1,000 research outputs found
Introduction to Psychology
Introduction to Psychology is a modified version of Psychology 2e - OpenStax
Evaluation of a place-based asthma reduction initiative on asthma-related morbidity among children in East Harlem and the impact of the COVID-19 pandemic on health care utilization and medication adherence among Medicaid-enrolled children
Background: In New York City, asthma continues to be the leading cause of hospitalizations and emergency department (ED) visits among children, and disproportionally burdens Black and Latino children in low-income neighborhoods. Place-based, or geographically targeted, programs offer upstream strategies for addressing public health issues in these underserved neighborhoods, and given their targeted nature, quasi-experimental or other observational methods are needed to rigorously evaluate their impact. This dissertation uses multiple methodological approaches to assess the impact of the East Harlem Asthma Center of Excellence (EHACE) – an equity-focused, multi-faceted, place-based asthma mitigation initiative in the East Harlem neighborhood of a New York City, instituted in 2008, on population-level asthma-related morbidity among children ages 0 to 17. We use the same multi-methodological approaches to examine the impact of the COVID-19 pandemic restrictions and closures on asthma-related preventable and preventative health care utilization and asthma medication adherence and prescribing among Medicaid-enrolled children residing in East Harlem.
AIM 1: Evaluate the population-level impact of EHACE on asthma-related morbidity among children and youth aged 0 to 17 years residing in East Harlem.
AIM 2: Assess the impact of COVID-19 pandemic-related restrictions and closures in New York City on asthma-related preventable (ED visits, hospitalizations) and preventative (well child visits, telehealth visits) health care utilization among Medicaid-enrolled children ages 0 to 17 years in East Harlem vs. two comparison populations in the Bronx and Brooklyn.
AIM 3: Assess the impact of COVID-19-related health care disruptions on the prescribing of asthma controller medications by health care providers and medication adherence among Medicaid-enrolled children aged 2 to 17 years with persistent asthma residing in East Harlem vs. three comparison populations (Brooklyn, the Bronx, and citywide comparisons).
Methods: We employed an interrupted time series design and a quasi-Poisson segmented regression analyses using population-based administrative data for 2002-2014 hospital discharges and 2005-2014 emergency department (ED) visits, adjusting for seasonality and other time-varying covariates. Comparison populations in Brooklyn and the Bronx were identified through principal components analysis and were similar to the East Harlem catchment population with respect to both asthma burden, and socioeconomic and demographic characteristics. A difference-in-difference design was applied to statistically compare the pre (2002-2007)-to-post (2008-2014)-intervention changes in asthma-related morbidity rates and pre-to-post slope differences of the comparison populations compared to the target populations, using rate ratios as a relative measure of impact.
To assess the impact of the COVID-19 pandemic on asthma-related health care utilization, we used 2018-2021 administrative New York State Medicaid data (ED visits, hospitalizations, well-child visits, and telemedicine) and New York City syndromic surveillance ED data. We used quasi-Poisson segmented regression with difference-in-difference to make statistical comparisons between the changes in rates of asthma-related health care utilization among children on Medicaid between the pre- (Jan 1, 2018-Mar 31, 2020) and pandemic (Apr 2020 – Dec 31, 2021) time periods and pre-to-post slope differences. For Aim 3, where we used Medicaid claims and prescription data to construct a cohort of children aged 2 to 17 years with persistent asthma, to assess changes in asthma medication adherence and Asthma Medication Ratio (AMR) – a proxy measurement of the quality of asthma care – after the start of the COVID-19 pandemic (April 1, 2020-December 31, 2021) compared to the pre-pandemic period (January 1, 2018 – March 31, 2020). Using an interrupted time series with difference-in-difference design, we conducted multivariable regression analysis using log-linear Poisson segmented regression.
Results: East Harlem demonstrated a relative reduction of 31% (Rate Ratio (RR)=0.69, 95% CI=0.49, 0.98) and 28% (RR=0.72, 95% CI=0.53 ,0.98) in the monthly rates of asthma-related hospitalizations and ED visits, respectfully, during the post- vs pre-EHACE timeframes. Similarly, results for the Brooklyn comparison population demonstrated a relative reduction of 30% (RR=0.70, 95% CI=0.55, 0.87) and 23% (RR=0.77, 95%CI=0.62, 0.96) in the monthly rates of asthma-related hospitalizations and ED visits, respectively. Results from the difference-in-difference suggested a relative difference of 2% (RR=0.98, 95% CI=0.97, 0.99), between the East Harlem vs. the Brooklyn comparison population in the monthly slope change (i.e., pre- vs. the post-intervention) of asthma-related ED visits, but no statistically significant differences between the target and the Bronx comparison populations. The East Harlem and the two comparison populations did not experience an immediate impact in asthma-related hospitalization/ED visit rates following the opening of EHACE.
All three populations of Medicaid-enrolled children ages 0 to 17 experienced comparable decreases in asthma-related ED visits in the month immediately following the closures of New York City schools and the New York State PAUSE order – an 86% relative reduction among the EHACE catchment area (RR=0.14, 95% CI= 0.09, 0.23), compared to an 87% reduction among the Bronx (RR=0.13, 95% CI= 0.08, 0.21) and Brooklyn (RR=0.13, 95% CI= 0.09, 0.20) comparison populations. There was an immediate relative reduction in asthma-related hospitalization rates of 74% (RR=0.26, 95% CI=0.14, 0.45) among Medicaid-enrolled children in East Harlem and 78% in the Bronx (RR=0.22, 95%CI = 0.13, 0.35), compared to a smaller, but statistically significant, relative reduction of 57% (RR=0.43, 95% CI=0.22, 0.84) among children in the Brooklyn comparison population. Rates of preventative (i.e., well-child visits) utilization for asthma drastically declined in April (compared to March), immediately following the start of COVID-19 pandemic. Telemedicine visits for asthma across all populations, significantly increased immediately following the closure of schools and the implementation of the New York State PAUSE order.
Finally, there were no statistically significant changes in medication adherence among Medicaid-enrolled children immediately following the start of the COVID-19 pandemic in any population. Overall, medication adherence was lowest among the children in the older age category of 12 to 17 years. There were increases in AMR across all populations immediately following the start of the COVID-19 pandemic, all of which were statistically significantly different from that during the pre-pandemic period.
Conclusion: The results demonstrate changes in the post-EHACE slope (vs. pre-intervention slope) of asthma-related morbidity rates, suggesting EHACE may have had a small and gradual population-level impact on reducing asthma-related morbidity among children living in East Harlem following its inception. The COVID-19 pandemic drastically challenged the continuity of care model for asthma management and caused a precipitous disruption in health care services and availability of care, with analogous patterns of asthma-related preventative and preventable utilization observed across New York City. Both preventable and preventative health care utilization decreased immediately following the start of the COVID-19 pandemic but slowly increased over the course of the pandemic period. Telemedicine rates drastically increased once COVID-19 restrictions were implemented, with rates appearing to decrease during the months following the start of the pandemic. Despite the drastic disruption COVID-19 had on health care services across New York City, however, there were no marked changes in asthma medication adherence and unexpected improvements in the quality of asthma care among a cohort of Medicaid-children residing in East Harlem. This study provided insight on the adaptability and proactiveness of caregivers of asthmatic children during the COVID-19 pandemic. Findings from this dissertation research can be used to inform the need for the expansion and reach of sustainable place-based asthma mitigation programs in neighborhoods with high rates of asthma-related morbidity and elsewhere
The University of Montana: A History Through the Lens of Physical Culture, PE, Health, Athletics, and Recreation 1897-2019: The Evolution of a Department
https://scholarworks.umt.edu/burns/1000/thumbnail.jp
An empirical evaluation of m-health service users’ behaviours: A case of Bangladesh
A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.Mobile health (m-health) services are revolutionising healthcare in the developing world by improving accessibility, affordability, and availability. Although these services are revolutionising healthcare in various ways, there are growing concerns regarding users' service quality perceptions and overall influence on satisfaction and usage behaviours. In developing countries, access to healthcare and low healthcare costs are insufficient if users lack confidence in healthcare service quality.
Bangladesh's Directorate General of Health Services (DGHS) provides the only government-sponsored m-health service available to the entire population. DGHS's m-health service, available since 2009, is yet to be evaluated in terms of users' perceptions of the quality of service and its impact on satisfaction and usage. Hence, this study developed a conceptual model for evaluating the associations between overall DGHS m-health service quality, satisfaction, and usage behaviours. This study operationalised overall m-health service quality as a higher-order construct with three dimensions- platform quality, information quality, and outcome quality, and nine corresponding subdimensions-privacy, systems availability, systems reliability, systems efficiency, responsiveness, empathy, assurance, emotional benefit, and functional benefit.
Moreover, researchers in various service domains, including- healthcare, marketing, environmental protection, and information systems, evaluated and confirmed the influence of social and personal norms on satisfaction and behavioural outcomes like- intention to use. Despite this, no research has been conducted to determine whether these normative components affect m-health users' service satisfaction and usage behaviours. As a result, this study included social and personal norms along with overall service quality into the conceptual model to assess the influence of these variables on users' satisfaction and m-health service usage behaviours. Data was collected from two districts in Bangladesh- Dhaka and Rajshahi, utilising the online survey approach. A total of 417 usable questionnaires were analysed using partial least squares structural equation modelling to investigate the relationships between the constructs in Warp PLS.
The study confirms that all three dimensions of service quality and their corresponding subdimensions influence users' overall perceptions of DGHS m-health service quality. Moreover, overall DGHS m-health service quality has a significant direct association with satisfaction and an indirect association with usage behaviours through satisfaction. While social norms do not influence satisfaction and usage behaviours within the DGHS m-health context, personal norms directly influence users' satisfaction and indirectly influence usage behaviours through satisfaction. Theoretically, the study contributes by framing the influence of users' overall m-health service quality perceptions, social and personal norms on their actual usage behaviours rather than the intention to use. It also extends the existing knowledge by assessing and comparing m-health users' continuous and discontinuous behaviours. Methodologically this study confirms the usefulness of partial least squares structural equational modelling to analyse a complex model including a higher order construct (i.e., overall perceived service quality). Practically, the study demonstrates the importance of users' satisfaction in addition to service quality, as service quality only affects usage behaviours through satisfaction in the current study context. Additionally, knowing that personal norms significantly influence service satisfaction motivates providers of m-health services to strive to enhance users' personal norms toward m-health service to enhance service satisfaction and usage. Overall, the study will help enhance patient outcomes and m-health service usage
Modern meat: the next generation of meat from cells
Modern Meat is the first textbook on cultivated meat, with contributions from over 100 experts within the cultivated meat community.
The Sections of Modern Meat comprise 5 broad categories of cultivated meat: Context, Impact, Science, Society, and World.
The 19 chapters of Modern Meat, spread across these 5 sections, provide detailed entries on cultivated meat. They extensively tour a range of topics including the impact of cultivated meat on humans and animals, the bioprocess of cultivated meat production, how cultivated meat may become a food option in Space and on Mars, and how cultivated meat may impact the economy, culture, and tradition of Asia
Digital agriculture: research, development and innovation in production chains.
Digital transformation in the field towards sustainable and smart agriculture. Digital agriculture: definitions and technologies. Agroenvironmental modeling and the digital transformation of agriculture. Geotechnologies in digital agriculture. Scientific computing in agriculture. Computer vision applied to agriculture. Technologies developed in precision agriculture. Information engineering: contributions to digital agriculture. DIPN: a dictionary of the internal proteins nanoenvironments and their potential for transformation into agricultural assets. Applications of bioinformatics in agriculture. Genomics applied to climate change: biotechnology for digital agriculture. Innovation ecosystem in agriculture: Embrapa?s evolution and contributions. The law related to the digitization of agriculture. Innovating communication in the age of digital agriculture. Driving forces for Brazilian agriculture in the next decade: implications for digital agriculture. Challenges, trends and opportunities in digital agriculture in Brazil
Science and Innovations for Food Systems Transformation
This Open Access book compiles the findings of the Scientific Group of the United Nations Food Systems Summit 2021 and its research partners. The Scientific Group was an independent group of 28 food systems scientists from all over the world with a mandate from the Deputy Secretary-General of the United Nations. The chapters provide science- and research-based, state-of-the-art, solution-oriented knowledge and evidence to inform the transformation of contemporary food systems in order to achieve more sustainable, equitable and resilient systems
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Healthy Diet: A Definition for the United Nations Food Systems Summit 2021
AN EXAMINATION OF THE SUFFICIENCY OF EMERGENCY PLANNING IN NEW YORK CITY HOSPITALS FOR VULNERABLE POPULATIONS NEEDING COMMUNICATION OR LANGUAGE ASSISTANCE
Background: While all populations are susceptible to certain hazards that may expose their vulnerabilities in a disaster, populations with no or limited English proficiency, sight limitations, and hearing limitations are especially at risk due to communication and language barriers that they consistently experience. Purpose: This study explored the sufficiency of emergency planning that vulnerable populations with communication barriers may receive in a New York City hospital setting. It investigated the emergency plans, procedures, and practices that hospitals have for these specific, at-risk populations. The sufficiency of these were measured in accordance with their ability to meet the appropriate regulatory standards in existence. By collecting demographic information and characteristics about the hospitals participating, this study tested correlations between these variables with the levels of emergency planning these populations are provided with while in these hospitals. Methods: This mixed-methods study attained valuable information on these areas by surveying and interviewing a population of NYC hospital Emergency Preparedness Coordinators (EPC’s), from a sufficient representation of independent and healthcare systems hospitals; publicly and privately owned; located in different NYC boroughs; and with and without Emergency Departments. Findings: The results of this study draw our attention to the disparities in emergency and resiliency planning for these underserved populations with communication barriers through a rigorous analysis of the various levels of pre-planning they are afforded before a disaster strikes in a hospital facility setting. The presence of a vulnerability characteristic, as well as type of vulnerability characteristic, were found to have effects on the level of sufficiency of emergency planning they may receive in hospitals. The qualitative results also provided an overview of the challenges associated with this type of specialized planning, as well as suggested practices to achieve it. Conclusions: The results of this study should have implications for all emergency management personnel in hospital facilities in terms of enhancing their planning to sufficiently address the needs of vulnerable populations in their emergency planning. Future research should seek to evaluate the sufficiency of the rigor and specificity of the requirements set forth by accrediting bodies for addressing the needs of vulnerable populations in emergency planning
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