The Doubly Inflated Poisson and Related Regression Models

Most real life count data consists of some values that are more frequent than allowed by the common parametric families of distributions. For data consisting of only excess zeros, in a seminal paper Lambert (1992) introduced Zero-Inflated Poisson (ZIP) model, which is a mixture model that accounts for the inflated zeros. In this thesis, two Doubly Inflated Poisson (DIP) probability models, DIP (p, λ) and DIP ( p1, p2, λ), are discussed for situations where there is another inflated value k \u3e 0 besides the inflated zeros. The distributional properties such as identifiability, moments, and conditional probabilities are also discussed for both probability models. For the data consisting of raw counts as well as grouped frequencies, we have considered parameter estimation using maximum likelihood (ML) and method of moments techniques. Efficiencies show that the ML estimators perform far better than the moment estimators. An application to DIP models is illustrated using data on patients\u27 length of stay in a hospital. Parameter estimation of DIP regression models using maximum likelihood approach is also discussed using data on dental cavities. Finally, we conclude with a brief introduction to two Doubly Inflated Negative Binomial (DINB) distributions and their related regression models

A Decade of Diabetes Hospitalizations: Meaningful Information for Community-Based Health Services Administrators for Identifying and Assessing Risk

The American Diabetes Association has established that the largest contributor of expenditures related to the cost of care for diabetes is inpatient hospital care. Research has shown that when multiple hospitalizations have been examined, patients diagnosed with diabetes have higher same year readmission rates. Medicare-enrolled patients with coronary artery disease and diabetes who participated in a diabetes management intervention that included self-care behavior instructions and nurse management had fewer emergency room visits and hospitalizations for diabetes related care. In the US, an aging population and expected changes in the ethnic composition prompts an alert to actively address the need for prevention, early detection, reduction of associated complications experienced, and exploration of a cure of the chronic condition of diabetes. This study’s purpose was two-fold: to examine the variability in hospitalization rates of diabetes by geographical location and age groups from 2000-2011 to examine any statistically significant relationships. The study further proposes the exploration of low-cost technology mechanisms to reduce diabetes related hospitalizations through the use of mHealth. Practical interventions using mHealth technologies are feasible solutions to addressing virtual prevention efforts and improving the outcomes of care among patients diagnosed with diabetes

Assessment of Mass Fatality Preparedness and Response Content in Dental Hygiene Education

When mass fatality incidents (MFIs) occur, they can quickly overwhelm local, state, and government agencies, resources, and personnel. It is important to have a rapid and effective response with skilled, multidisciplinary victim identification teams since specific skill sets are necessary to participate in mass fatality preparedness and response. The aims of this study were to determine the extent of formal education related to mass fatality preparedness and response training in U.S. dental hygiene programs and to assess program directors\u27 perceptions of the need for such training. A 23-item cross-sectional survey was emailed to 319 U.S. dental hygiene programs in 2015. Survey questions addressed if the program offered mass fatality preparedness and response training to its students and how much training was given, as well as collecting respondents\u27 demographics and opinions regarding education and training. An overall response rate of 36% was obtained, with 111 program chairs completing the survey. The results showed that only a small percentage of responding programs incorporated coursework related to mass fatality and preparedness in their curricula. Of the responding programs, 84% had no formal instruction on the role of a dental hygienist in MFIs; however, 53 of 69 program directors agreed or strongly agreed that the role of dental hygienists in MFIs should be covered in dental hygiene curricula. The top three barriers to incorporating such training reported by respondents were time requirements, lack of faculty expertise, and lack of equipment. Future research is needed to establish standardized competencies for mass fatality preparedness and response in dental hygiene education

Epidemiology of Pediatric Prehospital Basic Life Support Care in the United States

Children have unique medical needs compared to adults. Emergency medical services personnel need proper equipment and training to care for children. The purpose of this study is to characterize emergency medical services pediatric basic life support to help better understand the needs of children transported by ambulance. Pediatric basic life support patients were identified in this retrospective descriptive study. Descriptive statistics were used to examine incident location, possible injury, cardiac arrest, resuscitation attempted, chief complaint, primary symptom, provider\u27s primary impression, cause of injury, and procedures performed during pediatric basic life support calls using the largest aggregate of emergency medical services data available, the 2013 National Emergency Medical Services Information System (NEMSIS) Public Release Research Data Set. Pediatric calls represented 7.4% of emergency medical services activations. Most pediatric patients were male (49.8%), White (40.0%), and of non-Hispanic origin (56.5%). Most incidents occurred in the home. Injury, cardiac arrest, and resuscitation attempts were highest in the 15 to 19 year old age group. Global complaints (37.1%) predominated by anatomic location and musculoskeletal complaints (26.9%) by organ system. The most common primary symptom was pain (30.3%) followed by mental/psychiatric (13.4%). Provider\u27s top primary impression was traumatic injury (35.7%). The most common cause of injury was motor vehicle accident (32.3%). The most common procedure performed was patient assessment (27.4%). Median EMS system response time was 7 minutes (IQR: 5?12). Median EMS scene time was 12 minutes (IQR: 8?19). Median transport time was 14 minutes (IQR: 8?24). Median EMS total call time was 51 minutes (IQR: 33?77). The epidemiology of pediatric basic life support can help to guide efforts in both emergency medical services operations and training

Virginia Air Quality: Trends, Exposure, and Respiratory Health Impacts

Air quality is an important determinant of public health and quality of life. A secondary data analysis was carried out to investigate trends and air quality in Virginia. The analysis included an evaluation of two major air pollution source categories, emission of criteria and hazardous air pollutants, ambient concentrations of criteria pollutants, ozone standard violations and associated meteorology, and hospital admissions for asthma and chronic obstructive pulmonary disease in Virginia. Comparisons were also made to national trends and statistics. Data was gathered from many open reputable on-line sources available through various state and federal agencies. Virginia routinely meets 5 of the 6 criteria air pollutant ambient standards. Ozone does continue to represent a challenge for Virginia, as it does for many other states. Potential focus on further production and consumption of renewable energy, improvement in fuel efficiency among SUV’s and light trucks, reduction of the metals content in fuels burned by electric utilities, utilization of emissions inspections for automobiles, utilization of vapor recovery systems at gas stations, and continued emphasis on ozone precursors all have the potential to further improve air quality within Virginia. This is important because the very young and the elderly are particularly vulnerable to the adverse effects of poor air quality

Impact of Poor Air Quality on Chronic Respiratory Problems Among the Elderly

[First Paragraph] There is a considerable body of evidence that suggests poor ambient air quality contributes to increased mortality and morbidity. 1,2,3,4,5 The impact of ambient air quality on different segments of the general population, including children and among the elderly has also been investigated.6,7,8,9 In light of the well documented public health significance of air pollution, it is imperative that investigators continue to evaluate details regarding the impact of poor air quality. In particular, it is interesting to note that some research has indicated an increased risk of the young and the elderly being admitted to the hospital for cardiac and pulmonary conditions when ozone and PM levels are elevated.10 Our study endeavored to use public data sources to assess the trends and potential impacts on a statewide basis

Big Data Knowledge in Global Health Education

The ability to synthesize and analyze massive amounts of data is critical to the success of organizations, including those that involve global health. As countries become highly interconnected, increasing the risk for pandemics and outbreaks, the demand for big data is likely to increase. This requires a global health workforce that is trained in the effective use of big data. To assess implementation of big data training in global health, we conducted a pilot survey of members of the Consortium of Universities of Global Health. More than half the respondents did not have a big data training program at their institution. Additionally, the majority agreed that big data training programs will improve global health deliverables, among other favorable outcomes. Given the observed gap and benefits, global health educators may consider investing in big data training for students seeking a career in global health

Pilot and Controller Evaluations of Separation Function Allocation in Air Traffic Management

Two human-in-the-loop simulation experiments were conducted in coordinated fashion to investigate the allocation of separation assurance functions between ground and air and between humans and automation. The experiments modeled a mixed-operations concept in which aircraft receiving ground-based separation services shared the airspace with aircraft providing their own separation service (i.e., self-separation). Ground-based separation was provided by air traffic controllers without automation tools, with tools, or by ground-based automation with controllers in a managing role. Airborne self-separation was provided by airline pilots using self-separation automation enabled by airborne surveillance technology. The two experiments, one pilot-focused and the other controller-focused, addressed selected key issues of mixed operations, assuming the starting point of current-day operations and modeling an emergence of NextGen technologies and procedures. In the controller-focused experiment, the impact of mixed operations on controller performance was assessed at four stages of NextGen implementation. In the pilot-focused experiment, the limits to which pilots with automation tools could take full responsibility for separation from ground-controlled aircraft were tested. Results indicate that the presence of self-separating aircraft had little impact on the controllers' ability to provide separation services for ground-controlled aircraft. Overall performance was best in the most automated environment in which all aircraft were data communications equipped, ground-based separation was highly automated, and self-separating aircraft had access to trajectory intent information for all aircraft. In this environment, safe, efficient, and highly acceptable operations could be achieved for twice today's peak airspace throughput. In less automated environments, reduced trajectory intent exchange and manual air traffic control limited the safely achievable airspace throughput and negatively impacted the maneuver efficiency of self-separating aircraft through high-density airspace. In a test of scripted conflicts with ground-managed aircraft, flight crews of self-separating aircraft prevented separation loss in all conflicts with detection time greater than one minute. In debrief, pilots indicated a preference for at least five minute's alerting notice and trajectory intent information on all aircraft. When intent information on ground-managed aircraft was available, self-separating aircraft benefited from fewer conflict alerts and fewer required deviations from trajectory-based operations