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Thesis
Peer Reviewed

Water Effectiveness and Targeting: Insights from a Geospatial Dataset on Uganda Water Projects

Berger, David Richard
Advisor(s): Miguel, Edward

UC Berkeley Electronic Theses and Dissertations (2017)

Developing countries have long relied on foreign aid and international NGOs to provide

supplemental public goods such as communal drinking water points. Exploiting

a geospatial dataset of water projects in Uganda, I consider both eectiveness and

targeting of projects. To evaluate eectiveness as practiced at scale, I use a retrospective

design that links placement of water projects with Demographic and

Health Survey (DHS) clusters, nding that over a ve year span, protected sources

produce statistically signicant improvement of weight-for-age, height-for-age, fever,

and hemoglobin levels, but not of weight-for-height and diarrhea. In exploring poverty

targeting, I link water data with spatial poverty data and argue for a relative

targeting measure that compares dierent entity types to one another in terms of

how progressive their allocation of projects is. Finally, I use a similar procedure to

analyze placement in terms of its correlation with election outcomes.

Cover page: Water Effectiveness and Targeting: Insights from a Geospatial Dataset on Uganda Water Projects

Article
Peer Reviewed

Bilateral Posterior Native Hip Dislocations after Fall from Standing

Clinical Practice and Cases in Emergency Medicine, Volume 1, Issue 4 (2017)

We present a case of bilateral posterior native hip dislocations after a fall from standing. This exceedingly rare diagnosis is classically associated with younger patients whose bones are strong enough to dislocate rather than fracture in the setting of a high-momentum collision. We present an unusual case of an 88-year-old male with native hips who sustained a low-energy collision after falling from standing and was found to have bilateral posterior hip dislocations without associated pelvis or femur fractures.

Cover page: Bilateral Posterior Native Hip Dislocations after Fall from Standing

Creative Commons 'BY' version 4.0 license

Article
Peer Reviewed

Resuscitation Rotation: A Novel Emergency Medicine Rotation to Augment Resuscitative Training

Journal of Education and Teaching in Emergency Medicine, Volume 4, Issue 4 (2019)

Article
Peer Reviewed

Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Clinical Practice and Cases in Emergency Medicine, Volume 3, Issue 3 (2019)

Operative hysteroscopy intravascular absorption syndrome is an iatrogenic syndrome caused by absorption of hypo-osmolar distension medium during hysteroscopy, which can lead to rapid hyponatremia with resulting cerebral and pulmonary edema. We present a case of a 47-year-old female who underwent hysteroscopic myomectomy at an outpatient ambulatory surgical center who was brought to the emergency department with dyspnea, hypoxia, and altered mental status. Workup showed hyponatremia with cerebral edema on computed tomography of the head and pulmonary edema on chest radiograph. The patient improved after resuscitation with intravenous saline and supplemental oxygen, and she was discharged home the next day.

Cover page: Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Article

Change in Resuscitation-Specific Confidence and Anxiety Levels in Residents From a Novel Rotation

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 21, Issue 4.1 (2020)

Article

Emergency Medicine Resident Use of a Differential Diagnosis Generator for Critical Patients in the Emergency Department

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 23, Issue 4.1 (2022)

Learning Objective: We aimed to evaluate the use of a differential diagnosis tool by emergency medicine residents in the critical care area of an emergency department to determine patient presentations where the tool would be most valuable and widely used.

Background: Generating a differential diagnosis (DDx) is a vital skill for emergency medicine (EM) residents to develop in their care of critically ill patients. Electronic DDx tools allow a physician DDx to be cross-checked with artificial intelligence to broaden the DDx in complex cases, and may assist in resident DDx generation. Currently, DDx tools have not been well studied in EM high-acuity scenarios. It is unclear which patient presentations challenge EM residents most in their DDx generation.

Objective: We aimed to evaluate the use of a DDx tool by EM residents in the critical care area of an emergency department (ED) to determine patient presentations where the tool would be most valuable.

Methods: We performed a prospective observational study of usage of a DDx tool in an academic ED. The tool was evaluated in the high-acuity area of the ED in patients requiring immediate evaluation. A resuscitation resident rotates each month in the area and evaluates each patient. The resident queried the DDx tool on the patient’s symptoms and completed a data collection tool. Data was summarized by frequencies for use in DDx creation with attention to body system categories. Chi-squared or Fisher’s exact tests were employed on comparison.

Results: The DDx tool was used for 98 patients, of whom 60.2% were female and 7% were pediatric. The tool was not used for 87 patients seen by the resident. Compared with non-DDx tool use, the DDx tool was used significantly for more patients with gastroenterology (GI), infectious disease (ID), metabolic/renal, and neuropsych complaints, and significantly less for trauma patients (Table 1).

Conclusions: A DDx tool has potential to enhance DDx generation in the resuscitation setting for EM residents, particularly for assessing patients with chief complaints consisting of GI, ID, metabolic/renal, and neuropsych involvement. It has less utility for trauma diagnosis, likely because trauma protocols follow strict, stepwise management.

Cover page: Emergency Medicine Resident Use of a Differential Diagnosis Generator for Critical Patients in the Emergency Department

Article
Peer Reviewed

Spillover effects in epidemiology: parameters, study designs and methodological considerations

UC Berkeley Previously Published Works (2018)

Many public health interventions provide benefits that extend beyond their direct recipients and impact people in close physical or social proximity who did not directly receive the intervention themselves. A classic example of this phenomenon is the herd protection provided by many vaccines. If these 'spillover effects' (i.e. 'herd effects') are present in the same direction as the effects on the intended recipients, studies that only estimate direct effects on recipients will likely underestimate the full public health benefits of the intervention. Causal inference assumptions for spillover parameters have been articulated in the vaccine literature, but many studies measuring spillovers of other types of public health interventions have not drawn upon that literature. In conjunction with a systematic review we conducted of spillovers of public health interventions delivered in low- and middle-income countries, we classified the most widely used spillover parameters reported in the empirical literature into a standard notation. General classes of spillover parameters include: cluster-level spillovers; spillovers conditional on treatment or outcome density, distance or the number of treated social network links; and vaccine efficacy parameters related to spillovers. We draw on high quality empirical examples to illustrate each of these parameters. We describe study designs to estimate spillovers and assumptions required to make causal inferences about spillovers. We aim to advance and encourage methods for spillover estimation and reporting by standardizing spillover parameter nomenclature and articulating the causal inference assumptions required to estimate spillovers.

Article
Peer Reviewed

Standard fractionation external beam radiotherapy with and without intraoperative radiotherapy for locally recurrent rectal cancer: the role of local therapy in patients with a high competing risk of death from distant disease

UCLA Previously Published Works (2017)

Objective

We sought to evaluate the effectiveness and safety of utilizing radiotherapy (RT) with standard fractionation, with or without intraoperative RT (IORT), to treat locally recurrent rectal cancer (LRRC).

Methods

Retrospective review of 25 patients with LRRC treated with standard fractionation RT from 2005 to 2011. 15 patients (60%) had prior pelvic RT and 10 (40%) had synchronous metastases. The median equivalent dose in 2-Gy fractions was 30 and 49.6 Gy in patients with and without prior RT, respectively. 23 patients (92%) received concurrent chemotherapy and 16 (64%) underwent surgical resection. Eight patients (33.3%, four with and four without prior RT) received IORT. A competing risks model was developed to estimate the cumulative incidence of local failure with death treated as a competing event.

Results

Median follow-up was 36.9 months after the date of local recurrence. 3-year rates of overall survival (OS), local control (LC) and death with LC were 51.6%, 73.3% and 69.2%, respectively. On multivariable analysis, surgical resection was significantly predictive of improved OS (p < 0.05). If surgical resection were removed from the multivariable model, given the collinearity between IORT delivery and surgical resection, then IORT also became a significant predictor of OS (p < 0.05). Systemic disease at the time of local recurrence was not associated with either LC or OS. No patient had grade ≥3 acute or late toxicity.

Conclusion

RT with standard fractionation is safe and effective in the treatment of patients with LRRC, even in patients with significant risk of systemic disease and/or history of prior RT. Advances in knowledge: The utility of RT with standard fractionation, generally with chemotherapy, in the treatment of LRRC is demonstrated. In this high-risk cohort of patients with a 40% incidence of synchronous metastatic disease, surgical resection of the recurrence was the major predictor of OS, though a benefit to IORT was also suggested. No patients had grade ≥3 acute or late toxicity, though 40% had undergone prior RT, underscoring the tolerability of standard fractionation RT in this setting.

$Cover page: Standard fractionation external beam radiotherapy with and without intraoperative radiotherapy for locally recurrent rectal cancer: the role of local therapy in patients with a high competing risk of death from distant disease$

Article
Peer Reviewed

Spillover effects on health outcomes in low- and middle-income countries: a systematic review

UC Berkeley Previously Published Works (2017)

Background

Many interventions delivered to improve health may benefit not only direct recipients but also people in close physical or social proximity. Our objective was to review all published literature about the spillover effects of interventions on health outcomes in low-middle income countries and to identify methods used in estimating these effects.

Methods

We searched 19 electronic databases for articles published before 2014 and hand-searched titles from 2010 to 2013 in five relevant journals. We adapted the Cochrane Collaboration's quality grading tool for spillover estimation and rated the quality of evidence.

Results

A total of 54 studies met inclusion criteria. We found a wide range of terminology used to describe spillovers, a lack of standardization among spillover methods and poor reporting of spillovers in many studies. We identified three primary mechanisms of spillovers: reduced disease transmission, social proximity and substitution of resources within households. We found the strongest evidence for spillovers through reduced disease transmission, particularly vaccines and mass drug administration. In general, the proportion of a population receiving an intervention was associated with improved health. Most studies were of moderate or low quality. We found evidence of publication bias for certain spillover estimates but not for total or direct effects. To facilitate improved reporting and standardization in future studies, we developed a reporting checklist adapted from the CONSORT framework specific to reporting spillover effects.

Conclusions

We found the strongest evidence for spillovers from vaccines and mass drug administration to control infectious disease. There was little high quality evidence of spillovers for other interventions.

Article
Peer Reviewed

Spillover effects on health outcomes in low- and middle-income countries: a systematic review.

UC Berkeley Previously Published Works (2019)

The following errors were discovered in this article: The third row of Figure 1 was mislabelled; the result for the row for Ali et al., 2013 in Table 1 was mislabelled; in Table 3, the rows for Contreras and Maitra, for Avitabile 2012 and for German et al had errors; two studies were omitted from Figure 3B; the values for % cholera vaccine coverage for Emch et al., 2009 in Supplement 7, Figure 2 were incorrect; and "quality of evidence" values for Ali et al., 2013 and for Cooper and Fitch 1983 were incorrect.