364 results on '"KO, MICHELLE"'
Search Results
2. ILC2-derived LIF licences progress from tissue to systemic immunity
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Gogoi, Mayuri, Clark, Paula A., Ferreira, Ana C. F., Rodriguez Rodriguez, Noe, Heycock, Morgan, Ko, Michelle, Murphy, Jane E., Chen, Victor, Luan, Shi-Lu, Jolin, Helen E., and McKenzie, Andrew N. J.
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- 2024
- Full Text
- View/download PDF
3. Perceptions of School Climate Shape Adolescent Health Behavior: A Longitudinal Multischool Study
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Ko, Michelle Y, Rosenberg, Sofia M, Meza, Benjamin PL, Dudovitz, Rebecca N, Dosanjh, Kulwant K, and Wong, Mitchell D
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Education Policy ,Sociology and Philosophy ,Education ,Substance Misuse ,Behavioral and Social Science ,Clinical Research ,Basic Behavioral and Social Science ,Pediatric ,Good Health and Well Being ,Adolescent ,Humans ,Male ,United States ,Female ,Adolescent Health ,Health Promotion ,Schools ,Adolescent Behavior ,Longitudinal Studies ,school climate ,adolescent health ,substance use ,cannabis ,risk-taking ,bullying ,educational measurement ,longitudinal studies ,Public Health and Health Services ,Curriculum and Pedagogy ,Public Health ,Education policy ,sociology and philosophy ,Public health - Abstract
BackgroundAdolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes.MethodsData from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh-grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th-grade school climate measures (independent variables: institutional environment, student-teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates.ResultsThe 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30-day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30-day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes.Implications for school health policy, practice, and equitySchool health practitioners may prospectively leverage school environment, teacher-student relationships, and disciplinary style to promote health and learning.ConclusionsOur findings identify specific modifiable aspects of the school environment with critical implications for life course health.
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- 2023
4. Perceptions of workplace climate and diversity, equity, and inclusion within health services and policy research
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Chantarat, Tongtan, Rogers, Taylor B, Mitchell, Carmen R, and Ko, Michelle J
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Health Services and Systems ,Health Sciences ,Clinical Research ,Basic Behavioral and Social Science ,Behavioral and Social Science ,Quality Education ,Humans ,Male ,Female ,Diversity ,Equity ,Inclusion ,Gender Identity ,Workplace ,Ethnicity ,Policy ,discrimination ,diversity ,equity ,inclusion ,structural racism ,workforce ,workplace culture ,Public Health and Health Services ,Policy and Administration ,Health Policy & Services ,Health services and systems ,Policy and administration - Abstract
ObjectiveTo describe the perception of professional climate in health services and policy research (HSPR) and efforts to advance diversity, equity, and inclusion (DEI) in the HSPR workforce and workplaces.Data sourceWe administered the HSPR Workplace Culture Survey online to health services and policy researchers.Study designOur survey examined participants' sociodemographic, educational, and professional backgrounds, their perception on DEI in HSPR, experience with DEI initiatives, feeling of inclusion, and direct and witnessed experiences of discrimination at their institutions/organizations. We calculated sample proportions of responses by gender identity, sexual orientation, race/ethnicity, and disability status and compared them with Fisher's exact test.Data collectionWe administered the survey online from July 28 to September 4, 2020. HSPR professionals and trainees aged 18 and older were eligible to participate. Analyses used complete cases only (n = 906; 70.6% completion rate).Principal findings53.4% of the participants did not believe that the current workforce reflects the diversity of communities impacted by HSPR. Although most participants have witnessed various DEI initiatives at their institutions/organizations, nearly 40% characterized these initiatives as "tokenistic." Larger proportions of participants who identified as female, LGBQI+, underrepresented racial/ethnic groups, and those with a disability held this perception than their male, heterosexual, White, and non-disabled counterparts. Current DEI initiatives focused on "planning" activities (e.g., convening task forces) rather than "implementation" activities (e.g., establishing mentoring or network programs). 43.7% of the participants felt supported on their career development, while female, Black, Hispanic/Latino, LGBQI+ participants and those with a disability experienced discrimination at their workplace.ConclusionsDespite an increasing commitment to increasing the diversity of the HSPR workforce and improving equity and inclusion in the HSPR workplace, our results suggest that there is more work to be done to achieve such goals.
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- 2023
5. US Medical School Admissions Leaders’ Experiences With Barriers to and Advancements in Diversity, Equity, and Inclusion
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Ko, Michelle, Henderson, Mark C, Fancher, Tonya L, London, Maya R, Simon, Mark, and Hardeman, Rachel R
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Health Sciences ,Clinical Research ,Humans ,Female ,Schools ,Medical ,Diversity ,Equity ,Inclusion ,Ethnicity ,Hispanic or Latino ,Black or African American ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportanceDespite decades-long calls for increasing racial and ethnic diversity, the medical profession continues to exclude members of Black or African American, Hispanic or Latinx, and Indigenous groups.ObjectiveTo describe US medical school admissions leaders' experiences with barriers to and advances in diversity, equity, and inclusion.Design, setting, and participantsThis qualitative study involved key-informant interviews of 39 deans and directors of admission from 37 US allopathic medical schools across the range of student body racial and ethnic composition. Interviews were conducted in person and online from October 16, 2019, to March 27, 2020, and analyzed from October 2019 to March 2021.Main outcomes and measuresParticipant experiences with barriers to and advances in diversity, equity, and inclusion.ResultsAmong 39 participants from 37 medical schools, admissions experience ranged from 1 to 40 years. Overall, 56.4% of participants identified as women, 10.3% as Asian American, 25.6% as Black or African American, 5.1% as Hispanic or Latinx, and 61.5% as White (participants could report >1 race and/or ethnicity). Participants characterized diversity broadly, with limited attention to racial injustice. Barriers to advancing racial and ethnic diversity included lack of leadership commitment; pressure from faculty and administrators to overemphasize academic scores and school rankings; and political and social influences, such as donors and alumni. Accreditation requirements, holistic review initiatives, and local policy motivated reforms but may also have inadvertently lowered expectations and accountability. Strategies to overcome challenges included narrative change and revision of school leadership structure, admissions goals, practices, and committee membership.Conclusions and relevanceIn this qualitative study, admissions leaders characterized the ways in which entrenched beliefs, practices, and power structures in medical schools may perpetuate institutional racism, with far-reaching implications for health equity. Participants offered insights on how to remove inequitable structures and implement process changes. Without such action, calls for racial justice will likely remain performative, and racism across health care institutions will continue.
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- 2023
6. Generation and age of immigration on later life cognitive performance in KHANDLE
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Meyer, Oanh L, Eng, Chloe W, Ko, Michelle J, Chan, Michelle L, Ngo, Uyen, Gilsanz, Paola, Glymour, M Maria, Mayeda, Elizabeth Rose, Mungas, Dan M, and Whitmer, Rachel A
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Biological Psychology ,Psychology ,Behavioral and Social Science ,Aging ,Acquired Cognitive Impairment ,Neurosciences ,Neurodegenerative ,Dementia ,Basic Behavioral and Social Science ,Brain Disorders ,2.1 Biological and endogenous factors ,Humans ,Aged ,Child ,Emigration and Immigration ,Life Change Events ,Prospective Studies ,Healthy Aging ,Memory ,Episodic ,Cognition ,nativity status ,cognition ,race ,ethnicity ,diversity ,race/ethnicity ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Geriatrics ,Applied and developmental psychology - Abstract
ObjectivesWe examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans.DesignBaseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, and a prospective cohort is initiated in 2017.SettingOlder adults in Northern California.ParticipantsOur cohort consisted of Asians (n = 411) and Latinos (n = 340) who were on average 76 years old (SD = 6.8).MeasurementsWe used multivariable linear regression models to estimate associations between generational status and age at immigration (collapsed into one five-level variable) with measures of verbal episodic memory, semantic memory, and executive function, adjusting for age, gender, race and ethnicity, and own- and parental education.ResultsGenerational status and age at immigration were associated with cognitive outcomes in a graded manner. Compared to third-generation or higher immigrants, first-generation immigration in adulthood was associated with lower semantic memory (β = -0.96; 95% CI: -1.12, -0.81) than immigration in adolescence (β = -0.68; 95% CI: -0.96, -0.41) or childhood (β = -0.28; 95% CI: -0.49, -0.06). Moreover, immigration in adulthood was associated with lower executive function (β = -0.63; 95% CI: -0.78, -0.48) than immigration in adolescence (β = -0.49; 95% CI: -0.75, -0.23). Similarly, compared to third-generation individuals, first-generation immigrants had lower executive functioning scores.ConclusionsOur study supports the notion that sociocontextual influences in early life impact later life cognitive scores. Longitudinal studies are needed to further clarify how immigration characteristics affect cognitive decline.
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- 2023
7. Comparing the pooled cohort equations and coronary artery calcium scores in a symptomatic mixed Asian cohort
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Baskaran, Lohendran, Lee, Jing Kai, Ko, Michelle Shi Min, Al’Aref, Subhi J, Neo, Yu Pei, Ho, Jien Sze, Huang, Weiting, Yoon, Yeonyee Elizabeth, Han, Donghee, Nakanishi, Rine, Tan, Swee Yaw, Al-Mallah, Mouaz, Budoff, Matthew J, and Shaw, Leslee J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Heart Disease - Coronary Heart Disease ,Cardiovascular ,Prevention ,Heart Disease ,Clinical Research ,Agatston score ,coronary artery calcium score ,major adverse cardiovascular events ,pooled cohort equation ,predictive model ,Cardiovascular medicine and haematology - Abstract
BackgroundThe value of pooled cohort equations (PCE) as a predictor of major adverse cardiovascular events (MACE) is poorly established among symptomatic patients. Coronary artery calcium (CAC) assessment further improves risk prediction, but non-Western studies are lacking. This study aims to compare PCE and CAC scores within a symptomatic mixed Asian cohort, and to evaluate the incremental value of CAC in predicting MACE, as well as in subgroups based on statin use.MethodsConsecutive patients with stable chest pain who underwent cardiac computed tomography were recruited. Logistic regression was performed to determine the association between risk factors and MACE. Cohort and statin-use subgroup comparisons were done for PCE against Agatston score in predicting MACE.ResultsOf 501 patients included, mean (SD) age was 53.7 (10.8) years, mean follow-up period was 4.64 (0.66) years, 43.5% were female, 48.3% used statins, and 50.0% had no CAC. MI occurred in 8 subjects while 9 subjects underwent revascularization. In the general cohort, age, presence of CAC, and ln(Volume) (OR = 1.05, 7.95, and 1.44, respectively) as well as age and PCE score for the CAC = 0 subgroup (OR = 1.16 and 2.24, respectively), were significantly associated with MACE. None of the risk factors were significantly associated with MACE in the CAC > 0 subgroup. Overall, the PCE, Agatston, and their combination obtained an area under the receiver operating characteristic curve (AUC) of 0.501, 0.662, and 0.661, respectively. Separately, the AUC of PCE, Agatston, and their combination for statin non-users were 0.679, 0.753, and 0.734, while that for statin-users were 0.585, 0.615, and 0.631, respectively. Only the performance of PCE alone was statistically significant (p = 0.025) when compared between statin-users (0.507) and non-users (0.783).ConclusionIn a symptomatic mixed Asian cohort, age, presence of CAC, and ln(Volume) were independently associated with MACE for the overall subgroup, age and PCE score for the CAC = 0 subgroup, and no risk factor for the CAC > 0 subgroup. Whilst the PCE performance deteriorated in statin versus non-statin users, the Agatston score performed consistently in both groups.
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- 2023
8. Rural residence across the life course and late‐life cognitive decline in KHANDLE: A causal inference study
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Peterson, Rachel L, Gilsanz, Paola, Lor, Yi, George, Kristen M, Ko, Michelle, Wagner, Jenny, Soh, Yenee, Meyer, Oanh L, Glymour, M Maria, and Whitmer, Rachel A
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Biological Psychology ,Biomedical and Clinical Sciences ,Neurosciences ,Psychology ,Clinical Research ,Dementia ,Aging ,Brain Disorders ,Behavioral and Social Science ,Neurodegenerative ,Rural Health ,Acquired Cognitive Impairment ,cognitive aging ,cohort study ,epidemiology ,health disparities ,Genetics ,Biological psychology - Abstract
BackgroundModifiable risks for dementia are more prevalent in rural populations, yet there is a dearth of research examining life course rural residence on late-life cognitive decline.MethodsThe association of rural residence and socioeconomic status (SES) in childhood and adulthood with late-life cognitive domains (verbal episodic memory, executive function, and semantic memory) and cognitive decline in the Kaiser Healthy Aging and Diverse Life Experiences cohort was estimated using marginal structural models with stabilized inverse probability weights.ResultsAfter adjusting for time-varying SES, the estimated marginal effect of rural residence in childhood was harmful for both executive function (β = -0.19, 95% confidence interval [CI] = -0.32, -0.06) and verbal episodic memory (β = -0.22, 95% CI = -0.35, -0.08). Effects of adult rural residence were imprecisely estimated with beneficial point estimates for both executive function (β = 0.19; 95% CI = -0.07, 0.44) and verbal episodic memory (β = 0.24, 95% CI = -0.07, 0.55).ConclusionsChildhood rurality is associated with poorer late-life cognition independent of SES.
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- 2023
9. Perceptions of School Climate Shape Adolescent Health Behavior: A Longitudinal Multischool Study
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Ko, Michelle Y., Rosenberg, Sofia M., Meza, Benjamin P. L., Dudovitz, Rebecca N., Dosanjh, Kulwant K., and Wong, Mitchell D.
- Abstract
Background: Adolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes. Methods: Data from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh-grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th-grade school climate measures (independent variables: institutional environment, student-teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates. Results: The 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30-day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30-day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes. Implications for School Health Policy, Practice, and Equity: School health practitioners may prospectively leverage school environment, teacher-student relationships, and disciplinary style to promote health and learning. Conclusions: Our findings identify specific modifiable aspects of the school environment with critical implications for life course health.
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- 2023
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10. The health implications of neighborhood networks based on daily mobility in US cities
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Brazil, Noli, Chakalov, Bozhidar T., and Ko, Michelle
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- 2024
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11. Doing the Work-or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers.
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Esparza, Caitlin Jade, Simon, Mark, Bath, Eraka, and Ko, Michelle
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Schools ,Medical ,Academic Medical Centers ,academic medicine ,diversity ,equity ,inclusion ,medical schools ,Public Health and Health Services - Abstract
While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.
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- 2022
12. HyperXite 9
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Antony, Jacob, Chin, Anthony, Whaley, Christopher, Hsing, Allen, Eslava, Aaron, Trauger, Andrew, Diaz, Angel, Licos, Angelina, Chau, Brian, Chung, Brigitte, Kang, Calvin, Parker, Crew, Pena, Daniel, Kim, Dillon, Li, Harbour, Ng, Jefferson, Nguyen, Joshua, Nguyen, Kaitlyn, Haddad, Marc, Stark, Max, Veloya, Nicol, Koo, Rachael, Goja, Riya, Mawlawi, Ryan, Quach, Ryan, Scholin, Rye, Der, Sam, Mehra, Syona, Hwang, Taesung, Ngo, Timothy, Anand, Vrushang, Ning, Oscar, Solorzano, Diego, Nomura, Kaydi, and Ko, Michelle
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Demo Day ,Electromagnetic propulsion ,Elon Musk ,High-speed transportation ,Hyperloop ,Linear induction motor ,poster ,Thermal Cooling ,UCI Dean's Choice Award 2024 ,UCI HyperXite - Abstract
The overall objective for HyperXite 9 was to design and build a more robust, and reliable pod, capable of proving the feasibility of a high-speed transportation system. We are working to improve a linear induction motor as the pod's propulsion system. We are also designing and implementing a thermal cooling system to actively dissipate the heat generated by this propulsion system. Our team is comprised of the following 7 subteams: Static Structures, Braking & Pneumatics, Dynamic Structures, Propulsion, Power Systems, Control Systems, and Outreach.
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- 2024
13. Assessing Program Mission and Graduate Practice Outcomes: University of California, Davis School of Medicine Community Health Scholars
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Tran-Reina, Melody, Ko, Michelle, London, Maya, Gonzalez-Flores, Alicia, Hou, Melody Y, Westervelt, Marjorie, and Fancher, Tonya
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Health Services and Systems ,Health Sciences ,Clinical Research ,Good Health and Well Being ,Adult ,California ,Career Choice ,Databases ,Factual ,Family Practice ,Female ,Humans ,Male ,Organizational Objectives ,Professional Practice Location ,Program Development ,Program Evaluation ,Public Health ,Rural Health ,Schools ,Medical ,Clinical Sciences ,Curriculum and Pedagogy ,General & Internal Medicine ,Curriculum and pedagogy ,Health services and systems - Published
- 2021
14. Addressing COVID-19 Barriers to Clinical Trial Enrollment and Implementation in the PHARM-DC Study
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Pevnick, Joshua, Keller, Michelle, Kennelty, Korey, Ko, Michelle, Murry, Logan, Nguyen, An, Henreid, Andrew, and Schnipper, Jeffrey
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Clinical sciences - Abstract
Abstract Recent hospitalization puts older adults at higher risk of experiencing adverse drug events (ADEs) that are a common cause of hospital readmission. Yet, most ADEs are preventable. The PHARMacist Discharge Care (PHARM-DC) study is a multi-site randomized controlled trial that seeks to evaluate the effect of pharmacist-led peri- and post-discharge interventions on 30-day hospital readmissions among older adults taking ≥10 medications or ≥3 high-risk medications. The PHARM-DC intervention includes pharmacist-led patient counseling, medication reconciliation at discharge, and a follow-up phone call post-discharge. We will highlight study protocol adaptations undertaken during the COVID-19 pandemic to address challenges to enrollment and to minimize risk of COVID-19 exposure for study participants and research personnel. Additionally, we will share insights from focus groups and semi-structured interviews with pharmacist interventionists and pharmacy leaders on barriers and facilitators to implementation due to the pandemic and strategies for future clinical trials to overcome barriers.
- Published
- 2021
15. Wearable Sensor System to Monitor Physical Activity and the Physiological Effects of Heat Exposure.
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Pham, Sean, Yeap, Danny, Escalera, Gisela, Basu, Rupa, Wu, Xiangmei, Kenyon, Nicholas J, Hertz-Picciotto, Irva, Ko, Michelle J, and Davis, Cristina E
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Humans ,Oxygen ,Oximetry ,Photoplethysmography ,Monitoring ,Physiologic ,Exercise ,Spectroscopy ,Fourier Transform Infrared ,Linear Models ,Galvanic Skin Response ,Skin Temperature ,Electric Conductivity ,Heart Rate ,Adult ,Middle Aged ,Female ,Male ,Hot Temperature ,Young Adult ,Accelerometry ,Support Vector Machine ,Wearable Electronic Devices ,activity monitoring ,galvanometric response ,heart rate ,personalized medicine ,skin temperature ,telehealth ,wearable physiological sensors ,Bioengineering ,Health Services ,Clinical Research ,Networking and Information Technology R&D ,4.2 Evaluation of markers and technologies ,Generic health relevance ,Analytical Chemistry ,Distributed Computing ,Electrical and Electronic Engineering ,Environmental Science and Management ,Ecology - Abstract
Mobile health monitoring via non-invasive wearable sensors is poised to advance telehealth for older adults and other vulnerable populations. Extreme heat and other environmental conditions raise serious health challenges that warrant monitoring of real-time physiological data as people go about their normal activities. Mobile systems could be beneficial for many communities, including elite athletes, military special forces, and at-home geriatric monitoring. While some commercial monitors exist, they are bulky, require reconfiguration, and do not fit seamlessly as a simple wearable device. We designed, prototyped and tested an integrated sensor platform that records heart rate, oxygen saturation, physical activity levels, skin temperature, and galvanic skin response. The device uses a small microcontroller to integrate the measurements and store data directly on the device for up to 48+ h. continuously. The device was compared to clinical standards for calibration and performance benchmarking. We found that our system compared favorably with clinical measures, such as fingertip pulse oximetry and infrared thermometry, with high accuracy and correlation. Our novel platform would facilitate an individualized approach to care, particularly those whose access to healthcare facilities is limited. The platform also can be used as a research tool to study physiological responses to a variety of environmental conditions, such as extreme heat, and can be customized to incorporate new sensors to explore other lines of inquiry.
- Published
- 2020
16. Changing home care aides: Differences between family and non-family care in California Medicaid home and community-based services.
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Ko, Michelle, Newcomer, Robert J, Bindman, Andrew B, Kang, Taewoon, Hulett, Denis, and Spetz, Joanne
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Humans ,Community Networks ,Aged ,Aged ,80 and over ,Middle Aged ,Caregivers ,Home Health Aides ,Medicaid ,Patient Satisfaction ,Quality of Health Care ,United States ,California ,Female ,Male ,Community and home care: staff roles ,Medicare/Medicaid ,caregiving: filial ,policies/policy analysis ,staff responsibilities ,staffing patterns ,work issues ,Clinical Research ,Good Health and Well Being ,Community and home care ,staff roles ,policies ,policy analysis ,caregiving ,filial ,Medicare ,Nursing ,Public Health and Health Services ,Gerontology - Abstract
In California Medicaid home-and-community-based services (HCBS), recipients' family members receive payment as home care aides (HCAs). We analyzed data on first-time HCBS recipients to examine factors associated with the likelihood of switching HCAs within the first year of services. Those with family HCAs were less than half as likely to change than those with non-family HCAs and racial/ethnic minorities with non-family HCAs had the highest switching rates. Lower wages and local unemployment were associated with switching of non-family HCAs but not family HCAs. Policymakers can foster continuity of home care by paying family members for home care and raising worker wages.
- Published
- 2020
17. A Cross-Sectional study on risk factors for severe hypoglycemia among Insulin-Treated elderly type 2 diabetes Mellitus (T2DM) patients in Singapore
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Shi Min Ko, Michelle, Kit Lee, Wai, Chang Ang, Li, Goh, Su-Yen, Mong Bee, Yong, and Ming Teh, Ming
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- 2022
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18. Psychological Outcomes in Families of PICU Survivors: A Meta-Analysis.
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Shi Min Ko, Michelle, Wai Kit Lee, Sultana, Rehena, Murphy, Beverly, Yi Ching Heng, Katrina, Sin Wee Loh, Pei Fen, and Jan Hau Lee
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FAMILIES & psychology , *MENTAL illness risk factors , *MEDICAL information storage & retrieval systems , *STATISTICAL models , *POST-traumatic stress disorder , *PSYCHOLOGICAL distress , *RESEARCH funding , *CINAHL database , *META-analysis , *SEVERITY of illness index , *ANXIETY , *DESCRIPTIVE statistics , *CLASSIFICATION of mental disorders , *HOSPITAL mortality , *PEDIATRICS , *SYSTEMATIC reviews , *MEDLINE , *INTENSIVE care units , *PSYCHOLOGY of mothers , *ONLINE information services , *COUNSELING , *LENGTH of stay in hospitals , *PSYCHOLOGY of parents , *DATA analysis software , *CONFIDENCE intervals , *PSYCHOLOGY information storage & retrieval systems , *MENTAL depression , *COMORBIDITY , *REGRESSION analysis - Abstract
BACKGROUND: Pediatric critical illness exposes family members to stressful experiences that may lead to subsequent psychological repercussions. OBJECTIVE: To systematically review psychological outcomes among PICU survivors' family members. DATA SOURCES: Four medical databases (PubMed, Embase, CINAHL and PsycInfo) were searched from inception till October 2023. STUDY SELECTION: Studies reporting psychological disorders in family members of PICU patients with at least 3 months follow-up were included. Family members of nonsurvivors and palliative care patients were excluded. DATA EXTRACTION: Screening and data extraction was performed according to PRISMA guidelines. Data were pooled using a random-effects model. RESULTS: Of 5360 articles identified, 4 randomized controlled trials, 16 cohort studies, and 2 cross-sectional studies were included (total patients = 55 597; total family members = 97 506). Psychological distress was reported in 35.2% to 64.3% and 40.9% to 53% of family members 3 to 6 months and 1 year after their child's PICU admission, respectively. Posttraumatic stress disorder was diagnosed in 10% to 48% of parents 3 to 9 months later. Parents that experienced moderate to severe anxiety and depression 3 to 6 months later was 20.9% to 42% and 6.1% to 42.6%, respectively. Uptake of mental counseling among parents was disproportionately low at 0.7% to 29%. Risk factors for psychiatric morbidity include mothers, parents of younger children, and longer duration of PICU stay. LIMITATIONS: The majority of studies were on parents with limited data on siblings and second degree relatives. CONCLUSIONS: There is a high burden of psychological sequelae in family members of PICU survivors. Risk stratification to identify high-risk groups and early interventions are needed. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.
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Ko, Michelle, Wagner, Laura, and Spetz, Joanne
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Humans ,Focus Groups ,Communication ,Medical Informatics ,Health Personnel ,Nursing Homes ,Health Plan Implementation ,Quality of Health Care ,United States ,information technology ,nursing home staff ,nursing homes ,outcome and process assessment ,Health Policy & Services ,Public Health and Health Services - Abstract
Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation.
- Published
- 2018
20. Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California.
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Ko, Michelle, Newcomer, Robert J, Harrington, Charlene, Hulett, Denis, Kang, Taewoon, and Bindman, Andrew B
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Humans ,Long-Term Care ,Retrospective Studies ,Adult ,Aged ,Middle Aged ,Disabled Persons ,Nursing Homes ,Medicaid ,Eligibility Determination ,United States ,California ,Female ,Male ,Cognitive Dysfunction ,home and community-based services ,long-term services and supports ,skilled nursing facilities ,Clinical Research ,Brain Disorders ,Health Services ,Behavioral and Social Science ,Aging ,Mental health ,Good Health and Well Being ,Public Health and Health Services ,Health Policy & Services - Abstract
Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.
- Published
- 2018
21. Asian Americans and Racial Justice in Medicine
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Ko, Michelle, primary, Ngo, Victoria, additional, Zhang, Angela Y., additional, Mabeza, Russyan M., additional, and Hahn, Monica, additional
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- 2024
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22. Changes in healthcare access and utilization among participants in a public housing relocation program in Atlanta, Georgia
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Cummings, Janet R, Allen, Lindsay, Ko, Michelle, Bonney, Loida, Hunter-Jones, Josalin, and Cooper, Hannah
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Human Geography ,Public Health ,Health Sciences ,Human Society ,Health Services ,Clinical Research ,Behavioral and Social Science ,Basic Behavioral and Social Science ,Good Health and Well Being ,Adult ,Black or African American ,Female ,Georgia ,Health Services Accessibility ,Humans ,Insurance ,Health ,Interviews as Topic ,Logistic Models ,Longitudinal Studies ,Male ,Middle Aged ,Poverty ,Primary Health Care ,Public Housing ,Residence Characteristics ,Health insurance ,Healthcare access ,Neighborhood poverty ,Public housing relocation ,Public Health and Health Services ,Health sciences ,Human society - Abstract
Using survey data from participants in a public housing relocation program in Atlanta, Georgia, we examine post-relocation changes in healthcare access (having a usual source of care, having an unmet need) and utilization (receiving a medical exam). Although participants moved to safer, less impoverished neighborhoods, some participants experienced improvements in access and utilization whereas others experienced declines. The supply of healthcare providers in the new neighborhood and having health insurance were associated with improvements in access for this population. Future relocation efforts may seek to assist individuals with choosing a new neighborhood that has accessible healthcare resources for low-income populations.
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- 2016
23. The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review.
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Raven, Maria C, Kushel, Margot, Ko, Michelle J, Penko, Joanne, and Bindman, Andrew B
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Humans ,Program Evaluation ,Adult ,Emergency Service ,Hospital ,Health Services Misuse ,United States ,Emergency Care ,Clinical Research ,Health Services ,Patient Safety ,Good Health and Well Being ,Clinical Sciences ,Emergency & Critical Care Medicine - Abstract
Study objectivePrevious reviews of emergency department (ED) visit reduction programs have not required that studies meet a minimum quality level and have therefore included low-quality studies in forming conclusions about the benefits of these programs. We conduct a systematic review of ED visit reduction programs after judging the quality of the research. We aim to determine whether these programs are effective in reducing ED visits and whether they result in adverse events.MethodsWe identified studies of ED visit reduction programs conducted in the United States and targeted toward adult patients from January 1, 2003, to December 31, 2014. We evaluated study quality according to the Grading of Recommendations Assessment, Development, and Evaluation criteria and included moderate- to high-quality studies in our review. We categorized interventions according to whether they targeted high-risk or low-acuity populations.ResultsWe evaluated the quality of 38 studies and found 13 to be of moderate or high quality. Within these 13 studies, only case management consistently reduced ED use. Studies of ED copayments had mixed results. We did not find evidence for any increase in adverse events (hospitalization rates or mortality) from the interventions in either high-risk or low-acuity populations.ConclusionHigh-quality, peer-reviewed evidence about ED visit reduction programs is limited. For most program types, we were unable to draw definitive conclusions about effectiveness. Future ED visit reduction programs should be regarded as demonstrations in need of rigorous evaluation.
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- 2016
24. Decline In Public Substance Use Disorder Treatment Centers Most Serious In Counties With High Shares Of Black Residents
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Cummings, Janet R, Wen, Hefei, and Ko, Michelle
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Policy and Administration ,Human Society ,Clinical Research ,Substance Misuse ,Health Services ,8.1 Organisation and delivery of services ,Health and social care services research ,Good Health and Well Being ,African Americans ,Cross-Sectional Studies ,Health Facilities ,Proprietary ,Health Services Accessibility ,Humans ,Medicaid ,Ownership ,Public Sector ,Racial Groups ,Substance Abuse Treatment Centers ,Substance-Related Disorders ,Surveys and Questionnaires ,United States ,Black or African American ,Disparities ,Mental Health/Substance Abuse ,Nonprofit/For-Profit Status ,Safety-Net Systems ,Public Health and Health Services ,Applied Economics ,Health Policy & Services ,Health services and systems ,Policy and administration - Abstract
Previous research has associated declines in health care resources such as hospitals and trauma centers with communities' racial composition. However, little is known about changes in the substance use disorder treatment infrastructure in recent years and the implications for black communities. We used data for the period 2002-10 from the National Survey of Substance Abuse Treatment Services to describe changes in the supply of public and private outpatient facilities for substance use disorder treatment, and to determine whether these trends had implications for the geographical availability of these facilities in counties with high percentages of black residents. During the study period the number of publicly owned facilities declined 17.2 percent, whereas the number of private for-profit facilities grew 19.1 percent. At baseline, counties with very high percentages of black residents (that is, more than one standard deviation above the mean) were more likely than counties with less than the mean percentage of black residents to be served by public facilities and were thus disproportionately affected by the overall decline in public facilities. Future research should examine the effect of expanding eligibility for Medicaid on the supply of substance use disorder treatment facilities across diverse communities.
- Published
- 2016
25. Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.
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Newcomer, Robert J, Ko, Michelle, Kang, Taewoon, Harrington, Charlene, Hulett, Denis, and Bindman, Andrew B
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Humans ,Long-Term Care ,Retrospective Studies ,Cognition ,Age Factors ,Health Status ,Residence Characteristics ,Socioeconomic Factors ,Aged ,Aged ,80 and over ,Middle Aged ,Homes for the Aged ,Nursing Homes ,Community Health Services ,Home Care Services ,Health Expenditures ,Medicaid ,Medicare ,Eligibility Determination ,United States ,California ,Female ,Male ,Propensity Score ,Health Services ,Aging ,Clinical Research ,Health and social care services research ,8.1 Organisation and delivery of services ,Good Health and Well Being ,home and community-based services ,long-term services and supports ,nursing facilities ,health care expenditures ,Public Health and Health Services ,Applied Economics ,Health Policy & Services - Abstract
BackgroundIndividuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs.ObjectivesTo compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care.Research designRetrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007.SubjectsPropensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded.MeasuresAverage monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care.ResultsThose initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community.ConclusionsThe higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.
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- 2016
26. Lifestyle Interventions to Prevent Type 2 Diabetes in Women with a History of Gestational Diabetes: A Systematic Review and Meta-Analysis through the Lens of Health Equity
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Ukke, Gebresilasea Gendisha, primary, Boyle, Jacqueline A., additional, Reja, Ahmed, additional, Lee, Wai Kit, additional, Chen, Mingling, additional, Ko, Michelle Shi Min, additional, Alycia, Chelsea, additional, Kwon, Jane, additional, and Lim, Siew, additional
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- 2023
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27. A 19-Year-Old With Hemoptysis and Shortness of Breath
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Ko, Michelle Y., primary, Guzner, Alex, additional, and Saini, Inderpreet, additional
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- 2023
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28. Race, community disadvantage, and cognitive decline: Findings from KHANDLE and STAR
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Peterson, Rachel L., primary, Pejak, Rebecca, additional, George, Kristen M., additional, Gilsanz, Paola, additional, Ko, Michelle, additional, Meyer, Oanh L., additional, Mayeda, Elizabeth Rose, additional, Kind, Amy, additional, and Whitmer, Rachel A., additional
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- 2023
- Full Text
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29. Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers
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Ko, Michelle, Murphy, Julia, and Bindman, Andrew B
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Health Services and Systems ,Health Sciences ,Health Services ,Patient Safety ,Clinical Research ,8.1 Organisation and delivery of services ,Health and social care services research ,Generic health relevance ,No Poverty ,Good Health and Well Being ,Community Health Centers ,Health Services Accessibility ,Hospital Administration ,Humans ,Medicaid ,Medically Uninsured ,Organizational Culture ,Safety-net Providers ,Systems Integration ,United States ,Vulnerable Populations ,Medical and Health Sciences ,Public Health ,Biomedical and clinical sciences ,Health sciences - Abstract
Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs.
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- 2015
30. The 'How' and 'For Whom' of Program Effectiveness: Dissecting the 'Responsive Classroom'[R] Approach in Relation to Academic Achievement
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Society for Research on Educational Effectiveness (SREE), Abry, Tashia, Rimm-Kaufman, Sara E., Hulleman, Chris S., Thomas, Julie, and Ko, Michelle
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In the context of an experimental trial, the authors examined variability in treatment and control teachers' use of several "Responsive Classroom" (RC) practices to predict students' 4th grade academic achievement. Further, they examined the extent to which use of the "RC" practices is differentially important for subgroups of students. They conducted analyses corresponding to two research questions. First what is the relative contribution of practice-specific indices of teachers' use of "RC" practices on 4th grade students' mathematics and reading achievement? Second, to what extent are these associations moderated by student characteristics including initial achievement and gender? (Contains 2 tables and 2 figures.)
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- 2012
31. Safety Net Integration: A Shared Strategy for Becoming Providers of Choice
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Murphy, Julia, Ko, Michelle, Kizer, Kenneth W, and Bindman, Andrew B
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Policy and Administration ,Human Society ,Health Services ,Clinical Research ,Generic health relevance ,No Poverty ,Benchmarking ,Choice Behavior ,Community Health Centers ,Electronic Health Records ,Government Regulation ,Health Care Surveys ,Health Services Accessibility ,Humans ,Insurance ,Health ,Reimbursement ,Interviews as Topic ,Medicaid ,Safety-net Providers ,United States ,safety net ,delivery system ,integration ,health policy ,Public Health and Health Services ,Law ,Health Policy & Services ,Policy and administration ,Political science - Abstract
With the expansion of coverage as a result of federal health care reform, safety net providers are confronting a challenge to care for the underserved while also competing as a provider of choice for the newly insured. Safety net institutions may be able to achieve these goals by pursuing greater delivery system integration. We interviewed safety net hospital and community health center (CHCs) leaders in five US cities to determine what strategies these organizations are employing to promote care integration in the safety net. Although there is some experimentation with payment reform and health information exchange, safety net providers identify significant policy and structural barriers to integrating service delivery. The enhanced Medicaid payments for CHCs and the federal requirement that CHCs retain independent boards discourage these organizations from integrating with other safety net providers. Current policies are not mobilizing safety net providers to pursue integration as a way to deliver more efficient and effective care. Medicaid and other policies at the federal and state level could be revised to overcome known fragmentation in the health care safety net. This includes addressing the conflicts in financing and governance arrangements that are encouraging providers to resist integration to preserve their independence.
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- 2015
32. Payment rates for personal care assistants and the use of long-term services and supports among those dually eligible for Medicare and Medicaid.
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Ko, Michelle, Newcomer, Robert, Kang, Taewoon, Hulett, Denis, Chu, Philip, and Bindman, Andrew B
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Humans ,Long-Term Care ,Cross-Sectional Studies ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Middle Aged ,Personal Health Services ,Health Expenditures ,California ,Female ,Male ,Young Adult ,Dual MEDICAID MEDICARE Eligibility ,Long-term care ,Medicaid ,Medicare ,home care/nursing homes ,state health policies ,home care ,nursing homes ,Public Health and Health Services ,Policy and Administration ,Health Policy & Services - Abstract
ObjectiveTo examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries.Data sourcesState hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008.Study designCross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California.Data extraction methodsWe identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months.Principal findingsPersonal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0-1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2-7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5-23.4). Payment rate was not associated with the probability of nursing facility entry.ConclusionsHigher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care.
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- 2014
33. No man is an island: disentangling multilevel effects in health services research
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Ko, Michelle and Bindman, Andrew B
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Health Services and Systems ,Public Health ,Health Sciences ,Health Services Misuse ,Hospitalization ,Humans ,Income ,Primary Health Care ,Health services research ,Health policy ,Social sciences ,Health services and systems ,Public health - Published
- 2014
34. Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States
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Cummings, Janet R, Wen, Hefei, Ko, Michelle, and Druss, Benjamin G
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Public Health ,Health Sciences ,Human Society ,Behavioral and Social Science ,Prevention ,Health Services ,Clinical Research ,Brain Disorders ,Rural Health ,Substance Misuse ,Good Health and Well Being ,No Poverty ,Ethnicity ,Health Services Accessibility ,Humans ,Medicaid ,Racial Groups ,Socioeconomic Factors ,Substance Abuse Treatment Centers ,Substance-Related Disorders ,United States ,Continental Population Groups ,Ethnic Groups ,Other Medical and Health Sciences ,Psychology ,Cognitive Sciences ,Clinical sciences ,Clinical and health psychology - Abstract
ImportanceAlthough substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. Unlike physical and mental health problems, treatment for SUDs is predominantly provided in a separate specialty sector and more heavily financed by public sources. Medicaid expansion under the Patient Protection and Affordable Care Act has the potential to increase access to treatment for SUDs but only if an infrastructure exists to serve new enrollees.ObjectiveTo examine the availability of outpatient SUD treatment facilities that accept Medicaid across US counties and whether counties with a higher percentage of racial/ethnic minorities are more likely to have gaps in this infrastructure.Design, setting, and participantsWe used data from the 2009 National Survey of Substance Abuse Treatment Services public use file and the 2011-2012 Area Resource file to examine sociodemographic factors associated with county-level access to SUD treatment facilities that serve Medicaid enrollees. Counties in all 50 states were included. We estimated a probit model with state indicators to adjust for state-level heterogeneity in demographics, politics, and policies. Independent variables assessed county racial/ethnic composition (ie, percentage black and percentage Hispanic), percentage living in poverty, percentage living in a rural area, percentage insured with Medicaid, percentage uninsured, and total population.Main outcomes and measuresDichotomous indicator for counties with at least 1 outpatient SUD treatment facility that accepts Medicaid.ResultsApproximately 60% of US counties have at least 1 outpatient SUD facility that accepts Medicaid, although this rate is lower in many Southern and Midwestern states than in other areas of the country. Counties with a higher percentage of black (marginal effect [ME], -3.1; 95% CI, -5.2% to -0.9%), rural (-9.2%; -11.1% to -7.4%), and/or uninsured (-9.5%; -13.0% to -5.9%) residents are less likely to have one of these facilities.Conclusions and relevanceThe potential for increasing access to SUD treatment via Medicaid expansion may be tempered by the local availability of facilities to provide care, particularly for counties with a high percentage of black and/or uninsured residents and for rural counties. Although states that opt in to the expansion will secure additional federal funds for the SUD treatment system, additional policies may need to be implemented to ensure that adequate geographic access exists across local communities to serve new enrollees.
- Published
- 2014
35. Race, community disadvantage, and cognitive decline: Findings from KHANDLE and STAR.
- Author
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Peterson, Rachel L., Pejak, Rebecca, George, Kristen M., Gilsanz, Paola, Ko, Michelle, Meyer, Oanh L., Mayeda, Elizabeth Rose, Kind, Amy, and Whitmer, Rachel A.
- Abstract
INTRODUCTION: Community disadvantage is associated with late‐life cognition. Few studies examine its contribution to racial disparities in cognition/cognitive change. METHODS: Inverse probability weighted models estimated expected mean differences in cognition/cognitive change attributed to residing in less advantaged communities, defined as cohort top quintile of Area Deprivation Indices (ADI): childhood 66–100; adulthood ADI 5‐99). Interactions by race tested. RESULTS: More Black participants resided in less advantaged communities. Semantic memory would be lower if all participants had resided in less advantaged childhood (b = ‐0.16, 95% confidence interval [CI] = ‐0.30, ‐0.03) or adulthood (b = ‐0.14, 95% CI = ‐0.22, ‐0.04) communities. Race interactions indicated that, among Black participants, less advantaged childhood communities were associated with higher verbal episodic memory (interaction p‐value = 0.007) and less advantaged adulthood communities were associated with lower semantic memory (interaction p‐value = 0.002). DISCUSSION: Examining racial differences in levels of community advantage and late‐life cognitive decline is a critical step toward unpacking community effects on cognitive disparities. [ABSTRACT FROM AUTHOR]
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- 2024
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36. A Real‐Life Comparison of Hypoglycaemia Symptomatology between Insulin‐treated Type 2 Diabetes Participants with and without Impaired Awareness of Hypoglycaemia (IAH)
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Lee, Wai Kit, primary, Ko, Michelle Shi Min, additional, Ang, Li Chang, additional, Zhu, Ling, additional, Bee, Yong Mong, additional, Goh, Su Yen, additional, and Teh, Ming Ming, additional
- Published
- 2023
- Full Text
- View/download PDF
37. Geography and the Medicaid Mental Health Care Infrastructure: Implications for Health Care Reform
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Cummings, Janet R, Wen, Hefei, Ko, Michelle, and Druss, Benjamin G
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Health Services and Systems ,Public Health ,Health Sciences ,Human Society ,Mental Health ,Clinical Research ,Health Services ,Rural Health ,Good Health and Well Being ,No Poverty ,Black or African American ,Community Mental Health Services ,Health Care Reform ,Health Services Accessibility ,Hispanic or Latino ,Humans ,Logistic Models ,Medicaid ,Rural Population ,Topography ,Medical ,United States ,Other Medical and Health Sciences ,Psychology ,Cognitive Sciences ,Clinical sciences ,Clinical and health psychology - Abstract
ImportanceMedicaid is the largest payer of mental health (MH) care in the United States, and this role will increase among states that opt into the Medicaid expansion. However, owing to the dearth of MH care providers who accept Medicaid, expanded coverage may not increase access to services. Facilities that provide specialty outpatient MH services and accept Medicaid compose the backbone of the community-based treatment infrastructure for Medicaid enrollees. For states that opt into the expansion, it is important to understand which local communities may face the greatest barriers to access these facilities.ObjectiveTo examine the availability of outpatient MH facilities that accept Medicaid across US counties and whether specific types of communities are more likely to lack this infrastructure.Design, setting, and participantsData from the 2008 National Survey of Mental Health Treatment Facilities and Area Resource File were merged. A generalized ordered logistic regression with state fixed effects was estimated to examine determinants of accessibility of these facilities. Covariates included the percentages of residents who are black, Hispanic, living in poverty, and living in a rural area.Main outcomes and measuresAn ordered variable assessed whether a county had no access to outpatient MH facilities that accept Medicaid, intermediate access to these facilities (ie, ≥1 facility, but not top quintile of facility to Medicaid enrollee per capita ratio), or high access (ie, top quintile of facility to Medicaid enrollee per capita ratio).ResultsMore than one-third of counties do not have any outpatient MH facilities that accept Medicaid. Communities with a larger percentage of residents who are black (marginal effect [ME] = 3.9%; 95% CI, 1.2%-6.6%), Hispanic (ME = 4.8%; 95% CI, 2.3%-7.4%), or living in a rural area (ME = 27.9%; 95% CI, 25.3%-30.4%) are more likely to lack these facilities.Conclusions and relevanceMany communities may face constraints on the MH safety-net system as Medicaid is expanded, especially rural communities and communities with a large percentage of black or Hispanic residents.
- Published
- 2013
38. Chapter 9. The Declining Public Hospital Sector
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Needleman, Jack, primary and Ko, Michelle, additional
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- 2019
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39. Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007–2018
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PLANEY, ARRIANNA MARIE, primary, PLANEY, DONALD A., additional, WONG, SANDY, additional, MCLAFFERTY, SARA L., additional, and KO, MICHELLE J., additional
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- 2023
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40. The Role of Medical Education in Reducing Health Care Disparities: The First Ten Years of the UCLA/Drew Medical Education Program
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Ko, Michelle, Heslin, Kevin C, Edelstein, Ronald A, and Grumbach, Kevin
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Health Services and Systems ,Health Sciences ,Clinical Research ,Prevention ,Adult ,California ,Cohort Studies ,Education ,Medical ,Undergraduate ,Female ,Health Services Accessibility ,Humans ,Los Angeles ,Male ,Medically Underserved Area ,Professional Practice Location ,Retrospective Studies ,Universities ,medical education ,health care disparities ,UCLA ,Drew program ,Clinical Sciences ,General & Internal Medicine ,Clinical sciences ,Health services and systems ,Public health - Abstract
BackgroundThe University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction at UCLA and complete their required clinical rotations in South Los Angeles, an impoverished urban community. We have previously shown that, in comparison to their UCLA counterparts, students in the Drew program had greater odds of maintaining their commitment to medically disadvantaged populations over the course of medical education.ObjectiveTo examine the independent association of graduation from the UCLA/Drew program with subsequent choice of physician practice location. We hypothesized that participation in the UCLA/Drew program predicts future practice in medically disadvantaged areas, controlling for student demographics such as race/ethnicity and gender, indicators of socioeconomic status, and specialty choice.DesignRetrospective cohort study.ParticipantsGraduates (1,071) of the UCLA School of Medicine and the UCLA/Drew Medical Education Program from 1985-1995, practicing in California in 2003 based on the address listed in the American Medical Association (AMA) Physician Masterfile.MeasurementsPhysician address was geocoded to a California Medical Service Study Area (MSSA). A medically disadvantaged community was defined as meeting any one of the following criteria: (a) federally designated HPSA or MUA; (b) rural area; (c) high minority area; or (d) high poverty area.ResultsFifty-three percent of UCLA/Drew graduates are located in medically disadvantaged areas, in contrast to 26.1% of UCLA graduates. In multivariate analyses, underrepresented minority race/ethnicity (OR: 1.57; 95% CI: 1.10-2.25) and participation in the Drew program (OR: 2.47; 95% CI: 1.59-3.83) were independent predictors of future practice in disadvantaged areas.ConclusionsPhysicians who graduated from the UCLA/Drew Medical Education Program have higher odds of practicing in underserved areas than those who completed the traditional UCLA curriculum, even after controlling for other factors such as race/ethnicity. The association between participation in the UCLA/Drew Medical Education Program and physician practice location suggests that medical education programs may reinforce student goals to practice in disadvantaged communities.
- Published
- 2007
41. What Preschool Classroom Experiences Are Associated with Whether Children Improve in Visuomotor Integration?
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Byers, Anthony I., Cameron, Claire E., Ko, Michelle, LoCasale-Crouch, Jennifer, and Grissmer, David W.
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Research Findings: This study examined the contribution of several classroom experience measures (classroom characteristics, teacher characteristics, and teacher-child interactions) to preschoolers' improvement in visuomotor integration. Children (N = 467) ranged in age from 3 to 5 years old and were enrolled in 115 classrooms in 5 U.S. states. Children's visuomotor integration was measured twice (on average 5.2 months apart) using the Beery-Buktenica Developmental Test of Visual-Motor Integration (visuomotor integration subtest). Hierarchical linear models controlling for background characteristics and inhibitory control showed that children improved more in visuomotor integration when they were in classrooms with fewer 3-year-olds, when their teacher had at least a bachelor's degree, and when teachers demonstrated high quality in their interactions. Practice or Policy: Visuomotor integration, and specifically the ability to copy designs with a writing utensil, is a robust indicator of children's school readiness and longitudinal achievement. U.S. preschoolers gained more on visuomotor integration in classrooms with fewer 3-year-old children that were taught by a college-educated teacher and when such classrooms provided high-quality organizational and instructional interactions. These results expand the outcomes linked to early childhood education experiences and emphasize the need for well-prepared early childhood teachers who interact with children effectively.
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- 2016
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42. The Not Underrepresented Minorities: Asian Americans, Diversity, and Admissions
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Ko, Michelle and Ton, Hendry
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- 2020
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43. Sickening: Anti-Black Racism and Health Disparities in the United States
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Ko, Michelle, primary
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- 2023
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44. Comparing the pooled cohort equations and coronary artery calcium scores in a symptomatic mixed Asian cohort
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Baskaran, Lohendran, primary, Lee, Jing Kai, additional, Ko, Michelle Shi Min, additional, Al’Aref, Subhi J., additional, Neo, Yu Pei, additional, Ho, Jien Sze, additional, Huang, Weiting, additional, Yoon, Yeonyee Elizabeth, additional, Han, Donghee, additional, Nakanishi, Rine, additional, Tan, Swee Yaw, additional, Al-Mallah, Mouaz, additional, Budoff, Matthew J., additional, and Shaw, Leslee J., additional
- Published
- 2023
- Full Text
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45. Perceptions of School Climate Shape Adolescent Health Behavior: A Longitudinal Multischool Study
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Ko, Michelle Y., primary, Rosenberg, Sofia M., additional, Meza, Benjamin P. L., additional, Dudovitz, Rebecca N., additional, Dosanjh, Kulwant K., additional, and Wong, Mitchell D., additional
- Published
- 2022
- Full Text
- View/download PDF
46. Efficacy of the 'Responsive Classroom' Approach: Results from a 3-Year, Longitudinal Randomized Controlled Trial
- Author
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Rimm-Kaufman, Sara E., Larsen, Ross A. A., Baroody, Alison E., Curby, Timothy W., Ko, Michelle, Thomas, Julia B., Merritt, Eileen G., Abry, Tashia, and DeCoster, Jamie
- Abstract
This randomized controlled field trial examined the efficacy of the Responsive Classroom (RC) approach on student achievement. Schools (n = 24) were randomized into intervention and control conditions; 2,904 children were studied from end of second to fifth grade. Students at schools assigned to the RC condition did not outperform students at schools assigned to the control condition in math or reading achievement. Use of RC practices mediated the relation between treatment assignment and improved math and reading achievement. Effect sizes (ES) were calculated as standardized coefficients. ES relations between use of RC practices and achievement were 0.26 for math and 0.30 for reading. The RC practices and math achievement relation was greater for students with low initial math achievement (ES = 0.89). Results emphasize fidelity of implementation.
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- 2014
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47. Potent GCN2 Inhibitor Capable of Reversing MDSC-Driven T Cell Suppression Demonstrates In Vivo Efficacy as a Single Agent and in Combination with Anti-Angiogenesis Therapy
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Jackson, Jeffrey J., primary, Shibuya, Grant M., additional, Ravishankar, Buvana, additional, Adusumilli, Lavanya, additional, Bradford, Delia, additional, Brockstedt, Dirk G., additional, Bucher, Cyril, additional, Bui, Minna, additional, Cho, Cynthia, additional, Colas, Christoph, additional, Cutler, Gene, additional, Dukes, Adrian, additional, Han, Xinping, additional, Hu, Dennis X., additional, Jacobson, Scott, additional, Kassner, Paul D., additional, Katibah, George E., additional, Ko, Michelle Yoo Min, additional, Kolhatkar, Urvi, additional, Leger, Paul R., additional, Ma, Anqi, additional, Marshall, Lisa, additional, Maung, Jack, additional, Ng, Andrew A., additional, Okano, Akinori, additional, Pookot, Deepa, additional, Poon, Daniel, additional, Ramana, Chandru, additional, Reilly, Maureen K., additional, Robles, Omar, additional, Schwarz, Jacob B., additional, Shakhmin, Anton A., additional, Shunatona, Hunter P., additional, Sreenivasan, Raashi, additional, Tivitmahaisoon, Parcharee, additional, Xu, Mengshu, additional, Zaw, Thant, additional, Wustrow, David J., additional, and Zibinsky, Mikhail, additional
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- 2022
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48. Perceptions of workplace climate and diversity, equity, and inclusion within health services and policy research
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Chantarat, Tongtan, primary, Rogers, Taylor B., additional, Mitchell, Carmen R., additional, and Ko, Michelle J., additional
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- 2022
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49. Whose social capital matters? The case of U.S. urban public hospital closures and conversions to private ownership
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Ko, Michelle, Derose, Kathryn Pitkin, Needleman, Jack, and Ponce, Ninez A.
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- 2014
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50. Efficacy of the Responsive Classroom Approach: Results From a 3-Year, Longitudinal Randomized Controlled Trial
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Rimm-Kaufman, Sara E., Larsen, Ross A. A., Baroody, Alison E., Curby, Timothy W., Ko, Michelle, Thomas, Julia B., Merritt, Eileen G., Abry, Tashia, and DeCoster, Jamie
- Published
- 2014
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