Browsing by Subject "Effectiveness"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Can policy influence teacher preparation programs with regard to self-efficacy: a case study of Wisconsin PI34
    (2013-09) Schlesser Erwin, Wanda
    ABSTRACT This mixed methods study examined if state policy can influence pre-service teachers' sense of self-efficacy. Specifically, this study examined if teachers' sense of self-efficacy is associated with implementation of the Wisconsin Policy Initiative 34 (PI34). The University of Wisconsin-River Falls (UWRF) teacher preparation program served as a case study. Data were collected from identified elementary teacher candidates who completed their preparation program prior to and after implementation of PI34. Responding to a modified version of the Ohio State Teacher Efficacy Scale survey, participants provided information on their sense of self-efficacy. Questions were included to assess teacher perception on the influence of various support systems with regard to their sense of self-efficacy. Findings indicate that even after controlling for content knowledge, participants who graduated after PI34, reported higher self-efficacy scores than those who graduated before the law was enacted. All groups had similar perceptions regarding the influence of the support received from peers, principals and formal mentoring programs. However, those teachers who graduated after implementation of PI34, had lower ratings of their teacher preparation programs than those who graduated before the law. These findings suggest that policy can influence teachers' sense of self-efficacy. However, policy makers and practitioners need to identify specific programmatic changes that can affect that influence.
  • Thumbnail Image
    Item
    Comparative Effectiveness And Safety Of P2Y12 Inhibitors In The Secondary Prophylaxis Of Acute Coronary Syndrome
    (2021-07) Kumar, Arun
    One of the major problems among patients suffering from coronary heart disease especially acute coronary syndrome (ACS) is recurrent cardiovascular events following revascularization. Therefore, treatment with P2Y12 receptor antagonists and aspirin, widely known as dual antiplatelet therapy (DAPT), is strongly recommended as secondary prophylaxis following revascularization. DAPT has been shown to be effective at reducing recurrent events and rehospitalization. However, it has also been shown to increase the risk of major bleeding events. Clopidogrel, a P2Y12 inhibitor, has been utilized for ACS management since its approval in 1997 with two additional P2Y12 agents approved by the US Food and Drug Administration in 2009 (prasugrel) and 2011 (ticagrelor). Compared with clopidogrel these newer agents have more potent and predictable antiplatelet aggregation profiles, attributed to consistent pharmacokinetics and dynamics. However, the evidence related to their safety and efficacy/effectiveness is inconsistent. Moreover, the evidence from the studies conducted in the US comes from electronic health records that may not be generalizable to a broader US population. In this dissertation, we sought to assess the comparative effectiveness and safety of different P2Y12 inhibitors in patients with ACS following revascularization with percutaneous coronary intervention (PCI) using commercial claims and encounters (CCAE) and Medicare Supplement (MDCR) data samples of the MarketScan database that may represent a broader US population In the first aim of this dissertation, we looked at the treatment patterns of different P2Y12 inhibitors among patients with coronary heart disease. Recommendations for antiplatelet treatment with P2Y12 agents after revascularization vary across types of revascularization i.e., fibrinolysis, PCI, or coronary artery bypass grafting, and across different clinical characteristics. Aim 1 examined patterns of P2Y12 inhibitor utilization across a number of important characteristics including high bleeding risk, history of stroke/trans-ischemic attack, and associated comorbidities. Our results show that in the year 2018, ticagrelor became the most prescribed drug among patients below age 65 years compared to clopidogrel and prasugrel. We also observed an increased utilization of ticagrelor among patients managed with PCI. However, regardless of age, clopidogrel was the most commonly used drug in patients revascularized using coronary artery bypass graft. Clopidogrel use was more common than other P2Y12 inhibitors in patients with higher comorbid indices, a history of stroke/trans ischemic attacks, and in patients with a high risk of bleeding. In the second and third aims, we assessed the effectiveness and safety of different P2Y12 inhibitors among ACS patients undergoing PCI respectively. Our results showed no difference in the primary effectiveness outcome, defined as any cardiovascular event at 30 days and 180 days observation between propensity score (PS) matched treatment cohorts in our combined CCAE and MDCR population. However, in the MDCR sample, we saw an 84% higher risk of hospitalization due to composite cardiovascular outcome in the female population associated with prasugrel compared to ticagrelor in 180 days outcome using a time to event analysis with Cox-regression hazard models. Additionally, in the CCAE sample, those who were managed with bare-metal stents (BMS) stent had a 43% lower risk of hospitalization due to composite cardiovascular outcome when prescribed prasugrel compared to ticagrelor at 180 days. We did not find any difference in hospitalizations due to composite major bleeding identified using the Cunningham algorithm in all of the PS matched comparisons across all the groups. However, we found a significant 44% increased risk of hospitalization because of major bleeding with prasugrel compared to ticagrelor at 180 days. This study provides useful information related to coronary heart disease management and insight into how newer agents are being utilized in a real-world US population. We show a significant increase in the use of ticagrelor in younger populations undergoing a PCI. Multiple predictors of P2Y12 inhibitor use were studied. Although antiplatelet prescription guidelines were generally followed, the use of prasugrel among patients with a history of stroke or transient ischemic attack was also observed which is contraindicated and may be worth additional investigation. Differences in the use of P2Y12 inhibitors across different patient clinical characteristics may have important policy implications and help to guide appropriate prescribing. Additionally, we observed that the female population benefited more from newer P2Y12 use in our study. Given the differential mechanism of sex on ACS prognosis, future studies are warranted to confirm this finding.
  • Thumbnail Image
    Item
  • Thumbnail Image
    Item
    Flattening the Eviction Curve: A Quasi-Experimental Evaluation of the Brooklyn Center Tenant Protection Ordinance
    (2024-02-29) Gramlich, Jack
    This paper uses two quasi-experimental methods—synthetic control (SC) and difference-in-differences (DiD)—to evaluate the effects of the 2022 Brooklyn Center Tenant Protection Ordinance. The ordinance was adopted at a time when eviction filings were on the rise across the state. Descriptive statistics provide an indication that after the ordinance was adopted, Brooklyn Center’s eviction rate did not increase by as much as the eviction rate in other parts of suburban Hennepin County. For SC models, I compared Brooklyn Center to most other Hennepin County cities. I found statistically significant evidence that the ordinance reduced eviction rates in the period 37-48 weeks after policy adoption. This result survived several placebo tests (though it was sensitive to whether Brooklyn Park was included in the donor pool). Results for filing rates did not survive all placebo tests. For DiD, I drew from a sample of most block groups in suburban Hennepin County. Conditioning on pre-treatment covariates via doubly robust DiD, I found the policy brought reduced eviction rates and filing rates in some of the first eight months after policy adoption. DiD models survived a wide variety of robustness checks. SC and DiD provided consistent evidence of reduced eviction rates in some periods of time. The two methods produced mixed evidence on filing rates, and did not produce strong evidence of policy effects for other outcomes. This paper concludes that when evictions spiked across Minnesota following the expiration of COVID-19 eviction moratorium policies, the City of Brooklyn Center flattened the eviction curve.
  • Thumbnail Image
    Item
    How Perceptions of Influence Tactic Effectiveness and Relationship Norms Predict Agents’ Decision to Influence their Partner’s Health Behavior
    (2023-08) Jaeger, Margaret
    It is well established that close relationships, particularly romantic relationships, can have a powerful impact on physical health, and that social influence plays a key role in this association. However, research has focused on the health and relationship outcomes associated with different types of influence use, and not on how influence agents (i.e., the person enacting influence) decide when and how to influence their target (i.e., the person having the influence enacted upon them). The present work addresses this gap in the literature by establishing three key tactic-specific variables (influence type, perceived tactic effectiveness, and tactic normativeness) that play a role in an agent’s decision of whether or not to use a certain influence tactic. Additionally, two key context variables (health threat severity and relationship stability) were included to examine whether the associations among the tactic-specific variables shift in different health and relational contexts. Three experimental studies were conducted using an iterative experimental vignette methodology in which the health and relational context was initially fixed (Study 1), then the health context was manipulated (Study 2), and finally the health and relational context was manipulated (Study 3). Throughout all three studies, the three tactic-specific variables were manipulated to demonstrate how each variable affected perceived likelihood that the agent would enact a specific influence tactic. In each study, participants first indicated the likelihood of the agent enacting a given influence tactic and then, having been told the tactic had been enacted, rated the relational and health motivations behind why the agent had chosen to enact the tactic. Across all three studies, the tactic-specific variables emerged as consistent predictors of perceptions of likelihood of influence use, with more normative, effective, and supportive tactics being associated with greater likelihood of use. However, the predictive patterns of the tactic-specific variables did not shift as expected with the inclusion of the context variables. Overall, health motivation was more impacted by the context variables, and relational motivation was more impacted by tactic-specific variables.