medical director of pediatric emergency services. Barriers to referral to Teen and Tots Clinic were identified and documented. In addition, these gatekeepers made suggestions about potential strategies that could increase referral to the Clinic.Results/Outcomes: A flow sheet describing the referral process to members in the emergency department was created. Additionally, a pregnancy logbook was placed in the emergency department to ensure that pregnant teens are recorded for follow up referral to the Teen and Tots Clinic. Going forward, a folder will be included in EPIC to provide meaningful access to data about new pregnant teens, regardless of where they received care.

Name: Eakes, SamanthaPracticum Site: Virginia Commonwealth University Study AbroadLocation: Richmond, VA United StatesTitle: Contemporary Social Challenges in Rural Communities in South Africa: Service Learning Abroad

Introduction: This practicum was a four-week trip to the province of KwaZulu-Natal, South Africa sponsored by Virginia Commonwealth University. The purpose of the practicum was to learn about the status of the healthcare system in rural South Africa, consider best strategies for improving the major health issues faced by these communities, provide the opportunity to explore the social, political and economic issues occurring in the rural areas and participate in several service learning projects.Methods: Visits to hospitals, rural clinics, medical schools and non-governmental organizations illuminated many different aspects of the South African health care system. Meetings with community leaders and traditional healers provided insights about how the Zulu community views modern medicine compared to their own cultural practices. Academic aspects of this practicum included readings, group seminars, a daily journal and final research project.Results: Many rural communities in KwaZulu-Natal rely on small health care clinics for most of their health care needs and many of these clinics are burdened by a lack of adequate resources. The major hospitals are located in the city of Durban, which are additionally overcrowded, run-down, expensive and far away from most rural communities. A lack of government funding and a shortage of health care professionals are major contributors to the healthcare issues in South Africa. Additionally, the practicum afforded an opportunity to focus on a potential grant opportunity to support a sport development program aimed at improving the mental and physical health of adolescent girls in the rural areas.

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Social and Behavioral SciencesName: Erickson, KristenPracticum Site: Institute for Community HealthLocation: Cambridge, MA United StatesTitle: Partnership for Success II Intern

Introduction: The Institute for Community Health collaborates with the City of Worcester on the Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) initiative funded by the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services (BSAS). The purpose of the MOAPC initiative is to increase the capacity of communities to address opioid abuse through changes in practice, policy and the environment. This practicum focused on the evaluation and reporting stage of this program. The goal of the evaluation was to identify the coalition’s successes, strengths and weaknesses in order for the coalition to improve as they continue to work with the community.Methods: Interviews were conducted with members of a coalition formed by the Worcester Division of Public Health (WDPH) to address substance abuse problems, particularly opioid abuse. These interviews were transcribed and a codebook for qualitative data analysis was developed. Interviews were then coded and several key themes were identified and communicated in a final report for use by the client organization.Results: The coalition raised awareness of substance abuse in the community. Several key coalition challenges were identified: difficulty maintaining participation, need to identify specific goals, and developing internal and community-wide communication strategies. Additionally, key stakeholders who are not currently involved in the coalition were identified: faith- based organizations, representation from towns in the surrounding area, and representatives of specific neighborhoods and communities within Worcester. The report will inform future coalition activities and WDPH collaboration with community coalitions.

Name: Floreen, AshleyPracticum Site: Massachusetts State HouseLocation: Boston, MA United StatesTitle: White Paper on Emerging Models of Best Practices of Telemedicine in the Commonwealth of Massachusetts

Introduction: The Joint Committee on Health Care Financing considers all bills related to the funding of health care programs, including Medicaid and public assistance programs. Additionally, the Committee considers fiscal matters related to healthcare policy, MassHealth, and Medicaid, including Telemedicine legislation. The American Telemedicine Association defines telemedicine as the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status, including two-way video, email, smartphones, and other forms of wireless technology. This year, HB267: An Advancing and Expanding Access to Telemedicine Services, was filed and is currently before the Joint Committee on Health Care Financing.Methods: I researched telemedicine legislation in other states and how Massachusetts faired in comparison across the nation regarding such legislation. Additionally, I attended a hearing at the State House on HB267: An Act Advancing and Expanding Access to Telemedicine Services, where I listened to multiple parties testify and express why this bill would impact their line of work and personal lives. I also interviewed parties who had a direct interest in the bill to gain a further understanding of how this bill may influence future healthcare in the Commonwealth.Results/Outcomes: While the bill is currently before the Committee, I will compile my research and findings into a White Paper for the Chairman to reference for future use and guidance throughout the legislative process.

Name: Gero, AlexandraPracticum Site: Oregon Health AuthorityLocation: Portland, OR United StatesTitle: Enhanced Sampling for 2017 Smile Survey

Introduction: The Center for Prevention and Health Promotion (CPHP) at the Oregon Health Authority, Oregon’s state health department, conducts a quinquennial survey examining oral health trends among Oregonian children. The purpose of this practicum, conducted under the auspices of the Chief Science Officer at CPHP, was to determine the efficacy of using an enhanced sampling strategy for the upcoming 2017 Smile Survey.Methods: Activities included: 1) mapping the distribution of Oregon children ages 6 through 9 by county and by coordinated care organization (CCO) regions [CCOs are a type of health plan that integrate all health care providers into one network for people who receive care under Medicaid]; 2) consulting with a contractor with the Association of State and Territorial Dental Directors and the Centers for Disease Control and Prevention to determine sample size needed per region for a randomized representative sample.Project Results/Outcomes: A report was prepared describing four alternative sampling strategies and details, for each, the number of students necessary to screen per region, and prepares cost estimates for each approach. Alternatives include: 1) sample all 6 through 9 years olds throughout Oregon’s 36 counties; 2) limit the student population to only 9 year olds - which is consistent with Smile Surveys conducted by other states; and 3) predict the number of students needed per region assuming 16 sampling regions, defined by CCO boundaries, and depending on eligible student age. This report will help make the final determination for which sampling strategy is used in the 2017 survey.

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Social and Behavioral Sciences

Name: Johnson, LindsayPracticum Site: Professor Paula Quantromoni, DSc, MS, RDLocation: Boston, MA United StatesTitle: Program Planner, Mediterranean Diet and Chronic Disease Course

Introduction: Epidemiologic studies indicate that a Mediterranean diet rich in vegetables, fruits, whole grains, nuts, fish, oils, and a moderate amount of wine, lowers rates of chronic disease. The Mediterranean diet is widely recommended in the U.S., yet the western lifestyle and food supply stand in opposition to its principles. Nutrition and public health professionals need opportunities to learn about the health-promoting benefits of the Mediterranean diet. The Boston University study abroad program has an opportunity to offer its first nutrition-related program. The purpose of this practicum was to develop a course, “The Mediterranean Diet and Chronic Disease”, to be offered in Padua, Italy. It will enable students to learn about Mediterranean food and culture while exploring the epidemiologic evidence that supports the health benefits of this eating pattern.Methods: Activities included: 1) conducting comprehensive literature reviews on the Mediterranean diet and health outcomes, 2) selecting relevant articles for the course reader; 3) reviewing existing programs at other universities to define a unique curriculum plan; 4) creating narratives and organizational spreadsheets to summarize information specific to the Padua region; 5) drafting curriculum assignments; 6) meeting consistently with Dr. Quatromoni to integrate information provided by our Italian partners and develop the course in advance of summer travel.Project Outcomes: All practicum deliverables were met including narrative summaries; evaluation of existing programs; and curriculum planning. The course materials will be submitted to the Study Abroad office for approval and the course will be taught beginning Summer 2017

Name: Khan, HurainPracticum Site: Mattapan Community Health CenterLocation: Mattapan, MA United StatesTitle: Boston Healthy Start Initiative/Fellow at Mattapan Community Health Center

Introduction: The Boston Healthy Start Initiative within the Boston Public Health Commission works to improve birth outcomes and the overall health of mother and child, particularly among minorities and women of color. The goal of the One Key Question (OKQ) campaign is to get primary care physicians and other health care officials to ask patients, “Would you like to become pregnant in the next year?”Methods: Practicum activities included: 1) spoke with expectant mothers at Mattapan Community Health Center; 2) participated in Centering Pregnancy prenatal groups; 3) assisted with the completion of the BHSI data system; 4) expanded the marketing component of One Key Question to Roxbury and Bunker Hill Community Colleges; initiated implementation throughout the city of Boston; and 5) conducted a brief evaluation on each campus to determine the effectiveness of the OKQ materials on those specific populations.Results/Outcomes: The OKQ Campaign enables women of color who are pregnant or thinking about getting pregnant to recognize and make healthier decisions regarding preconceptional health. OKQ is an innovative approach and ideally could be introduced to all women. Most students had favorable impressions of the campaign and strongly supported application to college campuses. Recommendations include expanding OKQ to more schools in order to assure that important populations receive the preconceptional, prenatal, and overall care that they need.

Name: Manganelli, RyanPracticum Site: Boston Public Health CommissionLocation: Boston, MA United StatesTitle: Start Strong Intern

Introduction: Start Strong is an initiative aimed at working with youth to end teen dating violence by promoting healthy relationships. Through the Start Strong Peer Leader program, teens aged 11-18 years old develop skills to adopt healthy relationship behaviors and challenge societal norms around dating culture. Educational workshops on healthy dating behaviors and analyzing social norms in mass media are the primary intervention of the program. The purpose of this practicum is to assist Start Strong staff in event planning, evaluating youth peer leader behavior change, and writing a comprehensive program data report.Methods: Data analysis of youth program evaluations was completed in collaboration with BUSPH faculty member, Emily Rothman. Youth responses to program questionnaires on various dating violence prevention topics were analyzed using SAS. Focus groups were conducted with youth peer leaders to acquire qualitative data on the effectiveness of program. Additionally, the practicum also included organizing a daylong workshop event, the Break Up Summit.Results/Outcomes: Outcomes from the youth questionnaires and qualitative data from the peer leader focus groups were utilized by program managers to guide future intervention efforts. Data will also be used to pursue funding opportunities. More than 250 youths and community leaders attended the Break Up Summit.

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Social and Behavioral SciencesMaternal & Child Health

Name: Retamozo, CynthiaPracticum Site: MetamovementsLocation: Boston, United StatesTitle: Practicum Intern

Introduction: The mission of MetaMovements is to create positive social change through the arts. Each summer, the organization hosts Salsa In The Park (SITP), a free social event where attendees can learn and dance salsa. This practicum evaluated the outcome and process of SITP, and outlined recommendations for the program.Methods: Practicum activities included: 1) creating both program process and health impact evaluation surveys for distribution among guests who participated in SITP; 2) distributing, collecting and analyzing data from completed process and impact evaluation surveys; 3) aiding in the coordination of each SITP event; and 4) keeping record of SITP logistics.Results/Outcomes: The outcome evaluation revealed that the majority of respondents indicated they engaged in more than the daily recommended length of exercise at SITP. The majority also indicated feeling safe at the event, and perceived that the event included a diverse crowd and was inclusive to all backgrounds. The process evaluation revealed that each SITP was executed as planned, and recommendations include hosting the event in a larger space and in more neighborhoods throughout Boston. On a broader scale, SITP and similar events could potentially be used as an exercise intervention for individuals living in public housing in Boston, who have identified lack of perceived safety as a barrier to physical activity.

Name: Schmidt, AnnaPracticum Site: Boston University School of Public HealthLocation: Boston, MA United StatesTitle: Research/Project Assistant

Introduction: The Catalyst Center is a national center dedicated to improving health care coverage and financing for Children and Youth with Special Health Care Needs (CYSHCN) through creating strategies that improve coverage and financing of care at the policy level. The scope of this practicum ranged from providing research support for current projects, updating existing resources, and developing new communications materials.Methods: The Catalyst Center provides a variety of trusted, reliable information for families and the general public regarding innovative financing strategies. Families, stakeholders, and other leaders rely on these topical resources to support research and advocacy efforts, particularly the State-at-a-Glance Chartbook on Coverage and Financing of Care for CYSHCN. This one-stop database provides topical data on carefully selected indicators of health coverage and health care financing for CYSHCN in every state. All indicator data was checked for accuracy and currency, and updates/revisions were tracked and monitored. Research support was provided for the Family Leaders project by coding state interviews using NVivo. A fact sheet on Section 1932 of the Affordable Care Act was developed using credible data sources, written in a style appropriate for the public. Results/ProjectedResults: Revision and quality improvement steps were documented. Chartbook data was uploaded to a test site prior to making the information live. The Family Leaders surveys were coded in NVivo and analyses were compiled to summarize themes and insights garnered from interviews. The ACA Fact Sheet will be disseminated after undergoing copy editing procedures, and will be publically available online.

Name: Walmer, BeccaPracticum Site: Massachusetts Department of Public HealthLocation: Boston, United StatesTitle: Maternal and Child health Evaluation Associate

Introduction: Universal home visiting programs are a promising strategy to identify family needs and facilitate linkages to community resources. Welcome Family is a pilot home-visiting program that delivers a universal, one -time nurse visit to all mothers with newborns living or giving birth in Boston, Fall River, Lawrence and Lowell. Home visits provide an assessment of individual family needs, brief interventions based on screening results, and referrals to services. In order to demonstrate the program’s potential to serve as an entry point into a statewide system of care, evaluation of the Welcome Family program is currently focused on assessing the value of several key elements: 1) program universality; 2) identification of unmet family needs; and 3) connection to social services and community resources.Methods: Practicum activities included the following: 1) conducted 49 2-3 month telephone surveys with Welcome Family participants; 2) assisted with evaluation planning process, including development of process and outcomes measures; 3) revised evaluation logic model ; 4) developed report template to disseminate data to project sites; 5) summarized trends in 2-3 month follow-up data for site -level CQI projects; and 6) conducted key informant interviews with program stakeholders and focus group participants.Results/Outcomes: Practicum activities provided insight on the program’s current process and outcome evaluation progress, and helped identify areas for improvement to support ongoing monitoring and evaluation efforts. Data is currently being collected through 2-3-month follow-up surveys, key informant interviews, and focus group sessions, and will be used to guide future program enhancements.

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Social and Behavioral Sciences

Name: Wilding, SarahPracticum Site: Health Connector Authority - Mass Health Insurance ExchangeLocation: Boston, United StatesTitle: Operations and Customer Service Intern

Introduction: The Health Connector is the Massachusetts state health care exchange. In order to assure efficient daily operations and performance that serves the needs of its customers, a performance monitoring mechanism is needed. The purpose of this practicum was to participate with the organization’s operations team in the development of an executive metrics dashboard.Methods: Activities included: 1) Develop a management plan; 2) Facilitate daily touch point calls with vendors; 3.) Identify with business leads those metrics that are drivers of operational performance and customer experience; and 4) Assist in the creation of the dashboard. Results/Projected Outcomes: The daily operational dashboard and monthly Board Dashboard will provide the operations team, executive leadership, and the Board of the Commonwealth Health Insurance Connector Authority, with a comprehensive view with regards to daily operations performance and ongoing customer satisfaction. The emphasis on metrics that impact customer satisfaction will ultimately enable Health Connector to optimally serve those individuals, families, and small business that receive insurance coverage through the Massachusetts healthcare exchange.

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