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Journal of General Internal Medicine

By Nirav Shah and Jason Wang

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Journal Article

Ethics and Governance for Digital Disease Surveillance

Michelle Mello, C. Jason Wang
Science Magazine , 2020

Digital epidemiology—the use of data generated outside the public health system for disease surveillance—has been in use for more than a quarter century [see supplementary materials (SM)]. But several countries have taken digital epidemiology to the next level in responding to COVID-19. Focusing on core public health functions of case detection, contact tracing, and isolation and quarantine, we explore ethical concerns raised by digital technologies and new data sources in public health surveillance during epidemics.

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Journal Article

Thinking Globally, Acting Locally — The U.S. Response to Covid-19

Rebecca L. Haffajee, Michelle Mello
New England Journal of Medicine , 2020

Covid-19 has exposed major weaknesses in the United States’ federalist system of public health governance, which divides powers among the federal, state, and local governments. SARS-CoV-2 is exactly the type of infectious disease for which federal public health powers and emergencies were conceived: it is highly transmissible, crosses borders efficiently, and threatens our national infrastructure and economy. Its prevalence varies around the country, with states such as Washington, California, and New York hit particularly hard, but cases are mounting nationwide with appalling velocity.

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Journal Article

How to Prevent and Manage Hospital-Based Infections During Coronavirus Outbreaks: Five Lessons from Taiwan

C. Jason Wang, Henry Bair, Ching-Chuan Yeh
Journal of Hospital Medicine , 2020

During the severe acute respiratory syndrome (SARS) outbreak in 2003, Taiwan reported 346 confirmed cases and 73 deaths. Of all known infections, 94% were transmitted inside hospitals. Nine major hospitals were fully or partially shut down, and many doctors and nurses quit for fear of becoming infected. The Taipei Municipal Ho-Ping Hospital was most severely affected.

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Journal Article

Examining Pharmaceutical Benefits in the United States—A Framework

Alex Chan, Kavin Schulman
JAMA Network , 2020

Pharmacy benefit managers (PBM) are important intermediaries in the pharmaceutical supply chain in the US. Under the general umbrella of administering outpatient prescription drug benefits for health plans, PBMs took on a variety of roles, including managing the drug formulary, negotiating with drug manufacturers and retailers, and processing drug claims.

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Journal Article

Federal Funding For State And Local Contact Tracing Efforts Is An Urgent Priority, And A Bargain

Joshua Salomon, Arthur L. Reingold
Health Affairs , 2020

Rallying cries around COVID-19 have shifted from “flatten the curve” to “reopen America.” After weeks of restrictions on movement, commerce, and social connections across most areas of the country, the tantalizing possibility of relaxing current measures in time for summer baseball and beach parties eroded the resolve of many communities in lockdown. At least 30 states have already moved to reopen some businesses or loosen stay-at-home orders against the warnings of health experts.

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Journal Article

Privileges and Immunity Certification During the COVID-19 Pandemic

Mark A. Hall, David Studdert
JAMA Network , 2020

As the coronavirus disease 2019 (COVID-19) crisis enters its next phase, attention turns to the widespread testing programs needed to resume and maintain normal life activities. Effective prevention and surveillance require testing for active infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and for antibodies that indicate prior infection and potential immunity. There is an established approach for infected individuals: mild cases self-isolate; and severe cases receive treatment. But what is the appropriate response for people with positive antibody tests?

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Commentary

Standing Up against Gender Bias and Harassment — A Matter of Professional Ethics

Michelle Mello, Reshma Jagsi
New England Journal of Medicine , 2020

“We believe health professionals have a moral duty to practice `upstanding’ — intervening as bystanders — in response to sexual harassment and general bias and that this obligation should be described in codes of medical professional ethics and supported within institutional training,” the authors write. While many medical professional societies now mention sexual harassment in their ethical codes, these guidelines fall short in that they do not encourage professionals to respond to the behaviors and intervene when they become aware of discrimination or harassment.

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Journal Article

Diagnostic Testing for the Novel Coronavirus

Joshua M. Sharfstein, Scott J. Becker, Michelle Mello
JAMA Network , 2020

Controversies over diagnostic testing have dominated US headlines about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease 2019 (COVID-19). Technical challenges with the first test developed by the Centers for Disease Control and Prevention (CDC) left the nation with minimal diagnostic capacity during the first few weeks of the epidemic. The CDC also initially limited access to testing to a narrow group of individuals with known exposure.

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Journal Article

Response to COVID-19 in Taiwan Big Data Analytics, New Technology, and Proactive Testing

C. Jason Wang, Chun Y. Ng, Robert H. Brook
JAMA Network , 2020

Taiwan is 81 miles off the coast of mainland China and was expected to have the second highest number of cases of coronavirus disease 2019 (COVID-19) due to its proximity to and number of flights between China. The country has 23 million citizens of which 850 000 reside in and 404 000 work in China. In 2019, 2.71 million visitors from the mainland traveled to Taiwan. As such, Taiwan has been on constant alert and ready to act on epidemics arising from China ever since the severe acute respiratory syndrome (SARS) epidemic in 2003.

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Journal Article

Cost-Effectiveness of Transitional Care Services After Hospitalization With Heart Failure

Manuel R. Blum, Henning Øien, Harris Carmichael, Paul A. Heidenreich, Douglas K. Owens, Jeremy Goldhaber-Fiebert
Annals of Internal Medicine , 2020

Background:

Patients with heart failure (HF) discharged from the hospital are at high risk for death and rehospitalization. Transitional care service interventions attempt to mitigate these risks.

Results of Base-Case Analysis:

All 3 transitional care interventions examined were more costly and effective than standard care, with NHVs dominating the other 2 interventions. Compared with standard care, NHVs increased QALYs (2.49 vs. 2.25) and costs ($81 327 vs. $76 705), resulting in an ICER of $19 570 per QALY gained.

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Journal Article

The 2016 California Policy to Eliminate Nonmedical Vaccine Exemptions and Changes in Vaccine Coverage: An Empirical Policy Analysis

Sindiso Nyathi, Hannah C. Karpel, Kristin L. Sainani, Yvonne Maldonado, Peter J. Hotez, Eran Bendavid, Nathan C. Lo
PLOS Medicine , 2019

Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical (“personal belief”) exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements.

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Journal Article

Estimation of global insulin use for type 2 diabetes, 2018–30: a microsimulation analysis

Sanjay Basu, John S. Yudkin, Sylvia Kehlenbrink, Justine I. Davies, Sarah H. Wild, Kasia J. Lipska, Jeremy B. Sussman, David Beran
The Lancet , 2018

Background:

The amount of insulin needed to effectively treat type 2 diabetes worldwide is unknown. It also remains unclear how alternative treatment algorithms would affect insulin use and disability-adjusted life-years (DALYs) averted by insulin use, given that current access to insulin (availability and affordability) in many areas is low. The aim of this study was to compare alternative projections for and consequences of insulin use worldwide under varying treatment algorithms and degrees of insulin access.

Methods:

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Journal Article

Anesthesia Care Team Composition and Surgical Outcomes

Eric Sun, Thomas R. Miller, Jasmin Moshfegh, Laurence C. Baker
The Journal of the American Society of Anesthesiologists , 2018

The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70).

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Journal Article

Cost Effectiveness of Radiation and Chemotherapy for High-Risk Low Grade Glioma

Eran Bendavid, Eran Bendavid, Douglas K. Owens, Yushen Qian, Satoshi Muruyama
2018

The standard of care treatment for maximally resected, high risk (≥ 40 years old or sub-totally resected) low grade glioma (LGG) patients was established by RTOG 9802, which showed an overall survival (OS) of 13.3 years for patients treated with radiotherapy (RT) + PCV (procarbazine, lomustine [CCNU], vincristine) chemotherapy compared to 7.8 years for RT alone. In the era of value-based health care, cost-effectiveness analyses (CEA) have the potential to inform coverage decisions and patient care.

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Journal Article

Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase–Producing Organisms, Hyderabad, India

Nagamani Kammili, Jyothi Lakshmi, Anlu Xing, Afia Khan, Manisha Rani, Prasanthi Kolli, Anlu Xing, Douglas K. Owens
Emerging Infectious Diseases Journal , 2018

The decreasing effectiveness of antimicrobial agents is a global public health threat, yet risk factors for community-acquired antimicrobial resistance (CA-AMR) in low-income settings have not been clearly elucidated. Our aim was to identify risk factors for CA-AMR with extended-spectrum β-lactamase (ESBL)–producing organisms among urban-dwelling women in India. We collected microbiological and survey data in an observational study of primigravidae women in a public hospital in Hyderabad, India.

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Journal Article

ACA Marketplace Premiums and Competition Among Hospitals and Physician Practices

Maria Polyakova, M. Kate Bundorf, Daniel P. Kessler, Laurence C. Baker
The American Journal of Managed Care , 2018

In this study published in the American Journal of Managed Care, the authors found that premiums for ACA Marketplace plans were higher in rating areas in which physician, hospital, and insurance markets were less competitive.

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Journal Article

Robust relationship between air quality and infant mortality in Africa

Eran Bendavid, Jennifer Burney, Marshall Burke
Nature , 2018

Poor air quality is thought to be an important mortality risk factor globally, but there is little direct evidence from the developing world on how mortality risk varies with changing exposure to ambient particulate matter. Current global estimates apply exposure-response relationships that have been derived mostly from wealthy, mid-latitude countries to spatial population data, and these estimates remain unvalidated across large portions of the globe.

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Working Paper

Learning on the Job: Evidence from Physicians in Training

David C. Chan
Stanford University , 2018

Abstract: Learning on the job creates a tradeoff in team decisions: Workers with less knowledge have less to contribute to team decisions, but experiential learning may require that trainees also have a stake in decisions to learn. This paper studies learning and influence in team decisions among physicians trainees. Exploiting a discontinuity in relative experience, I find reduced-form evidence of influence due to seniority between trainees.

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Working Paper

Industry Input in Policymaking: Evidence from Medicare

David Chan, David C. Chan, Michael J. Dickstein
Stanford University , 2018

Abstract: In setting prices for physician services, Medicare solicits input from a committee that evaluates proposals from industry. We investigate whether this arrangement leads to prices biased toward the interests of committee members. We find that increasing a measure of affiliation between the committee and proposers by one standard deviation increases prices by 10%, demonstrating a pathway for regulatory capture. We then evaluate the effect of affiliation on the quality of information used in price-setting.

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Journal Article

Is Single Payer the Answer for the US Health Care System?

Victor R. Fuchs
JAMA , 2018

The recent challenges to the Affordable Care Act (ACA), which has increased the number of individuals with health insurance in the United States but has had little effect on cost, has revived the debate about a single-payer health care system.

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Journal Article

Drug Companies’ Liability for the Opioid Epidemic

Rebecca L. Haffejee, Michelle Mello
The New England Journal of Medicine , 2017

The opioid epidemic has claimed more than 300,000 lives in the United States since 20001

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Working Paper

Family Planning and Fertility Behavior: Evidence from Twentieth Century Malaysia

Kim Babiarz, Jiwon Lee, Grant Miller, Tey Nai Peng, Christine Valente
Center for Global Development , 2017

There is longstanding debate about the contribution of family planning programs to fertility decline. Studying the staggered introduction of family planning across Malaysia during the 1960s and 1970s, we find modest responses in fertility behavior. Higher (but not lower) parity birth hazards declined by one-quarter—but imply only a 5 percent decline in the overall annual probability of birth. Age at marriage rose by 0.48 years, but birth spacing conditional on this did not otherwise change.

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Journal Article

Relationship between season of birth, temperature exposure, and later life wellbeing

Adam Isen, Maya Rossin-Slater, Reed Walker
Proceedings of the National Academy of Sciences , 2017

We study how exposure to extreme temperatures in early periods of child development is related to adult economic outcomes measured 30 y later. Our analysis uses administrative earnings records for over 12 million individuals born in the United States between 1969 and 1977, linked to fine-scale, daily weather data and location and date of birth.

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