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Quality Management: A Global Case Study In Organ Transplantation, Cassie L. Rodriguez 2016 University of San Francisco

Quality Management: A Global Case Study In Organ Transplantation, Cassie L. Rodriguez

Master's Projects

Every year the US and European countries face an epidemic of organ failure from a multitude of reasons: cancer, genetic predisposition, exposure to harmful chemicals in home or surrounding areas or through drinking, drugs and smoking. Another problem faced, is the ratio of organ donors to organ recipients. Over 121,000 patients are on the waiting for an organ transplant, and a fraction of those waiting will die because of time. The Hanover Medical school and department of quality management, have created an integrated approach to organ transplant avenues. Quality management is a systematic guide for organ transplantation that allows ...


Mathematical Modeling Of Vaccine Noncompliance, Jordan A. Bauer 2016 Valparaiso University

Mathematical Modeling Of Vaccine Noncompliance, Jordan A. Bauer

Annual Symposium on Biomathematics and Ecology: Education and Research

No abstract provided.


Influence Of Awareness That Results From Direct Experience On The Spread Of Epidemics, Ying Xin 2016 Ohio University - Main Campus

Influence Of Awareness That Results From Direct Experience On The Spread Of Epidemics, Ying Xin

Annual Symposium on Biomathematics and Ecology: Education and Research

No abstract provided.


Zika Virus And Global Health Security, Lawrence O. Gostin, James G. Hodge Jr. 2016 Georgetown University Law Center

Zika Virus And Global Health Security, Lawrence O. Gostin, James G. Hodge Jr.

Georgetown Law Faculty Publications and Other Works

Americans are largely apathetic about the risks of Zika virus and Congress cannot agree on preparedness funding. Strategies to counter the spread of Zika by the World Health Organisation (WHO) grossly underestimate the disease’s impact. WHO and member countries lack sufficient resources to respond. Consequences of fiscal apathy can be measured in lives lost and long-term disabilities. Zika prevention is a matter of global health security.

The epidemiologic brunt of Zika in South America falls largely on vulnerable women at heightened risk of exposure through mosquitoes and sexual transmission. Resulting transmission to fetuses and infants will have generational impacts ...


Atrial Fibrillation Without Comorbidities: Prevalence, Incidence And Prognosis (From The Framingham Heart Study), Eun-Jeong Kim, Xiaoyan Yin, Joao D. Fontes, Jared W. Magnani, Steven A. Lubitz, David D. McManus, Sudha Seshadri, Ramachandran S. Vasan, Patrick T. Ellinor, Martin G. Larson, Emelia J. Benjamin, Michael Rienstra 2016 Massachusetts General Hospital

Atrial Fibrillation Without Comorbidities: Prevalence, Incidence And Prognosis (From The Framingham Heart Study), Eun-Jeong Kim, Xiaoyan Yin, Joao D. Fontes, Jared W. Magnani, Steven A. Lubitz, David D. Mcmanus, Sudha Seshadri, Ramachandran S. Vasan, Patrick T. Ellinor, Martin G. Larson, Emelia J. Benjamin, Michael Rienstra

David D. McManus

BACKGROUND: The epidemiology of atrial fibrillation (AF) without comorbidities, known as 'lone AF', is uncertain. Although it has been considered a benign condition, we hypothesized that it confers a worse prognosis compared with a matched sample without AF.

METHODS: We described the proportion of AF without comorbidities (clinical, subclinical cardiovascular disease and triggers) among the entire AF sample in Framingham Heart Study (FHS). We compared AF without comorbidities with typical AF, and age-, sex- and cohort-matched individuals without AF, using Cox proportional hazards analysis in relation to combined cardiovascular events (stroke, heart failure, myocardial infarction), and mortality.

RESULTS: Of 10 ...


A Synthesis Of Current Surveillance Planning Methods For The Sequential Monitoring Of Drug And Vaccine Adverse Effects Using Electronic Health Care Data, Jennifer C. Nelson, Robert Wellman, Onchee Yu, Andrea J. Cook, Judith C. Maro, Rita Ouellet-Hellstrom, Denise Boudreau, James S. Floyd, Susan R. Heckbert, Simone Pinheiro, Marsha Reichman, Azadeh Shoaibi 2016 Group Health Research Institute; University of Washington

A Synthesis Of Current Surveillance Planning Methods For The Sequential Monitoring Of Drug And Vaccine Adverse Effects Using Electronic Health Care Data, Jennifer C. Nelson, Robert Wellman, Onchee Yu, Andrea J. Cook, Judith C. Maro, Rita Ouellet-Hellstrom, Denise Boudreau, James S. Floyd, Susan R. Heckbert, Simone Pinheiro, Marsha Reichman, Azadeh Shoaibi

eGEMs (Generating Evidence & Methods to improve patient outcomes)

Introduction: The large-scale assembly of electronic health care data combined with the use of sequential monitoring has made proactive postmarket drug- and vaccine-safety surveillance possible. Although sequential designs have been used extensively in randomized trials, less attention has been given to methods for applying them in observational electronic health care database settings.

Existing Methods: We review current sequential-surveillance planning methods from randomized trials, and the Vaccine Safety Datalink (VSD) and Mini-Sentinel Pilot projects—two national observational electronic health care database safety monitoring programs.

Future Surveillance Planning: Based on this examination, we suggest three steps for future surveillance planning in health ...


Sample Size Formulas For Estimating Intraclass Correlation Coefficients In Reliability Studies With Binary Outcomes, Mengxiao Xu 2016 The University of Western Ontario

Sample Size Formulas For Estimating Intraclass Correlation Coefficients In Reliability Studies With Binary Outcomes, Mengxiao Xu

Electronic Thesis and Dissertation Repository

Introduction: Measurement errors can seriously affect quality of clinical practice and medical research. It is therefore important to assess such errors by conduct- ing studies to estimate a coefficients reliability and assessing its precision. The intraclass correlation coefficient (ICC), defined on a model that an observation is a sum of information and random error, has been widely used to quantify reliability for continuous measurements. Sample formulas have been derived for explicitly incorporation of a prespecified probability of achieving the prespecified precision, i.e., the width or lower limit of a confidence interval for ICC. Although the concept of ICC is ...


Evaluation Of Sexual Orientation Items In Population Health Surveys Among Canadians: A Mixed Methods Approach, Christoffer Dharma 2016 The University of Western Ontario

Evaluation Of Sexual Orientation Items In Population Health Surveys Among Canadians: A Mixed Methods Approach, Christoffer Dharma

Electronic Thesis and Dissertation Repository

A single item sexual orientation question has been asked in Statistics Canada health surveys to identify health inequalities in Canada. Using a mixed methods study with convenience sample of Canadians, we evaluated this question in comparison to a set of US questions that includes domains of sexual identity, behaviour and attraction. The single item question had an 85.8% sensitivity and 100% specificity in capturing sexual minorities from the broadest definition (n = 311). Chance-corrected agreements with sexual identity, 12 months and life time sexual behaviour were 0.89, 0.39 and 0.48 respectively. Both trans and cisgender people revealed ...


Palliative Chemotherapy Among People Living In Poverty With Metastasised Colon Cancer: Facilitation By Primary Care And Health Insurance, Kevin M. Gorey, Emma Bartfay, Sindu M. Kanjeekal, Frances C. Wright, Caroline Hamm, Isaac N. Luginaah, Guangyong Zou, Eric J. Holowaty, Nancy L. Richter, Madhan K. Balagurusamy 2016 University of Windsor

Palliative Chemotherapy Among People Living In Poverty With Metastasised Colon Cancer: Facilitation By Primary Care And Health Insurance, Kevin M. Gorey, Emma Bartfay, Sindu M. Kanjeekal, Frances C. Wright, Caroline Hamm, Isaac N. Luginaah, Guangyong Zou, Eric J. Holowaty, Nancy L. Richter, Madhan K. Balagurusamy

Social Work Publications

Background: Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California.

Methods: We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models.

Results: Palliative chemotherapy was received by less than half of the participants ...


Using Machine Learning And Natural Language Processing Algorithms To Automate The Evaluation Of Clinical Decision Support In Electronic Medical Record Systems, Donald A. Szlosek, Jonathan M. Ferretti 2016 University of Southern Maine

Using Machine Learning And Natural Language Processing Algorithms To Automate The Evaluation Of Clinical Decision Support In Electronic Medical Record Systems, Donald A. Szlosek, Jonathan M. Ferretti

eGEMs (Generating Evidence & Methods to improve patient outcomes)

Introduction: As the number of clinical decision support systems incorporated into electronic medical records increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. Here we use machine learning and natural language processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an electronic medical record system and compare it against manual evaluation.

Methods: Modeled after the electronic medical record system EPIC at Maine Medical Center, we developed a dummy dataset containing physician notes in free text for 3621 artificial patients ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Tiffany A. Moore Simas

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Jeroan J. Allison

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar 2016 University of Massachusetts Medical School

Association Of Common Mental Disorder Symptoms With Health And Healthcare Factors Among Women In Rural Western India: Results Of A Cross-Sectional Survey, Apurv Soni, Nisha Fahey, Nancy Byatt, Anusha Prabhakaran, Tiffany A. Moore Simas, Jagdish Vankar, Ajay Phatak, Eileen O'Keefe, Jeroan J. Allison, Somashekhar Nimbalkar

Nancy Byatt

OBJECTIVES: Information about common mental disorders (CMD) is needed to guide policy and clinical interventions in low-income and middle-income countries. This study's purpose was to characterise the association of CMD symptoms with 3 inter-related health and healthcare factors among women from rural western India based on a representative, cross-sectional survey.

SETTING: Surveys were conducted in the waiting area of various outpatient clinics at a tertiary care hospital and in 16 rural villages in the Anand district of Gujarat, India.

PARTICIPANTS: 700 Gujarati-speaking women between the ages of 18-45 years who resided in the Anand district of Gujarat, India, were ...


Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. McManus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Multiple Chronic Conditions And Psychosocial Limitations In A Contemporary Cohort Of Patients Hospitalized With An Acute Coronary Syndrome, Mayra Tisminetsky, Jerry H. Gurwitz, David D. Mcmanus, Jane S. Saczynski, Molly E. Waring, Nathaniel Erskine, Milena D. Anatchkova, David C. Parish, Darleen M. Lessard, Catarina I. Kiefe, Robert J. Goldberg

Molly E. Waring

Background: As adults live longer, multiple chronic conditions have become more prevalent over the past several decades. We describe the prevalence of, and patient characteristics associated with, cardiac and non-cardiac-related multimorbidities in patients discharged from the hospital after an acute coronary syndrome (ACS).

Methods: We studied 2,174 patients discharged from the hospital after an ACS at 6 medical centers in Massachusetts and Georgia between April, 2011 and May, 2013. Hospital medical records yielded clinical information including presence of 8 cardiac-related and 8 non-cardiac-related morbidities on admission. We assessed multiple psychosocial characteristics during the index hospitalization using standardized in-person instruments ...


Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones 2016 Harvard Medical School

Accumulation Of Metabolic Cardiovascular Risk Factors In Black And White Young Adults Over 20 Years, Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, David C. Goff, Donald Lloyd-Jones

Catarina I. Kiefe

BACKGROUND: Cross-sectional clustering of metabolic risk factors for cardiovascular disease in middle-aged adults is well described, but less is known regarding the order in which risk factors develop through young adulthood and their relation to subclinical atherosclerosis.

METHOD AND RESULTS: A total of 3178 black and white women and men in the Coronary Artery Risk Development in Young Adults study were assessed to identify the order in which cardiovascular disease risk factors including diabetes, hypertension, dyslipidemia (low high-density lipoprotein cholesterol or high triglyceride levels), hypercholesterolemia (high total or low-density lipoprotein cholesterol), and obesity develop. Observed patterns of risk factor development ...


Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg 2016 University of Colorado

Age And Sex Differences In Long-Term Outcomes Following Implantable Cardioverter-Defibrillator Placement In Contemporary Clinical Practice: Findings From The Cardiovascular Research Network, Frederick A. Masoudi, Jerry H. Gurwitz, Robert J. Goldberg

Robert J. Goldberg

BACKGROUND: Patient sex and age may influence rates of death after receiving an implantable cardioverter-defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not well characterized.

METHODS AND RESULTS: We studied 2954 patients with left ventricular ejection fraction < /=0.35 undergoing first-time implantable cardioverter-defibrillator for primary prevention within the Cardiovascular Research Network; 769 patients (26%) were women, and 2827 (62%) were aged > 65 years. In a median follow-up of 2.4 years, outcome rates per 1000 patient-years were 109 for death, 438 for hospitalization, and 111 for heart failure hospitalizations. Procedure-related complications occurred in 8.36%. In multivariable models, women had significantly lower risks of death (hazard ...


Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg 2016 University of Massachusetts Medical School

Culturally Adaptive Storytelling Method To Improve Hypertension Control In Vietnam - "We Talk About Our Hypertension": Study Protocol For A Feasibility Cluster-Randomized Controlled Trial, Jeroan J. Allison, Hoa L. Nguyen, Duc A. Ha, German A. Pihan, Ha N. Ly, Hanh T. Tran, Ngoc T. Phan, Nguyen C. Vu, Minjin Kim, Robert J. Goldberg

Jeroan J. Allison

BACKGROUND: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and ...


Can Physician Champions Improve Kangaroo Care? Trends Over 5 Years In Rural Western India, Apurv Soni, Amee Amin, Dipen V. Patel, Nisha Fahey, Ajay G. Phatak, Jeroan Allison, Somashekhar M. Nimbalkar 2016 University of Massachusetts Medical School

Can Physician Champions Improve Kangaroo Care? Trends Over 5 Years In Rural Western India, Apurv Soni, Amee Amin, Dipen V. Patel, Nisha Fahey, Ajay G. Phatak, Jeroan Allison, Somashekhar M. Nimbalkar

Jeroan J. Allison

Introduction: In 2013, approximately 2.8 million children worldwide died within the neonatal period. India is at the epicenter of this tragedy, accounting for one-third of all neonatal mortalities. Prematurity and/or with low birth weight are the leading cause of neonatal mortality and India has the highest number of neonates born preterm and weighing less than 2,500 grams worldwide. It is estimated that Kangaroo Care can avert up to 48% of all neonatal deaths among premature babies by 2025. However, the promise of Kangaroo Care as a low-cost, safe, and efficacious intervention to reduce neonatal mortality in India ...


Memory And Fine Motor Skill Test Performance Among Children Living Near Coal Ash Storage Sites., Lindsay Koloff Tompkins 2016 University of Louisville

Memory And Fine Motor Skill Test Performance Among Children Living Near Coal Ash Storage Sites., Lindsay Koloff Tompkins

Electronic Theses and Dissertations

Coal ash, a byproduct of coal combustion,is reduced in 47 U.S. states andfrequently contains heavy metals, some of which are known neurotoxins. An estimated 1.5 million children live near sites where coal ash is produced andstored, yet there have been no studies assessing coal ash exposure and children’s neuro behavioral health. This study is part of a larger cross-sectional study, Coal Ash and Neuro behavioral Symptoms in Children Aged 6- 14 Years Old, and aimed to determine the relationship between children’s memory and fine motor skill test performance and the proximity of the home to ...


The Rivas Cohort Study: Design And Baseline Characteristics Of A Nicaraguan Cohort, Madeline Fiore, Amos Lichtman, Keriann Nobil, Louis Fiore 2016 University of Massachusetts Medical School

The Rivas Cohort Study: Design And Baseline Characteristics Of A Nicaraguan Cohort, Madeline Fiore, Amos Lichtman, Keriann Nobil, Louis Fiore

Open Access Articles

BACKGROUND: A lack of advanced healthcare information systems and validated scientific cohorts in Nicaragua makes it difficult to estimate disease prevalences and other public health statistics. Although there is concern of an "epidemic" of chronic kidney disease (CKD) in this country, statistics regarding its magnitude are derived from only a small number of non-representative studies. Budgetary constraints and the logistical problems of maintaining a study cohort make longitudinal studies difficult. The Rivas Cohort was created to measure disease burden of CKD and other public health priorities in the Department of Rivas, Nicaragua. Using primarily volunteer research students and technologic innovation ...


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