York City Metropolitan Area Research Articles

Lost in Translation: The Jimmo Case as Policy Implementation Failure

The Jimmo case involved a 2011 lawsuit against the Centers for Medicare and Medicaid Services (CMS) alleging they illegally used an improvement standard instead of a need standard to make coverage decisions for Medicare home health and other Medicare beneficiaries. In 2013 CMS and the plaintiffs reached a settlement with CMS agreeing to replace the improvement standard with a need standard and conduct an education campaign to ensure its proper implementation. A literature review indicates no studies on the nature, significance, or impacts of the Jimmo case in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 28 home care nurses between January 2019 and May 2019 in the New York City metropolitan area. Results indicate nurses believe they had little to no knowledge of the Jimmo case; there was limited communication about the case from their agencies; they lacked guidance on the implications of the case on intake and eligibility decisions; they received no guidance on the impact of the case on documentation; and that their lack of knowledge and guidance had adverse impacts on patients.

End-Stage Renal Disease Patients on Chronic Hemodialysis Fare Better With COVID-19: A Retrospective Cohort Study From the New York Metropolitan Region.

IntroductionSeveral comorbid conditions have been identified as risk factors in patients with coronavirus disease 2019 (COVID-19). However, there is a dearth of data describing the impact of COVID-19 infection in patients with end-stage renal disease on hemodialysis (ESRD-HD).MethodsThis retrospective case series analyzed 362 adult patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020, and May 13, 2020, at a teaching hospital in the New York City metropolitan area. The primary outcome was severe pneumonia as defined by the World Health Organization. Secondary outcomes were the (1) the Combined Outcome of Acute respiratory distress syndrome or in-hospital Death (COAD), and (2) need for high levels of oxygen supplementation (HiO2).ResultsPatients with ESRD-HD had lower odds for poor outcomes including severe pneumonia [odds ratio (OR) 0.4, confidence interval (CI) 0.2-0.9, p=.04], HiO2 [OR 0.3, CI (0.1-0.8), p=.02] and COAD [OR 0.4, CI (0.2-1.05), p=.06], when compared to patients without ESRD. In contrast, higher odds for severe pneumonia, COAD and HiO2 were seen with advancing age. African Americans were over-represented in the hospitalized patient cohort, when compared to their representation in the community (35% vs 18%). Hispanics had higher odds for severe illness and HiO2 when compared to Caucasians.ConclusionsPatients with ESRD-HD had a milder course of illness with a lower likelihood of severe pneumonia and a lesser need for aggressive oxygen supplementation when compared to patients not on chronic dialysis. The lower odds of severe illness in ESRD-HD patients might have a pathophysiologic basis and need to be further explored.

Prevalence of SARS-CoV-2 Antibodies Among Healthcare Workers in a Disease Epicenter

The New York City metropolitan area emerged as an epicenter of the COVID-19 pandemic. A recent population study showed a prevalence of SARS-CoV-2

Cardiac electrophysiology consultative experience at the epicenter of the COVID-19 pandemic in the United States

BackgroundThe COVID-19 pandemic has greatly altered the practice of cardiac electrophysiology around the world for the foreseeable future. Professional organizations have provided guidance for practitioners, but real-world examples of the consults and responsibilities cardiac electrophysiologists face during a surge of COVID-19 patients is lacking. MethodsIn this observational case series we report on 29 consecutive inpatient electrophysiology consultations at a major academic medical center in New York City, the epicenter of the pandemic in the United States, during a 2 week period from March 30-April 12, 2020, when 80% of hospital beds were occupied by COVID-19 patients, and the New York City metropolitan area accounted for 10% of COVID-19 cases worldwide. ResultsReasons for consultation included: Atrial tachyarrhythmia (31%), cardiac implantable electronic device management (28%), bradycardia (14%), QTc prolongation (10%), ventricular arrhythmia (7%), post-transcatheter aortic valve replacement conduction abnormality (3.5%), ventricular pre-excitation (3.5%), and paroxysmal supraventricular tachycardia (3.5%). Twenty-four patients (86%) were positive for COVID-19 by nasopharyngeal swab. All elective procedures were canceled, and only one urgent device implantation was performed. Thirteen patients (45%) required in-person evaluation and the remainder were managed remotely. ConclusionOur experience shows that the application of a massive alteration in workflow and personnel forced by the pandemic allowed our team to efficiently address the intersection of COVID-19 with a range of electrophysiology issues. This experience will prove useful as guidance for emerging hot spots or areas affected by future waves of the pandemic.

The Boiled Frog in Organizational Learning: Sensing, Adapting to, and Surviving Environmental Change

Radical change in a firm’s environment is often viewed as discontinuous. We introduce the concept of continuous radical change by which old beliefs are rendered fallacious at an incremental pace. We theorize that incremental change can be as harmful as discontinuous change because it can remain undetected for too long by incumbent organizations. Specifically, we argue for a curvilinear relationship between the pace of environmental change and the organizational lifespan. We test out predictions using data from some 31,000 restaurants in the New York City Metropolitan area between the years 2007-2018. We use a fixed effects regression model to test for differences in the lifespan of restaurants located in areas of slow but radical gentrification versus those located in areas with accelerated and radical gentrification. We find support for an inverted U-shape between the pace of gentrification and restaurant lifespan. We explore whether this relationship is driven by differences in restaurants’ adaptation behavior.

SARS-CoV-2 IgG antibody responses in New York City

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a strain of coronavirus that causes coronavirus disease 2019 (Covid-19) and has been declared a global pandemic by the World Health Organization. Total cases of SARS-CoV-2 worldwide exceed 10.2 million, with over 503,000 deaths recorded. Little is known about the body's immune response to SARS-CoV-2 infection. In this paper, we describe SARS-CoV-2 IgG antibody responses in 28,523 patients from the New York City metropolitan area and report a SARS-CoV-2 IgG positivity rate of 44%, indicating the widespread nature of the pandemic in the city and state of New York. Additionally, for a subset of patients, we report on the correlation between SARS-CoV-2 patient symptom severity and level of SARS-CoV-2 IgG antibody found in the patient sample.

From the American Epicenter: Coronavirus Disease 2019 in Patients with Inflammatory Bowel Disease in the New York City Metropolitan Area.

BackgroundWe aimed to characterize patients with inflammatory bowel disease (IBD) and novel coronavirus disease 2019 (COVID-19).MethodsWe performed a case series of patients with IBD and confirmed or highly suspected COVID-19 to assess rates of severe outcomes.ResultsWe identified 83 patients with IBD with confirmed (54%) or highly suspected (46%) COVID-19. The overall hospitalization rate was 6%, generally comprising patients with active Crohn’s disease or older men with comorbidities, and 1 patient expired.DiscussionIn this series of patients with IBD, severe outcomes of COVID-19 were rare and comparable to similarly aged individuals in the general population.

Urbanization reduces gene flow but not genetic diversity of stream salamander populations in the New York City metropolitan area.

Natural landscape heterogeneity and barriers resulting from urbanization can reduce genetic connectivity between populations. The evolutionary, demographic, and ecological effects of reduced connectivity may lead to population isolation and ultimately extinction. Alteration to the terrestrial and aquatic environment caused by urban influence can affect gene flow, specifically for stream salamanders who depend on both landscapes for survival and reproduction. To examine how urbanization affects a relatively common stream salamander species, we compared genetic connectivity of Eurycea bislineata (northern two‐lined salamander) populations within and between streams in an urban, suburban, and rural habitat around the New York City (NYC) metropolitan area. We report reduced genetic connectivity between streams within the urban landscape found to correspond with potential barriers to gene flow, that is, areas with more dense urbanization (roadways, industrial buildings, and residential housing). The suburban populations also exhibited areas of reduced connectivity correlated with areas of greater human land use and greater connectivity within a preserve protected from development. Connectivity was relatively high among neighboring rural streams, but a major roadway corresponded with genetic breaks even though the habitat contained more connected green space overall. Despite greater human disturbance across the landscape, urban and suburban salamander populations maintained comparable levels of genetic diversity to their rural counterparts. Yet small effective population size in the urban habitats yielded a high probability of loss of heterozygosity due to genetic drift in the future. In conclusion, urbanization impacted connectivity among stream salamander populations where its continual influence may eventually hinder population persistence for this native species in urban habitats.

Home sleep apnea testing in the era of COVID-19: a community perspective.

Citation:Kole A. Home sleep testing in the era of COVID-19: a community perspective. J Clin Sleep Med. 2020;16(9):1633.

Mobile Laboratory Measurements of High Surface Ozone Levels and Spatial Heterogeneity During LISTOS 2018: Evidence for Sea Breeze Influence

AbstractThe Long Island Sound Tropospheric Ozone Study (LISTOS) was organized to investigate ozone formation and transport in the New York City metropolitan area and locations downwind. During LISTOS, the University at Albany Atmospheric Sciences Research Center (ASRC) mobile laboratory was used for measuring surface O3, NO2, and aerosol number and mass concentration. Sharp O3 concentration gradients, with ΔO3 Δy−1 over 15 ppb km−1, were measured both at and near the land‐water interface and on the highway on days characterized by high regional O3 concentrations. These large O3 gradients at or near the land‐water interface, and in air masses relatively low in NO2, are shown to be influenced in part by the transport of highly oxidized air masses via sea breeze circulation and convergence with gradient flow. On the highway under regionally high O3 concentrations, strong anticorrelation (R2 = 0.78, p < 0.05) between O3 and NO2 and an absolute slope less than 1 suggested that Ox concentrations (O3 + NO2) increased with increasing NO2. Overall, the on‐road measurements made during LISTOS help to better characterize the interaction between the emitted pollution and the meteorological conditions on Long Island, thereby having potential policy implications.

Employers as Subjects of the Immigration State: How the State Foments Employment Insecurity for Temporary Immigrant Workers

AbstractThe state plays a key role in shaping worker precarity, and employers are key actors in mediating this process. While employers sometimes may act as willing extensions of the deportation machinery, they are also subjects of the immigration state. In this article, we highlight the impact of state-employer dynamics on migrant workers with Temporary Protected Status (TPS). These workers have only provisional permission to live and work in the United States, but are not tied to any single employer. Even though they are privileged over unauthorized workers and employer-sponsored guest workers, TPS holders experience their own brand of state-induced precarity. Their employers risk civil or criminal liability if they are not in compliance with work authorization requirements and must repeatedly navigate an unpredictable and confusing immigration bureaucracy. Drawing on interviews with 121 low-wage TPS workers and two dozen of their advocates in the New York City metropolitan area, our findings reveal that the intertwined coercive and bureaucratic arms of the immigration state together make hiring TPS workers a more risky and costly proposition for employers, thereby exacerbating the job insecurity that TPS workers already face due to an at-will employment regime that offers few protections against firing.

Social Workers Assert Medicare Home Care Ignores Social Determinants of Health

There is significant literature on the importance of addressing social determinants of health (SDOH) to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage, including social work, in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and rehospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of social work and SDOH to Medicare home health.

Chagas Disease in the New York City Metropolitan Area.

BackgroundChagas disease, caused by the parasite Trypanosoma cruzi, once considered a disease confined to Mexico, Central America, and South America, is now an emerging global public health problem. An estimated 300 000 immigrants in the United States are chronically infected with T. cruzi. However, awareness of Chagas disease among the medical community in the United States is poor.MethodsWe review our experience managing 60 patients with Chagas disease in hospitals throughout the New York City metropolitan area and describe screening, clinical manifestations, EKG findings, imaging, and treatment.ResultsThe most common country of origin of our patients was El Salvador (n = 24, 40%), and the most common detection method was by routine blood donor screening (n = 21, 35%). Nearly half of the patients were asymptomatic (n = 29, 48%). Twenty-seven patients were treated with either benznidazole or nifurtimox, of whom 7 did not complete therapy due to side effects or were lost to follow-up. Ten patients had advanced heart failure requiring device implantation or organ transplantation.ConclusionsBased on our experience, we recommend that targeted screening be used to identify at-risk, asymptomatic patients before progression to clinical disease. Evaluation should include an electrocardiogram, echocardiogram, and chest x-ray, as well as gastrointestinal imaging if relevant symptoms are present. Patients should be treated if appropriate, but providers should be aware of adverse effects that may prevent patients from completing treatment.

Biomedical HIV Prevention among Gay Male Couples: A Qualitative Study of Motivations and Concerns

ABSTRACT Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are highly efficacious biomedical prevention strategies, which significantly reduce the risk of HIV transmission. Yet, partnered sexual minority men (SMM) continue to exhibit poorer uptake rates especially those in a non-monogamous or serodiscordant relationship for whom PrEP is recommended. The purpose of the study was to identify factors that may facilitate or impede the uptake of PrEP or PEP among partnered SMM. This qualitative study conducted semi-structured interviews with 10 sexual minority male couples recruited from the New York City metropolitan area. Thematic analysis identified relationship-specific and structural-level factors, which influence motivation and willingness for biomedical prevention uptake. Specifically, results highlighted the tension between relationship functioning and HIV prevention. In addition, stigma and access to knowledgeable health care providers diminished interest in biomedical prevention. Findings suggest a need for interventions that frame biomedical prevention in ways that minimize social perceptions of mistrust between partners and improve access.

Sexual orientation and gender identity victimization among young adults in the New York City metropolitan area: The P18 cohort study.

Sexual and gender minority populations are significantly more likely to experience verbal and physical victimization in young adulthood. These analyses examine the types, contexts, and sources of lifetime sexual orientation and gender identity victimization (SGV) in a diverse sample of sexual minority men (SMM) and transgender women as well as the extent to which experiences of SGV vary between subgroups of the population. Cross-sectional data were collected as part of a study of sexual health, mental health, and HIV examined through the lens of syndemic production in young SMM. Measures assessed sociodemographic characteristics as well as the types, sources, and contexts of physical assault and verbal harassment due to actual or perceived gender or sexuality. Verbal harassment was more prevalent in the sample than physical assault (44.5% vs. 11.6%). Schools or sports teams and neighborhoods were the most common contexts for verbal and physical SGV. Strangers were the most frequent perpetrators of SGV, followed by family and peers. Bivariate analyses showed significant differences in SGV based on race, education, perceived familial SES, sexual identity, and borough of residence. In multivariate analyses, race, SES, sexual identity, and borough of residence were significant predictors of verbal SGV. Findings suggest that SGV experiences are not uniform in sexual minority young adults, and thus prevention and care must be targeted. Understanding the multiple identities of sexual minority young adults who experience greater levels of victimization can allow for policy and interventions to best support those at risk.

\u201cWe just get paid for 12 hours a day, but we work 24\u201d: home health aide restrictions and work related stress

BackgroundHome-bound patients in New York State requiring long-term care services have seen significant changes to their benefits due to turmoil in the Managed Long Term Care (MLTC) market. While there has been research conducted regarding the effect of MLTC challenges on beneficiaries, the impact of MLTC regulatory changes on home health aides has not been explored.MethodsQualitative interviews were conducted with formal caregivers, defined as paid home health aides (HHAs) (n = 13) caring for patients in a home-based primary care program in the New York City metropolitan area. HHAs were asked about their satisfaction with the home based primary care program, their own job satisfaction, and whether HHA restrictions affect their work in any way. Interviews were audio-recorded, transcribed, and analyzed.ResultsTwo main themes emerged: (1) Pay, benefits and hours worked and (2) Concerns about patient well-being afterhours. HHAs are working more hours than they are compensated for, experience wage stagnation and loss of benefits, and experience stress related to leaving frail clients alone after their shifts end.ConclusionsHHAs experience significant job-related stress when caring for frail elderly patients at home, which may have implications for both patient care and HHA turnover. As government bodies contemplate new policy directions for long-term care programs which rely on HHAs the impact of these changes on this vulnerable workforce must be considered.

HOME CARE NURSES CLAIM MEDICARE IGNORES SOCIAL DETERMINANTS OF HEALTH

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area. Results indicate nurses believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs.

HOME CARE SOCIAL WORKERS CLAIM MEDICARE IGNORES PATIENT NEEDS

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area. Results indicate social workers believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs. Policymakers are urged to consider adding coverage of SDOH to Medicare home health primarily through expanded social work coverage.

Home Care Nurses Claim Medicare Ignores Social Determinants of Health

There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes. In response, the Centers for Medicare and Medicaid Services (CMS) has expanded the ability of Medicare Advantage plans to cover SDOH-related services. Medicare home health does not cover SDOH-related services. A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 37 home care nurses between January 2013 and May 2014 in the New York City metropolitan area. Results indicate that nurses believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients’ mental health and substance abuse needs.

Exposure to air pollution is associated with adverse cardiopulmonary health effects in international travellers.

With the number of annual global travellers reaching 1.2 billion, many individuals encounter greater levels of air pollution when they travel abroad to megacities around the world. This study's objective was to determine if visits to cities abroad with greater levels of air pollution adversely impact cardiopulmonary health. A total of 34 non-smoking healthy adult participants who travelled abroad to selected cities from the New York City (NYC) metropolitan area were pre-trained to measure lung function, blood pressure and heart rate (HR)/HR variability (HRV) and record symptoms before, during and after travelling abroad. Outdoor particulate matter (PM)2.5 concentrations were obtained from central monitors in each city. Associations between PM exposure concentrations and cardiopulmonary health endpoints were analysed using a mixed effects statistical design. East and South Asian cities had significantly higher PM2.5 concentrations compared with pre-travel NYC PM2.5 levels, with maximum concentrations reaching 503μg/m3. PM exposure-related associations for lung function were statistically significant and strongest between evening Forced Expiratory Volume in the first second (FEV1) and same-day morning PM2.5 concentrations; a 10-μg/m3 increase in outdoor PM2.5 was associated with a mean decrease of 7mL. Travel to a highly polluted city (PM2.5 > 100μg/m3) was associated with a 209-ml reduction in evening FEV1 compared with a low polluted city (PM2.5 < 35μg/m3). In general, participants who travelled to East and South Asian cities experienced increased respiratory symptoms/scores and changes in HR and HRV. Exposure to increased levels of PM2.5 in cities abroad caused small but statistically significant acute changes in cardiopulmonary function and respiratory symptoms in healthy young adults. These data suggest that travel-related exposure to increased PM2.5 adversely impacts cardiopulmonary health, which may be particularly important for travellers with pre-existing respiratory or cardiac disease.