Digital Commons Network^™

Protocols, Practices, And Needs For Investigating Sudden Unexpected Infant Deaths, Carri Cottengim, Sharyn Parks, Dale Rhoda, Tom Andrew, Kurt B. Nolte, John Fudenberg, Mary Ann Sens, Jennifer Brustrom, Betsy Payn, Carrie K. Shapiro-Mendoza

Pathology Research and Scholarship

Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine …

Problematic Plant Monitoring In Homestead National Monument Of America, 2006–2017, Craig C. Young

United States National Park Service: Publications

Abstract

Managers are challenged with the impact of problematic plants, including exotic, invasive, and pest plant species. Information on the abundance, distribution, and location of these plants is essential for developing risk-based approaches to managing these species. Based on surveys conducted in 2006, 2009, 2013, and 2017, Heartland Inventory and Monitoring Network staff and contractors identified a cumulative total of 20 potentially problematic plant species in Homestead National Monument of America (NMA). Of the 13 species found in 2017, we characterized 4 as very low frequency, 4 as low frequency, 2 as medium frequency, and 3 as high frequency. Only …

2008-2009 Automotive Bridge Loans For Chrysler And Gm, Alexander Nye

Documents

In fall of 2008, America's Big Three automakers neared their breaking point. Two of them, General Motors (GM) and Chrysler, asked Congress for funding to prevent uncontrolled bankruptcies. Policymakers realized these uncontrolled bankruptcies would damage the manufacturing sector. Congress considered but failed to pass, a framework conditioning short-term financing on the companies producing acceptable restructuring plans. With the companies warning that they could not survive the coming presidential transition, on December 19, 2008, President Bush announced the Automotive Industry Financing Program under the authority of the Emergency Economic Stability Act of 2008, which made up to $17.4 billion available to …

Bone Marrow Concentrate (Bmc) Therapy In Musculoskeletal Disorders: Evidence-Based Policy Position Statement Of American Society Of Interventional Pain Physicians (Asipp), Laxmaiah Manchikanti, Christopher J. Centeno, Sairam Atluri, Sheri L. Albers, Shane Shapiro, Gerard A. Malanga, Alaa Abd-Elsayed, Mairin Jerome, Joshua A. Hirsch, Alan David Kaye, Steve M. Aydin, Douglas Beall, Don Buford, Joanne Borg-Stein, Ricardo M. Buenaventura, Joseph A. Cabaret, Aaron K. Calodney, Kenneth D. Candido, Cameron Cartier, Richard Latchaw, Sudhir Diwan, Ehren Dodson, Zachary Fausel, Michael Fredericson, Christopher G. Gharibo, Mayank Gupta, Adam M. Kaye, Nebojsa Nick Knezevic, Radomir Kosanovic, Matthew Lucas, Maanasa V. Manchikanti, R. Amadeus Mason, Kenneth Mautner, Samuel Murala, Annu Navani, Vidyasagar Pampati, Sarah Pastoriza, Ramarao Pasupuleti, Cyril Philip, Mahendra R Sanapati, Theodore Sand, Rinoo V Shah, Amol Soin, Ian Stemper, Bradley W Wargo, Philippe Hernigou

School of Pharmacy Faculty Articles

BACKGROUND: The use of bone marrow concentrate (BMC) for treatment of musculoskeletal disorders has become increasingly popular over the last several years, as technology has improved along with the need for better solutions for these pathologies. The use of cellular tissue raises a number of issues regarding the US Food and Drug Administration's (FDA) regulation in classifying these treatments as a drug versus just autologous tissue transplantation. In the case of BMC in musculoskeletal and spine care, this determination will likely hinge on whether BMC is homologous to the musculoskeletal system and spine.

OBJECTIVES: The aim of this review is …

Analysis Of Us Accidents And Solutions, Swapnil Kisan Nikam

Electronic Theses, Projects, and Dissertations

Reducing traffic accidents is an essential public safety challenge all over the world; therefore, accident analysis has been a subject of much research in recent decades.

The objective of the project is to analyze the US accident data from 50 states to inform the US government agencies and the general public on trends and possible causes of traffic accidents and what could be done to reduce them. The analysis include number of accidents by year, number of accidents by state, best time to travel by month, day and hour, accident-prone area in each state, factors responsible of the accidents like …

Analysis On Addiction And Opioid Crisis: Implications And Solutions, Bhavika Korat

Electronic Theses, Projects, and Dissertations

Opioids have become a popular way of pain management treatment over the past decades and although they have proven to be very successful to treat pain, they require serious attention as they have become the cause of addiction and overdose deaths. Opioid overdose costs the US government $78.5 billion each year. This project exhibits the background on opioids, the different types of opioids and their role in the addiction and overdose epidemic. The objective behind this project was to demonstrate what kind of people are more vulnerable to addiction and overdose.

This project shows the statistics of opioid overdose deaths …

Cost-Effectiveness Analysis Of Ocriplasmin Versus Watchful Waiting For Treatment Of Symptomatic Vitreomacular Adhesion In The Us, Arshad M Khanani, Pravin U Dugel, Julia A Haller, Alan L Wagner, Benedicte Lescrauwaet, Ralph Schmidt, Craig Bennison

Wills Eye Hospital Papers

Aim: Evaluate the cost-effectiveness of ocriplasmin in symptomatic vitreomacular adhesion (VMA) with or without full-thickness macular hole ≤400 μm versus standard of care.

Methods: A state-transition model simulated a cohort through disease health states; assignment of utilities to health states reflected the distribution of visual acuity. Efficacy of ocriplasmin was derived from logistic regression models using Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole trial data. Model inputs were extracted from Phase III trials and published literature. The analysis was conducted from a US Medicare perspective.

Results: Lifetime incremental cost-effectiveness ratio was US$4887 per quality-adjusted life year gained …

Evidence For Gene-Smoking Interactions For Hearing Loss And Deafness In Japanese American Families, Jia Y Wan, Christina Cataby, Andrew Liem, Emily Jeffrey, Trina M Norden-Krichmar, Deborah Goodman, Stephanie A Santorico, Karen L Edwards

Faculty, Staff and Student Publications

BACKGROUND: This study investigated the relationship between smoking and hearing loss and deafness (HLD) and whether the relationship is modified by genetic variation. Data for these analyses was from the subset of Japanese American families collected as part of the American Diabetes Association Genetics of Non-insulin Dependent Diabetes Mellitus study. Logistic regression with generalized estimating equations assessed the relationship between HLD and smoking. Nonparametric linkage analysis identified genetic regions harboring HLD susceptibility genes and ordered subset analysis was used to identify regions showing evidence for gene-smoking interactions. Genetic variants within these candidate regions were then each tested for interaction with …

Disease-Modifying Therapy Adherence And Associated Factors In A National Sample Of Medicare Patients With Multiple Sclerosis, Pengxiang Li, Vrushabh P Ladage, Joseph Berger, Salim Chahin, Mehul Jhaveri, Caroline Geremakis, Jalpa A Doshi

Open Access Publications

OBJECTIVES: Disease-modifying therapies (DMTs) reduce relapse rates and disability progression for relapsing multiple sclerosis (MS). Although 25% to 30% of all US patients with MS are Medicare beneficiaries, limited information exists on this population. This is the first study using national Medicare data to (1) describe characteristics of patients with MS using DMTs, (2) estimate adherence to DMTs over a 1-year and 3-year follow-up, and (3) examine factors associated with DMT adherence.

METHODS: This retrospective claims analysis used 2011-2014 100% Medicare files. Monthly adherence to MS DMTs was defined as the proportion of days covered ≥0.80 with any DMT in …

Probable African Tick Bite Fever In The United States, Kami Lowery, Theodore Rosen

Faculty, Staff and Students Publications

African tick bite fever (ATBF) is a tick-borne rickettsial disease most often observed in North American and European tourists returning home from the southern portion of Africa. Ticks infected with Rickettsia africae transmit this parasitic bacterium to humans, who subsequently develop an influenza-like illness, one or more inoculation eschars, and in some cases, a cutaneous rash. Because ATBF often presents with non-specific symptoms that suggest other infectious diseases, establishing the diagnosis may be difficult. Confirmatory assays, including serology and nucleic acid amplification, may take weeks to return and cannot help with acute treatment decisions. We present a case of a …

Thoroughbred Racehorse Welfare Through The Lens Of ‘Social License To Operate—With An Emphasis On A U.S. Perspective, Camie Heleski, C. Jill Stowe, Julie Fiedler, Michael L. Peterson, Colleen Brady, Carissa Wickens, James N. Macleod

Agricultural Economics Faculty Publications

This review addresses the question of whether Thoroughbred horse racing is sustainable in the context of current social values. A recently acknowledged framework, known as ‘Social License to Operate’ (SLO), provides us with a lens through which to view and assess racehorse welfare. In multiple surveys of the general public, the horse owning public, and university students, the primary topics of concern regarding Thoroughbred racing show considerable concordance: concern about catastrophic injuries—particularly as related to track surfaces, concern over the racing of two-year-olds, whip use by jockeys, drug/medication policies, and aftercare opportunities for retired Thoroughbred racehorses. Legitimacy of an industry, …

Congenital Chagas Disease In The United States: The Effect Of Commercially Priced Benznidazole On Costs And Benefits Of Maternal Screening, Victoria Perez-Zetune, Stephanie R. Bialek, Susan P. Montgomery, Eileen Stillwaggon

Economics Faculty Publications

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and …

A Ten-Year Retrospective Evaluation Of Acute Flaccid Myelitis At 5 Pediatric Centers In The United States, 2005-2014., Margaret M. Cortese, Anita K. Kambhampati, Jennifer E. Schuster, Zaid Alhinai, Gary R. Nelson, Gloria J. Guzman Perez-Carrillo, Arastoo Vossough, Michael A. Smit, Robert C. Mckinstry, Timothy Zinkus, Kevin R. Moore, Jeffrey M. Rogg, Meghan S. Candee, James J. Sejvar, Sarah E. Hopkins

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics.

METHODS: We conducted a retrospective study covering 2005-2014 at 5 pediatric centers in 3 …

Nonstate Actors And Anti-Access/Area Denial Strategies: The Coming Challenge, Jean-Loup Samaan Dr.

Books, Monographs & Collaborative Studies

This monograph explores the emerging challenge of nonstate actors’ anti-access and area denial (A2/AD) strategies and their implications for the United States and its allies by looking at two regions, the Middle East and Eastern Europe, with case studies such as Hezbollah in Lebanon, Hamas in the Gaza Strip, the Houthis in Yemen, and separatist groups in Ukraine. The historical monopoly of states over precision-guided munitions has eroded, and this evolution eventually challenges the ability of the most advanced militaries to operate in specific environments. As they gain greater access to advanced military technology, some nonstate actors increasingly lean toward …

Are Men Who Pay For Sex Sexist? Masculinity And Client Attitudes Toward Gender Role Equality In Different Prostitution Markets, Barbara G. Brents, Takashi Yamashita, Andrew L. Spivak, Olesya Venger, Christina Parreira, Alessandra Lanti

Sociology Faculty Research

Prostitution clients’ attitudes toward gender equality are important indicators of how masculinity relates to the demand for commercial sexual services. Research on male client misogyny has been inconclusive, and few studies compare men in different markets. Using an online survey of 519 clients of sexual services, we examine whether male client attitudes toward gender role equality are related to the main methods customers used to access prostitution services (i.e., through print or online media vs. in-person contact). We found no differences among men in these markets in attitudes toward gender role equality in the workplace and home. This is in …

Their Cheese Has Holes But Their Gun Policy Doesn’T: A Review Of The Swiss Gun Policy Compared To The United States, Nikolaos Manuel Hernandez

University of Miami International and Comparative Law Review

“With the right to bear arms come a great responsibility to use caution and common sense on handgun purchases.” – Ronald Reagan

The left will say we need more gun control, the right will say it is our constitutional right to bear arms. Is one truly better than the other? Does the answer lie simply in gun education? This note will scrutinize the history of the Second Amendment to the United States Constitution as it relates to gun rights, gun laws, and gun violence. Next, this note will compare those rights, laws, and statistics to that of Switzerland. Switzerland’s gun …

The Shortcomings Of The “Public Charge” Doctrine: Why The Dhs Final Rule Should Be Abandoned And Why The United States Should Look To The Progressive Immigration Policies Of Sweden, Emily Demetree

University of Miami International and Comparative Law Review

The United States has a longstanding history of denying aliens admission based on a wide range of grounds that we have deemed to demonstrate the alien would be either dangerous to society or a financial burden on the state. “Self-sufficiency” has been a basic principle of US immigration law since the country’s earliest immigration statutes. It is the contention of the Department of Homeland Security that the availability of public benefits can create an incentive for immigration to the United States at a rate that cannot be financially supported by the government. Certain European countries, such as Sweden, see a …

Environmental Racism: How Governments Are Systematically Poisoning Indigenous Communities & The U.N.’S Role, Maia Dombey

University of Miami International and Comparative Law Review

This note examines the practice of toxic waste dumping on indigenous lands and how it fits within the broader concept of environmental racism. It further evaluates the international human rights framework and how the United Nations and other international bodies interact with this concept and provide means for protection against this illicit practice. Further, it examines the role of the Special Rapporteur on the Implications for Human Rights of the Environmentally Sound Management and Disposal of Hazardous Substances and Wastes and how he, in his role as Special Rapporteur, can provide relief to indigenous communities suffering the effects of this …

Bird Community Monitoring At Tallgrass Prairie National Preserve, Kansas, Status Report 2001–2018, David G. Peitz, Kathleen A. Kull

United States National Park Service: Publications

Executive Summary

In 2001, the Heartland I&M Network initiated breeding bird surveys on Tallgrass Prairie National Preserve, Kansas, to assess the ecological integrity of the preserve’s habitat. Birds are an important component of ecosystems and can serve as good indicators of habitat change in an ecosystem. In the 17 years of bird surveys at the preserve (2001 to 2018, excluding 2003), there were 2,089 plot visits and 119 different bird species recorded, 96 of which have the potential to breed within the preserve. These 96 species represent approximately 81% of the total species one would reasonably expect to have breeding …

Homestead National Monument Of America, Acoustic Monitoring Report, 2017, Emma Brown

United States National Park Service: Publications

Executive Summary

This report presents acoustical data gathered by Student Conservation Association interns and the Natural Resource Specialist at Homestead National Monument of America in 2017. Data were collected at one site to provide park managers with information about the acoustical environment, sources of noise, and the existing ambient sound levels within the monument. This deployment also captured acoustic conditions during the total solar eclipse on 8/21/2017. (Results of the eclipse monitoring effort are provided in Appendix B.)

In this deployment, sound pressure level (SPL) was measured continuously every second by a calibrated sound level meter. Other equipment included an …

Homestead National Monument Of America, Acoustic Monitoring, 2011-2012

United States National Park Service: Publications

Executive Summary

This report presents acoustical data gathered by Student Conservation Association interns and the Natural Resource Specialist at Homestead National Monument of America in 2011 and 2012. Data were collected at four sites to provide park managers with information on the acoustical environment, sources of noise, and the existing ambient sound levels within the monument. The data will also inform the park managers with information regarding the potential impact of traffic on Highway 4.

Monitoring occurred at each site during two different seasons (except HOME002) in order to document seasonal variations. In each deployment, sound pressure level (SPL) was …

Rationale And Design Of The Steroids To Reduce Systemic Inflammation After Infant Heart Surgery (Stress) Trial, Kevin D Hill, H Scott Baldwin, David P Bichel, Ryan J Butts, Reid C Chamberlain, Alicia M Ellis, Eric M Graham, Jesse Hickerson, Christoph P Hornik, Jeffrey P Jacobs, Marshall L Jacobs, Robert Db Jaquiss, Prince J Kannankeril, Sean M O'Brien, Rachel Torok, Joseph W Turek, Jennifer S Li, Stress Network Investigators

Faculty, Staff and Students Publications

For decades, physicians have administered corticosteroids in the perioperative period to infants undergoing heart surgery with cardiopulmonary bypass (CPB) to reduce the postoperative systemic inflammatory response to CPB. Some question this practice because steroid efficacy has not been conclusively demonstrated and because some studies indicate that steroids could have harmful effects. STRESS is a randomized, placebo-controlled, double-blind, multicenter trial designed to evaluate safety and efficacy of perioperative steroids in infants (age < 1 year) undergoing heart surgery with CPB. Participants (planned enrollment = 1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered into the CPB pump prime versus placebo. The trial is nested within the existing infrastructure of the Society of Thoracic Surgeons Congenital Heart Surgery Database. The primary outcome is a global rank score of mortality, major morbidities, and hospital length of stay with components ranked commensurate with their clinical severity. Secondary outcomes include several measures of major postoperative morbidity, postoperative hospital length of stay, and steroid-related safety outcomes including prevalence of hyperglycemia and postoperative infectious complications. STRESS will be one of the largest trials ever conducted in children with heart disease and will answer a decades-old question related to safety and efficacy of perioperative steroids in infants undergoing heart surgery with CPB. The pragmatic "trial within a registry" design may provide a mechanism for conducting low-cost, high-efficiency trials in a heretofore-understudied patient population.

Final Two-Year Outcomes For The Sentry Bioconvertible Inferior Vena Cava Filter In Patients Requiring Temporary Protection From Pulmonary Embolism., Michael D Dake, Timothy P Murphy, Albrecht H Krämer, Michael D Darcy, Luke E Sewall, Michael A Curi, Matthew S Johnson, Frank Arena, James L Swischuk, Gary M Ansel, Mitchell J Silver, Souheil Saddekni, Jayson S Brower, Robert Mendes, Sentry Trial Investigators

Heart and Vascular Articles

PURPOSE: To report final 2-year outcomes with the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE).

MATERIALS AND METHODS: In a prospective multicenter trial, the Sentry filter was implanted in 129 patients with documented deep vein thrombosis (DVT) and/or PE (67.5%) or who were at temporary risk of developing DVT/PE (32.6%). Patients were monitored and bioconversion status ascertained by radiography, computed tomography (CT), and CT venography through 2 years.

RESULTS: The composite primary 6-month endpoint of clinical success was achieved in 97.4% (111/114) of patients. The rate of new symptomatic PE was …

Prognostic Value Of 6-Minute Walk Distance In Patients Undergoing Percutaneous Coronary Intervention: A Veterans Affairs Prospective Study, Tarun W Dasari, Bhavin Patel, Siddharth A Wayangankar, David Alexander, Yan D Zhao, Joann Schlegel, Cheuk Leung, Pedro Lozano, Faisal Latif, Udho Thadani

The Texas Heart Institute Journal

The 6-minute walk distance (6MWD) test is a useful prognostic tool in chronic heart failure. Its usefulness after percutaneous coronary intervention is unknown.

In a prospective observational study, patients underwent a 6MWD test within 2 weeks after percutaneous coronary intervention. The primary endpoint was major adverse cardiovascular events (MACE) (death, acute coronary syndrome, and heart failure admission) at one year. Receiver operating characteristic curves and area under the curve were used to determine the 6MWD test's predictive power, and the Youden index was used to measure its effectiveness.

A total of 212 patients were enrolled (98% men; mean age, 65 …

A Retrospective Matched-Cohort Study Of 3994 Lower Extremity Wounds Of Multiple Etiologies Across 644 Institutions Comparing A Bioactive Human Skin Allograft, Theraskin, Plus Standard Of Care, To Standard Of Care Alone, Geoff C Gurtner, Aimee D Garcia, Katie Bakewell, Jason B Alarcon

Faculty, Staff and Students Publications

Most chronic wounds are related to comorbidities, for which no clinical trials are performed. This retrospective propensity matched-cohort study examined data from 2 074 000 lower extremity wounds across 644 institutions to determine the effectiveness of TheraSkin plus standard of care (SOC; n = 1997) versus SOC alone (n = 1997). Multivariate modelling comparing outcomes such as healing rates, percent area reductions (PARs), amputations, recidivism, treatment completion, and medical transfers were evaluated. A higher proportion of wounds in the treatment group compared with the controls were more likely to close (68.3% versus 60.3%), particularly wounds with exposed structures (64% versus …

A Multicenter Study Of The Revogene C. Difficile System For Detection Of The Toxin B Gene From Unformed Stool Specimens, Michael J. Mashock, Matthew L. Faron, Karen C. Carroll, Christina Dang, Shawna Lewis, Hossein Salimnia, Paul Lephart, Vivian G. Loo, Bryan H. Schmitt, Stephen Young, Blake W. Buchan, Nathan A. Ledeboer

Pathology Research and Scholarship

Clostridioides difficile is the leading cause of diarrhea in hospitalized U.S. patients and results in over 400,000 cases of C. difficile infection per year. C. difficile infections have mortality rates of 6 to 30% and significantly increase health care costs, because of increased length of stay and increased frequency of readmissions due to recurrences. Efforts to reduce the spread of C. difficile in hospitals have led to the development of rapid sensitive diagnostic methods. A multicenter study was performed to establish the performance characteristics of the Revogene C. difficile test (Meridian Bioscience, Cincinnati, OH, USA) for use in detection of …

The Impact Of Due Process And Disruptions On Emergency Medicine Education In The United States, Al'ai Alvarez, Anne Messman, Melissa Platt, Megan Healy, Elaine B Josephson, Shawn London, Douglas Char

Open Access Publications

INTRODUCTION: Academic Emergency Medicine (EM) departments are not immune to natural disasters, economic or political forces that disrupt a training program's operations and educational mission. Due process concerns are closely intertwined with the challenges that program disruption brings. Due process is a protection whereby an individual will not lose rights without access to a fair procedural process. Effects of natural disasters similarly create disruptions in the physical structure of training programs that at times have led to the displacement of faculty and trainees. Variation exists in the implementation of transitions amongst training sites across the country, and its impact on …

What Is "Safe Sex"? Understanding The Need For Sex Education Reform, Julianne Baker

Gettysburg Social Sciences Review

Currently, the United States has no standardized requirement for sex education. This has precipitated a large gap in knowledge about safe sex and a lack of consensus in current social and educational policy. Debates about abstinence-only and comprehensive sex education have reached a standstill. In an effort to advance the discussion, this paper reveals that the neuroscience behind adolescent sexual risk taking provides underutilized evidence for comprehensive sex education programs. Research shows that adolescents have biological differences in their brain structure that result in a decision-making process different from that of adults, one that can preference rash decisions and potentially …

We Need A Loud And Fractious Poor, Jeff Maskovsky, Frances Fox Piven

Publications and Research

This article explores the political consequences of four decades of consistent humiliation of the poor by the most authoritative voices in the land, and offers insights into ways that new movements are creating spaces for poor people’s political voices to surface and become relevant again. Our specific concern is the challenge that the current humiliation regime poses to those who seek to revive radical, disruptive and fractious anti-poverty activism and politics. By humiliation regime, we mean a form of political violence that maltreats those classified popularly and politically as “the poor” by treating them as undeserving of citizenship, rights, public …

Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among The Insured Elderly, Minjee Lee, M Mahmud Khan, Heather M. Brandt, Ramzi G. Salloum, Brian Chen

Faculty Publications

BACKGROUND: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA's directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare. METHODS: Data from the 2008-2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the …