College and University Ranking Systems: Global Perspectives and American Challenges

Examines how higher education ranking systems function, how other countries use ranking systems, and the impact of college rankings in the United States on student access, choice, and opportunity

Participatory Design

Participatory design is the involvement of people in the creation and management of their built and natural environments. Its strengths are that it cuts across traditional professional boundaries and cultures. The activity of participatory design is based on the principle that the built and natural environments work better if citizens are active and involved in its creation and management instead of being treated as passive consumers. The main purposes of participation are to involve citizens in planning and design decision-making processes and, as a result increase their trust and confidence in organizations, making it more likely that they will work within established systems when seeking solutions to problems; to provide citizens with a voice in planning, design and decision-making in order to improve plans, decisions, service delivery, and overall quality of the environment; and to promote a sense of community by bringing people together who share common goals. A wide range of techniques is available to designers. Some of these techniques have become a standard method used in participatory processes, such as interactive group decision-making techniques that take place in workshops. At the same time, designers have effectively used field techniques such as questionnaires, interviewing, focus groups and group mapping to acquire information. In general, many of the techniques facilitate citizen’s awareness to environmental situations, and help activate their creative thinking. The techniques can be classified as awareness methods, group interaction methods, and indirect methods

Access, Quality, Cost: Optimizing Care for Undocumented Immigrants with End-Stage Kidney Disease Through Intelligent Health Policy

End-stage kidney disease (ESKD) is a lethal condition requiring ongoing treatment in order to prevent one of several potential life-threatening complications. Federal policy mandates hospitals provide emergent treatment to undocumented immigrants suffering one of these complications (such as hemodialysis) and provides partial funding for this treatment through Emergency Medicaid. It does not however, provide explicit funding for the ongoing, scheduled treatments necessary to prevent these lethal complications. Indirect epidemiologic evidence suggests undocumented immigrants present a significant ESKD burden to the U.S. health care system, and limited patient level data suggests that the absence of funding for routine treatment has led to the delivery of substandard care at increased cost. Given the lethality of ESKD, and both the availability and significant cost of effective treatment, timely investigation is required to identify health care policy that will optimize treatment of ESKD in the undocumented immigrant population. Meanwhile, immediate intervention is needed to improve access to, as well as the quality and cost of treatment currently received by members of this population. Such intervention could include nationwide expansion of Emergency Medicaid to all undocumented immigrants with ESKD.Master of Public Healt

Podium Presentation: Differences in Exercise Patterns among Day and Night Shift Nurses During COVID-19 Surges

Background: Registered nurses (RN) working in acute-care hospitals during the Covid-19 pandemic reported unprecedented stress. Walking between 7000-10,000 steps each day offers positive benefits such as improved mood, reduced stress, and reduction in overall mortality risk. Additionally, the American College of Sports Medicine’s (ACSM) Physical Activity Guidelines recommends adults should engage in 75 -150 minutes per week of moderate to intense activity for health benefits. Yet, some research suggests that number of steps taken per week decreased and time spent sedentary increased during the first year of the onset of COVID-19 compared to the year prior. Among nurses working full-time in the hospital setting during COVID-19-related surges, ability to meet national recommendations for activity was not known. Purpose: To describe activity levels of acute-care RN’s and to determine differences between RN working day and night shifts during the COVID-19 pandemic. Methods: A descriptive, observational study was conducted among hospital-based nurses across 3 states and 10 hospitals. 57 RNs participated, providing exercise data in REDCAP surveys over a 7-day period including 3, 12-hour shifts. Of the participants, 49/57 RNs wore pedometers of choice for 7 consecutive days (measuring weekly total step count) and recorded steps in a REDCAP survey. 53/57 participants completed the International Physical Activity Questionnaire (IPAQ) self-report instrument (reflecting overall physical activity for 7 days). Finally, 57/57 reported whether their exercise habits had worsened, stayed the same, or improved since the onset of COVID-19.  Descriptive statistics, t-tests, and an ANOVA were conducted with SPSS v27. Results: Of the 53 subjects who completed the IPAQ questionnaire, 60.4% of nurses met ACSM guidelines for moderate to intense activity. There were no significant differences in activity between day (n=34) and night shifts (n=23, p=0.97). Proportionally more NS nurses reported worse exercise habits since the pandemic (56.5%) compared to DS nurses (41.1%), although the difference was not significant (p=0.16). The average WTS taken by all subjects was 57,483.78 ± 2,3240.595. WTS taken by day shift (61,594.41 ± 4,519.47) versus night shift (49,746.12 ± 3,884.98; p=0.09). When on-shift, day shift nurses walked significantly more steps than night shift (p Conclusions: In our sample of day and night shift nurses, 39.6% did not meet the ACSM guidelines for minutes spent in moderate to intense activity each week during COVID-19 surges. RNs on average met the minimum recommended 49,000 steps/week, but not the upper limit of 70,000 steps per week. More nurses working night shift reported worse exercise habits since the pandemic and walked less steps during a work shift compared to day shift nurses. Future work with larger sample sizes should characterize nursing activity levels longitudinally to examine the impact of hospital surges, 12-hour shifts, and night shift, on RN exercise habits. Implications for Practice: Nursing well-being is of paramount importance, especially during pandemic-related hospital surges, and meeting national recommendations for exercise provides many health benefits. Strategies to enable RNs to meet ACSM recommendations for activity are warranted and should consider occupational factors

Facing the rising cost of chemotherapy in an aging population: Proposed reform of the drug approval process

The emergence of new, effective therapeutic options has brought marked improvements in survival times and cure rates for many cancers. The cost of these advances, however, is staggering and has stretched thin the budget of the Centers for Medicare and Medicaid Services (CMS). In order to maintain its fiscal stability, CMS' s cost containment measures (e.g. the Medicare Modernization Act of 2003) have shifted cost to providers and health care consumers rather than restrict the availability of drugs or services. Such measures, however, fail to contain cost as they do not address the underlying etiology of soaring health care cost: unfettered access to exorbitantly priced drugs. I use the example of chemotherapy for colorectal cancer in the elderly to explore the cost of cancer care, and to demonstrate how current policies not only fail to contain cost, but also unintentionally increase the disparity between the wealthy who can afford optimal health care, and the average American senior who may be unable to afford stateof- the-art cancer care. I propose that in our system with finite resources, we must accept that we cannot provide all possible care to everyone. If cost containment measures are to be successful and equitable, we must redefine quality care as excellent care for all, rather than all care for some. Cost-effectiveness, in addition to comparative clinical effectiveness, must become a focus of the drug approval process. Reforms such as the establishment of an Effectiveness Committee to review the clinical and cost-effectiveness of all new drugs, use of these data through a new conditional FDA approval system and incorporation of cost-effectiveness in CMS's reimbursement decisions, and a cost-sharing policy with the pharmaceutical industry for drugs receiving only conditional approval by the FDA would begin to slow the growth in the cost of care. Although making cost-effectiveness a central consideration in drug approval and reimbursement decisions is likely to be unpopular, the American populace and its physicians are already quite dissatisfied with the extent to which they must shoulder the burden ofthe rising cost of medical care. Failure to act will only worsen this dissatisfaction, while allowing the growing divide between the care available to the wealthy and the care available to most Americans to widen.Master of Public Healt

Sorafenib Effectiveness in Advanced Hepatocellular Carcinoma

Phase III trials show sorafenib improves survival in advanced hepatocellular carcinoma (HCC). Because of narrow trial eligibility, results may not be generalizable to a broader HCC population. We sought to evaluate the effectiveness of initial sorafenib versus no treatment among Medicare beneficiaries with advanced HCC