PERSONAL HEALTH RECORDS AND THEIR IMPACT ON BREAST CANCER SCREENING AMONG WOMEN

Screening for breast cancer, the most common cancer in women and the second leading cause of cancer death, facilitates early detection and timely treatment that can reduce cancer-related morbidity and mortality. Increasingly, health information technology, including personal health records (PHRs) which contain detailed health information, has been suggested as having the potential to improve outcomes and reduce disparities in health care. Updated and relevant health information can help at-risk women participate in breast cancer screening and make appropriate clinical decisions.This dissertation consists of three essays that explore health information seeking behaviors of women at potential risk of breast cancer through PHRs and examines the effects of PHRs on the use of recommended breast cancer screening services, with a focus on racial/ethnic and geographic disparities.The first essay explores the decision-making process of health information seeking among women through the PHR use by developing the two-part Hurdle model. This essay finds that two distinct processes influence health information seeking through PHRs: the use of PHRs and the frequency of use. Furthermore, determinants of these two processes are different: demographic factors are the primary factors for the use of PHRs, and socioeconomic factors, salience, self-efficacy, and health status are the main factors associated with the frequency of use.The second essay examines health information seeking behavior of women at potential risk of breast cancer by exploring factors associated with the use of PHRs for health information seeking. The essay finds that women who use PHRs are younger, more educated, and more interested in exchanging medical information with a provider electronically, as well as value more the importance of getting their own medical information electronically compared with those who do not use PHRs. The third essay examines the effects of PHRs on breast cancer screening among women and its racial and geographic differences using an instrumental variables approach. This essay finds that use of PHRs is positively associated with the use of recommended breast cancer screening services among women, particularly among underserved and racial/ethnic minorities. In conclusion, PHR use can empower at-risk women, particularly underserved and minority women, to participate in recommended breast cancer screening

Wearable Activity Tracker Use and Physical Activity Among Informal Caregivers in the United States: Quantitative Study

Background: With an increase in aging population and chronic medical conditions in the United States, the role of informal caregivers has become paramount as they engage in the care of their loved ones. Mounting evidence suggests that such responsibilities place substantial burden on informal caregivers and can negatively impact their health. New wearable health and activity trackers (wearables) are increasingly being used to facilitate and monitor healthy behaviors and to improve health outcomes. Although prior studies have examined the efficacy of wearables in improving health and well-being in the general population, little is known about their benefits among informal caregivers. Objective: This study aimed to examine the association between use of wearables and levels of physical activity (PA) among informal caregivers in the United States. Methods: We used data from the National Cancer Institute’s Health Information National Trends Survey 5 (cycle 3, 2019 and cycle 4, 2020) for a nationally representative sample of 1273 community-dwelling informal caregivers—aged ≥18 years, 60% (757/1273) female, 75.7% (990/1273) had some college or more in education, and 67.3% (885/1273) had ≥1 chronic medical condition—in the United States. Using jackknife replicate weights, a multivariable logistic regression was fit to assess an independent association between the use of wearables and a binary outcome: meeting or not meeting the current World Health Organization’s recommendation of PA for adults (≥150 minutes of at least moderate-intensity PA per week). Results: More than one-third (466/1273, 37.8%) of the informal caregivers met the recommendations for adult PA. However, those who reported using wearables (390/1273, 31.7%) had slightly higher odds of meeting PA recommendations (adjusted odds ratios 1.1, 95% CI 1.04-1.77; P=.04) compared with those who did not use wearables. Conclusions: The results demonstrated a positive association between the use of wearables and levels of PA among informal caregivers in the United States. Therefore, efforts to incorporate wearable technology into the development of health-promoting programs or interventions for informal caregivers could potentially improve their health and well-being. However, any such effort should address the disparities in access to innovative digital technologies, including wearables, to promote health equity. Future longitudinal studies are required to further support the current findings of this study

Optimal Strategies for a Knowledge Workers Acquisition Problem with Expanding and Volatile Demand: Train Internally or Recruit Externally?

The aim of this paper is to consider the process of supplying trained workers with knowledge and skills for upcoming business opportunities, and of training apprentices prepared to meet future demands in an IT service firm. As the demand for new workers has fluctuations, a firm should employ a buffer workforce such as apprentices or interns. However, as a result of rapid development of a business, the buffer‟s capacity may be exceeded, thus requiring the company to recruit skilled workers from outside the firm. It is thus important for a firm to map out a strategy for manpower planning so as to fulfill the demands of new business and minimize operation costs related to training apprentices and recruiting experienced workers. This paper first analyzes the demand and supply of workers for IT service in a knowledge-intensive field. It then presents optimal human resource planning via the familiar method of stochastic process - queueing analysis

A Sensitivity Analysis on the Impact of Uncertanties of the Supply and Demand of a Workforce on a Recruiting Strategy in an IT Service Company

This paper investigates a managerial problem related to human resource planning for an IT service company which mainly carries out time-base projects. As the demand for new workers is subject to wide fluctuations, the firm should hire workers in advance and train them. However, the firm should urgently recruit skilled workers from outside the firm due to the shortages in the workforce. Hence, it is important for the firm to design an optimal human resource planning program so as to fulfill the needs of new IT service projects and minimize operation costs, though this involves a trade-off between holding excess workers to prepare for upcoming demand and recruiting experienced workers. This paper presents a quantitative model that describes the stochastic behavior of the supply and demands of the workforce. Numerical results pertaining to the optimal solution are given via a simulation

Opportunities and Challenges in Twisted Bilayer Graphene: A Review

Two-dimensional (2D) materials exhibit enhanced physical, chemical, electronic, and optical properties when compared to those of bulk materials. Graphene demands significant attention due to its superior physical and electronic characteristics among different types of 2D materials. The bilayer graphene is fabricated by the stacking of the two monolayers of graphene. The twisted bilayer graphene (tBLG) superlattice is formed when these layers are twisted at a small angle. The presence of disorders and interlayer interactions in tBLG enhances several characteristics, including the optical and electrical properties. The studies on twisted bilayer graphene have been exciting and challenging thus far, especially after superconductivity was reported in tBLG at the magic angle. This article reviews the current progress in the fabrication techniques of twisted bilayer graphene and its twisting angle-dependent properties. © 2020, The Author(s).1

Hospital Value-Based Payment Programs and Disparity In the United States: A Review of Current Evidence and Future Perspectives

Beginning in the early 2010s, an array of Value-Based Purchasing (VBP) programs has been developed in the United States (U.S.) to contain costs and improve health care quality. Despite documented successes in these efforts in some instances, there have been growing concerns about the programs\u27 unintended consequences for health care disparities due to their built-in biases against health care organizations that serve a disproportionate share of disadvantaged patient populations. We explore the effects of three Medicare hospital VBP programs on health and health care disparities in the U.S. by reviewing their designs, implementation history, and evidence on health care disparities. The available empirical evidence thus far suggests varied impacts of hospital VBP programs on health care disparities. Most of the reviewed studies in this paper demonstrate that hospital VBP programs have the tendency to exacerbate health care disparities, while a few others found evidence of little or no worsening impacts on disparities. We discuss several policy options and recommendations which include various reform approaches and specific programs ranging from those addressing upstream structural barriers to health care access, to health care delivery strategies that target service utilization and health outcomes of vulnerable populations under the VBP programs. Future studies are needed to produce more explicit, conclusive, and consistent evidence on the impacts of hospital VBP programs on disparities