Objectives

Poverty is a common root cause of poor health and disrupts medical care. Clinically embedded antipoverty programs that address financial stressors may prevent missed visits and improve show rates. This pilot study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life.

Methods

In this community-partnered randomized controlled trial comparing clinic-based financial coaching to usual care among low-income parent-infant dyads attending pediatric preventive care visits, we examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). We also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit.

Results

Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls (0.46 vs 1.07 missed of 4 recommended visits; mean difference, 0.61 visits missed; P = .01). Intervention participants were more likely to have up-to-date immunizations each visit (relative risk, 1.26; P = .01) with fewer missed vaccinations by the end of the 6-month preventive care visit period (2.52 vs 3.8 missed vaccinations; P = .002).

Conclusions

In this pilot randomized trial, a medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families' adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.

We measure homogeneous distances to M31 and 38 associated stellar systems (−16.8 ≤ MV ≤ −6.0), using time-series observations of RR Lyrae stars taken as part of the Hubble Space Telescope Treasury Survey of M31 Satellites. From >700 orbits of new/archival Advanced Camera for Surveys imaging, we identify >4700 RR Lyrae stars and determine their periods and mean magnitudes to a typical precision of 0.01 day and 0.04 mag. Based on period–Wesenheit–metallicity relationships consistent with the Gaia eDR3 distance scale, we uniformly measure heliocentric and M31-centric distances to a typical precision of ∼20 kpc (3%) and ∼10 kpc (8%), respectively. We revise the 3D structure of the M31 galactic ecosystem and: (i) confirm a highly anisotropic spatial distribution such that ∼80% of M31's satellites reside on the near side of M31; this feature is not easily explained by observational effects; (ii) affirm the thin (rms 7–23 kpc) planar “arc” of satellites that comprises roughly half (15) of the galaxies within 300 kpc from M31; (iii) reassess the physical proximity of notable associations such as the NGC 147/185 pair and M33/AND XXII; and (iv) illustrate challenges in tip-of-the-red-giant branch distances for galaxies with MV > − 9.5, which can be biased by up to 35%. We emphasize the importance of RR Lyrae for accurate distances to faint galaxies that should be discovered by upcoming facilities (e.g., Rubin Observatory). We Original content from this work may be used under the terms of the Creative Commons Attribution 4.0 licence. Any further provide updated luminosities and sizes for our sample. Our distances will serve as the basis for future investigation of the star formation and orbital histories of the entire known M31 satellite system.

The Great Andromeda Galaxy (M31) is the nexus of the near-far galaxy evolution connection and a principal data point for near-field cosmology. Due to its proximity (780 kpc), M31 can be resolved into individual stars like the Milky Way (MW). Unlike the MW, we have the advantage of a global view of M31, enabling M31 to be observed with techniques that also apply to more distant galaxies. Moreover, recent evidence suggests that M31 may have survived a major merger within the last several Gyr, shaping the morphology of its stellar halo and triggering a starburst, while leaving the stellar disk largely intact. The MW and M31 thus provide complementary opportunities for in-depth studies of the disks, halos, and satellites of L* galaxies. Our understanding of the M31 system will be transformed in the 2020s if they include wide field facilities for both photometry (HST-like sensitivity and resolution) and spectroscopy (10-m class telescope, >1 sq. deg. field, highly multiplexed, R~ 3000 to 6000). We focus here on the power of these facilities to constrain the past, present, and future merger history of M31, via chemo-dynamical analyses and star formation histories of phase-mixed stars accreted at early times, as well as stars in surviving tidal debris features, M31's extended disk, and intact satellite galaxies that will eventually be tidally incorporated into the halo. This will yield an unprecedented view of the hierarchical formation of the M31 system and the subhalos that built it into the L* galaxy we observe today.