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Articles 211 - 240 of 527

Full-Text Articles in Community Psychology

Determining The Racial And Ethnic Differences In Neonatal Intensive Care Unit Admission Rates, Youngran Kim Aug 2020

Determining The Racial And Ethnic Differences In Neonatal Intensive Care Unit Admission Rates, Youngran Kim

Dissertations and Theses (Open Access)

Background: Recent trends show that the utilization of neonatal intensive care unit (NICU) has extended beyond severely ill infants and increased substantially across all birth weights. However, little is known about what drives the growth of NICU admission rates and whether these trends differ by race/ethnicity. Methods: The study used 2008-2018 Natality Files with restricted use of state and county-level information. Crude and risk-adjusted NICU admission rates, overall and stratified by birth weight group, were compared between black and white infants and between Hispanic and white infants. Kitagawa decomposition and Oaxaca-Blinder decomposition analyses were conducted for the temporal increase in …

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Causal Analysis Theory And Application To Alzheimer’S Disease (Ad) And Heart Failure (Hf), Shudi Li Aug 2020

Causal Analysis Theory And Application To Alzheimer’S Disease (Ad) And Heart Failure (Hf), Shudi Li

Dissertations and Theses (Open Access)

Alzheimer's disease (AD) and heart failure (HF) are two complex diseases that are caused by the combination of genetic and epigenetic, environmental and other lifestyle factors. Understanding the relationships between genetic and epigenetic variants and other factors of such complex diseases could assist researchers discover disease mechanisms and develop targeted therapies. Much of the research in genetics/epigenetics studies regarding AD and heart diseases have been focused on association analysis. Many researchers have identified genetic/epigenetics variants and phenotypes that are significantly associated with disease pathology. While most of these studies utilize association analysis as the analytical platform, the signals identified by …

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Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyou Li Aug 2020

Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyou Li

Dissertations and Theses (Open Access)

The objective of this study was to estimate the relationship between heat stress and pulmonary function among OSRC workers following the Deepwater Horizon (DWH) disaster. Methods: Pulmonary function test results were analyzed from a cohort of oil spill response and cleanup workers 1-3 years following the DWH disaster (N=5,131). Proxies for heat stress was employed by using information on heat stress-related symptoms as well as a questionnaire on stopping work due to heat reported during a structured telephone enrollment questionnaire. Associations between heat stress proxies and lung function were estimated using multivariable linear models and binomial logistic regression models while …

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Epidemiology Of No -Syndromic, Orofacial Clefts In A Registry­Based, Birth-Cohort In Texas: Differences By Cleft Type And Presence Of Additional Defects, Maria Luisa Navarro Sanchez Aug 2020

Epidemiology Of No -Syndromic, Orofacial Clefts In A Registry­Based, Birth-Cohort In Texas: Differences By Cleft Type And Presence Of Additional Defects, Maria Luisa Navarro Sanchez

Dissertations and Theses (Open Access)

Although orofacial clefts, which include cleft palate alone (CP) and cleft lip with or without cleft palate (CL±P), are among the most common birth defects, their etiology is complex and is generally not well understood. While some clefts are caused by rare syndromes, the majority occur in the absence of a syndrome, either in association with co-occurring defects or as isolated defects. Among these non-syndromic cases, epidemiologic studies have identified demographic variables that are associated with CP and/or CL±P, such as geographic location and infant sex, as well as several maternal characteristics, though some of these associations have been weak …

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Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyao Li Aug 2020

Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyao Li

Dissertations and Theses (Open Access)

Objective: The objective of this study was to estimate the relationship between heat stress and pulmonary function among OSRC workers following the Deepwater Horizon (DWH) disaster. Methods: Pulmonary function test results were analyzed from a cohort of oil spill response and cleanup workers 1-3 years following the DWH disaster (N=5,131). Proxies for heat stress was employed by using information on heat stress-related symptoms as well as a questionnaire on stopping work due to heat reported during a structured telephone enrollment questionnaire. Associations between heat stress proxies and lung function were estimated using multivariable linear models and binomial logistic regression models …

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Area-Level Landfill Density And Asthma Prevalence In Urban Texas Areas, Jessica Meighan Herrin Aug 2020

Area-Level Landfill Density And Asthma Prevalence In Urban Texas Areas, Jessica Meighan Herrin

Dissertations and Theses (Open Access)

Environmental exposures, especially air pollutants, pose a threat for an increase in asthma prevalence. In particular, hydrogen sulfide (H2S) gas can cause severe health effects closely resembling asthmatic symptoms. Ambient concentrations of H2S gas correlates with the amount of solid waste found in landfills. The potential for adverse health risks associated with H2S emitted from landfills is of concern for those populations living in close proximity to landfills. Asthma is one of the adverse health effects that can occur due to H2S exposure. However, there is a lack of detailed studies characterizing possible associations between the density of landfills and …

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Impact Of Substance Use In Social Networks On Antiretroviral Therapy Adherence For Hiv-Positive Younger Men Who Have Sex With Men, Natascha Del Vecchio Aug 2020

Impact Of Substance Use In Social Networks On Antiretroviral Therapy Adherence For Hiv-Positive Younger Men Who Have Sex With Men, Natascha Del Vecchio

Dissertations and Theses (Open Access)

The community of young men who have sex with men (YMSM) has higher rates of substance use than the general population and the use of alcohol, cannabis, and illicit drugs has been shown to have a negative impact on the HIV care continuum. Our first aim was to understand the prevalence of substance use in the community through the use of self-reported, RDS-II, and RDS-SS estimates. We used multivariable logistic and negative binomial GEE with QIC selection to determine the factors important to having a prescription and staying adherent, respectively. Selected variables were included with a subset of substance use …

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Effect Of The Expanded Prospective Payment System On Dialysis Initiation, The Usage Of Erythropoiesis-Stimulating Agents, And Medicare Expenditures, Lu Zhang Aug 2020

Effect Of The Expanded Prospective Payment System On Dialysis Initiation, The Usage Of Erythropoiesis-Stimulating Agents, And Medicare Expenditures, Lu Zhang

Dissertations and Theses (Open Access)

In January 2011, the U.S. Centers for Medicare & Medicaid Services (CMS) implemented the expanded prospective payment system (PPS) for financing the management of end-stage renal disease (ESRD). Expanded PPS may not only change healthcare providers’ decisions about patient care by removing the financial incentives associated with the previous composite rate payment methodology, but also change the Medicare expenditures associated with various treatment patterns by using a constant base rate for all dialysis modalities. This study aimed to examine the effect of the expanded PPS on providers’ decisions on timing of dialysis initiation and ESA utilizations in ESRD patients as …

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Hospital Market Analysis Using A Cohort Of Privately Insured Patients With Total Hip And Knee Replacement Procedures, Elifnur Yay Donderici Aug 2020

Hospital Market Analysis Using A Cohort Of Privately Insured Patients With Total Hip And Knee Replacement Procedures, Elifnur Yay Donderici

Dissertations and Theses (Open Access)

Background: Several recent studies have analyzed the contribution of hospital inpatient prices and utilization to variation in medical spending. However, it is still unknown how the drivers of spending for specific procedures differ within privately insured patients. Next, the market concentration of hospitals has been a matter of concern for several decades. However, researchers usually calculate Herfindahl-Hirschman index (HHI) as a measure of market concentration or power, but there is a drawback of using this measure. Hospitals sell differentiated products, and the HHI measure does not take this differentiation into account in its formulation (Gaynor and Town, 2011). Objective: First …

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The Multilevel Factors Facilitating Or Impeding Healthcare Access Among Refugees Residing In Bexar County Texas, Howaida Werfelli Aug 2020

The Multilevel Factors Facilitating Or Impeding Healthcare Access Among Refugees Residing In Bexar County Texas, Howaida Werfelli

Dissertations and Theses (Open Access)

The goal of this study was to increase understanding of healthcare access among refugees by investigating the multilevel factors that facilitate or impede healthcare access among refugees who have resettled in Bexar County, Texas. The multilevel factors facilitating or impeding access to healthcare for refugees resettled in Bexar County were identified as follows: health literacy, level of educational attainment, proficiency (reading, writing and, speaking) in English, proficiency (reading, writing and speaking) in native language, translation services, public transportation, income level, a shortage of healthcare providers, navigation of the healthcare system, the fragmentation of the healthcare system, insurance status, staff shortages …

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Health Disparities Across Funcitonal Disability Groups, Katherine Sanches Aug 2020

Health Disparities Across Funcitonal Disability Groups, Katherine Sanches

Dissertations and Theses (Open Access)

Background: People with disabilities experience higher rates of chronic disease and poor health status compared to those without disability. People with disabilities do not participate in community health programs to the same degree as those without disability due to social, programmatic, and environmental barriers. The Community Health Inclusion Index (CHII) is a community health assessment tool which evaluates the degree to which community-level health promoting opportunities to promote nutrition and physical activity are inclusive and accessible to people with disabilities. The CHII assess barriers to inclusion across five domains: build environment, equipment, program/services, staff, and policies. Objective: The purpose of …

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Using Spatial Methods To Better Understand Food Insecurity And Snap Under-Participation In Texas, Ryan Ramphul Jul 2020

Using Spatial Methods To Better Understand Food Insecurity And Snap Under-Participation In Texas, Ryan Ramphul

Dissertations and Theses (Open Access)

The overall objective of this research is to use spatial methods to better understand food insecurity and SNAP under-participation in Texas. Paper 1 assesses whether a sample of community dwelling Medicare and Medicaid beneficiaries, who screen positive for food insecurity at healthcare locations in Harris County, exhibit a spatial pattern in terms of where they live. In other words, it tests whether or not there are statistically significant neighborhood hot spots or cold spots of food insecurity against a null hypothesis of complete spatial randomness. This approach is novel because it uses address-level data on patients who report being food …

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Physician Burnout: Slowing The Burn Through Positive Deviance Strategies, Swapna Reddy Jul 2020

Physician Burnout: Slowing The Burn Through Positive Deviance Strategies, Swapna Reddy

Dissertations and Theses (Open Access)

Introduction: Affecting 42% of physicians in the United States, “physician burnout” is considered a public health crisis with adverse impacts for personal providers, patients and organizations. Though much research has been devoted to the existence and causes of burnout, to date few studies have been conducted to identify factors associated with physician fulfillment. Aims: This dissertation research was intended to increase and improve knowledge of factors effective in contributing to physician professional fulfillment utilizing a Positive Deviance based approach. To that end, two studies were conducted: the first, a narrative review of the literature to identify specific correlates of physician …

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Bayesian Modeling Of Censored Data With Application To Meta-Analysis Of Immunotherapy Trials, Xinyue Qi Jul 2020

Bayesian Modeling Of Censored Data With Application To Meta-Analysis Of Immunotherapy Trials, Xinyue Qi

Dissertations and Theses (Open Access)

My dissertation builds on a systematic review of 125 clinical trials reporting on treatment-related adverse events (AEs) associated with PD-1/PD-L1 inhibitors published from 2010 to 2018. The motivating dataset contained the following study-level components extracted from each publication: trial name, number of treated patients, selected immunotherapy drug, dosing schedule, cancer type, number of AEs within each category, and the pre-specified criteria for AE reporting. The number of AEs were reported based upon all-grade (Grade 1-5) and Grade 3 or higher (Grade 3-5) severity. My overall objective was to increase our understanding of the toxicity profiles of five most common cancer …

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A Literature Review Of Community Art Therapy With Youth In Inner City Communities Of Color, Jennifer Habeeb May 2020

A Literature Review Of Community Art Therapy With Youth In Inner City Communities Of Color, Jennifer Habeeb

Expressive Therapies Capstone Theses

This literature review was developed to synthesize the research surrounding community-based art therapy with youth who reside in inner city communities of color. Youth of color in inner city communities face a number of different challenges such as low socioeconomic status, social inequality, discrimination, and lack of political representation. There is currently little research on the impact of art therapy and expressive arts interventions with this population, however; these interventions have shown to be effective in a number of different areas. Literature revealed that community-based art therapy with inner city youth of color has shown to increase self-esteem, decrease symptoms …

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Dance/Movement Therapy And Its Implications In A Studio-Based Dance Program: A Community Engagement Project, Akeila Sharp May 2020

Dance/Movement Therapy And Its Implications In A Studio-Based Dance Program: A Community Engagement Project, Akeila Sharp

Expressive Therapies Capstone Theses

Adolescent females often struggle with emotional regulation, developing relationships, and poor body image. Research indicates that taking dance classes or participating in dance movement therapy sessions can be an effective technique to improve in these areas. However, there is limited research on the use of both in one setting. Therefore, this capstone explored the impacts of dance on adolescent females and the implications of dance/movement therapy (DMT) in a studio-based dance program. The objective of this project was to examine how restructuring a dance class using DMT interventions could improve problem areas such as low self-esteem, lack of communication skills, …

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Student Wellbeing And Open Studio Process In The School Curriculum, Maria Kim May 2020

Student Wellbeing And Open Studio Process In The School Curriculum, Maria Kim

Expressive Therapies Dissertations

This study aimed to explore whether Open Studio Process (OSP) increased wellbeing of middle and high school students when facilitated by teachers as a part of the regular art curriculum. It was hypothesized that OSP might increase the sense of wellbeing among middle and high school students as well as facilitating teachers. The research was conducted as a mixed methods study in South Korea where students need preventative interventions for their wellbeing. The researcher trained eight teachers to facilitate OSP and five of them implemented it with their classes for seven sessions. Quantitative data (K-YSR; pre- and posttest) were collected …

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The Effectiveness Of Implementing A Collaborative Mental Health Approach On Quality Of Life For Individuals Of Low Socioeconomic Status, Tyler Z. Tooley May 2020

The Effectiveness Of Implementing A Collaborative Mental Health Approach On Quality Of Life For Individuals Of Low Socioeconomic Status, Tyler Z. Tooley

Graduate Theses/Dissertations

The ultimate purpose of this study is to provide insight and education to mental health clinicians, politicians and the general public of the numerous effects poverty has on mental health, in addition to the most beneficial ways to combat those insidious effects. The specific barriers met by individuals of low socioeconomic status severely affect psychological and physical health, as well as social and environmental relationships, which therefore diminish overall quality of life. The aim of this study is to examine the effectiveness of implementing a collaborative mental health approach for low income individuals on length of engagement in services and …

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Safe Patient Handling – A Case For National Legislation, David O. Oba May 2020

Safe Patient Handling – A Case For National Legislation, David O. Oba

Dissertations and Theses (Open Access)

Introduction: This study examined the effectiveness of Safe Patient Handling (SPH) legislations in difference states across the country. In January 2006, the state of Texas legislated the Safe Patient Handling and Movement Practices Act which required all hospitals and nursing homes to implement safe patient handling and movement program. To date, 10 other states have enacted law or regulations to control work-related musculoskeletal disorders (MSDs) among healthcare workers (HW). Despite the effectiveness of these policies in the individual states, MSDs remain prevalent among HW nationwide. Hence, the call for national legislation. Methods: Using the state-level incidence rate data from the …

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Physician Hospital Arrangement Influence On Nonprofit Hospital Quality,Financial Performance And Community Benefit Expenditures, Andrea Cervin May 2020

Physician Hospital Arrangement Influence On Nonprofit Hospital Quality,Financial Performance And Community Benefit Expenditures, Andrea Cervin

Dissertations and Theses (Open Access)

Federal policy has encouraged hospitals to provide certain quality outcomes and cost containment. Hospitals have responded by forming physician hospital organizations in attempts to achieve quality outcomes and capture reimbursements. At the same time, federal policy has awarded hospitals with nonprofit status with the requirement to provide community benefits in exchange for the tax exemption they receive. With the formation of physician hospital organizations, there remains the question of whether hospitals are achieving desired quality metrics and whether hospitals are financially viable. There is also public and media interest recently regarding whether nonprofit hospitals fulfill their obligations for community benefit …

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T​He​ E​Ffect​ ​Of​ U​Nconventional​ G​As​ ​And​ O​Il​ D​Rilling​ E​Missions​ ​On​ A​Sthma​ ​And​ R​Espiratory D​Iseases​ ​In​ ​The​ B​Arnett​ S​Hale​ ​Of​ T​Exas, Stella A. Okoroafor May 2020

T​He​ E​Ffect​ ​Of​ U​Nconventional​ G​As​ ​And​ O​Il​ D​Rilling​ E​Missions​ ​On​ A​Sthma​ ​And​ R​Espiratory D​Iseases​ ​In​ ​The​ B​Arnett​ S​Hale​ ​Of​ T​Exas, Stella A. Okoroafor

Dissertations and Theses (Open Access)

Unconventional gas and oil drilling (UGOD) has increased substantially in the United States for more than a decade. The resultant environmental unsafe air pollution effects of UGOD both locally and regionally have been well documented in the literature. Despite the dramatic increase in unconventional well drilling and the toxicant exposure, the health consequences of UGOD remain largely uncertain. This study assesses the relationship between active wells and healthcare use for respiratory diseases by zip code from 2004 to 2008 in the Barnett shale area of Texas. The first modern shale gas well was drilled in the Barnett shale area of …

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A Geospatial Examination Of The Association Between Geographic Food Access And Food Insecurity In Central Texas: The Role Of Race/Ethnicity And Urbanicity, Kathryn Janda May 2020

A Geospatial Examination Of The Association Between Geographic Food Access And Food Insecurity In Central Texas: The Role Of Race/Ethnicity And Urbanicity, Kathryn Janda

Dissertations and Theses (Open Access)

Food insecurity is a public health issue that affects one in ten Americans, one in seven Central Texans, and is associated with malnutrition, chronic disease, and obesity. Geographic food access is the most intervened upon aspect of food insecurity and is often measured objectively through mapping software, such as ArcGIS. Yet when geographic food access is only measured in terms of distance to food retail, analyses do not full capture the nuances of community context. Thus, other sources of data, like survey data, and demographic indicators, such as race/ethnicity and urbanicity, should be incorporated into the research exploring the association …

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Determining The Drivers Of Quality Of Life In Hiv Patints Treated With Antiretroviral Therapy In Subsaharan Africa, Oubote Sangbana May 2020

Determining The Drivers Of Quality Of Life In Hiv Patints Treated With Antiretroviral Therapy In Subsaharan Africa, Oubote Sangbana

Dissertations and Theses (Open Access)

During the last decade, HIV in sub-Saharan Africa has shifted from a fatal disease to a chronic condition thanks to the expansion of antiretroviral therapy (ART). As a result, the focus of care has transitioned from survival to quality of life (QoL), and the latter has become a significant outcome measure during patient follow up. Yet, the determinants of QoL among HIV patients in western and central Africa are not well known. The objective of this dissertation was to determine the main factors associated with QoL among ART-treated HIV adult patients in western and central Africa to ensure healthcare providers …

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Utility Of Plasma Biomarkers In The Validation Of Reported Loc & Pta For Gcs 13-15 Patients: A Track-Tbi Pilot Study, Jeffrey Brennan May 2020

Utility Of Plasma Biomarkers In The Validation Of Reported Loc & Pta For Gcs 13-15 Patients: A Track-Tbi Pilot Study, Jeffrey Brennan

Dissertations and Theses (Open Access)

Depending on a brain injury patient to accurately report their duration of unconsciousness and amnesia is clearly flawed. We constructed biomarker-based models to validate these self-reported measurements using a GCS 13-15 subset of participants from TRACK-TBI, a multi-institutional study on traumatic brain injury. Potential covariates were assessed for significant interactions with biomarker level. We report that the predictions of LOC and PTA failed. GFAP exhibited the most consistent serum level increase between categories of both LOC and PTA. Given a number of issues with the study sample, we recommend continued investigation on the prediction of LOC and PTA using a …

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Sample Size Calculations For Longitudinal Mediation Analysis With Continuous-Time Markov Chain Variables, Abigail Christine Sedory May 2020

Sample Size Calculations For Longitudinal Mediation Analysis With Continuous-Time Markov Chain Variables, Abigail Christine Sedory

Dissertations and Theses (Open Access)

Mediation is a type of analysis used to determine the causal mechanism linking a predictor and an outcome through a mediator variable. Various research has examined the inclusion of different variable types for the predictor, mediator, and outcome. However, no studies include the presence of a continuous-time Markov chain (CTMC) as any of the components in a mediating model. If researchers wanted to design a study with a CTMC in the mediating process, one of the first steps would be to determine the minimum number of subjects or observations needed to detect a significant mediating effect. Therefore, in this study, …

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Nudging Quality Improvement In Cancer Care: Influence Of A Clinical Decision Support System To Nudge Adherance To Evidence Based Guidelines In Adult Cancers, Debra Patt May 2020

Nudging Quality Improvement In Cancer Care: Influence Of A Clinical Decision Support System To Nudge Adherance To Evidence Based Guidelines In Adult Cancers, Debra Patt

Dissertations and Theses (Open Access)

Cancer care is changing rapidly. Understanding of the increasing subtypes of cancer and exponentially increasing therapeutic interventions are unprecedented due to the rapid pace of scientific discovery and clinical innovation. This immense change within the field, lends itself to quality control initiatives, especially among general oncology providers who see a wide array of cancer types as general oncologists will see many different tumor types, and most of which have several potential treatment choices that have grown over time. Evidence-based pathways are an effective way to nudge quality control by presenting choice architecture at the point of care to facilitate guideline …

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Understanding Participation In A Workplace Physical Activity Intervention Using Self-Determination Theory: The Booster Break Study, Kathleen Ochipa May 2020

Understanding Participation In A Workplace Physical Activity Intervention Using Self-Determination Theory: The Booster Break Study, Kathleen Ochipa

Dissertations and Theses (Open Access)

Abstract: Sedentary behavior can lead to premature mortality, cardiovascular disease, Type 2 diabetes, and cancer incidence. Office workers are at risk for high amounts of sedentary behavior. Even brief bouts of physical activity that interrupt sedentary behavior can improve office workers’ physical and mental health. The workplace is an optimal setting for increasing physical activity and reducing sedentary behavior among office workers. However, limited literature exists related to the characteristics of participants that adhere to workplace physical activity interventions. This study aimed to identify characteristics of participants who enrolled in the Booster Break program, a 15 minute once-daily intervention during …

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Economic Evaluation Of Implementing Hpv Vaccine Promotion Interventions For Cervical Cancer In The United States, Chi-Fang Wu May 2020

Economic Evaluation Of Implementing Hpv Vaccine Promotion Interventions For Cervical Cancer In The United States, Chi-Fang Wu

Dissertations and Theses (Open Access)

The HPV vaccine has been proven as a safe and effective method for preventing cervical cancer. However, the HPV vaccine coverage rate in the U.S. is suboptimal. Various interventions have been implemented to improve HPV vaccine coverage. However, evidence of the cost-effectiveness of HPV vaccine promotion interventions is lacking. We conducted an economic evaluation to assess HPV vaccine promotion interventions of cervical cancer in the U.S. Firstly, a systematic review was conducted to review evidence on interventions aimed at increasing HPV vaccine coverage and to summarize the cost and effectiveness of these interventions. We included 56 HPV vaccine promotion studies …

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Comparison Of Interactive Electronic Versus Standard Document Method For Obtaining Patient Informed Consent, Jermaine Mcmillan May 2020

Comparison Of Interactive Electronic Versus Standard Document Method For Obtaining Patient Informed Consent, Jermaine Mcmillan

Dissertations and Theses (Open Access)

The primary objective of this study was to determine whether participants who received an interactive electronic consent (EC) had a better understanding of a medical procedure (apheresis) compared to those who received the standard document (SD) consent. The study was conducted with apheresis donors whose responses were used to determine if the EC facilitated better comprehension and retention of consent information by the study participants than by SD consenting methods. By comprehension, the goal was to have participants who can understand, summarize, or make judgments based on the content presented in the informed consent. By retention, the goal was to …

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A Partial Likelihood Approach To Longitudinal Categorical Data Using A Continuous Time Semi-Markov Chain Model, Kusha A. Mohammadi May 2020

A Partial Likelihood Approach To Longitudinal Categorical Data Using A Continuous Time Semi-Markov Chain Model, Kusha A. Mohammadi

Dissertations and Theses (Open Access)

Longitudinal studies have been critical in understanding the characteristics of chronic diseases or interventions. Since many processes have natural multi-categorical responses over time, multi-state stochastic models have been used to estimate the transition rates between stages. Some multi-state models applied in practice assume the Markov property. The Markov property constrains the sojourn distribution to be exponentially distributed. While useful theoretical properties arise by the Markov assumption, we will consider a more flexible framework by allowing arbitrarily distributed waiting times. This describes a semi-Markov process which has already been applied to various fields in Public Health. Similar to Markov model developments, …

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