Benjamin L. Castleman

RENAL BIOPSY STUDIES CORRELATED WITH RENAL CLEARANCE OBSERVATIONS IN HYPERTENSIVE PATIENTS TREATED BY RADICAL SYMPATHECTOMY

The morphologic changes in the kidneys of patients who have died from essential hypertension and its complications are well known. The structural pattern at death is informative, but it offers little clue as to the intervening degenerative processes responsible for the terminal picture. A noteworthy effort has been made in recent years to fill the void. Various investigators (1, 2, 3) have applied the ingenious renal clearance procedures devised by Smith (4) to hypertensive patients and have obtained consistent and definite data. Anatomical studies also have been pursued in living patients, and recently one of us (B. C.) reported a small series of renal biopsies, taken during life from patients with various degrees of essential hypertension (5). The specimens were obtained during operation for sympathectomy, and all showed diffuse vascular disease. Since this preliminary report the number of biopsies has been increased to more than 100.2 No attempt was made at that time to consider anatomic findings in relation to renal clearance data or to the clinical status. In the first portion of the present communication, such an attempt has been made, and the microscopic appearance of renal tissue from 20 living patients has been correlated with the function of the kidneys. The quantitative clearance procedures include measurement of rate of formation of glomerular filtrate, renal plasma flow, and maximal capacity of the tubules to excrete diodrast.3 The second portion of the paper deals

Freshman Year Financial Aid Nudges: An Experiment to Increase FAFSA Renewal and College Persistence

In this paper we investigate, through a randomized controlled trial design, the impact of a personalized text messaging intervention designed to encourage college freshmen to refile their Free Application for Federal Student Aid (FAFSA) and maintain their financial aid for sophomore year. The intervention produced large and positive effects among freshmen at community colleges where text recipients were almost 14 percentage points more likely to remain continuously enrolled through the Spring of sophomore year. By contrast, the intervention did not improve sophomore year persistence among freshmen at four-year institutions among whom the rate of persistence was already high.

Stemming the Tide of Summer Melt: An Experimental Study of the Effects of Post-High School Summer Intervention on Low-Income Students’ College Enrollment

Abstract The summer after high school graduation is a largely unexamined stage of college access among underrepresented populations in higher education. Yet two recent studies revealed that anywhere from 10% to 40% of low-income students who have been accepted to college and signaled their intent to enroll reconsider where, and even whether, to matriculate in the months after graduation. This experimental study investigates the effect of providing college counseling to low-income students during the summer. We randomly assigned students at 7 innovative high schools to receive proactive outreach from high school counselors. The treatment focused on addressing financial and information barriers students faced. Results show that providing college counseling to low-income students during the summer months leads to substantial improvements in both the rate and quality of college enrollment. Students in the treatment group were 14 percentage points more likely to enroll immediately in college and 19 percentage points more likely to keep the postsecondary plans they developed during senior year. Policy recommendations include strategies for high schools and/or colleges to provide effective support during the post–high school summer.

A record case of the tetralogy of Fallot, with comments on metabolic and pathologic studies☆

Abstract Clinical, metabolic, and pathologic studies of a patient with advanced morbus caeruleus (tetralogy of Fallot) are reported. The patient died at the age of 19, and had been cyanosed since the age of 2. He was proficient scholastically, and, until a year before death, suffered a minimum of handicap from his malady. He was thought to have had rheumatic fever at the age of 9 and subacute bacterial endocarditis during his last year of life. A colon bacillus abscess of the cerebrum was immediately responsible for death. The metabolic investigations revealed a profound variation from the normal in the acid-base equilibrium of the body, and changes in renal function. As much as 75 per cent of the blood in the cardiac chambers was thought to traverse a right-to-left shunt. The oxygen saturation of the arterial blood varied between 62 and 58 per cent. These are critical levels for human existence. The oxygen capacity was about 35 volumes per cent. The carbon dioxide content of the arterial blood was less than 33 volumes per cent. The arterial pH s was less than 7.29. A profound, uncompensated acidosis was attributed to the increased concentration of undetermined acids and failure of the respiratory center to maintain the usual balance between free and combined carbon dioxide. The functional insufficiency of the kidneys was attributed to anoxemia, venous congestion, and acidosis.

Customized Nudging to Improve FAFSA Completion and Income Verification.

For most students from low- or moderate-income families, successfully completing the Free Application for Federal Student Aid (FAFSA) is a crucial gateway on the path to college access. Yet, researchers have long recognized that the complexity of the FAFSA can serve as a barrier to students applying for — and in turn receiving — financial aid. We investigate the impact of a texting campaign specifically to address the informational and behavioral barriers associated with initial FAFSA filing. We advance beyond prior work by designing a texting system that leveraged regularly-updated administrative data on the status of students’ FAFSA submissions to provide students with personalized outreach and updates on their FAFSA completion status. Students were able to write back for one-on-one, text-based assistance. We implemented the intervention in two distinct locations. In partnership with a set of eight school districts in Texas that together serve over 17,000 high school seniors, we tested the impact of this intervention through a school-level randomized trial. In partnership with the state of Delaware, we offered the text-based outreach to all high school seniors in Delaware public high schools, and we tested the impact of this statewide effort using a quasi-experimental matching strategy. Evidence from both sites indicates that the text-based outreach serves to improve FAFSA filing outcomes. In Delaware, rates of FAFSA completion were improved overall. In Texas, students filed the FAFSA earlier as a result of the outreach. In Texas, where we are able to observe subsequent college enrollment, the outreach impacted immediate college matriculation by four percentage points. We consider two potential mechanisms beyond simply completing the FAFSA through which the intervention could have improved rates of college enrollment. First, as a result of earlier filing, students may have accessed more generous financial aid. Second, the messaging may have made more salient the income verification process for the sizeable share of filers selected for verification. Earlier filing also may have afforded these students more time to navigate the verification process. We provide evidence to support both of these potential channels.

More than Dollars for Scholars: The Impact of the Dell Scholars Program on College Access, Persistence and Degree Attainment

ABSTRACT:Socioeconomic inequalities in college completion have widened over time. A critical question is how to support low-income and first-generation students to achieve college success. We investigate one effort, the Dell Scholars Program, which provides a combination of financial support and individualized advising to selected students who attend institutions throughout the United States. Using two quasi-experimental analytic strategies, regression discontinuity and difference-in-differences with a matched comparison sample, we find consistent evidence that being selected as a Dell Scholar leads to substantially higher rates of bachelorsdegree completion within six years, as well improvements on multiple other measures of college success.

Parental Influences on Postsecondary Decision Making

Research increasingly points to the importance of parental engagement in children’s education. Yet, little research has investigated whether prompting parents to be more involved in college processes improves student outcomes. We investigate experimentally whether providing both students and their parents with personalized outreach about tasks students need to complete to enroll in college leads to improved college enrollment outcomes relative to providing outreach to students only. We utilize text messaging to provide information and advising to students and parents. Across treatment arms, the text outreach increased on-time college enrollment by a statistically significant 3.1 percentage points. Texting both parents and students, however, did not increase the efficacy of the outreach. We situate this result in the broader parental engagement literature.

Parental Influences on Postsecondary Decision-Making: Evidence from a Text Messaging Experiment

A growing body of research points to the importance of increasing parental engagement in their children’s education. Yet, little research has investigated whether prompting parents to be more involved in the college process leads to improved student outcomes. We investigate, through a large-scale experiment, whether providing both students and their parents with personalized information about tasks students need to complete in order to enroll in college leads to improved college enrollment outcomes relative to providing information to students only. We utilize text messaging as a vehicle for providing information and one-on-one college advising to students and parents. Across treatment arms, the text outreach increased on-time college enrollment by a statistically significant 3.1 percentage points. We do not find compelling evidence that texting both parents and students increased the efficacy of the outreach relative to just texting students. We discuss this result in the context of the broader parental engagement literature.

Intensive College Counseling and the Enrollment and Persistence of Low-Income Students

Though counseling is one commonly pursued intervention to improve college enrollment and completion for disadvantaged students, there is relatively little causal evidence on its efficacy. We use a regression discontinuity design to study the impact of intensive college counseling provided by a Massachusetts program to college-seeking, low-income students that admits applicants partly on the basis of a minimum grade point average requirement. Counseling shifts enrollment toward four-year colleges that are less expensive and have higher graduation rates than alternatives students would otherwise choose. Counseling also improves persistence through at least the second year of college, suggesting a potential to increase the degree completion rates of disadvantaged students.

Case 32-1964

Presentation of Case A thirty-nine-year-old physician entered the hospital because of dyspnea and pain in the chest. He had been vigorous and asymptomatic until the onset of fatigue and exertional ...