The authors analyze the relationship between heat events in Los Angeles County and (1) emergency medical services, (2) emergency room visits, (3) deaths investigated by the medical examiner, and (4) bookings for violent offenses. Heat events are classified according to the National Weather Service HeatRisk system. Days classified as moderate, major, and severe HeatRisk days are associated with worse results for all these outcomes.
View Article and Find Full Text PDFAlthough the US FDA encourages manufacturers of medical devices to submit real-world evidence (RWE) to support regulatory decisions, the ability of real-world data (RWD) to generate evidence suitable for decision making remains unclear. The 2017 Medical Device User Fee Amendments (MDUFA IV), authorized the National Evaluation System for health Technology Coordinating Center (NESTcc) to conduct pilot projects, or 'Test-Cases', to assess whether current RWD captures the information needed to answer research questions proposed by industry stakeholders. We synthesized key lessons about the challenges conducting research with RWD and the strategies used by research teams to enhance their ability to generate evidence from RWD based on 18 Test-Cases conducted between 2020 and 2022.
View Article and Find Full Text PDFDementia specialists-neurologists, geriatricians, and geriatric psychiatrists-serve a critical clinical function in diagnosing early-stage Alzheimer's disease and determining eligibility for treatment with disease-modifying therapies. However, the availability of dementia specialists is limited and varies across the United States. Using data from the Area Health Resources Files, we found that the median density of dementia specialists across hospital referral regions in United States is 28.
View Article and Find Full Text PDFImportance: Millions of economically disadvantaged children depend on Medicaid for dental care, with states differing in whether they deliver these benefits using fee-for-service or capitated managed care payment models. However, there is limited research examining the association between managed care and the accessibility of dental services.
Objective: To estimate the association between the adoption of managed care for dental services in Florida's Medicaid program and nontraumatic dental emergency department visits and associated charges.
Excess non-point nutrient loading continues to impair urban surface waters. Because of the potential contribution of tree litterfall to nutrient pollution in stormwater, street sweeping is a promising management tool for reducing eutrophication in urban and suburban regions. However, nutrient concentrations and loads of material removed through street sweeping have not been well characterized, impeding the development of pollution reduction credits and improvement of models for stormwater management.
View Article and Find Full Text PDFThe one-year U.S. Equity-First Vaccination Initiative (EVI), launched in April 2021, aimed to reduce racial inequities in coronavirus disease 2019 (COVID-19) vaccination across five demonstration cities (Baltimore, Chicago, Houston, Newark, and Oakland) and over the longer term strengthen the United States' public health system to achieve more-equitable outcomes.
View Article and Find Full Text PDFResearch into using artificial intelligence (AI) in health care is growing and several observers predicted that AI would play a key role in the clinical response to the COVID-19. Many AI models have been proposed though previous reviews have identified only a few applications used in clinical practice. In this study, we aim to (1) identify and characterize AI applications used in the clinical response to COVID-19; (2) examine the timing, location, and extent of their use; (3) examine how they relate to pre-pandemic applications and the U.
View Article and Find Full Text PDFBackground: Emerging artificial intelligence (AI) applications have the potential to improve health, but they may also perpetuate or exacerbate inequities.
Objective: This review aims to provide a comprehensive overview of the health equity issues related to the use of AI applications and identify strategies proposed to address them.
Methods: We searched PubMed, Web of Science, the IEEE (Institute of Electrical and Electronics Engineers) Xplore Digital Library, ProQuest U.
Policymakers in Connecticut are considering various options to increase the affordability of insurance in the state, such as expansions to premium and cost-sharing reduction subsidies on the state's health insurance marketplace, as well as expanded plan offerings, including extending eligibility for the state employee health plan (SEHP) to other groups and a publicly contracted, privately operated plan (the public option plan) offered to individuals on the marketplace. The authors used the RAND Corporation's COMPARE microsimulation model to estimate the impacts of such policy options. For each policy scenario, they calculated enrollment, premiums, consumer spending, and state spending and considered whether the results differed by race, ethnicity, or income group.
View Article and Find Full Text PDFWe investigated racial and ethnic disparities in COVID-19 vaccine uptake, using data from the Centers for Disease Control and Prevention. As of March 29, 2022, uptake of the first dose was higher among Hispanic and Asian people than among White and Black people. In contrast, uptake rates of the booster were higher among Asian and White people than among Black and Hispanic people.
View Article and Find Full Text PDFThe coronavirus disease 2019 pandemic required significant public health interventions from local governments. Early in the pandemic, RAND researchers developed a decision support tool to provide policymakers with insight into the trade-offs they might face when choosing among nonpharmaceutical intervention levels. Using an updated version of the model, the researchers performed a stress-test of a variety of alternative reopening plans, using California as an example.
View Article and Find Full Text PDFWe developed a COVID-19 transmission model to compare the effects of nonpharmaceutical public health interventions (NPIs) on health and economic outcomes. An interdisciplinary approach informed the selection and use of multiple NPIs, combining quantitative modeling of the health and economic impacts of interventions with qualitative assessments of other important considerations (e.g.
View Article and Find Full Text PDFResearch and development (R&D) costs factor into considerations of the tradeoffs between prices, intellectual property protection, and incentivizing innovation, all of which can have implications for policy development. Yet, there is little consensus on the actual cost of R&D for new drugs. We review and synthesize papers estimating drug R&D costs incurred by industry.
View Article and Find Full Text PDFThe COVID-19 pandemic required significant public health interventions from local governments. Although nonpharmaceutical interventions often were implemented as decision rules, few studies evaluated the robustness of those reopening plans under a wide range of uncertainties. This paper uses the Robust Decision Making approach to stress-test 78 alternative reopening strategies, using California as an example.
View Article and Find Full Text PDFAs the global population is projected to increase by two billion people by 2050, so will the demand for phosphorus (P), an essential nutrient for all living organisms and a major driver of eutrophication. To sustainably meet these challenges, we apply the conceptual framework of transition management (TM) to demonstrate how the trajectory of the current linear P use system could be strategically shifted toward a more circular P system. We present US case studies to examine P transitions management in intensive agriculture, wastewater disposal, and food waste management.
View Article and Find Full Text PDFAmid global scarcity of COVID-19 vaccines and the threat of new variant strains, California and other jurisdictions face the question of when and how to implement and relax COVID-19 Nonpharmaceutical Interventions (NPIs). While policymakers have attempted to balance the health and economic impacts of the pandemic, decentralized decision-making, deep uncertainty, and the lack of widespread use of comprehensive decision support methods can lead to the choice of fragile or inefficient strategies. This paper uses simulation models and the Robust Decision Making (RDM) approach to stress-test California's reopening strategy and other alternatives over a wide range of futures.
View Article and Find Full Text PDFAnalysis of real-world glucose and insulin clinical data recorded in electronic medical records can provide insights into tailored approaches to clinical care, yet presents many analytic challenges. This work makes publicly available a dataset that contains the curated entries of blood glucose readings and administered insulin on a per-patient basis during ICU admissions in the Medical Information Mart for Intensive Care (MIMIC-III) database version 1.4.
View Article and Find Full Text PDFWe developed a COVID-19 transmission model used as part of RAND's web-based COVID-19 decision support tool that compares the effects of nonpharmaceutical public health interventions (NPIs) on health and economic outcomes. An interdisciplinary approach informed the selection and use of multiple NPIs, combining quantitative modeling of the health/economic impacts of interventions with qualitative assessments of other important considerations (e.g.
View Article and Find Full Text PDFThe heterogeneity of critical illness complicates both clinical trial design and real-world management. This complexity has resulted in conflicting evidence and opinion regarding the optimal management in many intensive care scenarios. Understanding this heterogeneity is essential to tailoring management to individual patients.
View Article and Find Full Text PDFJudicious phosphorus (P) management is a global grand challenge and critical to achieving and maintaining water quality objectives while maintaining food production. The management of point sources has been successful in lowering P inputs to aquatic environments, but more difficult is reducing P discharges associated with diffuse sources, such as nonpoint runoff from agriculture and urban landscapes, as well as P accumulated in soils and sediments. Strategies for effective diffuse-P management are imperative.
View Article and Find Full Text PDFAbout 40% of the total food produced in the United States is wasted throughout the supply chain. The objective of this study was to determine the energy and nutrient content and variability of food waste sources generated at different stages within the food supply chain in the Minneapolis-St. Paul, MN, metropolitan area, and their potential for use in swine diets.
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