Digital Commons Network^™

Hospital Performance And Market Share: Implications For Patient Choice, Value-Based Care, And Health Equity, David August Oddleifson

Yale Medicine Thesis Digital Library

There is substantial hospital-level variation in the quality of healthcare delivered in the United States. Although patients now have greater access to public reporting of hospital quality than ever before, many individual, geographic, and structural factors limit patient choice. The degree to which hospital quality aligns with hospital market share is largely unknown.

Using public performance measure score and volume data from CMS’s Hospital Care Compare, we assessed the association between publicly reported hospital performance scores and hospital market share for elective, semi-elective, and non-elective procedures.

Using logistic regression, we found a significant association between hospitals’ risk-adjusted complication rate and …

Medicine@Yale May/June 2022 Volume 17, Issue 1, Yale School Of Medicine Office Of Communications

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Characterizing Introductions Of Sars-Cov-2 To The U.S. Virgin Islands Using Pathogen Genomic Surveillance, Kendall Billig

Public Health Theses

Pathogen genomic surveillance systems have proven invaluable throughout the course of the global COVID-19 pandemic. Despite this, genomic surveillance programs are under-resourced or nonexistent in regions with reduced access to advanced public health tools, like the Caribbean. In this study, we documented and evaluated the establishment of a genomic surveillance system in the U.S. Virgin Islands during 2021, and used data from the program to place the story of COVID-19 in the U.S. Virgin Islands in a global context. We constructed a phylogenetic tree and conducted phylogeographic analyses to estimate the timing and geographic origin of the most recent common …

Cardiovascular Disease Mortality Among Asian American And Pacific Islander Breast Cancer Survivors In The United States By Socioeconomic Status And Rurality, 2000-2018, Katherine Luis Ho

Public Health Theses

Background: Known racial/ethnic disparities in cardiovascular disease (CVD) mortality among breast cancer survivors exist and it is well-documented that non-Hispanic Black (NHB) breast cancer survivors experience higher incidence of CVD mortality compared to NHW women. However, few studies have examined CVD mortality among Asian American, Native Hawaiian, and other Pacific Islanders (AANHPI) survivors, especially with respect to socioeconomic factors and rurality at the county-level. The aim of this study was to describe how county-level factors influence disparities in CVD mortality among AANHPI breast cancer survivors. Methods: Using Surveillance, Epidemiology, and End Results 18 registries, we analyzed a retrospective cohort of …

Role Of Covid-19 Attributions In Inciting Violence Toward Older Asian Individuals, Emily Zhen Ning Hwang

Public Health Theses

Older adults in the Asian Americans and Pacific Islanders (AAPI) community faced heightened levels of violence and discrimination during the COVID-19 pandemic. Yet, little is known about the factors driving Asian-specific violence. This study investigated if individuals who attributed COVID-19 to stable factors and anything related to China were more likely to commit violence against older Asian adults. From April 23 to May 5 2020, a survey was conducted with 1498 American individuals (M = 55.19 years, SD = 17.97 years) using two online platforms. Participants who made stable attributions about the origin of COVID-19 were significantly more likely to …

A Nonsense Mutation In Gsdmc Is Associated With Cancer Mortality In Dogs, Hang Li

Public Health Theses

Over 400 distinct canine breeds today were result from artificial selection during the last centuries. And due to the selection pressure from human interest and the founder effects, the difference among individual genomes from one same breed is less than the difference between breeds. 446 samples were included in this study to recognize the cancer-associated nonsense mutations in canine genome. 17 of the 446 samples were lab-recruited dogs, and the other 429 samples were downloaded from Sequence Read Archive. One nonsense mutation in GSDMC protein is found significantly associated with cancer risk in dogs. Since nonsense mutations could provide premature …

Informational Intermediation, Market Feedback, And Welfare Losses, Wenji Xu, Kai Hao Yang

Cowles Foundation Discussion Papers

This paper examines the welfare implications of third-party informational intermediation. A seller sets the price of a product that is sold through an informational intermediary. The intermediary can disclose information about the product to consumers and earns a fied percentage of sales revenue in each period. The intermediary's market base grows at a rate that increases with past consumer surplus. We characterize the stationary equilibria and the set of subgame perfect equilibrium payoffs. When market feedback (i.e., the extent to which past consumer surplus affects future market bases) increases, welfare may decrease in the Pareto sense.

Consumer Guilt And Sustainable Choice: Environmental Impact Of Durable Goods Innovation, K. Sudhir, Ramesh Shankar, Yuan Jin

Cowles Foundation Discussion Papers

The paper develops a modeling framework to study how sustainability interventions impact consumer adoption of durable goods innovation, firm profit and environmental outcomes in equilibrium. Our two period model with forward looking consumers and a monopoly firm introducing an innovation in the second period accommodates three key features: (1) it builds on the psychology literature linking reactive and anticipatory guilt to consumers’ environmental sensitivity on initial purchase and upgrade decisions; (2) it disentangles environmental harm over the product life into that arising from product use and dumping at replacement; and (3) it clarifies how a taxonomy of innovations (function, fashion …

Market-Minded Informational Intermediary And Unintended Welfare Loss, Wenji Xu, Kai Hao Yang

Cowles Foundation Discussion Papers

This paper examines the welfare effects of informational intermediation. A (short-lived) seller sets the price of a product that is sold through a (long-lived) informational intermediary. The intermediary can disclose information about the product to consumers, earns a fixed percentage of the sales revenue in each period, and has concerns about its prominence---the market size it faces in the future, which in turn is increasing in past consumer surplus. We characterize the Markov perfect equilibria and the set of subgame perfect equilibrium payoffs of this game and show that when the market feedback (i.e., how much past consumer surplus affects …

Factors Associated With Burnout Amongst Medical Students, Residents, And Attendings In Orthopaedics, David S. Kirwin

Yale Medicine Thesis Digital Library

Burnout is an important and timely topic in medicine as a whole and orthopaedics as a specialty. Prior studies analyzing burnout in orthopaedics generally assess for the prevalence of burnout, without using a targeted analysis on possible causes and/or the potential association with work hours. An anonymous survey was given to 24 medical students on surgical rotations, 20 orthopaedic residents, and 20 orthopaedic surgeons between June 2019 and August 2019 at a single academic institution. The survey inquired about demographics, general attributes (job satisfaction, home support, control over life/schedule), work hours, and included the abbreviated Maslach Burnout Inventory [aMBI]. Residents …

Trends In Recurrent Clostridioides Difficile Infection In New Haven County, Chinenye Maryanne Okafor

Public Health Theses

Background: Recurrent Clostridioides difficile infection (CDI) is a cause of increased burden on the healthcare system and factors associated with this disease merit understanding. This study aimed to determine the incidence rate and to describe the factors associated with recurrent CDI cases in New Haven County from 2015 to 2020. It also examined the trends in annual recurrent CDI cases across epidemiological classes. Methods: This study utilized data from a population-based surveillance program of the Healthcare-Associated Infectious Community Interface (HAIC) Program within the Connecticut Emerging Infectious Program (CT EIP) at Yale School of Public Health which served all residents of …

Impact Of Covid-19 On The Mental Health Of Resettled Refugee Children, Joseph Lawsel Williams

Public Health Theses

Background: Mental health difficulties disproportionately impact resettled refugee children (RRC). Little is known regarding the impact between COVID-19 and RRC mental health. A mixed-methods retrospective pilot study was conducted to examine the impact of COVID-19 on RRC mental health.

Methods: Families were recruited in partnership with Elena’s Light, a refugee resettlement community-stakeholder. Participants included 20 RRC (N=11 ages 4-11; N=9 ages 11-15; equal gender distribution) from 10 families (N=6 Afghanistan; N=1 Turkey; N=1 Syria; N=2 non-disclosed) resettled to New Haven, CT before March 2019. Pre-Covid (PC) and During-Covid (DC) maternal responses for three Strength and Difficulties Questionnaire (SDQ) dimensions (Emotional, …

Receivership Management Program, United States: Federal Deposit Insurance Corporation (Fdic)

Documents

No abstract provided.

European Union And Monetary Union In Permanent Crisis I: An Inventory, Dirk Meyer

Documents

No abstract provided.

Annual Report 2021, Hong Kong Monetary Authority

Documents

No abstract provided.

Bhutan Rma Ar 2021-22, Royal Monetary Authority Of Bhutan (Rma)

Documents

No abstract provided.

2022 Rmb Internationalization Report, People's Bank Of China

Documents

No abstract provided.

The Central Bank Of Cyprus Law, 2002, Republic Of Cyprus

Documents

No abstract provided.

Governing Council, European Central Bank (Ecb)

Documents

No abstract provided.

A Scoping Review On Maternal Mortality Review Committees Efforts To Improve Black Maternal Health, Shannon Tracy Larsuel

Public Health Theses

Background: The United States has the highest rate of maternal mortality of all developed nations which is largely due to vast racial and ethnic disparities in maternal health outcomes.1 To address the high rates of maternal mortality many states have implemented Maternal Mortality Review Committees (MMRCs) to identify the causes of pregnancy-related deaths and generate recommendations to reduce the number of maternal deaths. However, MMRCs have failed to adequately address the role that racism has in producing high rates of maternal mortality for Black women.Methods: This thesis employed a modified scoping review approach to chart the existing literature on MMRCs' …

“It Takes A Village”: A Qualitative Analysis Of Black Women’S Experiences Navigating Healthcare With High-Risk Perinatal Conditions, Simileoluwa Elizabeth Falako

Public Health Theses

Black women have a likelihood of maternal mortality that is three to four times higher than white women in the United States. In Connecticut, most pregnancy-related deaths are from Black and Latinx women, even though they do not have the majority of live births in the state. This study aims to explore the medical experiences of Black women with high-risk perinatal conditions and their navigation of healthcare at a tertiary care center in Connecticut. A qualitative study was conducted using semi-structured interviews with seven Black women with hypertension and/or diabetes in pregnancy who gave birth at a large, tertiary medical …

The Impact Of Personalized Nursing Care On Anxiety, Depression, Angina Related Life Quality, And Physiological Conditions In Older Adults With Coronary Heart Disease, Qiao Fan

Public Health Theses

AbstractObjective: To study the impact of medical-personalized nursing care on anxiety, depression, BMI, blood pressure, blood lipid and quality of life in elderly patients with coronary heart disease. Methods: In this study, 160 older adults with coronary heart disease had been enrolled and randomized using the random range method. The control group included 80 older adults who received a conventional nursing intervention, and the experiment group included 80 older adults who were treated with a focused and personalized nursing intervention. The two groups of older adults had been compared and evaluated for Self-rating Anxiety Scale (SAS) mark, the Self-rating Depression …

A Scoping Review Comparing Sustainable Diet Indices, Natalie Henning

Public Health Theses

Interest in environmentally sustainable diets (i.e., diets beneficial for both human and planetary health) has increased as the role of food systems in climate change and population health has become better understood. Sustainable diet indices have been proposed as a holistic approach to assessing diets around the world with regards to human and planetary outcomes. The aim of this scoping review was to summarize and compare sustainable diet indices and their applicability to various populations.A literature search of three databases (Scopus, PubMed, and the Climate Change and Human Health Literature Search Portal) was conducted to identify articles that developed, validated, …

Comprehensive West Nile Virus Phylogenetic Analysis: Europe And Beyond, Robert T. Koch

Public Health Theses

ABSTRACT West Nile virus (WNV) inhabits a unique position in the infectious disease landscape. It is both the most widespread arbovirus in the world, and yet is one of the least known. WNV is spread by mosquitoes and has high morbidity and mortality in birds, humans are dead-end hosts of the virus but can develop a serious neuroinvasive form of the disease (WNND). The incidence of such cases is on the rise around the world. To explore WNV, we created a comprehensive phylogenetic analysis with all available WNV genomes in genbank database using Nextstrain to identify use cases for increasing …

Comparative Impact Of Network Adequacy Standard Strategies On Medicaid Recipient Cvd Outcomes: A Computer Simulation Modeling Study, Sreeja Kondeti

Public Health Theses

Context: Medicaid managed care network adequacy standards vary widely across states and are not typically informed by scientific evidence. The comparative efficacy of these standards for protecting the health of the Medicaid population has not yet been comprehensively researched.Objective: The aims of this study are to construct simulation modeling methods to approach this policy problem and to determine which numeric values for network adequacy standards are most effective for producing favorable health outcomes for Medicaid recipients who develop CVD. Design and Setting: A continuous-time Markov model was used to simulate the natural history of cardiovascular disease, using a cohort that …

Identification Of An In Vitro Medium For Leptospira Spp. As A Surrogate For Host Environment, Using Rna-Seq Transcriptome Analysis, Zitong Lin

Public Health Theses

Pathogenic Leptospira species causes millions of leptospirosis cases around the world and is an urgent public health issue that needs to be properly addressed. The infection leads to clinical manifestations ranging from self-limiting febrile illness to severe life-threatening symptoms. Currently, there is a lack of sensitive assay for early diagnosis of leptospirosis, and there is no FDA-approved vaccine for human use in the United States. Despite the worldwide occurrence of this zoonotic disease, low and middle-income countries are disproportionately affected by it. A better understanding of the pathogenesis of Leptospira is a crucial step for the development of better diagnostic …

Effectiveness Of Primary And Booster Covid-19 Mrna Vaccination Against Infection Caused By The Sars-Cov-2 Omicron Variant In People With A Prior Sars-Cov-2 Infection, Alexander James Robertson

Public Health Theses

Objective: To estimate the effectiveness of a primary (two-dose) and booster (third dose) vaccination against Omicron infection among previously infected people.Methods: We designed a test-negative case-control study among vaccine eligible people who received SARS-CoV-2 RT-PCR testing between November 1, 2021, and January 31, 2022 from the Yale New Haven Health System facilities serving southern Connecticut communities. Our primary exposure was COVID-19 mRNA primary and booster vaccination. We conducted two analyses, each with an outcome of Omicron BA.1 variant infection (S-gene target failure defined) and each stratified by prior SARS-CoV-2 infection status. We estimated the effectiveness of primary vaccination on the …

Melissa: Monitoring The Environment With Living Investigatory Sentinel Species Apis Mellifera, Brady Rowe

Public Health Theses

Without the ability to meaningfully detect an environmental contaminant, public health efforts can get behind the curve, and people suffer for it. Industrial polluters are the major source of environmental contamination. Despite regulation, industrial compliance efforts are often limited by the difficulty of getting samples to analyze due to cost and logistical challenges. The current method requires a compliance officer to gather a sample or rely on self-reported measures from the potential polluters. This process can be remarkably costly both in capital and human labor. These issues can be remedied by relying on the domesticated honeybee to gather the “samples.” …

Interactions Between Diabetes And Covid-19: A Scoping Review, Vani Topkar

Public Health Theses

Abstract

Background: The COVID-19 pandemic that started in March 2020 caused by the SARS-CoV-2 virus introduced an incredible number of unknowns that ongoing research aims to investigate. One such unknown is the relationship between diabetes and COVID-19. Existing literature has identified diabetes as a risk factor for poor health outcomes in COVID-19 patients, however, other information is limited and inconclusive.

Objective: There are two primary goals of this scoping review. First, to consolidate existing literature about both associations between COVID-19 and diabetes, and the biological mechanisms of how diabetes and COVID-19 may interact. This includes consolidating information about diabetes as …

The Joint Effects Of Pre-Pregnancy Bmi, Race/Ethnicity On Infants’ Birth Weights, Mei Wang

Public Health Theses

AbstractObjective: We characterized the joint impacts of maternal race/ethnicity and pre-pregnancy BMI on adverse birth weight outcomes including low birth weight (LBW), and macrosomia. Methods: Retrospective cohort study of linked birth data for the years 2016-2020. Maternal race/ethnicity and maternal BMI were the key exposures; we analyzed their joint impact on outcomes using Poisson regression models. Results: When using race-specific reference groups, the difference in risk between NHB and NHW decreased as pre-pregnancy BMI increased and additionally, the difference in risk of macrosomia between the two groups increased with increasing BMI. NHB women generally had higher risk of low birth …