Econometrics Commons^™

Patterns Of Interaction In Public Health Research Networks: Insight From Network Analysis, Glen P. Mays

Health Management and Policy Presentations

OBJECTIVES: Studies from the past three decades have found evidence of wide variation in public health practices and policies across states and communities despite an expanding evidence base of efficacious public health strategies, suggesting gaps in implementation and translation processes. Practice-based research networks (PBRNs) are expected to accelerate research participation and translation. This study uses social network analysis methods with twelve Public Health PBRNs to study processes influencing the implementation and translation of research within diverse public health settings.

DATA and METHODS: A cross-sectional network analysis survey was validated and fielded with participants in two cohorts of public health PBRNs …

Using State And Local Health Survey Data To Advance Phssr, Glen P. Mays

Health Management and Policy Presentations

State and local health survey data can be used to evaluate the implementation and impact of public health delivery innovations in real-world practice settings.

Harnessing The Potential Of Comparative Effectiveness Research And Delivery System Innovation Through Practice-Based Research, Glen P. Mays

Health Management and Policy Presentations

Testing delivery system innovations in health care and public health allows the practice-based research enterprise to lead the way toward gains in health and economic efficiency.

Estimating Medical Cost Offsets Attributable To Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Uncertainty about the magnitude and timing of economic returns associated with spending on public health services has contributed to policy debates about the optimal role of the federal government in financing these services.

Public Health Spending, Preventable Outcomes, And Medical Cost Offsets: Questions For Health Reform, Glen P. Mays

Health Management and Policy Presentations

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care.

Driving Qi With Research: Findings From Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

The Science Of Public Health Delivery: Evidence, Uncertainties & Research Needs, Glen P. Mays

Health Management and Policy Presentations

Policy initiatives to reform the nation's health system increasingly recognize the need to incorporate public health and prevention strategies. The nation's delivery system for public health, however, varies widely across states and communities in its structure, authority, and capabilities. This session examines research from the growing field of public health services and systems research to identify directions for improving public health delivery.

Estimating The Value Of Public Health Services & Systems: Evidence, Uncertainties, And Research Needs, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act authorized the largest expansion in federal funding for public health services and delivery systems in decades. These provisions, designed to support programs and services that promote health and prevent disease and injury on a population-wide basis, remain controversial because of uncertainties regarding their effectiveness in improving health and constraining medical cost growth. This session examines a series of recent studies to shed light on the health and economic value of spending on public health.

Disparities Research In Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are well positioned within the health system to play key roles in addressing oral health issues on a population-wide basis, However, current evidence reveals wide geographic variation in the delivery of public health interventions for oral health promotion. This session explores the factors contributing to this variation, and it highlights studies underway through the Public Health Practice-Based Research Networks (PBRNs) to produce more and better evidence about public health delivery and impact.

The Effects Of Marital Status & Gender On Health Care Insurance Coverage In The United States, Jessica S. T. Kong

Honors Projects

Having health insurance is a crucial factor for many to sustain life in America. This study examines the demographic determinants of health care coverage within the United States with a focus on how gender and marital status influence the likelihood of having health insurance. Using the human capital theory and the theory of statistical discrimination, it is predicted that married females will have a higher probability of being insured than divorced and separated females. Also, divorced males are predicted to have a higher probability of coverage than divorced females. The data for this research is retrieved from the United States …

Efficient Parameter Estimation In Longitudinal Data Analysis Using A Hybrid Gee Method, Denis H. Y. Leung, You Gan Wang, Min Zhu

Research Collection School Of Economics

The method of generalized estimating equations (GEEs) provides consistent estimates of the regression parameters in a marginal regression model for longitudinal data, even when the working correlation model is misspecified (Liang and Zeger, 1986). However, the efficiency of a GEE estimate can be seriously affected by the choice of the working correlation model. This study addresses this problem by proposing a hybrid method that combines multiple GEEs based on different working correlation models, using the empirical likelihood method (Qin and Lawless, 1994). Analyses show that this hybrid method is more efficient than a GEE using a misspecified working correlation model. …

Opportunities For Comparative Research In Public Health Pbrns : A Baseline Analysis Of Local Practice Settings, Glen P. Mays, Sharla A. Smith, Elaine B. Wootten, Sylvia J. Porchia

Health Management and Policy Presentations

This analysis describes the organizational and operational characteristics of local public health agencies participating in an initial cohort of five (5) public health PBRNs in the U.S. We examine variation in practice settings within and between PBRNs; compare practice settings to state and national norms; and identify opportunities for comparative research that can be conducted through PBRNs.

Does Unemployment Decrease Cancer Mortality?, Benjamin Torres Galick

Economics Honors Projects

Recent research indicates that healthier lifestyles during recessions decrease the most common U.S. mortalities, but not cancer. However, they combine specific cancer mortalities with different progressions into one, possibly obscuring cancer’s link to unemployment. This paper estimates a fixed-effects regression model on unemployment and the nine most prevalent cancers between 1988 and 2002 using state-level panel data. Five cancers and total cancer are procyclical, and suggest that unemployment affects both incidence and gestation for some cancers. Consistent with the medical literature, this paper contradicts previous economic research and suggests that behavioral factors significantly impact cancer mortality.

The Impact Of Being Born With Cleft And Cleft Reparative Surgery On Overall Health And Speech Outcomes, Khatansuudal Evsanaa

Master's Theses

Orofacial cleft is one of the most common and treatable birth defects in the world. If left untreated, orofacial cleft can impair normal speech development, growth, and could lead to a number of health consequences later in life. The main motivation of the study is to measure the impact of being born with cleft and the cleft reparative surgery on overall speech and health cleft for teenagers in India using difference-in-differences approach along with household fixed effects method. An overall health outcome was measured using height, weight, grip strength and BMI, and the speech acceptability was measured using a “Universal …

Multiple Testing To Establish Superiority/Equivalence Of A New Treatment Compared With K Standard Treatments For Unbalanced Designs, Koon Shing Kwong, Siu Hung Cheung, Wai-Sum Chan

Research Collection School Of Economics

In clinical studies, multiple superiority/equivalence testing procedures can be applied to classify a new treatment as superior, equivalent (same therapeutic effect), or inferior to each set of standard treatments. Previous stepwise approaches (Dunnett and Tamhane, 1997, Statistics in Medicine 16, 2489–2506; Kwong, 2001, Journal of Statistical Planning and Inference 97, 359–366) are only appropriate for balanced designs. Unfortunately, the construction of similar tests for unbalanced designs is far more complex, with two major difficulties: (i) the ordering of test statistics for superiority may not be the same as the ordering of test statistics for equivalence; and (ii) the correlation structure …

A Semi-Parametric Two-Component Compound Mixture Model And Its Application To Estimating Malaria Attributable Fractions, Jing Qin, Denis H. Y. Leung

Research Collection School Of Economics

Malaria remains a major epidemiologic problem in many developing countries. Malaria is defined as the presence of parasites and symptoms (usually fever) due to the parasites. In endemic areas, an individual may have symptoms attributable either to malaria or to other causes. From a clinical viewpoint, it is important to correctly diagnose an individual who has developed symptoms so that the appropriate treatments can be given. From an epidemiologic and economic viewpoint, it is important to determine the proportion of malaria-affected cases in individuals who have symptoms so that policies on intervention program can be developed. Once symptoms have developed …

Adrenocortical Adenoma And Carcinoma: Histopathological And Molecular Comparative Analysis, A. Stojadinovic, M. F. Brennan, A. Hoos, A. Omeroglu, Denis H. Y. Leung, M. Dudas, A. Nissan, C. Cordon-Cardo, R.A. Ghossein

Research Collection School Of Economics

We compared histomorphological features and molecular expression profiles of adrenocortical adenomas (ACAd) and carcinomas (ACCa). A critical histopathological review (mean, 11 slides per patient) was conducted of 37 ACAd and 67 ACCa. Paraffin-embedded tissue cores of ACAd (n = 33) and ACCa (n = 38) were arrayed in triplicate on tissue microarrays. Expression profiles of p53, mdm-2, p21, Bcl-2, cyclin D1, p27, and Ki-67 were investigated by immunohistochemistry and correlated with histopathology and patient outcome using standard statistical methodology. Median follow-up period was 5 years. Tumor necrosis, atypical mitoses, and >1 mitosis per 50 high-power fields were factors that were …

Factors Influencing Treatment Patterns In Breast Cancer Patients Age 75 And Over, Arti Hurria, Denis H. Y. Leung, Kathleen Trainor, Patrick Borgen, Larry Norton, Clifford Hudis

Research Collection School Of Economics

To retrospectively determine the factors influencing treatment decisions in older breast cancer patients at a single center. Experimental Design: 216 patients age > or = 75 seen in post-treatment follow-up between January, 1997 and June, 2000 were identified in the Memorial Sloan-Kettering breast cancer database. Eligible patients were > or = 75 years old at diagnosis, had a diagnosis of stage I, II, or III breast cancer, and received their follow-up care at Memorial Sloan Kettering Cancer Center. A retrospective chart review was performed. Patients were stratified by: (1) prognostic factors (age (75-79 or > or = 80), Charlson comorbidity score, tumor size, …

Antifibrinolytic Therapy And Perioperative Blood Loss In Cancer Patients Undergoing Major Orthopedic Surgery, David Amar, Florence M. Grant, Hao Zhang, Patrick J. Boland, Denis H. Y. Leung, John A. Healey

Research Collection School Of Economics

Background: Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether epsilon amino-caproic acid (EACA) is effective in this population are sparse.

Methods: Sixty-nine adults with malignancy scheduled for either pelvic, extremity or spine surgery during general anesthesia entered this randomized, double-blind, placebo-controlled trial, and received either intravenous aprotinin (n = 23), bolus of 2 x 10(6) kallikrein inactivator units (KIU), followed by an infusion of 5 x 10(5) KIU/h, or EACA (n = 22), bolus of 150 mg/kg, followed by a 15 mg/kg/h infusion or saline placebo (n = …

Isotonic Designs For Phase I Trials, Denis H. Y. Leung, You-Gan Wang

Research Collection School Of Economics

The purpose of a phase I trial in cancer is to determine the level (dose) of the treatment under study that has an acceptable level of adverse effects. Although substantial progress has recently been made in this area using parametric approaches, the method that is widely used is based on treating small cohorts of patients at escalating doses until the frequency of toxicities seen at a dose exceeds a predefined tolerable toxicity rate. This method is popular because of its simplicity and freedom from parametric assumptions. In this paper, we consider cases in which it is undesirable to assume a …

Clinical Significance Of Molecular Expression Profiles Of Hürthle Cell Tumors Of The Thyroid Gland Analyzed Via Tissue Microarrays, A. Hoos, A. Stojadinovic, B. Singh, M. Dudas, Denis H. Y. Leung, A. Shaha

Research Collection School Of Economics

Hürthle cell tumors are rare thyroid neoplasms for which disease biology is poorly understood and diagnosis of carcinoma can be challenging. The aim of the study was to characterize molecular expression profiles of Hürthle cell tumors and to determine the clinical significance of identified phenotypes. Paraffin-embedded tissue cores of normal thyroid (n = 18), and histopathologically well-defined Hürthle cell adenomas (n = 27), Hürthle cell tumors of unknown malignant behavior (n = 7), and minimally (n = 14) and widely (n = 21) invasive Hürthle cell carcinomas were arrayed in triplicate on tissue microarrays. Expression profiles of p53, mdm-2, p21, …

Prognostic Impact Of P53 Status, Tls-Chop Fusion Transcript Structure, And Histological Grade In Myxoid Liposarcoma: A Molecular And Clinicopathologic Study Of 82 Cases, C. R. Antonescu, S. J. Tschernyavsky, R. Decuseara, Denis H. Y. Leung, J. M. Woodruff, M. F. Brennan, J. A. Bridge, J. R. Neff, J. R. Goldblum, M. Ladanyi

Research Collection School Of Economics

Purpose: A specific TLS-CHOP fusion gene resulting from the t(12;16) is present in at least 95% of myxoid liposarcomas (MLS). Three common forms of the TLS-CHOP fusion have been described, differing by the presence or absence of TLS exons 6-8 in the fusion product. Type 5-2 (also known as type II) consists of TLS exons 1-5 fused to CHOP exon 2; type 7-2 (also known as type I) also includes TLS exons 6 and 7 in the fusion, whereas type 8-2 (also known as type III) fuses TLS exons 1-8 to CHOP exon 2. We sought to determine the impact …

Validation Of Tissue Microarrays For Immunohistochemical Profiling Of Cancer Specimens Using The Example Of Human Fibroblastic Tumors, Axel Hoos, M. J. Urist, A. Stojadinovic, S. Mastorides, M. Dudas, Denis H. Y. Leung

Research Collection School Of Economics

Tissue microarrays allow high-throughput molecular profiling of cancer specimens by immunohistochemistry. Phenotype information of sections from arrayed biopsies on a multitissue block needs to be representative of full sections, as protein expression varies throughout the entire tumor specimen. To validate the use of tissue microarrays for immunophenotyping, we studied a group of 59 fibroblastic tumors with variable protein expression patterns by immunohistochemistry for Ki-67, p53, and the retinoblastoma protein (pRB). Data on full tissue sections were compared to the results of one, two, and three 0.6-mm core biopsies per tumor on a tissue array. Ki-67 and p53 staining was read …

Optimal Designs For Evaluating A Series Of Treatments, Denis H. Y. Leung, You Gan Wang

Research Collection School Of Economics

Several articles in this journal have studied optimal designs for testing a series of treatments to identify promising ones for further study. These designs formulate testing as an ongoing process until a promising treatment is identified. This formulation is considered to be more realistic but substantially increases the computational complexity. In this article, we show that these new designs, which control the error rates for a series of treatments, can be reformulated as conventional designs that control the error rates for each individual treatment. This reformulation leads to a more meaningful interpretation of the error rates and hence easier specification …

A Bayesian Decision Approach For Sample Size Determination In Phase Ii Trials, Denis H. Y. Leung, You-Gan Wang

Research Collection School Of Economics

Stallard (1998, Biometrics54, 279–294) recently used Bayesian decision theory for sample-size determination in phase II trials. His design maximizes the expected financial gains in the development of a new treatment. However, it results in a very high probability (0.65) of recommending an ineffective treatment for phase III testing. On the other hand, the expected gain using his design is more than 10 times that of a design that tightly controls the false positive error (Thall and Simon, 1994, Biometrics50, 337–349). Stallard's design maximizes the expected gain per phase II trial, but it does not maximize the rate of gain or …

Prognostic Impact Of P53 Status In Ewing Sarcoma, E. De Alava, C. Antonescu, A. Panizo, Denis H. Y. Leung, P. Meyers, A. Huvos, F. J. Pardo-Mindan, J. Healey, M. Ladanyi

Research Collection School Of Economics

Disease stage at the time of diagnosis and response to therapy are the main prognostic factors for patients with Ewing sarcoma or peripheral neuroectodermal tumor (ES/PNET). The primary genetic alteration in ES/PNET, the fusion of the EWS gene with FLI1 or ERG, is diagnostically highly specific for these tumors, and molecular variation in the structure of the EWS-FLI1 fusion gene also is of prognostic significance. In contrast, secondary genetic alterations, such as P53 alterations, are relatively uncommon in ES/PNET, and their prognostic impact has not been extensively studied. METHODS: Prechemotherapy, paraffin embedded, nondecalcified, primary tumor material in a well-characterized series …

The Long Term Effects Of Angiotensin Converting Enzyme Inhibition And Metabolic Control On Cardiovascular And Renal Outcomes In Hypertensive Type 2 Diabetic Patients, Julien C. N. Chan, Gary T. C. Ko, Denis H. Y. Leung

Research Collection School Of Economics

Long-term effects of angiotensin-converting enzyme inhibition and metabolic control in hypertensive type 2 diabetic patients. Background. In hypertensive type 2 diabetic patients, treatment with angiotensin-converting enzyme (ACE) inhibitors is associated with a lower incidence of cardiovascular events than those treated with calcium channel-blocking agents. However, the long-term renal effects of ACE inhibitors in these patients remain inconclusive. In 1989, we commenced a placebo-controlled, double-blind, randomized study to examine the anti-albuminuric effects of enalapril versus nifedipine (slow release) in 102 hypertensive, type 2 diabetic patients. These patients have been followed up for a mean trial duration of 5.5 ± 2.2 years. …

Two Hundred Gastrointestinal Stromal Tumors: Recurrence Patterns And Prognostic Factors For Survival, Ronald P. Dematteo, Jonathan J. Lewis, Denis H. Y. Leung, Salvinder S. Mudan, James M. Woodruff, Murray F. Brennan

Research Collection School Of Economics

Objective: To analyze the outcome of 200 patients with gastrointestinal stromal tumor (GIST) who were treated at a single institution and followed up prospectively. Summary Background Data: A GIST is a visceral sarcoma that arises from the gastrointestinal tract. Surgical resection is the mainstay of treatment because adjuvant therapy is unproven. Methods: Two hundred patients with malignant GIST were admitted and treated at Memorial Hospital during the past 16 years. Patient, tumor, and treatment variables were analyzed to identify patterns of tumor recurrence and factors that predict survival. Results: Of the 200 patients, 46% had primary disease without metastasis, 47% …

Rearrangement Of The Bcl-6 Gene As A Prognostic Marker In Diffuse Large-Cell Lymphoma, K. Offit, D.C. Louie, N. Z. Parsa, Denis H. Y. Leung, C. Portlock, B.H. Ye, F. Lista, D.A. Filippa, A. Rosenbaum, M. Ladanyi, S. Jhanwar, R. Dalla-Favera, R.S.K. Changanti

Research Collection School Of Economics

Current therapy can induce a long-term remission in half the patients with diffuse lymphomas with a large-cell component (DLLC), but more intensive treatment has the potential to improve outcome. Rearrangement of a novel candidate proto-oncogene, bcl-6, correlates with a favorable clinical outcome in DLLC and may thus serve as a prognostic marker.