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Open Access Publications from the University of California

Scholarly Works (6 results)

  • Article
CSD Working Papers (2004)

Since the onset of the current wave of democratization, there has been a growing interest in researching the institutional factors underlying citizen support for democracy. This has also, in part, reflected a renewed scholarly interest in seeking answers to the questions of whether and how institutions ‘matter’. Of all the institutions that may matter, few would deny that electoral systems are among the most significant. They are the central institutional design issue for a new polity to resolve; and they are also among the most malleable of the political institutions. The aim of this paper is to assess whether ballot structure has a wider impact on levels of voter satisfaction with democracy. This paper uses the latest wave of data from the Comparative Study of Electoral Systems (CSES) to assess the role of ballot structure, as well as a battery of other electoral system and individual-level variables, in influencing voter satisfaction with democracy in thirty countries. Using an intra-party measure which identifies the main characteristics of preferential system, our comparative analysis has shown that such systems promote a greater sense of fairness about election outcomes among citizens, which in turn is a major component of the public’s satisfaction with the democratic system.

    Cover page: Voter Satisfaction and Electoral Systems: Does Preferential Voting in Candidate-Centered Systems Make A Difference
    • Article
    CSD Working Papers (2001)

    This paper examines whether participation in the electoral process has become easier or more difficult for new political parties. We identify barriers that might facilitate or discourage the participation of new parties in elections. This involves both the rules of ballot access, as well as media access and campaign funding. Then, we assemble empirical evidence on the changes in these barriers in advanced industrial democracies. The paper also considers whether any observed institutional changes have had demonstrable impact on the number of new and small parties in these electoral systems

      Cover page: Studying Electoral Institutions and their Consequences: Electoral Systems and Electoral Laws
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2014)

      Context

      We have reconceptualized advance care planning (ACP) as a multistep process focused on preparing patients with skills needed for communication and in-the-moment decision making.

      Objectives

      To operationalize this paradigm, we created an easy-to-use ACP website (prepareforyourcare.org) based on a theoretical framework of behavior change and pilot-tested its efficacy to engage older adults in ACP.

      Methods

      At baseline and 1 week after viewing the PREPARE website, we assessed behavior change in ACP by using a validated survey that includes Process Measures (knowledge, contemplation, self-efficacy, and readiness, 5-point Likert scales) and Action Measures (yes/no whether an ACP behavior was completed). We also assigned participants into behavior change stages (i.e., precontemplation, contemplation, preparation, action, maintenance) and determined the percentage of participants who moved from precontemplation at baseline to higher stages at 1 week. We also assessed PREPARE ease-of-use (10-point scale, 10 being the easiest). Changes were assessed with Wilcoxon signed rank sum tests and McNemar's tests.

      Results

      Mean age of the participants was 68.4 years (SD 6.6), and 65% were nonwhite. Behavior Change Process Measures average Likert scores increased from 3.1 (0.9) to 3.7 (0.7), P < 0.001. Action Measures did not change significantly. However, precontemplation significantly decreased for most actions (e.g., talking to doctor about desired medical care, 61% to 35%, P < 0.003), with a mean decrease of 21% (range, 16%-33%). PREPARE was rated a nine of ten (±1.9) for ease-of-use.

      Conclusion

      A new, patient-centered ACP website that focuses on preparing patients for communication and decision making significantly improves engagement in the process of ACP and behavior change. A clinical trial of PREPARE is currently underway.
        Cover page: A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2023)
        Coronavirus disease 2019 (COVID-19) is characterized by a pro-inflammatory state associated with organ failure, thrombosis, and death. We investigated a novel inflammatory biomarker, γ fibrinogen (GPF), in 103 hospitalized patients with COVID-19 and 19 healthy controls. We found significant associations between GPF levels and the severity of COVID-19 as judged by blood oxygen saturation (SpO2). The mean level of GPF in the patients with COVID-19 was significantly higher than in controls (69.8 (95 % CI 64.8-74.8) mg/dL compared with 36.9 (95 % CI 31.4-42.4) mg/dL, p < 0.0001), whereas C-reactive protein (CRP), lactate dehydrogenase (LDH), and total fibrinogen levels were not significantly different between groups. Mean GPF levels were significantly highest in patients with severe COVID-19 (SpO2 ≤ 93 %, GPF 75.2 (95 % CI 68.7-81.8) mg/dL), compared to mild/moderate COVID-19 (SpO2 > 93 %, GPF 62.5 (95 % CI 55.0-70.0) mg/dL, p = 0.01, AUC of 0.68, 95 % CI 0.57-0.78; Youdens index cutpoint 62.9 mg/dL, sensitivity 0.64, specificity 0.63). In contrast, CRP, interleukin-6, ferritin, LDH, D-dimers, and total fibrinogen had weaker associations with COVID-19 disease severity (all ROC curves with lower AUCs). Thus, GPF may be a useful inflammatory marker of COVID-19 respiratory disease severity.
          Cover page: γ fibrinogen levels as a biomarker of COVID-19 respiratory disease severity.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2021)

          Background/objectives

          Electronic Health (eHealth) tools offer opportunities for people to access health information online; yet, most tools are not designed to meet the unique needs of diverse older adults, leading to health disparities. Our goal was to provide guidance for the development of eHealth tools for diverse older populations for use in geriatric care models.

          Design

          Guidance for eHealth tools was compiled from user design resources and eHealth design literature. Pragmatic examples were provided from an evidenced-based eHealth tool called PREPAREforYourCare.org (PREPARE). We used quantitative feasibility data from PREPARE research studies and qualitative analysis of PREPARE focus groups, cognitive interviews, and feedback from randomized trials to further inform our recommendations.

          Results

          Guidance and lessons learned include: (1) define clear objectives and a conceptual framework; (2) co-create with the target population; (3) optimize the design and layout for accessibility and ease of use, such as text at the 5th grade reading level, closed captioning, etc.; (4) use simple, standardized navigation design; (5) use actionable information to enhance behavior change, such as modeling of behaviors; (6) align accompanying written materials with the eHealth tool; and (7) create tracking mechanisms for ongoing user feedback. PREPARE is used as a case example to provide pragmatic illustrations for how the guidance may be operationalized.

          Conclusion

          eHealth tools can be tailored to the unique characteristics, preferences, and needs of diverse older populations. Following the "lessons learned" may help decrease health disparities among diverse older adults and ensure eHealth tools are readily accessible and culturally appropriate.
            Cover page: Developing eHealth tools for diverse older adults: Lessons learned from the PREPARE for Your Care Program
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2020)

            Background

            Failure to deliver care near the end of life that reflects the needs, values and preferences of patients with advanced cancer remains a major shortcoming of our cancer care delivery system.

            Methods

            A mixed-methods comparative effectiveness trial of in-person advance care planning (ACP) discussions versus web-based ACP is currently underway at oncology practices in Western Pennsylvania. Patients with advanced cancer and their caregivers are invited to enroll. Participants are randomized to either (1) in-person ACP discussions via face-to-face visits with a nurse facilitator following the Respecting Choices® Conversation Guide or (2) web-based ACP using the PREPARE for your care™ web-based ACP tool. The trial compares the effect of these two interventions on patient and family caregiver outcomes (engagement in ACP, primary outcome; ACP discussions; advance directive (AD) completion; quality of end-of-life (EOL) care; EOL goal attainment; caregiver psychological symptoms; healthcare utilization at EOL) and assesses implementation costs. Factors influencing ACP effectiveness are assessed via in-depth interviews with patients, caregivers and clinicians.

            Discussion

            This trial will provide new and much-needed empirical evidence about two patient-facing ACP approaches that successfully overcome limitations of traditional written advance directives but entail very different investments of time and resources. It is innovative in using mixed methods to evaluate not only the comparative effectiveness of these approaches, but also the contexts and mechanisms influencing effectiveness. Data from this study will inform clinicians, payers and health systems seeking to adopt and scale the most effective and efficient ACP strategy in real-world oncology settings.
              Cover page: Patient-centered and efficacious advance care planning in cancer: Protocol and key design considerations for the PEACe-compare trial
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