Publications
2023 |
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 | Stringfellow, Erin J; Lim, Tse Yang; DiGennaro, Catherine; Zhang, Ziyuan; Paramasivam, Pritika; Bearnot, Benjamin; Humphreys, Keith; Jalali, Mohammad S Long-term Effects of Increasing Buprenorphine Treatment-Seeking, Duration, and Capacity on Opioid Overdose Fatalities: a Model-based Analysis Journal Article Forthcoming Journal of Addiction Medicine, Forthcoming. @article{Stringfellow2023bb, title = {Long-term Effects of Increasing Buprenorphine Treatment-Seeking, Duration, and Capacity on Opioid Overdose Fatalities: a Model-based Analysis}, author = {Erin J. Stringfellow and Tse Yang Lim and Catherine DiGennaro and Ziyuan Zhang and Pritika Paramasivam and Benjamin Bearnot and Keith Humphreys and Mohammad S. Jalali}, year = {2023}, date = {2023-01-19}, journal = {Journal of Addiction Medicine}, keywords = {}, pubstate = {forthcoming}, tppubtype = {article} } |
 | Beaulieu, Elizabeth; Jalali, Mohammad S Strengthening a Weak Link: Transparency of Qualitative Modeling Tools Unpublished 2023. @unpublished{Beaulieu2023, title = {Strengthening a Weak Link: Transparency of Qualitative Modeling Tools}, author = {Elizabeth Beaulieu and Mohammad S. Jalali}, year = {2023}, date = {2023-01-07}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
| Claypool, Anneke; DiGennaro, Catherine; Russell, Alton W; Yildirim, Melike; Zhang, Alan; Reid, Zuri; Stringfellow, Erin; Bearnot, Benjamin; Schackman, Bruce; Humphreys, Keith; Jalali, Mohammad Cost-effectiveness of Increasing Buprenorphine Treatment Capacity, Initiation, and Duration Unpublished 2023. @unpublished{Claypool2023, title = {Cost-effectiveness of Increasing Buprenorphine Treatment Capacity, Initiation, and Duration}, author = {Anneke Claypool and Catherine DiGennaro and W. Alton Russell and Melike Yildirim and Alan Zhang and Zuri Reid and Erin Stringfellow and Benjamin Bearnot and Bruce Schackman and Keith Humphreys and Mohammad Jalali}, year = {2023}, date = {2023-01-06}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
| Stringfellow, Erin; Lim, Tse Yang; Dong, Huiru; Zhang, Ziyuan; Jalali, Mohammad S The Association Between Longitudinal Trends in Receipt of Buprenorphine for Opioid Use Disorder and Buprenorphine-Waivered Providers in the United States, 2003-2021 Unpublished 2023. @unpublished{Stringfellow2023b, title = {The Association Between Longitudinal Trends in Receipt of Buprenorphine for Opioid Use Disorder and Buprenorphine-Waivered Providers in the United States, 2003-2021}, author = {Erin Stringfellow and Tse Yang Lim and Huiru Dong and Ziyuan Zhang and Mohammad S. Jalali }, year = {2023}, date = {2023-01-04}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
| Stringfellow, Erin J; Lim, Tse Yang; DiGennaro, Catherine; Hasgül, Zeynep; Jalali, Mohammad S Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis Unpublished 2023. @unpublished{Stringfellow2023, title = {Enumerating contributions of fentanyls and other factors to the unprecedented 2020 rise in opioid overdose deaths: model-based analysis}, author = {Erin J. Stringfellow and Tse Yang Lim and Catherine DiGennaro and Zeynep Hasgül and Mohammad S Jalali}, year = {2023}, date = {2023-01-03}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
| Yildirim, Melike; Webb, Karen A; Ciaranello, Andrea L; Amick, Alyssa K; Mushavi, Angela; Chimwaza, Anesu; Claypool, Anneke; Murape, Tendayi; McCann, Nicole C; Flanagan, Clare; Jalali, Mohammad S Increasing the initiation of antiretroviral therapy through optimal placement of diagnostic technologies for pediatric HIV in Zimbabwe: a modeling analysis Unpublished 2023. @unpublished{Yildirim2023, title = {Increasing the initiation of antiretroviral therapy through optimal placement of diagnostic technologies for pediatric HIV in Zimbabwe: a modeling analysis}, author = {Melike Yildirim and Karen A. Webb and Andrea L. Ciaranello and Alyssa K. Amick and Angela Mushavi and Anesu Chimwaza and Anneke Claypool and Tendayi Murape and Nicole C. McCann and Clare Flanagan and Mohammad S. Jalali }, year = {2023}, date = {2023-01-03}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
| Deutsch, Arielle; Motabar, Nikki; Chang, Edward; Jalali, Mohammad S 2023. @unpublished{Deutsch2023b, title = {Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States}, author = {Arielle Deutsch and Nikki Motabar and Edward Chang and Mohammad S. Jalali}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4238181}, year = {2023}, date = {2023-01-02}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
| Deutsch, Arielle; Frerichs, Leah; Perry, Madeline; Jalali, Mohammad S 2023. @unpublished{Deutsch2023, title = {Making Systems Modeling for Syndemics Useful: Challenges and Recommendations for Balancing Qualitative Understanding and Quantitative Questions}, author = {Arielle Deutsch and Leah Frerichs and Madeline Perry and Mohammad S. Jalali}, url = {https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4238173}, year = {2023}, date = {2023-01-01}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
2022 |
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 | Dong, Huiru; Stringfellow, Erin J; Russell, Alton W; Bearnot, Benjamin; Jalali, Mohammad S Impact of Alternative Ways to Operationalize Buprenorphine Treatment Duration on Understanding Continuity of Care for Opioid Use Disorder Journal Article International Journal of Mental Health and Addiction, 2022. @article{Dong2022, title = {Impact of Alternative Ways to Operationalize Buprenorphine Treatment Duration on Understanding Continuity of Care for Opioid Use Disorder}, author = {Huiru Dong and Erin J Stringfellow and W Alton Russell and Benjamin Bearnot and Mohammad S Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Dong-2022.pdf}, doi = {10.1007/s11469-022-00985-w}, year = {2022}, date = {2022-12-10}, journal = {International Journal of Mental Health and Addiction}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Dong, Huiru; Stringfellow, Erin J; Russell, Alton W; Jalali, Mohammad S Racial and Ethnic Disparities in Buprenorphine Treatment Duration in the US Journal Article JAMA Psychiatry, 2022. @article{Dong2022b, title = {Racial and Ethnic Disparities in Buprenorphine Treatment Duration in the US}, author = {Huiru Dong and Erin J. Stringfellow and W. Alton Russell and Mohammad S. Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Dong-2022-jamapsychiatry.pdf}, doi = {10.1001/jamapsychiatry.2022.3673}, year = {2022}, date = {2022-11-10}, journal = {JAMA Psychiatry}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Stringfellow, Erin J; Lim, Tse Yang; Humphreys, Keith; DiGennaro, Catherine; Stafford, Celia; Beaulieu, Elizabeth; Homer, Jack; Wakeland, Wayne; Bearnot, Benjamin; McHugh, Kathryn R; Kelly, John; Glos, Lukas; Eggers, Sara; Kazemi, Reza; Jalali, Mohammad S Reducing Opioid Use Disorder and Overdose in the United States: A Dynamic Modeling Analysis Journal Article Science Advances, 8 (25), 2022. @article{Stringfellow2021, title = {Reducing Opioid Use Disorder and Overdose in the United States: A Dynamic Modeling Analysis}, author = {Erin J. Stringfellow and Tse Yang Lim and Keith Humphreys and Catherine DiGennaro and Celia Stafford and Elizabeth Beaulieu and Jack Homer and Wayne Wakeland and Benjamin Bearnot and R. Kathryn McHugh and John Kelly and Lukas Glos and Sara Eggers and Reza Kazemi and Mohammad S. Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Stringfellow_2022_SciAdv.pdf}, doi = {10.1126/sciadv.abm8147}, year = {2022}, date = {2022-06-24}, journal = {Science Advances}, volume = {8}, number = {25}, abstract = {Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers’ capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers’ capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives. |
 | Stafford, Celia; Marrero, Wesley; Naumann, Rebecca B; Lich, Kristen Hassmiller; Wakeman, Sarah; Jalali, Mohammad S Identifying Key Risk Factors for Premature Discontinuation of Opioid Use Disorder Treatment in the United States: a Predictive Modeling Study Journal Article Drug and Alcohol Dependence, 237 (1), pp. 109507, 2022. @article{669758, title = {Identifying Key Risk Factors for Premature Discontinuation of Opioid Use Disorder Treatment in the United States: a Predictive Modeling Study}, author = {Celia Stafford and Wesley Marrero and Rebecca B Naumann and Kristen Hassmiller Lich and Sarah Wakeman and Mohammad S Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Stafford_2022_DAD.pdf}, doi = {10.1016/j.drugalcdep.2022.109507}, year = {2022}, date = {2022-06-01}, journal = {Drug and Alcohol Dependence}, volume = {237}, number = {1}, pages = {109507}, abstract = {Background Treatment for opioid use disorder (OUD), particularly medication for OUD, is highly effective; however, retention in OUD treatment is a significant challenge. We aimed to identify key risk factors for premature exit from OUD treatment. Methods We analyzed 2,381,902 cross-sectional treatment episodes for individuals in the U.S., discharged between Jan/1/2015 and Dec/31/2019. We developed classification models (Random Forest, Classification and Regression Trees (CART), Bagged CART, and Boosted CART), and analyzed 31 potential risk factors for premature treatment exit, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. We stratified our analysis based on length of stay in treatment and service setting. Models were compared using cross-validation and the receiver operating characteristic area under the curve (ROC-AUC). Results Random Forest outperformed other methods (ROC-AUC: 74%). The most influential risk factors included characteristics of service setting, geographic region, primary source of payment, and referral source. Race, ethnicity, and sex had far weaker predictive impacts. When stratified by treatment setting and length of stay, employment status and delay (days waited) to enter treatment were among the most influential factors. Their importance increased as treatment duration decreased. Notably, importance of referral source increased as the treatment duration increased. Finally, age and age of first use were important factors for lengths of stay of 2–7 days and in detox treatment settings. Conclusions The key factors of OUD treatment attrition identified in this analysis should be more closely explored (e.g., in causal studies) to inform targeted policies and interventions to improve models of care.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Treatment for opioid use disorder (OUD), particularly medication for OUD, is highly effective; however, retention in OUD treatment is a significant challenge. We aimed to identify key risk factors for premature exit from OUD treatment. Methods We analyzed 2,381,902 cross-sectional treatment episodes for individuals in the U.S., discharged between Jan/1/2015 and Dec/31/2019. We developed classification models (Random Forest, Classification and Regression Trees (CART), Bagged CART, and Boosted CART), and analyzed 31 potential risk factors for premature treatment exit, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. We stratified our analysis based on length of stay in treatment and service setting. Models were compared using cross-validation and the receiver operating characteristic area under the curve (ROC-AUC). Results Random Forest outperformed other methods (ROC-AUC: 74%). The most influential risk factors included characteristics of service setting, geographic region, primary source of payment, and referral source. Race, ethnicity, and sex had far weaker predictive impacts. When stratified by treatment setting and length of stay, employment status and delay (days waited) to enter treatment were among the most influential factors. Their importance increased as treatment duration decreased. Notably, importance of referral source increased as the treatment duration increased. Finally, age and age of first use were important factors for lengths of stay of 2–7 days and in detox treatment settings. Conclusions The key factors of OUD treatment attrition identified in this analysis should be more closely explored (e.g., in causal studies) to inform targeted policies and interventions to improve models of care. |
 | Lim, Tse Yang; Stringfellow, Erin J; Stafford, Celia A; DiGennaro, Catherine; Homer, Jack B; Wakeland, Wayne; Eggers, Sara L; Kazemi, Reza; Glos, Lukas; Ewing, Emily G; Bannister, Calvin B; Humphreys, Keith; Throckmorton, Douglas C; Jalali, Mohammad S Modeling the Evolution of the U.S. Opioid Crisis for National Policy Development Journal Article PNAS, 119 (23), 2022. @article{Lim2021, title = {Modeling the Evolution of the U.S. Opioid Crisis for National Policy Development}, author = {Tse Yang Lim and Erin J. Stringfellow and Celia A. Stafford and Catherine DiGennaro and Jack B. Homer and Wayne Wakeland and Sara L. Eggers and Reza Kazemi and Lukas Glos and Emily G. Ewing and Calvin B. Bannister and Keith Humphreys and Douglas C. Throckmorton and Mohammad S Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Lim_2022_PNAS.pdf}, doi = {10.1073/pnas.211571411}, year = {2022}, date = {2022-05-31}, journal = {PNAS}, volume = {119}, number = {23}, abstract = {The opioid crisis is a major public health challenge in the United States, killing about 70,000 people in 2020 alone. Long delays and feedbacks between policy actions and their effects on drug-use behavior create dynamic complexity, complicating policy decision-making. In 2017, the National Academies of Sciences, Engineering, and Medicine called for a quantitative systems model to help understand and address this complexity and guide policy decisions. Here, we present SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), a dynamic simulation model developed in response to that charge. SOURCE tracks the US population aged ≥12 y through the stages of prescription and illicit opioid (e.g., heroin, illicit fentanyl) misuse and use disorder, addiction treatment, remission, and overdose death. Using data spanning from 1999 to 2020, we highlight how risks of drug use initiation and overdose have evolved in response to essential endogenous feedback mechanisms, including: 1) social influence on drug use initiation and escalation among people who use opioids; 2) risk perception and response based on overdose mortality, influencing potential new initiates; and 3) capacity limits on treatment engagement; as well as other drivers, such as 4) supply-side changes in prescription opioid and heroin availability; and 5) the competing influences of illicit fentanyl and overdose death prevention efforts. Our estimates yield a more nuanced understanding of the historical trajectory of the crisis, providing a basis for projecting future scenarios and informing policy planning.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The opioid crisis is a major public health challenge in the United States, killing about 70,000 people in 2020 alone. Long delays and feedbacks between policy actions and their effects on drug-use behavior create dynamic complexity, complicating policy decision-making. In 2017, the National Academies of Sciences, Engineering, and Medicine called for a quantitative systems model to help understand and address this complexity and guide policy decisions. Here, we present SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), a dynamic simulation model developed in response to that charge. SOURCE tracks the US population aged ≥12 y through the stages of prescription and illicit opioid (e.g., heroin, illicit fentanyl) misuse and use disorder, addiction treatment, remission, and overdose death. Using data spanning from 1999 to 2020, we highlight how risks of drug use initiation and overdose have evolved in response to essential endogenous feedback mechanisms, including: 1) social influence on drug use initiation and escalation among people who use opioids; 2) risk perception and response based on overdose mortality, influencing potential new initiates; and 3) capacity limits on treatment engagement; as well as other drivers, such as 4) supply-side changes in prescription opioid and heroin availability; and 5) the competing influences of illicit fentanyl and overdose death prevention efforts. Our estimates yield a more nuanced understanding of the historical trajectory of the crisis, providing a basis for projecting future scenarios and informing policy planning. |
 | Garcia, Gian-Gabriel P; Dehghanpoor, Ramin; Stringfellow, Erin J; Gupta, Marichi; Rochelle, Jillian; Mason, Elizabeth; Pujol, Toyya A; Jalali, Mohammad S Identifying and Characterizing Medical Advice-Seekers on a Social Media Forum for Buprenorphine Use Journal Article Int. J. Environ. Res. Public Health, 19 (10), pp. 6281, 2022. @article{674513, title = {Identifying and Characterizing Medical Advice-Seekers on a Social Media Forum for Buprenorphine Use}, author = {Gian-Gabriel P Garcia and Ramin Dehghanpoor and Erin J Stringfellow and Marichi Gupta and Jillian Rochelle and Elizabeth Mason and Toyya A Pujol and Mohammad S Jalali}, url = {https://www.mdpi.com/1660-4601/19/10/6281/htm}, year = {2022}, date = {2022-05-22}, journal = {Int. J. Environ. Res. Public Health}, volume = {19}, number = {10}, pages = {6281}, abstract = {Background: Online communities such as Reddit can provide social support for those recovering from opioid use disorder. However, it is unclear whether and how advice-seekers differ from other users. Our research addresses this gap by identifying key characteristics of r/suboxone users that predict advice-seeking behavior. Objective: The objective of this analysis is to identify and describe advice-seekers on Reddit for buprenorphine-naloxone use using text annotation, social network analysis, and statistical modeling techniques. Methods: We collected 5258 posts and their comments from Reddit between 2014 and 2019. Among 202 posts which met our inclusion criteria, we annotated each post to determine which were advice-seeking (n = 137) or not advice-seeking (n = 65). We also annotated each posting user’s buprenorphine-naloxone use status (current versus formerly taking and, if currently taking, whether inducting or tapering versus other stages) and quantified their connectedness using social network analysis. To analyze the relationship between Reddit users’ advice-seeking and their social connectivity and medication use status, we constructed four models which varied in their inclusion of explanatory variables for social connectedness and buprenorphine use status. Results: The stepwise model containing “total degree” (p = 0.002), “using: inducting/tapering” (p < 0.001), and “using: other” (p = 0.01) outperformed all other models. Reddit users with fewer connections and who are currently using buprenorphine-naloxone are more likely to seek advice than those who are well-connected and no longer using the medication, respectively. Importantly, advice-seeking behavior is most accurately predicted using a combination of network characteristics and medication use status, rather than either factor alone. Conclusions: Our findings provide insights for the clinical care of people recovering from opioid use disorder and the nature of online medical advice-seeking overall. Clinicians should be especially attentive (e.g., through frequent follow-up) to patients who are inducting or tapering buprenorphine-naloxone or signal limited social support.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Online communities such as Reddit can provide social support for those recovering from opioid use disorder. However, it is unclear whether and how advice-seekers differ from other users. Our research addresses this gap by identifying key characteristics of r/suboxone users that predict advice-seeking behavior. Objective: The objective of this analysis is to identify and describe advice-seekers on Reddit for buprenorphine-naloxone use using text annotation, social network analysis, and statistical modeling techniques. Methods: We collected 5258 posts and their comments from Reddit between 2014 and 2019. Among 202 posts which met our inclusion criteria, we annotated each post to determine which were advice-seeking (n = 137) or not advice-seeking (n = 65). We also annotated each posting user’s buprenorphine-naloxone use status (current versus formerly taking and, if currently taking, whether inducting or tapering versus other stages) and quantified their connectedness using social network analysis. To analyze the relationship between Reddit users’ advice-seeking and their social connectivity and medication use status, we constructed four models which varied in their inclusion of explanatory variables for social connectedness and buprenorphine use status. Results: The stepwise model containing “total degree” (p = 0.002), “using: inducting/tapering” (p < 0.001), and “using: other” (p = 0.01) outperformed all other models. Reddit users with fewer connections and who are currently using buprenorphine-naloxone are more likely to seek advice than those who are well-connected and no longer using the medication, respectively. Importantly, advice-seeking behavior is most accurately predicted using a combination of network characteristics and medication use status, rather than either factor alone. Conclusions: Our findings provide insights for the clinical care of people recovering from opioid use disorder and the nature of online medical advice-seeking overall. Clinicians should be especially attentive (e.g., through frequent follow-up) to patients who are inducting or tapering buprenorphine-naloxone or signal limited social support. |
 | Deutsch, Arielle R; Jalali, Mohammad S; Stout, Sarah; Frerichs, Leah Equitable Policies Need Equitable Practices: Alcohol-and Substance-Exposed Pregnancy as a Case Study Journal Article Health Promotion Practice, 2022. @article{Deutsch2022, title = {Equitable Policies Need Equitable Practices: Alcohol-and Substance-Exposed Pregnancy as a Case Study}, author = {Arielle R Deutsch and Mohammad S Jalali and Sarah Stout and Leah Frerichs}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Deutsch_2022_HPP.pdf}, doi = {10.1177/15248399221107605}, year = {2022}, date = {2022-05-11}, journal = {Health Promotion Practice}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Liao, Che-Yi; Garcia, Gian-Gabriel P; DiGennaro, Catherine; Jalali, Mohammad S Racial Disparities in Opioid Overdose Deaths in Massachusetts Journal Article JAMA Network Open, 2022. @article{Liao2022, title = {Racial Disparities in Opioid Overdose Deaths in Massachusetts}, author = {Che-Yi Liao and Gian-Gabriel P. Garcia and Catherine DiGennaro and Mohammad S. Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Liao_2022_JAMA_no.pdf}, doi = {10.1001/jamanetworkopen.2022.9081}, year = {2022}, date = {2022-05-01}, journal = {JAMA Network Open}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Weiner, Scott G; Carroll, Aleta D; Brisbon, Nicholas M; Rodriguez, Claudia P; Covahey, Charles; Stringfellow, Erin J; DiGennaro, Catherine; Jalali, Mohammad S; Wakeman, Sarah E Evaluating disparities in prescribing of naloxone after emergency department treatment of opioid overdose Journal Article Journal of Substance Abuse Treatment, 139 , pp. 108785, 2022. @article{Weiner2022, title = {Evaluating disparities in prescribing of naloxone after emergency department treatment of opioid overdose}, author = {Scott G Weiner and Aleta D Carroll and Nicholas M Brisbon and Claudia P Rodriguez and Charles Covahey and Erin J Stringfellow and Catherine DiGennaro and Mohammad S Jalali and Sarah E Wakeman}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Weiner_2022_JSAT.pdf}, doi = {10.1016/j.jsat.2022.108785}, year = {2022}, date = {2022-04-22}, journal = {Journal of Substance Abuse Treatment}, volume = {139}, pages = {108785}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Beaulieu, Elizabeth; Spanjaart, Anne; Roes, Ashley; Rachet, Bernard; Dalle, Stéphane; Kersten, Marie José; Maucort-Boulch, Delphine; Jalali, Mohammad S Health-Related Quality of Life in Cancer Immunotherapy: A Systematic Perspective, Using Causal Loop Diagrams Journal Article Quality of Life Research, 31 , pp. 2357-2366, 2022. @article{Beaulieu2022, title = {Health-Related Quality of Life in Cancer Immunotherapy: A Systematic Perspective, Using Causal Loop Diagrams}, author = {Elizabeth Beaulieu and Anne Spanjaart and Ashley Roes and Bernard Rachet and Stéphane Dalle and Marie José Kersten and Delphine Maucort-Boulch and Mohammad S. Jalali}, doi = {10.1007/s11136-022-03110-5}, year = {2022}, date = {2022-03-19}, journal = {Quality of Life Research}, volume = {31}, pages = {2357-2366}, abstract = {Purpose: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the HRQoL of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for quality of life (HRQoL) of cancer immunotherapy patients. Methods: We first apply a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively review and enhance the CLD through interviews with subject-matter experts. Results: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL. Conclusion: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Purpose: System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the HRQoL of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for quality of life (HRQoL) of cancer immunotherapy patients. Methods: We first apply a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively review and enhance the CLD through interviews with subject-matter experts. Results: Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients’ HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams’ perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients’ HRQoL. Conclusion: The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains. |
 | DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad; Toumi, Asmae; Watson, Tina; Gazelle, Scott G; Mercaldo, Nathaniel; Lubitz, Carrie C Thyroid, 32 (10), 2022. @article{DiGennaro2022, title = {Assessing Bias and Limitations of Clinical Validation Studies of Molecular Diagnostic Tests for Indeterminate Thyroid Nodules: Systematic Review and Meta-Analysis}, author = {Catherine DiGennaro and Vahab Vahdat and Mohammad Jalali and Asmae Toumi and Tina Watson and G Scott Gazelle and Nathaniel Mercaldo and Carrie C Lubitz}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Digennaro_2022_Thyroid.pdf}, doi = {10.1089/thy.2022.0269}, year = {2022}, date = {2022-03-18}, journal = {Thyroid}, volume = {32}, number = {10}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Horvat, Andrijana ; Luning, Pieternel A; DiGennaro, Catherine ; Rommens, Edien ; van Daalen, Els ; Koene, Miriam ; Jalali, Mohammad S Food Control, 114 , 2022. @article{Horvat2022, title = {The impacts of biosecurity measures on Campylobacter contamination in broiler houses and slaughterhouses in the Netherlands: A simulation modelling approach}, author = {Horvat, Andrijana and Luning, Pieternel A and DiGennaro, Catherine and Rommens, Edien and van Daalen, Els and Koene, Miriam and Jalali, Mohammad S.}, url = {https://mj-lab.mgh.harvard.edu/campydynamics/}, year = {2022}, date = {2022-03-01}, journal = {Food Control}, volume = {114}, abstract = {Intestinal campylobacteriosis, caused by Campylobacter ingestion, is the most reported zoonosis in the EU; it is societally costly and can lead to more severe sequelae. To reduce Campylobacter infections, biosecurity measures at both farms and slaughterhouses are warranted. However, the potential improvements achieved by these interventions have not been quantified. We used a systems science approach to develop a simulation model, synthesizing information from interviews with stakeholders in the Dutch broiler production industry and the current literature. The model includes both farms and slaughterhouses in a “system of systems,” helping to clarify the complexity of interrelated components of these systems and analyse the impact of various interventions. Insects, transportation crates, farm personnel, and catchers were identified as potential Campylobacter sources and modelled as elements of feedback loops. Insect control, farm hygiene, visitor control, thinning, and transportation control interventions were analysed. The model was shown to accurately describe the seasonality of Campylobacter, which supports its validity. Model simulation revealed that insect control interventions had the strongest impacts, followed by combined farm hygiene and visitor control, and combined thinning and transportation control. Insect control interventions alone reduced the peak percentage of contaminated chickens from 51% to 26% and the peak percentage of highly contaminated (>1000 CFU/g) neck samples of chicken carcasses from 13% to 8%. Implementing all interventions concurrently reduced the peak percentages of contaminated chickens to 5% and highly contaminated chicken neck samples to 2%. These results suggest that multiple biosecurity measures must be implemented to reduce Campylobacter contamination. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Intestinal campylobacteriosis, caused by Campylobacter ingestion, is the most reported zoonosis in the EU; it is societally costly and can lead to more severe sequelae. To reduce Campylobacter infections, biosecurity measures at both farms and slaughterhouses are warranted. However, the potential improvements achieved by these interventions have not been quantified. We used a systems science approach to develop a simulation model, synthesizing information from interviews with stakeholders in the Dutch broiler production industry and the current literature. The model includes both farms and slaughterhouses in a “system of systems,” helping to clarify the complexity of interrelated components of these systems and analyse the impact of various interventions. Insects, transportation crates, farm personnel, and catchers were identified as potential Campylobacter sources and modelled as elements of feedback loops. Insect control, farm hygiene, visitor control, thinning, and transportation control interventions were analysed. The model was shown to accurately describe the seasonality of Campylobacter, which supports its validity. Model simulation revealed that insect control interventions had the strongest impacts, followed by combined farm hygiene and visitor control, and combined thinning and transportation control. Insect control interventions alone reduced the peak percentage of contaminated chickens from 51% to 26% and the peak percentage of highly contaminated (>1000 CFU/g) neck samples of chicken carcasses from 13% to 8%. Implementing all interventions concurrently reduced the peak percentages of contaminated chickens to 5% and highly contaminated chicken neck samples to 2%. These results suggest that multiple biosecurity measures must be implemented to reduce Campylobacter contamination. |
 | Beaulieu, Elizabeth; Naumann, Rebecca B; Deveaux, Genevieve; Wang, Lindsay; Stringfellow, Erin; Lich, Kristen Hassmiller; Jalali, Mohammad S Alcohol and Opioid Use Impacts on Road Safety-related Outcomes: Systematic Review Journal Article Accident Analysis & Prevention, 173 , pp. 106713, 2022. @article{666820, title = {Alcohol and Opioid Use Impacts on Road Safety-related Outcomes: Systematic Review}, author = {Elizabeth Beaulieu and Rebecca B Naumann and Genevieve Deveaux and Lindsay Wang and Erin Stringfellow and Kristen Hassmiller Lich and Mohammad S Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Beaulieu_2022_AAP.pdf}, doi = {10.1016/j.aap.2022.106713}, year = {2022}, date = {2022-01-02}, journal = {Accident Analysis & Prevention}, volume = {173}, pages = {106713}, abstract = {Connections between substance use, impairment, and road safety have been frequently researched. Yet, little is known about how simultaneous use of opioids and alcohol affects road safety outcomes, which is an increasingly critical link within the current landscape of the substance use environment and public health. Lack of this understanding is partly due to testing complications and data limitations. We define polysubstance use here as alcohol and opioids consumed together or within a small-time window such that both are present in the system. This polysubstance use is on the rise and produces greater health risks than when the substances are consumed separately. Given the increasing rate of opioid use, high prevalence of alcohol use, and dangers of polysubstance use, we aim to synthesize literature on the prevalence and impact of this polysubstance on road safety-related outcomes. We performed a systematic review of studies published between 1974 and 2020 that examined opioid and alcohol use exposures and road safety-related outcomes. Out of 644 initial findings, 20 studies were included in this review. Outcomes included motor vehicle crash injuries, deaths, or driver culpability; suspected driving under the influence; and simulated driving performance. Evidence from multiple sources showed a significant rise, approximately 1% to 7%, in the prevalence of opioids among fatally injured drivers in the U.S. from 1995 to 2016. Information published on the simultaneous presence of opioids and alcohol in people involved in crashes was scarce. The limited available findings point toward an overlap where up to 30% of opioid-positive people involved in a crash were also positive for alcohol. Studies also suggest a possibly elevated risk presented by this polysubstance use relative to the substances used alone, though the majority of identified studies did not estimate this association. The synthesized research indicates that alcohol and opioid use is not uncommon and may be increasing among people involved in adverse driving events. More research and better data are needed to improve estimates of association with road traffic-related outcomes, potentially improving substance testing in current surveillance systems or using linked data sets and other novel data sources to improve estimates.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Connections between substance use, impairment, and road safety have been frequently researched. Yet, little is known about how simultaneous use of opioids and alcohol affects road safety outcomes, which is an increasingly critical link within the current landscape of the substance use environment and public health. Lack of this understanding is partly due to testing complications and data limitations. We define polysubstance use here as alcohol and opioids consumed together or within a small-time window such that both are present in the system. This polysubstance use is on the rise and produces greater health risks than when the substances are consumed separately. Given the increasing rate of opioid use, high prevalence of alcohol use, and dangers of polysubstance use, we aim to synthesize literature on the prevalence and impact of this polysubstance on road safety-related outcomes. We performed a systematic review of studies published between 1974 and 2020 that examined opioid and alcohol use exposures and road safety-related outcomes. Out of 644 initial findings, 20 studies were included in this review. Outcomes included motor vehicle crash injuries, deaths, or driver culpability; suspected driving under the influence; and simulated driving performance. Evidence from multiple sources showed a significant rise, approximately 1% to 7%, in the prevalence of opioids among fatally injured drivers in the U.S. from 1995 to 2016. Information published on the simultaneous presence of opioids and alcohol in people involved in crashes was scarce. The limited available findings point toward an overlap where up to 30% of opioid-positive people involved in a crash were also positive for alcohol. Studies also suggest a possibly elevated risk presented by this polysubstance use relative to the substances used alone, though the majority of identified studies did not estimate this association. The synthesized research indicates that alcohol and opioid use is not uncommon and may be increasing among people involved in adverse driving events. More research and better data are needed to improve estimates of association with road traffic-related outcomes, potentially improving substance testing in current surveillance systems or using linked data sets and other novel data sources to improve estimates. |
| Social Vulnerability Increases Drug Poisoning Mortality in the United States: 2014-2018 Unpublished 2022. @unpublished{669757, title = {Social Vulnerability Increases Drug Poisoning Mortality in the United States: 2014-2018}, year = {2022}, date = {2022-01-01}, keywords = {}, pubstate = {published}, tppubtype = {unpublished} } |
 | Li, Peiyi; Luo, Yunmei; Yu, Xuexin; Zeng, Zhi; Wen, Jin; Mason, Elizabeth; Li, Weimin; Jalali, Mohammad S Readiness of healthcare providers for e-hospitals: a cross-sectional analysis in China before the COVID-19 period Journal Article BMJ Open, 12 , pp. e054169, 2022. @article{650797, title = {Readiness of healthcare providers for e-hospitals: a cross-sectional analysis in China before the COVID-19 period}, author = {Peiyi Li and Yunmei Luo and Xuexin Yu and Zhi Zeng and Jin Wen and Elizabeth Mason and Weimin Li and Mohammad S Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Li_2022_BMJOpen.pdf}, doi = {10.1136/bmjopen-2021-054169}, year = {2022}, date = {2022-01-01}, journal = {BMJ Open}, volume = {12}, pages = {e054169}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Garcia, Gian-Gabriel P; Stringfellow, Erin J; DiGennaro, Catherine; Poellinger, Nicole; Wood, Jaden; Wakeman, Sarah; Jalali, Mohammad S Opioid Overdose Decedent Characteristics during COVID-19 Journal Article 2022. @article{Garcia2021, title = {Opioid Overdose Decedent Characteristics during COVID-19}, author = {Gian-Gabriel P. Garcia and Erin J. Stringfellow and Catherine DiGennaro and Nicole Poellinger and Jaden Wood and Sarah Wakeman and Mohammad S. Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2022/12/Garcia_2022_AOM.pdf}, doi = {10.1080/07853890.2022.2067350}, year = {2022}, date = {2022-01-01}, abstract = {Introduction: Alongside the emergence of COVID-19 in the United States, several reports highlighted increasing rates of opioid overdose from preliminary data. Yet, little is known about how state-level opioid overdose death trends and decedent characteristics have evolved using official death records. Methods: We requested vital statistics data from 2018-2020 from all 50 states and the District of Columbia, receiving data from 14 states. Accounting for COVID-19, we excluded states without data past March 2020, leaving 11 states for analysis. We defined state-specific analysis periods from March 13 until the latest reliable date in each state's data, then conducted retrospective year-over-year analyses comparing opioid-related overdose death rates, the presence of specific opioids and other psychoactive substances, and decedents' sex, race, and age from 2020 to 2019 and 2019 to 2018 within each state's analysis period. We assessed whether significant changes in 2020 vs. 2019 in opioid overdose deaths were new or continuing trends using joinpoint regression. Results: We found significant increases in opioid-related overdose death rates in Alaska (55.3%), Colorado (80.2%), Indiana (40.1%), Nevada (50.0%), North Carolina (30.5%), Rhode Island (29.6%), and Virginia (66.4%) - all continuing previous trends. Increases in synthetic opioid-involved overdose deaths were new in Alaska (136.5%), Indiana (27.6%), and Virginia (16.5%), whilst continuing in Colorado (44.4%), Connecticut (3.6%), Nevada (75.0%), and North Carolina (14.6%). We found new increases in male decedents in Indiana (12.0%), and continuing increases in Colorado (15.2%). We also found continuing increases in Black non-Hispanic decedents in Massachusetts (43.9%) and Virginia (33.7%). Conclusion: This research analyzes vital statistics data from 11 states, highlighting new trends in opioid overdose deaths and decedent characteristics across 10 of these states. These findings can inform state-specific public health interventions and highlight the need for timely and comprehensive fatal opioid overdose data, especially amidst concurrent crises such as COVID-19. Key messages:Our results highlight shifts in opioid overdose trends during the COVID-19 pandemic that cannot otherwise be extracted from aggregated or provisional opioid overdose death data such as those published by the Centres for Disease Control and Prevention.Fentanyl and other synthetic opioids continue to drive increases in fatal overdoses, making it difficult to separate these trends from any possible COVID-19-related factors.Black non-Hispanic people are making up an increasing proportion of opioid overdose deaths in some states.State-specific limitations and variations in data-reporting for vital statistics make it challenging to acquire and analyse up-to-date data on opioid-related overdose deaths. More timely and comprehensive data are needed to generate broader insights on the nature of the intersecting opioid and COVID-19 crises.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction: Alongside the emergence of COVID-19 in the United States, several reports highlighted increasing rates of opioid overdose from preliminary data. Yet, little is known about how state-level opioid overdose death trends and decedent characteristics have evolved using official death records. Methods: We requested vital statistics data from 2018-2020 from all 50 states and the District of Columbia, receiving data from 14 states. Accounting for COVID-19, we excluded states without data past March 2020, leaving 11 states for analysis. We defined state-specific analysis periods from March 13 until the latest reliable date in each state's data, then conducted retrospective year-over-year analyses comparing opioid-related overdose death rates, the presence of specific opioids and other psychoactive substances, and decedents' sex, race, and age from 2020 to 2019 and 2019 to 2018 within each state's analysis period. We assessed whether significant changes in 2020 vs. 2019 in opioid overdose deaths were new or continuing trends using joinpoint regression. Results: We found significant increases in opioid-related overdose death rates in Alaska (55.3%), Colorado (80.2%), Indiana (40.1%), Nevada (50.0%), North Carolina (30.5%), Rhode Island (29.6%), and Virginia (66.4%) - all continuing previous trends. Increases in synthetic opioid-involved overdose deaths were new in Alaska (136.5%), Indiana (27.6%), and Virginia (16.5%), whilst continuing in Colorado (44.4%), Connecticut (3.6%), Nevada (75.0%), and North Carolina (14.6%). We found new increases in male decedents in Indiana (12.0%), and continuing increases in Colorado (15.2%). We also found continuing increases in Black non-Hispanic decedents in Massachusetts (43.9%) and Virginia (33.7%). Conclusion: This research analyzes vital statistics data from 11 states, highlighting new trends in opioid overdose deaths and decedent characteristics across 10 of these states. These findings can inform state-specific public health interventions and highlight the need for timely and comprehensive fatal opioid overdose data, especially amidst concurrent crises such as COVID-19. Key messages:Our results highlight shifts in opioid overdose trends during the COVID-19 pandemic that cannot otherwise be extracted from aggregated or provisional opioid overdose death data such as those published by the Centres for Disease Control and Prevention.Fentanyl and other synthetic opioids continue to drive increases in fatal overdoses, making it difficult to separate these trends from any possible COVID-19-related factors.Black non-Hispanic people are making up an increasing proportion of opioid overdose deaths in some states.State-specific limitations and variations in data-reporting for vital statistics make it challenging to acquire and analyse up-to-date data on opioid-related overdose deaths. More timely and comprehensive data are needed to generate broader insights on the nature of the intersecting opioid and COVID-19 crises. |
2021 |
|
 | Decouttere, Catherine; Banzimana, Stany; r a, P; Riet, Carla Van; Vandermeulen, Corinne; Mason, Elizabeth; Jalali, Mohammed S; Vandaele, Nico Insights into vaccine hesitancy from systems thinking, Rwanda Journal Article 2021. @article{668159, title = {Insights into vaccine hesitancy from systems thinking, Rwanda}, author = {Catherine Decouttere and Stany Banzimana and P r a and Carla Van Riet and Corinne Vandermeulen and Elizabeth Mason and Mohammed S Jalali and Nico Vandaele}, year = {2021}, date = {2021-08-03}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Leerapan, Borwornsom; Kaewkamjornchai, Phanuwich S; Atun, Rifat A; Jalali, Mohammad S How Systems Respond to Policies: Unintended Consequences of COVID-19 Lockdown Policies in Thailand Journal Article 2021. @article{669755, title = {How Systems Respond to Policies: Unintended Consequences of COVID-19 Lockdown Policies in Thailand}, author = {Borwornsom Leerapan and Phanuwich S Kaewkamjornchai and Rifat A Atun and Mohammad S Jalali}, year = {2021}, date = {2021-08-02}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Cerdá, M; Jalali, MS; Hamilton, A; Digennaro, C; Hyder, A; Santaella-Tenorio, J; Kaur, N; Wang, C; Keyes, KM A Systematic Review of Simulation Models to Track and Address the Opioid Crisis Journal Article 2021. @article{666785, title = {A Systematic Review of Simulation Models to Track and Address the Opioid Crisis}, author = {M Cerdá and MS Jalali and A Hamilton and C Digennaro and A Hyder and J Santaella-Tenorio and N Kaur and C Wang and KM Keyes}, year = {2021}, date = {2021-07-30}, abstract = {The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models offer a tool to help us understand and address this complex, dynamic, nonlinear, social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings. Further, we created a database of model parameters used for model calibration, and evaluated study transparency and reproducibility. Of the 1,381 articles screened, we identified 72 eligible articles. The most frequent types of models were Markov (26%), compartmental (25%), system dynamics (19%), and Agent-Based models (18%). Almost half (46%) evaluated intervention cost-effectiveness, while 29% of studies focused on treatment and harm reduction services for people with opioid use disorder (OUD). More than half (57%) calibrated their models to empirical data, and 31% discussed validation approaches used in their modeling process. From the 51 studies that provided data on model parameters, we mapped out the data sources for parameters on opioid use, OUD, OUD treatment, cessation/relapse, emergency medical services, and mortality. This database offers a tool that future modelers can use to identify model inputs, and to evaluate comparability of their models to prior work. Future applications of simulation models to this field should actively tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models offer a tool to help us understand and address this complex, dynamic, nonlinear, social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings. Further, we created a database of model parameters used for model calibration, and evaluated study transparency and reproducibility. Of the 1,381 articles screened, we identified 72 eligible articles. The most frequent types of models were Markov (26%), compartmental (25%), system dynamics (19%), and Agent-Based models (18%). Almost half (46%) evaluated intervention cost-effectiveness, while 29% of studies focused on treatment and harm reduction services for people with opioid use disorder (OUD). More than half (57%) calibrated their models to empirical data, and 31% discussed validation approaches used in their modeling process. From the 51 studies that provided data on model parameters, we mapped out the data sources for parameters on opioid use, OUD, OUD treatment, cessation/relapse, emergency medical services, and mortality. This database offers a tool that future modelers can use to identify model inputs, and to evaluate comparability of their models to prior work. Future applications of simulation models to this field should actively tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility. |
| Jalali, Mohammad S; DiGennaro, Catherine; Guitar, Abby; Lew, Karen; Rahmandad, Hazhir Evolution and Reproducibility of Simulation Modeling in Epidemiology and Health Policy over Half a Century Journal Article Epidemiologic Reviews, 2021. @article{643800, title = {Evolution and Reproducibility of Simulation Modeling in Epidemiology and Health Policy over Half a Century}, author = {Mohammad S Jalali and Catherine DiGennaro and Abby Guitar and Karen Lew and Hazhir Rahmandad}, url = {https://scholar.harvard.edu/files/jalali/files/simulation_modeling_in_health_policy.pdf}, year = {2021}, date = {2021-07-29}, journal = {Epidemiologic Reviews}, abstract = {Background: Simulation models are increasingly used to inform health policy. We provide an overview of applications of simulation models in health policy, analyze the use of best reporting practices, and assess the reproducibility of existing studies. Method: Studies that used simulation modeling as the core method to address any health policy questions were included. Health policy domain distribution and changes in quality over time were well-characterized using MeSH terms and model characteristics, respectively. Reproducibility was assessed using predefined, categorical criteria. Findings: 1,613 studies were analyzed. We found an exponential growth in the number of studies over the past half century, with the highest growth in dynamic modeling approaches. The largest subset of studies is focused on disease policy models (70%), within which pathological conditions, viral diseases, neoplasms, and cardiovascular diseases account for one-third of the articles. Nearly half of the studies do not report the details of their models. A subset of 100 articles (50 highly cited and 50 random) were selected to analyze in-depth criteria for reporting quality and reproducibility. Significant gaps between best modeling practices could be found in both the random and highly cited samples; only seven of 26 in-depth evaluation criteria were satisfied by more than 80% of samples. We found no evidence that the highly cited samples adhered better to the modeling best practices. Interpretation: Our results suggest crucial areas for increased applications of simulation modeling, and opportunities to enhance the rigor and documentation in the conduct and reporting of simulation modeling in health policy.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Simulation models are increasingly used to inform health policy. We provide an overview of applications of simulation models in health policy, analyze the use of best reporting practices, and assess the reproducibility of existing studies. Method: Studies that used simulation modeling as the core method to address any health policy questions were included. Health policy domain distribution and changes in quality over time were well-characterized using MeSH terms and model characteristics, respectively. Reproducibility was assessed using predefined, categorical criteria. Findings: 1,613 studies were analyzed. We found an exponential growth in the number of studies over the past half century, with the highest growth in dynamic modeling approaches. The largest subset of studies is focused on disease policy models (70%), within which pathological conditions, viral diseases, neoplasms, and cardiovascular diseases account for one-third of the articles. Nearly half of the studies do not report the details of their models. A subset of 100 articles (50 highly cited and 50 random) were selected to analyze in-depth criteria for reporting quality and reproducibility. Significant gaps between best modeling practices could be found in both the random and highly cited samples; only seven of 26 in-depth evaluation criteria were satisfied by more than 80% of samples. We found no evidence that the highly cited samples adhered better to the modeling best practices. Interpretation: Our results suggest crucial areas for increased applications of simulation modeling, and opportunities to enhance the rigor and documentation in the conduct and reporting of simulation modeling in health policy. |
 | Xu, Ran; Rahmandad, Hazhir; Gupta, Marichi; DiGennaro, Catherine; Ghaffarzadegan, Navid; Jalali, Mohammad S Weather, air pollution, and SARS-CoV-2 transmission: a global analysis Journal Article Lancet Planetary Health, 2021. @article{651235, title = {Weather, air pollution, and SARS-CoV-2 transmission: a global analysis}, author = {Ran Xu and Hazhir Rahmandad and Marichi Gupta and Catherine DiGennaro and Navid Ghaffarzadegan and Mohammad S Jalali}, year = {2021}, date = {2021-07-29}, journal = {Lancet Planetary Health}, abstract = {Background: Understanding and projecting the spread of COVID-19 requires reliable estimates of how weather components are associated with the transmission of the virus. Prior research on this topic has been inconclusive. Identifying key challenges to reliable estimation of weather impact on transmission we study this question using one of the largest assembled databases of COVID-19 infections and weather.Methods: We assemble a dataset that includes virus transmission and weather data across 3,739 locations from December 12, 2019 to April 22, 2020. Using simulation, we identify key challenges to reliable estimation of weather impacts on transmission, design a statistical method to overcome these challenges, and validate it in a blinded simulation study. Using this method and controlling for location-specific response trends we estimate how different weather variables are associated with the reproduction number for COVID-19. We then use the estimates to project the relative weather-related risk of COVID-19 transmission across the world and in large cities.Results: We show that the delay between exposure and detection of infection complicates the estimation of weather impact on COVID-19 transmission, potentially explaining significant variability in results to-date. Correcting for that distributed delay and offering conservative estimates, we find a negative relationship between temperatures above 25 degrees Celsius and estimated reproduction number (R ̂), with each degree Celsius associated with a 3.1% (95% CI, 1.5% to 4.8%) reduction in R ̂. Higher levels of relative humidity strengthen the negative effect of temperature above 25 degrees. Moreover, one millibar of additional pressure increases R ̂ by approximately 0.8 percent (95% CI, 0.6% to 1%) at the median pressure (1016 millibars) in our sample. We also find significant positive effects for wind speed, precipitation, and diurnal temperature on R ̂. Sensitivity analysis and simulations show that results are robust to multiple assumptions. Despite conservative estimates, weather effects are associated with a 43% change in R ̂ between the 5th and 95th percentile of weather conditions in our sample.Conclusions: These results provide evidence for the relationship between several weather variables and the spread of COVID-19. However, the (conservatively) estimated relationships are not strong enough to seasonally control the epidemic in most locations. [["fid":"715368","view_mode":"default","type":"media","attributes":"height":"498","width":"832","style":"width: 700px; height: 419px;","alt":"weather_conditions_and_covid19","class":"media-element file-default"]] Online simulator: https://projects.iq.harvard.edu/covid19}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Understanding and projecting the spread of COVID-19 requires reliable estimates of how weather components are associated with the transmission of the virus. Prior research on this topic has been inconclusive. Identifying key challenges to reliable estimation of weather impact on transmission we study this question using one of the largest assembled databases of COVID-19 infections and weather.Methods: We assemble a dataset that includes virus transmission and weather data across 3,739 locations from December 12, 2019 to April 22, 2020. Using simulation, we identify key challenges to reliable estimation of weather impacts on transmission, design a statistical method to overcome these challenges, and validate it in a blinded simulation study. Using this method and controlling for location-specific response trends we estimate how different weather variables are associated with the reproduction number for COVID-19. We then use the estimates to project the relative weather-related risk of COVID-19 transmission across the world and in large cities.Results: We show that the delay between exposure and detection of infection complicates the estimation of weather impact on COVID-19 transmission, potentially explaining significant variability in results to-date. Correcting for that distributed delay and offering conservative estimates, we find a negative relationship between temperatures above 25 degrees Celsius and estimated reproduction number (R ̂), with each degree Celsius associated with a 3.1% (95% CI, 1.5% to 4.8%) reduction in R ̂. Higher levels of relative humidity strengthen the negative effect of temperature above 25 degrees. Moreover, one millibar of additional pressure increases R ̂ by approximately 0.8 percent (95% CI, 0.6% to 1%) at the median pressure (1016 millibars) in our sample. We also find significant positive effects for wind speed, precipitation, and diurnal temperature on R ̂. Sensitivity analysis and simulations show that results are robust to multiple assumptions. Despite conservative estimates, weather effects are associated with a 43% change in R ̂ between the 5th and 95th percentile of weather conditions in our sample.Conclusions: These results provide evidence for the relationship between several weather variables and the spread of COVID-19. However, the (conservatively) estimated relationships are not strong enough to seasonally control the epidemic in most locations. [["fid":"715368","view_mode":"default","type":"media","attributes":"height":"498","width":"832","style":"width: 700px; height: 419px;","alt":"weather_conditions_and_covid19","class":"media-element file-default"]] Online simulator: https://projects.iq.harvard.edu/covid19 |
 | Beaulieu, Elizabeth; DiGennaro, Catherine; Stringfellow, Erin; Connolly, Ava; Hamilton, Ava; Hyder, Ayaz; á, Magdalena Cerd; Keyes, Katherine M; Jalali, Mohammad S Economic Evaluation in Opioids Modeling: Systematic Review Journal Article Value in Health, 24 (2), pp. 158-173, 2021. @article{650798, title = {Economic Evaluation in Opioids Modeling: Systematic Review}, author = {Elizabeth Beaulieu and Catherine DiGennaro and Erin Stringfellow and Ava Connolly and Ava Hamilton and Ayaz Hyder and Magdalena Cerd á and Katherine M Keyes and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/economic_evaluation_in_opioid_modeling.pdf https://scholar.harvard.edu/files/jalali/files/supplement_economic_evaluation_in_opioid_modeling.pdf}, year = {2021}, date = {2021-01-01}, journal = {Value in Health}, volume = {24}, number = {2}, pages = {158-173}, abstract = {ObjectivesThe rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. MethodsA systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. ResultsThe screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studiestextquoteright accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. ConclusionThe review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research.}, keywords = {}, pubstate = {published}, tppubtype = {article} } ObjectivesThe rapid increase in opioid overdose and opioid use disorder (OUD) over the past 20 years is a complex problem associated with significant economic costs for healthcare systems and society. Simulation models have been developed to capture and identify ways to manage this complexity and to evaluate the potential costs of different strategies to reduce overdoses and OUD. A review of simulation-based economic evaluations is warranted to fully characterize this set of literature. MethodsA systematic review of simulation-based economic evaluation (SBEE) studies in opioid research was initiated by searches in PubMed, EMBASE, and EbscoHOST. Extraction of a predefined set of items and a quality assessment were performed for each study. ResultsThe screening process resulted in 23 SBEE studies ranging by year of publication from 1999 to 2019. Methodological quality of the cost analyses was moderately high. The most frequently evaluated strategies were methadone and buprenorphine maintenance treatments; the only harm reduction strategy explored was naloxone distribution. These strategies were consistently found to be cost-effective, especially naloxone distribution and methadone maintenance. Prevention strategies were limited to abuse-deterrent opioid formulations. Less than half (39%) of analyses adopted a societal perspective in their estimation of costs and effects from an opioid-related intervention. Prevention strategies and studiestextquoteright accounting for patient and physician preference, changing costs, or result stratification were largely ignored in these SBEEs. ConclusionThe review shows consistently favorable cost analysis findings for naloxone distribution strategies and opioid agonist treatments and identifies major gaps for future research. |
 | Deutsch, Arielle R; Lustfield, Rebecca; Jalali, Mohammad S 2021. @article{651231, title = {Community-based System Dynamics Modeling of Sensitive Public Health Issues: Maximizing Diverse Representation of Individuals with Personal Experiences}, author = {Arielle R Deutsch and Rebecca Lustfield and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/community_based_sd_modeling.pdf}, year = {2021}, date = {2021-01-01}, abstract = {Community-based system dynamics (CBSD) models enhance our understanding of stigmatized public health issues and related health disparities. The accuracy and usefulness of these models depend upon the individuals who take part in group modeling sessions. Marginalized individuals that are personally impacted by these health issues are critical in the function and development of the models. However, the extent of inclusion varies between studies since such individuals are often hard to recruit. There is substantial diversity in how individuals experience a stigmatized public health issue and with the underrepresentation of individuals with personal experience, research may conclude in biased model development. The purpose of this study was to explore a method that would increase representation for individuals with personal experience of stigmatized issues in model development. We used a case study from a CBSD project on the association between alcohol misuse (AM) and intimate partner violence (IPV) within a Northern Plains American Indian community. Group model building sessions were held at three community organizations: a faith-based re-entry program, a substance use rehabilitation program for pregnant women and mothers, and a domestic violence shelter. Session participants (clients of these organizations) were quick to understand the systems method and were engaged in the modeling process. There were few similarities between the three CBSD models. Each model contributed unique system components, and a consolidated model provided a rich picture of the complex AM-IPV system, as well as the ways in which health disparities are maintained. Coupled with an emphasis on transparency and trust building between researchers and modelers, our approach illuminated the diversity of ways in which individuals with personal experience can perceive AM-IPV systems. Using similar strategies for model building can complement existing efforts to build representative models for stigmatized public health issues within communities.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Community-based system dynamics (CBSD) models enhance our understanding of stigmatized public health issues and related health disparities. The accuracy and usefulness of these models depend upon the individuals who take part in group modeling sessions. Marginalized individuals that are personally impacted by these health issues are critical in the function and development of the models. However, the extent of inclusion varies between studies since such individuals are often hard to recruit. There is substantial diversity in how individuals experience a stigmatized public health issue and with the underrepresentation of individuals with personal experience, research may conclude in biased model development. The purpose of this study was to explore a method that would increase representation for individuals with personal experience of stigmatized issues in model development. We used a case study from a CBSD project on the association between alcohol misuse (AM) and intimate partner violence (IPV) within a Northern Plains American Indian community. Group model building sessions were held at three community organizations: a faith-based re-entry program, a substance use rehabilitation program for pregnant women and mothers, and a domestic violence shelter. Session participants (clients of these organizations) were quick to understand the systems method and were engaged in the modeling process. There were few similarities between the three CBSD models. Each model contributed unique system components, and a consolidated model provided a rich picture of the complex AM-IPV system, as well as the ways in which health disparities are maintained. Coupled with an emphasis on transparency and trust building between researchers and modelers, our approach illuminated the diversity of ways in which individuals with personal experience can perceive AM-IPV systems. Using similar strategies for model building can complement existing efforts to build representative models for stigmatized public health issues within communities. |
 | Gupta, Marichi; Bansal, Aditya; Jain, Bhav; Rochelle, Jillian; Oak, Atharv; Jalali, Mohammad S Whether the Weather Will Help Us Weather the COVID-19 Pandemic: Using Machine Learning to Measure Twitter Users’ Perceptions Journal Article International Journal of Medical Informatics, 145 , pp. 104340, 2021. @article{660470, title = {Whether the Weather Will Help Us Weather the COVID-19 Pandemic: Using Machine Learning to Measure Twitter Users’ Perceptions}, author = {Marichi Gupta and Aditya Bansal and Bhav Jain and Jillian Rochelle and Atharv Oak and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/perceptions_weather_and_covid19.pdf}, year = {2021}, date = {2021-01-01}, journal = {International Journal of Medical Informatics}, volume = {145}, pages = {104340}, abstract = {Objective: The potential ability for weather to affect SARS-CoV-2 transmission has been an area of controversial discussion during the COVID-19 pandemic. Individualstextquoteright perceptions of the impact of weather can inform their adherence to public health guidelines; however, there is no measure of their perceptions. We quantified Twitter userstextquoteright perceptions of the effect of weather and analyzed how they evolved with respect to real-world events and time. Materials and Methods: We collected 166,005 tweets posted between January 23 and June 22, 2020 and employed machine learning/natural language processing techniques to filter for relevant tweets, classify them by the type of effect they claimed, and identify topics of discussion. Results: We identified 28,555 relevant tweets and estimate that 40.4% indicate uncertainty about weathertextquoterights impact, 33.5% indicate no effect, and 26.1% indicate some effect. We tracked changes in these proportions over time. Topic modeling revealed major latent areas of discussion. Discussion: There is no consensus among the public for weathertextquoterights potential impact. Earlier months were characterized by tweets that were uncertain of weathertextquoterights effect or claimed no effect; later, the portion of tweets claiming some effect of weather increased. Tweets claiming no effect of weather comprised the largest class by June. Major topics of discussion included comparisons to influenzatextquoterights seasonality, President Trumptextquoterights comments on weathertextquoterights effect, and social distancing. Conclusion: There is a major gap between scientific evidence and public opinion of weathertextquoterights impacts on COVID-19. We provide evidence of publictextquoterights misconceptions and topics of discussion, which can inform public health communications. [["fid":"715366","view_mode":"default","type":"media","attributes":"height":"713","width":"1249","style":"width: 700px; height: 400px;","alt":"Weather tweets","class":"media-element file-default"]]}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: The potential ability for weather to affect SARS-CoV-2 transmission has been an area of controversial discussion during the COVID-19 pandemic. Individualstextquoteright perceptions of the impact of weather can inform their adherence to public health guidelines; however, there is no measure of their perceptions. We quantified Twitter userstextquoteright perceptions of the effect of weather and analyzed how they evolved with respect to real-world events and time. Materials and Methods: We collected 166,005 tweets posted between January 23 and June 22, 2020 and employed machine learning/natural language processing techniques to filter for relevant tweets, classify them by the type of effect they claimed, and identify topics of discussion. Results: We identified 28,555 relevant tweets and estimate that 40.4% indicate uncertainty about weathertextquoterights impact, 33.5% indicate no effect, and 26.1% indicate some effect. We tracked changes in these proportions over time. Topic modeling revealed major latent areas of discussion. Discussion: There is no consensus among the public for weathertextquoterights potential impact. Earlier months were characterized by tweets that were uncertain of weathertextquoterights effect or claimed no effect; later, the portion of tweets claiming some effect of weather increased. Tweets claiming no effect of weather comprised the largest class by June. Major topics of discussion included comparisons to influenzatextquoterights seasonality, President Trumptextquoterights comments on weathertextquoterights effect, and social distancing. Conclusion: There is a major gap between scientific evidence and public opinion of weathertextquoterights impacts on COVID-19. We provide evidence of publictextquoterights misconceptions and topics of discussion, which can inform public health communications. [["fid":"715366","view_mode":"default","type":"media","attributes":"height":"713","width":"1249","style":"width: 700px; height: 400px;","alt":"Weather tweets","class":"media-element file-default"]] |
 | Jalali, Mohammad S; Ewing, Emily; Bannister, Calvin B; Glos, Lukas; Eggers, Sara; Lim, Tse Yang; Stringfellow, Erin; Stafford, Celia; Pacula, Rosalie Liccardo; Jalal, Hawre; Kazemi-Tabriz, Reza Data Needs in Opioid Systems Modeling: Challenges and Future Directions Journal Article American Journal of Preventive Medicine, 60 (2), pp. e95-e105, 2021. @article{661054, title = {Data Needs in Opioid Systems Modeling: Challenges and Future Directions}, author = {Mohammad S Jalali and Emily Ewing and Calvin B Bannister and Lukas Glos and Sara Eggers and Tse Yang Lim and Erin Stringfellow and Celia Stafford and Rosalie Liccardo Pacula and Hawre Jalal and Reza Kazemi-Tabriz}, url = {https://scholar.harvard.edu/files/jalali/files/slides_data_challenges_in_opioid_systems_modeling.pdf https://scholar.harvard.edu/files/jalali/files/data_needs_opioids_modeling.pdf}, year = {2021}, date = {2021-01-01}, journal = {American Journal of Preventive Medicine}, volume = {60}, number = {2}, pages = {e95-e105}, abstract = {Background: The opioid crisis is a pervasive public health threat in the U.S. Simulation modeling approaches that integrate a systems perspective are used to understand the complexity of this crisis and to analyze what policy interventions can best address it. However, limitations in currently available data sources can hamper the quantification of these models. Methods: To understand and discuss data needs and challenges for opioid systems modeling, a meeting of federal partners, modeling teams, and data experts was held at the U.S. Food and Drug Administration in April 2019. This paper synthesizes the meeting discussions and interprets them in the context of ongoing simulation modeling work. Results: The current landscape of national-level quantitative data sources of potential use in opioid systems modeling is identified, and significant issues within data sources are discussed. Major recommendations on how to improve data sources are to: maintain close collaboration among modeling teams; enhance data collection to better fit modeling needs; focus on bridging the most crucial information gaps; engage in direct and regular interaction between modelers and data experts; and gain a clearer definition of policymakerstextquoteright research questions and policy goals. Conclusions: This article provides an important step in identifying and discussing data challenges in opioid research in general and opioid systems modeling in particular. It also identifies opportunities for systems modelers and government agencies to improve opioid systems models.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: The opioid crisis is a pervasive public health threat in the U.S. Simulation modeling approaches that integrate a systems perspective are used to understand the complexity of this crisis and to analyze what policy interventions can best address it. However, limitations in currently available data sources can hamper the quantification of these models. Methods: To understand and discuss data needs and challenges for opioid systems modeling, a meeting of federal partners, modeling teams, and data experts was held at the U.S. Food and Drug Administration in April 2019. This paper synthesizes the meeting discussions and interprets them in the context of ongoing simulation modeling work. Results: The current landscape of national-level quantitative data sources of potential use in opioid systems modeling is identified, and significant issues within data sources are discussed. Major recommendations on how to improve data sources are to: maintain close collaboration among modeling teams; enhance data collection to better fit modeling needs; focus on bridging the most crucial information gaps; engage in direct and regular interaction between modelers and data experts; and gain a clearer definition of policymakerstextquoteright research questions and policy goals. Conclusions: This article provides an important step in identifying and discussing data challenges in opioid research in general and opioid systems modeling in particular. It also identifies opportunities for systems modelers and government agencies to improve opioid systems models. |
 | DiGennaro, Catherine; Garcia, Gian-Gabriel P; Stringfellow, Erin J; Wakeman, Sarah; Jalali, Mohammad S Changes in Characteristics of Drug Overdose Death Trends during the COVID-19 Pandemic Journal Article International Journal of Drug Policy, 2021. @article{665500, title = {Changes in Characteristics of Drug Overdose Death Trends during the COVID-19 Pandemic}, author = {Catherine DiGennaro and Gian-Gabriel P Garcia and Erin J Stringfellow and Sarah Wakeman and Mohammad S Jalali}, url = {https://mj-lab.mgh.harvard.edu/wp-content/uploads/2021/10/Overdoses_COVID19_MA.pdf}, year = {2021}, date = {2021-01-01}, journal = {International Journal of Drug Policy}, abstract = {Background: Reports analyzing drug overdose (OD) mortality data during the COVID-19 pandemic are limited. Outcomes across states are heterogenous, necessitating assessments of associations between COVID-19 and OD deaths on a state-by-state level. This report aims to analyze trends in OD deaths in Massachusetts during COVID-19. Methods: Analyzing 3,924 death records, we characterize opioid-, cocaine-, and amphetamine-involved OD mortality and substance co-presence trends from March 24-November 8 in 2020 as compared to 2018 and 2019. Results: OD deaths involving amphetamines increased by 85% from 2019 to 2020 (61 vs. 113; P<0.001) but were steady from 2018 to 2019. Herointextquoterights presence continued to decrease (341 in 2018, 247 in 2019, 157 in 2020; P<0.001); however, fentanyl was present in more than 85% of all OD deaths across all periods. Among OD deaths, alcohol involvement consistently increased, present in 250 deaths in 2018, 299 in 2019 (P=0.02), and 350 in 2020 (P=0.04). In 2019, 78% of OD decedents were White and 7% were Black, versus 73% and 10% in 2020 (P=0.02). Conclusion: Increased deaths involving stimulants, alcohol, and fentanyl reflect concerning trends in the era of COVID-19. Rising OD death rates among Black residents underscore that interventions focused on racial equity are necessary. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Reports analyzing drug overdose (OD) mortality data during the COVID-19 pandemic are limited. Outcomes across states are heterogenous, necessitating assessments of associations between COVID-19 and OD deaths on a state-by-state level. This report aims to analyze trends in OD deaths in Massachusetts during COVID-19. Methods: Analyzing 3,924 death records, we characterize opioid-, cocaine-, and amphetamine-involved OD mortality and substance co-presence trends from March 24-November 8 in 2020 as compared to 2018 and 2019. Results: OD deaths involving amphetamines increased by 85% from 2019 to 2020 (61 vs. 113; P<0.001) but were steady from 2018 to 2019. Herointextquoterights presence continued to decrease (341 in 2018, 247 in 2019, 157 in 2020; P<0.001); however, fentanyl was present in more than 85% of all OD deaths across all periods. Among OD deaths, alcohol involvement consistently increased, present in 250 deaths in 2018, 299 in 2019 (P=0.02), and 350 in 2020 (P=0.04). In 2019, 78% of OD decedents were White and 7% were Black, versus 73% and 10% in 2020 (P=0.02). Conclusion: Increased deaths involving stimulants, alcohol, and fentanyl reflect concerning trends in the era of COVID-19. Rising OD death rates among Black residents underscore that interventions focused on racial equity are necessary. |
 | Tatar, Moosa; Jalali, Mohammad S; Tak, Hyo Jung; Chen, Li-Wu; Araz, Ozgur M; Wilson, Fernando A Impact of Florida's Prescription Drug Monitoring Program on Fatal Vehicle Crashes: A Difference-in-Differences Approach Journal Article Injury Prevention, 2021. @article{666821, title = {Impact of Florida's Prescription Drug Monitoring Program on Fatal Vehicle Crashes: A Difference-in-Differences Approach}, author = {Moosa Tatar and Mohammad S Jalali and Hyo Jung Tak and Li-Wu Chen and Ozgur M Araz and Fernando A Wilson}, year = {2021}, date = {2021-01-01}, journal = {Injury Prevention}, abstract = {Objective: To examine the impact of Floridatextquoterights implementation of a mandatory PDMP on drug-related motor vehicle crashes occurring on public roads. Methods: We employed a difference-in-differences approach to estimate the difference in prescription drug-related fatal crashes in Florida associated with its 2011 PDMP implementation relative to those in Georgia, which did not utilize PDMPs during the same period (2009-2013). Results: In Florida, there was a significant decline in drug-related vehicle crashes during the 22 months post-PDMP. PDMP implementation was associated with approximately two (-2.21; 95%-CI: [-4.04,-0.37]; P<0.05) fewer prescribed opioid-related fatal crashes every month, indicating 25% reduction in the number of monthly crashes. We also conducted sensitivity analyses to investigate the impact of PDMP implementation on CNS depressants and stimulants as well as cocaine and marijuana-related fatal crashes but found no robust significant reductions. Conclusions: The implementation of PDMPs in Florida provided important benefits for traffic safety, reducing the rates of prescription opioid-related vehicle crashes. Policy implications: Mandatory PDMP implementation policies could decrease drug-related fatal vehicle crashes.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: To examine the impact of Floridatextquoterights implementation of a mandatory PDMP on drug-related motor vehicle crashes occurring on public roads. Methods: We employed a difference-in-differences approach to estimate the difference in prescription drug-related fatal crashes in Florida associated with its 2011 PDMP implementation relative to those in Georgia, which did not utilize PDMPs during the same period (2009-2013). Results: In Florida, there was a significant decline in drug-related vehicle crashes during the 22 months post-PDMP. PDMP implementation was associated with approximately two (-2.21; 95%-CI: [-4.04,-0.37]; P<0.05) fewer prescribed opioid-related fatal crashes every month, indicating 25% reduction in the number of monthly crashes. We also conducted sensitivity analyses to investigate the impact of PDMP implementation on CNS depressants and stimulants as well as cocaine and marijuana-related fatal crashes but found no robust significant reductions. Conclusions: The implementation of PDMPs in Florida provided important benefits for traffic safety, reducing the rates of prescription opioid-related vehicle crashes. Policy implications: Mandatory PDMP implementation policies could decrease drug-related fatal vehicle crashes. |
2020 |
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 | Jalali, Mohammad S; Botticelli, Michael; Hwang, Rachael; Koh, Howard K; McHugh, Kathryn R The opioid crisis: a contextual, social-ecological framework Journal Article Health Research Policy and Systems, 18 (87), 2020. @article{637263, title = {The opioid crisis: a contextual, social-ecological framework}, author = {Mohammad S Jalali and Michael Botticelli and Rachael Hwang and Howard K Koh and Kathryn R McHugh}, url = {https://scholar.harvard.edu/files/jalali/files/opioid_crisis_social_ecological_framework.pdf}, year = {2020}, date = {2020-01-01}, journal = {Health Research Policy and Systems}, volume = {18}, number = {87}, abstract = {The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment. |
 | Namin, Amir T; Vahdat, Vahab; DiGennaro, Catherine; Amid, Roham; Jalali, Mohammad S Adoption of new medical technologies: The effects of insurance coverage vs continuing medical education Journal Article Health Policy and Technology, 9 (1), pp. 31-41, 2020. @article{647807, title = {Adoption of new medical technologies: The effects of insurance coverage vs continuing medical education}, author = {Amir T Namin and Vahab Vahdat and Catherine DiGennaro and Roham Amid and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/adoption_insurance_vs_education.pdf}, year = {2020}, date = {2020-01-01}, journal = {Health Policy and Technology}, volume = {9}, number = {1}, pages = {31-41}, abstract = {Medical technologies innovate rapidly and responsively to patient needs, but the adoption of the latest technologies in practice can be delayed by lack of knowledge and ability to pay. Customized individually made (CIM) knee implants potentially provide an option for individuals to maintain moderate to high activity levels with fewer surgical revisions following a total knee replacement, however they are costlier upfront. Not only is the technology more expensive, but insurance typically covers around 50% (versus 90% for older off-the-shelf knee implants). We used a recent simulation model and analyzed the effects on overall adoption of CIM through 2026 and found that continuing medical education (CME)—a common intervention to increase the adoption of new medical technologies through increasing practitioner knowledge and comfort with the new technologies—can increase the adoption of CIM to 48% in the short term, but increasing insurance coverage to be equal to OTS knee replacement coverage increases the adoption to 87% in the sustained long term. Efforts to implement CME are well-placed and will increase the rate of adoption, however the combination of CME and increased insurance coverage provides the most benefit, with the technology reaching 80% of the population undergoing total knee replacement by 2021.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Medical technologies innovate rapidly and responsively to patient needs, but the adoption of the latest technologies in practice can be delayed by lack of knowledge and ability to pay. Customized individually made (CIM) knee implants potentially provide an option for individuals to maintain moderate to high activity levels with fewer surgical revisions following a total knee replacement, however they are costlier upfront. Not only is the technology more expensive, but insurance typically covers around 50% (versus 90% for older off-the-shelf knee implants). We used a recent simulation model and analyzed the effects on overall adoption of CIM through 2026 and found that continuing medical education (CME)—a common intervention to increase the adoption of new medical technologies through increasing practitioner knowledge and comfort with the new technologies—can increase the adoption of CIM to 48% in the short term, but increasing insurance coverage to be equal to OTS knee replacement coverage increases the adoption to 87% in the sustained long term. Efforts to implement CME are well-placed and will increase the rate of adoption, however the combination of CME and increased insurance coverage provides the most benefit, with the technology reaching 80% of the population undergoing total knee replacement by 2021. |
 | Jalali, Mohammad S; Bruckes, Maike; Westmattelmann, Daniel; Schewe, Gerhard Why Employees (Still) Click on Phishing Links: Investigation in Hospitals Journal Article Journal of Medical Internet Research, 22 (1), pp. e16775, 2020. @article{647808, title = {Why Employees (Still) Click on Phishing Links: Investigation in Hospitals}, author = {Mohammad S Jalali and Maike Bruckes and Daniel Westmattelmann and Gerhard Schewe}, url = {https://scholar.harvard.edu/files/jalali/files/phishing_investigation.pdf}, year = {2020}, date = {2020-01-01}, journal = {Journal of Medical Internet Research}, volume = {22}, number = {1}, pages = {e16775}, abstract = {Background: Hospitals have been one of the major targets for phishing attacks. Despite efforts to improve information security compliance, hospitals still significantly suffer from such attacks, impacting the quality of care and the safety of patients.Objective: This study aimed to investigate why hospital employees decide to click on phishing emails by analyzing actual clicking data.Methods: We first gauged the factors that influence clicking behavior using the theory of planned behavior (TPB) and integrating trust theories. We then conducted a survey in hospitals and used structural equation modeling to investigate the components of compliance intention. We matched employeestextquoteright survey results with their actual clicking data from phishing campaigns.Results: Our analysis (N=397) reveals that TPB factors (attitude, subjective norms, and perceived behavioral control), as well as collective felt trust and trust in information security technology, are positively related to compliance intention. However, compliance intention is not significantly related to compliance behavior. Only the level of employeestextquoteright workload is positively associated with the likelihood of employees clicking on a phishing link.Conclusions: This is one of the few studies in information security and decision making that observed compliance behavior by analyzing clicking data rather than using self-reported data. We show that, in the context of phishing emails, intention and compliance might not be as strongly linked as previously assumed; hence, hospitals must remain vigilant with vulnerabilities that cannot be easily managed. Importantly, given the significant association between workload and noncompliance behavior (ie, clicking on phishing links), hospitals should better manage employeestextquoteright workload to increase information security. Our findings can help health care organizations augment employeestextquoteright compliance with their cybersecurity policies and reduce the likelihood of clicking on phishing links.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Hospitals have been one of the major targets for phishing attacks. Despite efforts to improve information security compliance, hospitals still significantly suffer from such attacks, impacting the quality of care and the safety of patients.Objective: This study aimed to investigate why hospital employees decide to click on phishing emails by analyzing actual clicking data.Methods: We first gauged the factors that influence clicking behavior using the theory of planned behavior (TPB) and integrating trust theories. We then conducted a survey in hospitals and used structural equation modeling to investigate the components of compliance intention. We matched employeestextquoteright survey results with their actual clicking data from phishing campaigns.Results: Our analysis (N=397) reveals that TPB factors (attitude, subjective norms, and perceived behavioral control), as well as collective felt trust and trust in information security technology, are positively related to compliance intention. However, compliance intention is not significantly related to compliance behavior. Only the level of employeestextquoteright workload is positively associated with the likelihood of employees clicking on a phishing link.Conclusions: This is one of the few studies in information security and decision making that observed compliance behavior by analyzing clicking data rather than using self-reported data. We show that, in the context of phishing emails, intention and compliance might not be as strongly linked as previously assumed; hence, hospitals must remain vigilant with vulnerabilities that cannot be easily managed. Importantly, given the significant association between workload and noncompliance behavior (ie, clicking on phishing links), hospitals should better manage employeestextquoteright workload to increase information security. Our findings can help health care organizations augment employeestextquoteright compliance with their cybersecurity policies and reduce the likelihood of clicking on phishing links. |
| Li, Peiyi; Luo, Yunmei; Yu, Xuexin; Wen, Jin; Mason, Elizabeth; Li, Weimin; Jalali, Mohammad S Patients’ Perceptions of Barriers and Facilitators to the Adoption of e-Hospitals: Cross-sectional Study in Western China Journal Article Journal of Medical Internet Research, 22 (6), pp. e17221, 2020. @article{651232, title = {Patients’ Perceptions of Barriers and Facilitators to the Adoption of e-Hospitals: Cross-sectional Study in Western China}, author = {Peiyi Li and Yunmei Luo and Xuexin Yu and Jin Wen and Elizabeth Mason and Weimin Li and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/ehospitals_adoption.pdf}, year = {2020}, date = {2020-01-01}, journal = {Journal of Medical Internet Research}, volume = {22}, number = {6}, pages = {e17221}, abstract = {Background: As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end userstextquoteright acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective: This study aimed to provide insights regarding the adoption of e-hospitals by investigating patientstextquoteright willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods: We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patientstextquoteright sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions: We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: As an innovative approach to providing web-based health care services from physical hospitals to patients at a distance, e-hospitals (ie, extended care hospitals through the internet) have been extensively developed in China. This closed health care delivery chain was developed by combining e-hospitals with physical hospitals; treatment begins with web-based consultation and registration, and then, patients are diagnosed and treated in a physical hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of health care. However, there is limited research on end userstextquoteright acceptance of e-hospitals and the effectiveness of strategies aimed to prompt the adoption of e-hospitals in China. Objective: This study aimed to provide insights regarding the adoption of e-hospitals by investigating patientstextquoteright willingness to use e-hospitals and analyzing the barriers and facilitators to the adoption of this technology. Methods: We used a pretested self-administered questionnaire and performed a cross-sectional analysis in 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patientstextquoteright sociodemographic characteristics, medical history, current disease status, proficiency with electronic devices, previous experience with web-based health services, willingness to use e-hospitals, and perceived facilitators and barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups, as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify the potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6% (677/1032) of participants were willing to use e-hospitals. The significant predictors of willingness to use e-hospitals were employment status (P=.02), living with children (P<.001), education level (P=.046), information technology skills (P<.001), and prior experience with web-based health care services (P<.001), whereas age, income, medical insurance, and familiarity with e-hospitals were not predictors. Additionally, the prominent facilitators of e-hospitals were convenience (641/677, 94.7%) and accessibility to skilled medical experts (489/677, 72.2%). The most frequently perceived barrier varied among age groups; seniors most often reported their inability to operate technological devices as a barrier (144/166, 86.7%), whereas young participants most often reported that they avoided e-hospital services because they were accustomed to face-to-face consultation (39/52, 75%). Conclusions: We identified the variables, facilitators, and barriers that play essential roles in the adoption of e-hospitals. Based on our findings, we suggest that efforts to increase the adoption of e-hospitals should focus on making target populations accustomed to web-based health care services while maximizing ease of use and providing assistance for technological inquiries. |
 | Liang, L; Shang, Y; Xie, W; Shi, J; Tong, Z; Jalali, MS Trends in Hospitalization Expenditures for Acute Exacerbations of COPD in Beijing from 2009 to 2017 Journal Article International Journal of Chronic Obstructive Pulmonary Disease, (15), pp. 1165-1175, 2020. @article{651233, title = {Trends in Hospitalization Expenditures for Acute Exacerbations of COPD in Beijing from 2009 to 2017}, author = {L Liang and Y Shang and W Xie and J Shi and Z Tong and MS Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/trends-in-hospitalization-expenditures-COPD.pdf}, year = {2020}, date = {2020-01-01}, journal = {International Journal of Chronic Obstructive Pulmonary Disease}, number = {15}, pages = {1165-1175}, abstract = {Background: Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We investigated trends in hospitalizations for acute exacerbation of COPD in Beijing, China, from 2009 to 2017.Patients and Methods: Investigations were conducted using data from the discharge records of inpatients that were given a primary diagnosis of acute exacerbation of COPD. The dataset was a retrospective review of information collected from electronic medical records and included 315,116 admissions (159,368 patients). Descriptive analyses and multivariate regressions were used to investigate trends in per admission and per capita expenditures, as well as other potential contributing factors.Results: The mean per admission expenditures increased from 19,760 CNY ($2893, based on USD/CNY=6.8310) in 2009 to 20,118 CNY ($2980) in 2017 (a growth rate of 0.11%). However, the per capita expenditures increased from 23,716 CNY ($3472) in 2009 to 31,000 CNY ($4538) in 2017 (a growth rate of 1.7%). In terms of per admission expenditures, drug costs accounted for 52.9% of the total expenditures in 2009 and dropped to 39.4% in 2017 (P trend < 0.001). The mean length of stay (LOS) decreased from 16.0 days to 13.5 days (P trend < 0textperiodcentered 001). Age, gender, COPD type, LOS, and hospital level were all associated with per admission and per capita expenditures.Interpretation: Relatively stable per admission expenditures along with the decline in drug costs and LOS reflect the effectiveness of cost containment on some indicators in Chinatextquoterights health care reform. However, the increase in hospitalization expenditures per capita calls for better policies for controlling hospitalizations, especially multiple admissions.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Chronic obstructive pulmonary disease (COPD) is the cause of substantial economic and social burden. We investigated trends in hospitalizations for acute exacerbation of COPD in Beijing, China, from 2009 to 2017.Patients and Methods: Investigations were conducted using data from the discharge records of inpatients that were given a primary diagnosis of acute exacerbation of COPD. The dataset was a retrospective review of information collected from electronic medical records and included 315,116 admissions (159,368 patients). Descriptive analyses and multivariate regressions were used to investigate trends in per admission and per capita expenditures, as well as other potential contributing factors.Results: The mean per admission expenditures increased from 19,760 CNY ($2893, based on USD/CNY=6.8310) in 2009 to 20,118 CNY ($2980) in 2017 (a growth rate of 0.11%). However, the per capita expenditures increased from 23,716 CNY ($3472) in 2009 to 31,000 CNY ($4538) in 2017 (a growth rate of 1.7%). In terms of per admission expenditures, drug costs accounted for 52.9% of the total expenditures in 2009 and dropped to 39.4% in 2017 (P trend < 0.001). The mean length of stay (LOS) decreased from 16.0 days to 13.5 days (P trend < 0textperiodcentered 001). Age, gender, COPD type, LOS, and hospital level were all associated with per admission and per capita expenditures.Interpretation: Relatively stable per admission expenditures along with the decline in drug costs and LOS reflect the effectiveness of cost containment on some indicators in Chinatextquoterights health care reform. However, the increase in hospitalization expenditures per capita calls for better policies for controlling hospitalizations, especially multiple admissions. |
 | Li, Peiyi; Liu, Xiaoyu; Mason, Elizabeth; Hu, Guangyu; Zhou, Yongzhao; Li, Weimin; Jalali, Mohammad S How Telemedicine Integrated into China’s Anti-COVID-19 Strategies: Case from a National Referral Center Journal Article BMJ Health & Care Informatics, (27), pp. e100164, 2020. @article{651958, title = {How Telemedicine Integrated into China’s Anti-COVID-19 Strategies: Case from a National Referral Center}, author = {Peiyi Li and Xiaoyu Liu and Elizabeth Mason and Guangyu Hu and Yongzhao Zhou and Weimin Li and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/telemedicine_china.pdf}, year = {2020}, date = {2020-01-01}, journal = {BMJ Health & Care Informatics}, number = {27}, pages = {e100164}, abstract = {Introduction We present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic. Methods Implemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees. Discussion From 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction We present the integration of telemedicine into the healthcare system of West China Hospital of Sichuan University (WCH), one of the largest hospitals in the world with 4300 inpatient beds, as a means for maximising the efficiency of healthcare delivery during the COVID-19 pandemic. Methods Implemented on 22 January 2020, the telemedicine technology allowed WCH providers to conduct teleconsultations, telerounds, teleradiology and tele-intensive care unit, which in culmination provided screening, triage and treatment for COVID-19 and other illnesses. To encourage its adoption, the government and the hospital publicised the platform on social media and waived fees. Discussion From 1 February to 1 April 2020, 10557 online COVID-19 consultations were conducted for 6662 individuals; meanwhile, 32676 patients without COVID completed virtual follow-ups. We discuss that high-quality, secure, affordable and user-friendly telemedical platforms should be integrated into global healthcare systems to help decrease the transmission of the virus and protect healthcare providers from infection. |
 | Jalali, Mohammad S; DiGennaro, Catherine; Sridhar, Devi Transparency Assessment of COVID-19 Models Journal Article The Lancet Global Health, 8 (12), pp. E1459-E1460, 2020. @article{651959, title = {Transparency Assessment of COVID-19 Models}, author = {Mohammad S Jalali and Catherine DiGennaro and Devi Sridhar}, url = {https://scholar.harvard.edu/files/jalali/files/transparency_assessment_covid19.pdf https://scholar.harvard.edu/files/jalali/files/transparency_assessment_covid19_appendix.pdf}, year = {2020}, date = {2020-01-01}, journal = {The Lancet Global Health}, volume = {8}, number = {12}, pages = {E1459-E1460}, abstract = {As the COVID-19 pandemic has caused major societal unrest, modelers have worked to project future trends of COVID-19 and predict upcoming challenges and impacts of policy action. These models, alone or in aggregate, are influential for decision-makers at every level. Therefore, the method and documentation of COVID-19 models must be highly transparent to ensure that projections and consequential policies put forth have sound epistemological grounds. We evaluated 29 COVID-19 models receiving high attention levels within the scientific community and/or informing government responses. We evaluated these models against 27 transparency criteria. We found high levels of transparency in model documentation aspects such as reporting uncertainty analysis; however, about half of the models do not share code and a quarter do not report equations. These discrepancies underscore the need for transparency and reproducibility to be at the forefront of researcherstextquoteright priorities, especially during a global health crisis when stakes are critically high.}, keywords = {}, pubstate = {published}, tppubtype = {article} } As the COVID-19 pandemic has caused major societal unrest, modelers have worked to project future trends of COVID-19 and predict upcoming challenges and impacts of policy action. These models, alone or in aggregate, are influential for decision-makers at every level. Therefore, the method and documentation of COVID-19 models must be highly transparent to ensure that projections and consequential policies put forth have sound epistemological grounds. We evaluated 29 COVID-19 models receiving high attention levels within the scientific community and/or informing government responses. We evaluated these models against 27 transparency criteria. We found high levels of transparency in model documentation aspects such as reporting uncertainty analysis; however, about half of the models do not share code and a quarter do not report equations. These discrepancies underscore the need for transparency and reproducibility to be at the forefront of researcherstextquoteright priorities, especially during a global health crisis when stakes are critically high. |
 | Jalali, Mohammad S; Landman, Adam; Gordon, William J Telemedicine, Privacy, and Information Security in the Age of COVID-19 Journal Article Journal of the American Medical Informatics Association, 2020. @article{655528, title = {Telemedicine, Privacy, and Information Security in the Age of COVID-19}, author = {Mohammad S Jalali and Adam Landman and William J Gordon}, url = {https://scholar.harvard.edu/files/jalali/files/telemedicine_privacy_and_information_security_preprint.pdf}, year = {2020}, date = {2020-01-01}, journal = {Journal of the American Medical Informatics Association}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
 | Jalali, Mohammad S; Botticelli, Michael; Hwang, Rachael; Koh, Howard K; McHugh, Kathryn R The opioid crisis: need for systems science research Journal Article Health Research Policy and Systems, 18 (88), 2020. @article{661337, title = {The opioid crisis: need for systems science research}, author = {Mohammad S Jalali and Michael Botticelli and Rachael Hwang and Howard K Koh and Kathryn R McHugh}, url = {https://scholar.harvard.edu/files/jalali/files/opioid_crisis_systems_science.pdf}, year = {2020}, date = {2020-01-01}, journal = {Health Research Policy and Systems}, volume = {18}, number = {88}, abstract = {The opioid epidemic in the United States has had a devastating impact on millions of people as well as on their families and communities. The increased prevalence of opioid misuse, use disorder and overdose in recent years has highlighted the need for improved public health approaches for reducing the tremendous harms of this illness. In this paper, we explain and call for the need for more systems science approaches, which can uncover the complexities of the opioid crisis, and help evaluate, analyse and forecast the effectiveness of ongoing and new policy interventions. Similar to how a stream of systems science research helped policy development in infectious diseases and obesity, more systems science research is needed in opioids.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The opioid epidemic in the United States has had a devastating impact on millions of people as well as on their families and communities. The increased prevalence of opioid misuse, use disorder and overdose in recent years has highlighted the need for improved public health approaches for reducing the tremendous harms of this illness. In this paper, we explain and call for the need for more systems science approaches, which can uncover the complexities of the opioid crisis, and help evaluate, analyse and forecast the effectiveness of ongoing and new policy interventions. Similar to how a stream of systems science research helped policy development in infectious diseases and obesity, more systems science research is needed in opioids. |
 | Toumi, Asmae; DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S; Gazelle, Scott G; Chhatwal, Jagpreet; Kelz, Rachel R; Lubitz, Carrie C Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018 Journal Article Thyroid, 2020. @article{667452, title = {Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018}, author = {Asmae Toumi and Catherine DiGennaro and Vahab Vahdat and Mohammad S Jalali and Scott G Gazelle and Jagpreet Chhatwal and Rachel R Kelz and Carrie C Lubitz}, year = {2020}, date = {2020-01-01}, journal = {Thyroid}, abstract = {Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBMtextregistered MarketScantextregistered Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBMtextregistered MarketScantextregistered Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease. |
2019 |
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 | Jalali, Mohammad S; Kaiser, Jessica P; Siegel, Michael; Madnick, Stuart The Internet of Things Promises New Benefits and Risks: A Systematic Analysis of Adoption Dynamics of IoT Products Journal Article IEEE Security and privacy, 17 (2), pp. 39-48, 2019. @article{631218, title = {The Internet of Things Promises New Benefits and Risks: A Systematic Analysis of Adoption Dynamics of IoT Products}, author = {Mohammad S Jalali and Jessica P Kaiser and Michael Siegel and Stuart Madnick}, url = {https://scholar.harvard.edu/files/jalali/files/adoption_dynamics_of_iot_products.pdf}, year = {2019}, date = {2019-01-01}, journal = {IEEE Security and privacy}, volume = {17}, number = {2}, pages = {39-48}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
| Jalali, Mohammad S; Razak, Sabina; Gordon, William; Perakslis, Eric; Madnick, Stuart Health Care and Cybersecurity: Bibliometric Analysis of the Literature Journal Article Journal of Medical Internet Research, 21 (2), pp. e12644, 2019. @article{631228, title = {Health Care and Cybersecurity: Bibliometric Analysis of the Literature}, author = {Mohammad S Jalali and Sabina Razak and William Gordon and Eric Perakslis and Stuart Madnick}, url = {https://scholar.harvard.edu/files/jalali/files/cybersecurity_in_healthcare.pdf}, year = {2019}, date = {2019-01-01}, journal = {Journal of Medical Internet Research}, volume = {21}, number = {2}, pages = {e12644}, abstract = {Background: Over the past decade, clinical care has become globally dependent on information technology. The cybersecurity of health care information systems is now an essential component of safe, reliable, and effective health care delivery.Objective: The objective of this study was to provide an overview of the literature at the intersection of cybersecurity and health care delivery.Methods: A comprehensive search was conducted using PubMed and Web of Science for English-language peer-reviewed articles. We carried out chronological analysis, domain clustering analysis, and text analysis of the included articles to generate a high-level concept map composed of specific words and the connections between them.Results: Our final sample included 472 English-language journal articles. Our review results revealed that majority of the articles were focused on technology: Technology–focused articles made up more than half of all the clusters, whereas managerial articles accounted for only 32% of all clusters. This finding suggests that nontechnological variables (human–based and organizational aspects, strategy, and management) may be understudied. In addition, Software Development Security, Business Continuity, and Disaster Recovery Planning each accounted for 3% of the studied articles. Our results also showed that publications on Physical Security account for only 1% of the literature, and research in this area is lacking. Cyber vulnerabilities are not all digital; many physical threats contribute to breaches and potentially affect the physical safety of patients.Conclusions: Our results revealed an overall increase in research on cybersecurity and identified major gaps and opportunities for future work.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Over the past decade, clinical care has become globally dependent on information technology. The cybersecurity of health care information systems is now an essential component of safe, reliable, and effective health care delivery.Objective: The objective of this study was to provide an overview of the literature at the intersection of cybersecurity and health care delivery.Methods: A comprehensive search was conducted using PubMed and Web of Science for English-language peer-reviewed articles. We carried out chronological analysis, domain clustering analysis, and text analysis of the included articles to generate a high-level concept map composed of specific words and the connections between them.Results: Our final sample included 472 English-language journal articles. Our review results revealed that majority of the articles were focused on technology: Technology–focused articles made up more than half of all the clusters, whereas managerial articles accounted for only 32% of all clusters. This finding suggests that nontechnological variables (human–based and organizational aspects, strategy, and management) may be understudied. In addition, Software Development Security, Business Continuity, and Disaster Recovery Planning each accounted for 3% of the studied articles. Our results also showed that publications on Physical Security account for only 1% of the literature, and research in this area is lacking. Cyber vulnerabilities are not all digital; many physical threats contribute to breaches and potentially affect the physical safety of patients.Conclusions: Our results revealed an overall increase in research on cybersecurity and identified major gaps and opportunities for future work. |
 | Jalali, Mohammad S; Rahmandad, Hazhir; Bullock, Sally Lawrence; Lee-Kwan, Seung Hee; Gittelsohn, Joel; Ammerman, Alice Dynamics of intervention adoption, implementation, and maintenance inside organizations: The case of an obesity prevention initiative Journal Article Social Science & Medicine, 224 , pp. 67-76, 2019. @article{631231, title = {Dynamics of intervention adoption, implementation, and maintenance inside organizations: The case of an obesity prevention initiative}, author = {Mohammad S Jalali and Hazhir Rahmandad and Sally Lawrence Bullock and Seung Hee Lee-Kwan and Joel Gittelsohn and Alice Ammerman}, url = {https://scholar.harvard.edu/files/jalali/files/dynamics_of_intervention_adoption.pdf, dynamics of intervention adoption.pdf https://scholar.harvard.edu/files/jalali/files/vensimfiles.zip, Vensim Files}, year = {2019}, date = {2019-01-01}, journal = {Social Science & Medicine}, volume = {224}, pages = {67-76}, abstract = {Overall impact of public health prevention interventions relies not only on the average efficacy of an intervention, but also on the successful adoption, implementation, and maintenance (AIM) of that intervention. In this study, we aim to understand the dynamics that regulate AIM of organizational level intervention programs. We focus on two well-documented obesity prevention interventions, implemented in food carry-outs and stores in low-income urban areas of Baltimore, Maryland, which aimed to improve dietary behaviour for adults by providing access to healthier foods and point-of-purchase promotions. Building on data from field observations, in-depth interviews, and data discussed in previous publications, as well as the strategy and organizational behaviour literature, we developed a system dynamics model of the key processes of AIM. With simulation analysis, we show several reinforcing mechanisms that span stakeholder motivation, communications, and implementation quality and costs can turn small changes in the process of AIM into big difference in the overall impact of the intervention. Specifically, small changes in the allocation of resources to communication with stakeholders of intervention could have a nonlinear long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the erosion rates and enhancing sustainability. We present how the dynamics surrounding communication, motivation, and erosion can create significant heterogeneity in the overall impact of otherwise similar interventions. Therefore, careful monitoring of how those dynamics unfold, and timely adjustments to keep the intervention on track are critical for successful implementation and maintenance.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Overall impact of public health prevention interventions relies not only on the average efficacy of an intervention, but also on the successful adoption, implementation, and maintenance (AIM) of that intervention. In this study, we aim to understand the dynamics that regulate AIM of organizational level intervention programs. We focus on two well-documented obesity prevention interventions, implemented in food carry-outs and stores in low-income urban areas of Baltimore, Maryland, which aimed to improve dietary behaviour for adults by providing access to healthier foods and point-of-purchase promotions. Building on data from field observations, in-depth interviews, and data discussed in previous publications, as well as the strategy and organizational behaviour literature, we developed a system dynamics model of the key processes of AIM. With simulation analysis, we show several reinforcing mechanisms that span stakeholder motivation, communications, and implementation quality and costs can turn small changes in the process of AIM into big difference in the overall impact of the intervention. Specifically, small changes in the allocation of resources to communication with stakeholders of intervention could have a nonlinear long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the erosion rates and enhancing sustainability. We present how the dynamics surrounding communication, motivation, and erosion can create significant heterogeneity in the overall impact of otherwise similar interventions. Therefore, careful monitoring of how those dynamics unfold, and timely adjustments to keep the intervention on track are critical for successful implementation and maintenance. |
 | Namin, Amir T; Jalali, Mohammad S; Vahdat, Vahab; Bedair, Hany S; O'Connor, Mary I; Kamarthi, Sagar; Isaacs, Jacqueline A The Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants Journal Article Value in Health, 22 (4), pp. 423-430, 2019. @article{631232, title = {The Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants}, author = {Amir T Namin and Mohammad S Jalali and Vahab Vahdat and Hany S Bedair and Mary I O'Connor and Sagar Kamarthi and Jacqueline A Isaacs}, url = {https://scholar.harvard.edu/files/jalali/files/theadoptionofnewmedicaltechnologies.pdf https://scholar.harvard.edu/files/jalali/files/supporting_information.pdf https://scholar.harvard.edu/files/jalali/files/modeling_documentation_and_instruction_for_reproducibility_mdir.pdf}, year = {2019}, date = {2019-01-01}, journal = {Value in Health}, volume = {22}, number = {4}, pages = {423-430}, abstract = {Objectives: To investigate the impact of insurance coverage on the adoption of customized individually made (CIM) knee implants, and to compare patient outcomes and cost-effectiveness of off-the-shelf (OTS) and CIM implants.Study Design: A system dynamics simulation model is developed to study adoption dynamics of CIM and meet the research objectives.Methods: The model reproduced the historical data on primary and revision knee replacement implants obtained from the literature and the Nationwide Inpatient Sample. Then, the dynamics of adoption of CIM implants were simulated from 2018 to 2026. The rate of 90-day readmission, 3-year revision surgery, recovery period, time savings in operating rooms, and the associated cost within three years of primary knee replacement implants were used as performance metrics.Results: The simulation results indicate that, by 2026, an adoption rate of 90% for CIM implants can reduce the number of readmissions and revision surgeries by 62% and 39%, respectively, and can save hospitals and surgeons 6% on procedure time, and cut down cumulative healthcare costs by approximately $38 billion.Conclusions: CIM implants have the potential to deliver high-quality care while decreasing overall healthcare costs, but their adoption requires the expansion of current insurance coverage. This work presents a first systematic study to understand the dynamics of adoption of CIM knee implants and instrumentation. More broadly, the current modeling approach and systems thinking perspective could be utilized to consider the adoption of any emerging customized therapies for personalized medicine.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives: To investigate the impact of insurance coverage on the adoption of customized individually made (CIM) knee implants, and to compare patient outcomes and cost-effectiveness of off-the-shelf (OTS) and CIM implants.Study Design: A system dynamics simulation model is developed to study adoption dynamics of CIM and meet the research objectives.Methods: The model reproduced the historical data on primary and revision knee replacement implants obtained from the literature and the Nationwide Inpatient Sample. Then, the dynamics of adoption of CIM implants were simulated from 2018 to 2026. The rate of 90-day readmission, 3-year revision surgery, recovery period, time savings in operating rooms, and the associated cost within three years of primary knee replacement implants were used as performance metrics.Results: The simulation results indicate that, by 2026, an adoption rate of 90% for CIM implants can reduce the number of readmissions and revision surgeries by 62% and 39%, respectively, and can save hospitals and surgeons 6% on procedure time, and cut down cumulative healthcare costs by approximately $38 billion.Conclusions: CIM implants have the potential to deliver high-quality care while decreasing overall healthcare costs, but their adoption requires the expansion of current insurance coverage. This work presents a first systematic study to understand the dynamics of adoption of CIM knee implants and instrumentation. More broadly, the current modeling approach and systems thinking perspective could be utilized to consider the adoption of any emerging customized therapies for personalized medicine. |
2018 |
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 | Hosseinichimeh, Niyousha; Wittenborn, Andrea K; Rick, Jennifer; Jalali, Mohammad S; Rahmandad, Hazhir Modeling and Estimating the Feedback Mechanisms among Depression, Rumination, and Stressors in Adolescents Journal Article PLOS ONE, 13 (9), pp. e0204389, 2018. @article{631225, title = {Modeling and Estimating the Feedback Mechanisms among Depression, Rumination, and Stressors in Adolescents}, author = {Niyousha Hosseinichimeh and Andrea K Wittenborn and Jennifer Rick and Mohammad S Jalali and Hazhir Rahmandad}, url = {https://scholar.harvard.edu/files/jalali/files/modeling_depression.pdf}, year = {2018}, date = {2018-01-01}, journal = {PLOS ONE}, volume = {13}, number = {9}, pages = {e0204389}, abstract = {The systemic interactions among depressive symptoms, rumination, and stress are important to understanding depression but have not yet been quantified. In this article, we present a system dynamics simulation model of depression that captures the reciprocal relationships among stressors, rumination, and depression. Building on the response styles theory, this model formalizes three interdependent mechanisms: 1) Rumination contributes to textquoteleftkeeping stressors alivetextquoteright; 2) Rumination has a direct impact on depressive symptoms; and 3) Both textquoteleftstressors kept alivetextquoteright and current depressive symptoms contribute to rumination. The strength of these mechanisms is estimated using data from 661 adolescents (353 girls and 308 boys) from two middle schools (grades 6–8). These estimates indicate that rumination contributes to depression by keeping stressors textquoteleftalivetextquoteright—and the individual activated—even after the stressor has ended. This mechanism is stronger among girls than boys, increasing their vulnerability to a rumination reinforcing loop. Different profiles of depression emerge over time depending on initial levels of depressive symptoms, rumination, and stressors as well as the occurrence rate for stressors; levels of rumination and occurrence of stressors are stronger contributors to long-term depression. Our systems model is a steppingstone towards a more comprehensive understanding of depression in which reinforcing feedback mechanisms play a significant role. Future research is needed to expand this simulation model to incorporate other drivers of depression and provide a more holistic tool for studying depression.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The systemic interactions among depressive symptoms, rumination, and stress are important to understanding depression but have not yet been quantified. In this article, we present a system dynamics simulation model of depression that captures the reciprocal relationships among stressors, rumination, and depression. Building on the response styles theory, this model formalizes three interdependent mechanisms: 1) Rumination contributes to textquoteleftkeeping stressors alivetextquoteright; 2) Rumination has a direct impact on depressive symptoms; and 3) Both textquoteleftstressors kept alivetextquoteright and current depressive symptoms contribute to rumination. The strength of these mechanisms is estimated using data from 661 adolescents (353 girls and 308 boys) from two middle schools (grades 6–8). These estimates indicate that rumination contributes to depression by keeping stressors textquoteleftalivetextquoteright—and the individual activated—even after the stressor has ended. This mechanism is stronger among girls than boys, increasing their vulnerability to a rumination reinforcing loop. Different profiles of depression emerge over time depending on initial levels of depressive symptoms, rumination, and stressors as well as the occurrence rate for stressors; levels of rumination and occurrence of stressors are stronger contributors to long-term depression. Our systems model is a steppingstone towards a more comprehensive understanding of depression in which reinforcing feedback mechanisms play a significant role. Future research is needed to expand this simulation model to incorporate other drivers of depression and provide a more holistic tool for studying depression. |
 | Ghaffarzadegan, Navid; Larson, Richard C; Fingerhut, Henry; Jalali, Mohammad S; Ebrahimvandi, Alireza; Quaadgras, Anne; Kochan, Thomas Model-Based Policy Analysis to Mitigate Post-Traumatic Stress Disorder Book Chapter Policy Analytics, Modelling, and Informatics, 24 , pp. 387-406, Springer, 2018. @inbook{631224, title = {Model-Based Policy Analysis to Mitigate Post-Traumatic Stress Disorder}, author = {Navid Ghaffarzadegan and Richard C Larson and Henry Fingerhut and Mohammad S Jalali and Alireza Ebrahimvandi and Anne Quaadgras and Thomas Kochan}, url = {https://scholar.harvard.edu/files/jalali/files/ptsd_modeling_book_chapter.pdf}, year = {2018}, date = {2018-01-01}, booktitle = {Policy Analytics, Modelling, and Informatics}, volume = {24}, pages = {387-406}, publisher = {Springer}, organization = {Springer}, abstract = {A wide range of modeling methods have been used to inform health policies. In this chapter, we describe three models for understanding the complexities of post-traumatic stress disorder (PTSD), a major mental disorder. The models are: (1) a qualitative model describing the social and psychological complexities of PTSD treatment; (2) a system dynamics model of a population of PTSD patients in the military and the Department of Veterans Affairs (VA); and (3) a Monte Carlo simulation model of PTSD prevalence and clinical demand over time among the OEF/OIF population. These models have two characteristics in common. First, they take systems approaches. In all models, we set a large boundary and look at the whole system, incorporating both military personnel and veterans. Second, the models are informed by a wide range of qualitative and quantitative data. Model I is rooted in qualitative data, and models II and III are calibrated to several data sources. These models are used to analyze the effects of different policy alternatives, such as more screening, more resiliency, and better recruitment procedures, on PTSD prevalence. They also provide analysis of healthcare costs in the military and the VA for each policy. Overall, the developed models offer examples of modeling techniques that incorporate a wide range of data sources and inform policy makers in developing programs for mitigating PTSD, a major premise of policy informatics.}, keywords = {}, pubstate = {published}, tppubtype = {inbook} } A wide range of modeling methods have been used to inform health policies. In this chapter, we describe three models for understanding the complexities of post-traumatic stress disorder (PTSD), a major mental disorder. The models are: (1) a qualitative model describing the social and psychological complexities of PTSD treatment; (2) a system dynamics model of a population of PTSD patients in the military and the Department of Veterans Affairs (VA); and (3) a Monte Carlo simulation model of PTSD prevalence and clinical demand over time among the OEF/OIF population. These models have two characteristics in common. First, they take systems approaches. In all models, we set a large boundary and look at the whole system, incorporating both military personnel and veterans. Second, the models are informed by a wide range of qualitative and quantitative data. Model I is rooted in qualitative data, and models II and III are calibrated to several data sources. These models are used to analyze the effects of different policy alternatives, such as more screening, more resiliency, and better recruitment procedures, on PTSD prevalence. They also provide analysis of healthcare costs in the military and the VA for each policy. Overall, the developed models offer examples of modeling techniques that incorporate a wide range of data sources and inform policy makers in developing programs for mitigating PTSD, a major premise of policy informatics. |
 | Azghandi, Rana; Griffin, Jacqueline; Jalali, Mohammad S Minimization of Drug Shortages in Pharmaceutical Supply Chains: A Simulation-Based Analysis of Drug Recall Patterns and Inventory Policies Journal Article Complexity, pp. 1-14, 2018. @article{631223, title = {Minimization of Drug Shortages in Pharmaceutical Supply Chains: A Simulation-Based Analysis of Drug Recall Patterns and Inventory Policies}, author = {Rana Azghandi and Jacqueline Griffin and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/drug_shortage.pdf}, year = {2018}, date = {2018-01-01}, journal = {Complexity}, pages = {1-14}, abstract = {The drug shortage crisis in the last decade not only increased health care costs but also jeopardized patientstextquoteright health across the United States. Ensuring that any drug is available to patients at health care centers is a problem that official health care administrators and other stakeholders of supply chains continue to face. Furthermore, managing pharmaceutical supply chains is very complex, as inevitable disruptions occur in these supply chains (exogenous factors), which are then followed by decisions members make after such disruptions (internal factors). Disruptions may occur due to increased demand, a product recall, or a manufacturer disruption, among which product recalls—which happens frequently in pharmaceutical supply chains—are least studied. We employ a mathematical simulation model to examine the effects of product recalls considering different disruption profiles, e.g., the propagation in time and space, and the interactions of decision makers on drug shortages to ascertain how these shortages can be mitigated by changing inventory policy decisions. We also measure the effects of different policy approaches on supply chain disruptions, using two performance measures: inventory levels and shortages of products at health care centers. We then analyze the results using an approach similar to data envelopment analysis to characterize the efficient frontier (best inventory policies) for varying cost ratios of the two performance measures as they correspond to the different disruption patterns. This analysis provides insights into the consequences of choosing an inappropriate inventory policy when disruptions take place.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The drug shortage crisis in the last decade not only increased health care costs but also jeopardized patientstextquoteright health across the United States. Ensuring that any drug is available to patients at health care centers is a problem that official health care administrators and other stakeholders of supply chains continue to face. Furthermore, managing pharmaceutical supply chains is very complex, as inevitable disruptions occur in these supply chains (exogenous factors), which are then followed by decisions members make after such disruptions (internal factors). Disruptions may occur due to increased demand, a product recall, or a manufacturer disruption, among which product recalls—which happens frequently in pharmaceutical supply chains—are least studied. We employ a mathematical simulation model to examine the effects of product recalls considering different disruption profiles, e.g., the propagation in time and space, and the interactions of decision makers on drug shortages to ascertain how these shortages can be mitigated by changing inventory policy decisions. We also measure the effects of different policy approaches on supply chain disruptions, using two performance measures: inventory levels and shortages of products at health care centers. We then analyze the results using an approach similar to data envelopment analysis to characterize the efficient frontier (best inventory policies) for varying cost ratios of the two performance measures as they correspond to the different disruption patterns. This analysis provides insights into the consequences of choosing an inappropriate inventory policy when disruptions take place. |
 | Jalali, Mohammad; Russell, Bethany; Razak, Sabina; Gordon, William EARS to Cyber Incidents in Health Care Journal Article Journal of the American Medical Informatics Association, pp. 1-10, 2018. @article{631226, title = {EARS to Cyber Incidents in Health Care}, author = {Mohammad Jalali and Bethany Russell and Sabina Razak and William Gordon}, url = {https://scholar.harvard.edu/files/jalali/files/ears_framework.pdf}, year = {2018}, date = {2018-01-01}, journal = {Journal of the American Medical Informatics Association}, pages = {1-10}, abstract = {Background: Connected medical devices and electronic health records have added important functionality to patient care, but have also introduced a range of cybersecurity concerns. When a healthcare organization suffers from a cybersecurity incident, its incident response strategies are critical to the success of its recovery.Objective: In this article, we identify gaps in research concerning cybersecurity response plans in healthcare. Through a systematic literature review, we develop aggregated strategies that professionals can use to construct better response strategies in their organizations.Methods: We reviewed journal articles on cyber incident response plans in healthcare published in PubMed and Web of Science. We sought to collect articles on the intersection of cybersecurity and healthcare that focused on incident response strategies.Results: We identified and reviewed 13 articles for cybersecurity response recommendations. We then extracted information such as research methods, findings, and implications. Finally, we synthesized the recommendations into a framework of eight aggregated response strategies (EARS) that fall under managerial and technological categories.Conclusions: We conducted a systematic review of the literature on cybersecurity response plans in healthcare and developed a novel framework for response strategies that could be deployed by healthcare organizations. More work is needed to evaluate incident response strategies in healthcare.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Connected medical devices and electronic health records have added important functionality to patient care, but have also introduced a range of cybersecurity concerns. When a healthcare organization suffers from a cybersecurity incident, its incident response strategies are critical to the success of its recovery.Objective: In this article, we identify gaps in research concerning cybersecurity response plans in healthcare. Through a systematic literature review, we develop aggregated strategies that professionals can use to construct better response strategies in their organizations.Methods: We reviewed journal articles on cyber incident response plans in healthcare published in PubMed and Web of Science. We sought to collect articles on the intersection of cybersecurity and healthcare that focused on incident response strategies.Results: We identified and reviewed 13 articles for cybersecurity response recommendations. We then extracted information such as research methods, findings, and implications. Finally, we synthesized the recommendations into a framework of eight aggregated response strategies (EARS) that fall under managerial and technological categories.Conclusions: We conducted a systematic review of the literature on cybersecurity response plans in healthcare and developed a novel framework for response strategies that could be deployed by healthcare organizations. More work is needed to evaluate incident response strategies in healthcare. |
 | Jalali, Mohammad S; Siegel, Michael; Madnick, Stuart Decision-Making and Biases in Cybersecurity Capability Development: Evidence from a Simulation Game Experiment Journal Article Journal of Strategic Information Systems, 2018. @article{631229, title = {Decision-Making and Biases in Cybersecurity Capability Development: Evidence from a Simulation Game Experiment}, author = {Mohammad S Jalali and Michael Siegel and Stuart Madnick}, url = {https://scholar.harvard.edu/files/jalali/files/decision-making_in_cybersecurity.pdf}, year = {2018}, date = {2018-01-01}, journal = {Journal of Strategic Information Systems}, abstract = {We developed a simulation game to study the effectiveness of decision-makers in overcoming two complexities in building cybersecurity capabilities: potential delays in capability development; and uncertainties in predicting cyber incidents. Analyzing 1479 simulation runs, we compared the performances of a group of experienced professionals with those of an inexperienced control group. Experienced subjects did not understand the mechanisms of delays any better than inexperienced subjects; however, experienced subjects were better able to learn the need for proactive decision-making through an iterative process. Both groups exhibited similar errors when dealing with the uncertainty of cyber incidents. Our findings highlight the importance of training for decision-makers with a focus on systems thinking skills, and lay the groundwork for future research on uncovering mental biases about the complexities of cybersecurity.}, keywords = {}, pubstate = {published}, tppubtype = {article} } We developed a simulation game to study the effectiveness of decision-makers in overcoming two complexities in building cybersecurity capabilities: potential delays in capability development; and uncertainties in predicting cyber incidents. Analyzing 1479 simulation runs, we compared the performances of a group of experienced professionals with those of an inexperienced control group. Experienced subjects did not understand the mechanisms of delays any better than inexperienced subjects; however, experienced subjects were better able to learn the need for proactive decision-making through an iterative process. Both groups exhibited similar errors when dealing with the uncertainty of cyber incidents. Our findings highlight the importance of training for decision-makers with a focus on systems thinking skills, and lay the groundwork for future research on uncovering mental biases about the complexities of cybersecurity. |
| Jalali, Mohammad S; Kaiser, Jessica P Cybersecurity in Hospitals: a Systematic, Organizational Perspective Journal Article Journal of Medical Internet Research, 20 (5), pp. e10059, 2018. @article{631227, title = {Cybersecurity in Hospitals: a Systematic, Organizational Perspective}, author = {Mohammad S Jalali and Jessica P Kaiser}, url = {https://scholar.harvard.edu/files/jalali/files/cybersecurity_in_hospitals.pdf}, year = {2018}, date = {2018-01-01}, journal = {Journal of Medical Internet Research}, volume = {20}, number = {5}, pages = {e10059}, abstract = {Background: Cybersecurity incidents are a growing threat to the health care industry in general and hospitals in particular. The health care industry has lagged behind other industries in protecting its main stakeholder (ie, patients), and now hospitals must invest considerable capital and effort in protecting their systems. However, this is easier said than done because hospitals are extraordinarily technology-saturated, complex organizations with high end point complexity, internal politics, and regulatory pressures.Objective: The purpose of this study was to develop a systematic and organizational perspective for studying (1) the dynamics of cybersecurity capability development at hospitals and (2) how these internal organizational dynamics interact to form a system of hospital cybersecurity in the United States.Methods: We conducted interviews with hospital chief information officers, chief information security officers, and health care cybersecurity experts; analyzed the interview data; and developed a system dynamics model that unravels the mechanisms by which hospitals build cybersecurity capabilities. We then use simulation analysis to examine how changes to variables within the model affect the likelihood of cyberattacks across both individual hospitals and a system of hospitals.Results: We discuss several key mechanisms that hospitals use to reduce the likelihood of cybercriminal activity. The variable that most influences the risk of cyberattack in a hospital is end point complexity, followed by internal stakeholder alignment. Although resource availability is important in fueling efforts to close cybersecurity capability gaps, low levels of resources could be compensated for by setting a high target level of cybersecurity.Conclusions: To enhance cybersecurity capabilities at hospitals, the main focus of chief information officers and chief information security officers should be on reducing end point complexity and improving internal stakeholder alignment. These strategies can solve cybersecurity problems more effectively than blindly pursuing more resources. On a macro level, the cyber vulnerability of a countrytextquoterights hospital infrastructure is affected by the vulnerabilities of all individual hospitals. In this large system, reducing variation in resource availability makes the whole system less vulnerable—a few hospitals with low resources for cybersecurity threaten the entire infrastructure of health care. In other words, hospitals need to move forward together to make the industry less attractive to cybercriminals. Moreover, although compliance is essential, it does not equal security. Hospitals should set their target level of cybersecurity beyond the requirements of current regulations and policies. As of today, policies mostly address data privacy, not data security. Thus, policy makers need to introduce policies that not only raise the target level of cybersecurity capabilities but also reduce the variability in resource availability across the entire health care system.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Cybersecurity incidents are a growing threat to the health care industry in general and hospitals in particular. The health care industry has lagged behind other industries in protecting its main stakeholder (ie, patients), and now hospitals must invest considerable capital and effort in protecting their systems. However, this is easier said than done because hospitals are extraordinarily technology-saturated, complex organizations with high end point complexity, internal politics, and regulatory pressures.Objective: The purpose of this study was to develop a systematic and organizational perspective for studying (1) the dynamics of cybersecurity capability development at hospitals and (2) how these internal organizational dynamics interact to form a system of hospital cybersecurity in the United States.Methods: We conducted interviews with hospital chief information officers, chief information security officers, and health care cybersecurity experts; analyzed the interview data; and developed a system dynamics model that unravels the mechanisms by which hospitals build cybersecurity capabilities. We then use simulation analysis to examine how changes to variables within the model affect the likelihood of cyberattacks across both individual hospitals and a system of hospitals.Results: We discuss several key mechanisms that hospitals use to reduce the likelihood of cybercriminal activity. The variable that most influences the risk of cyberattack in a hospital is end point complexity, followed by internal stakeholder alignment. Although resource availability is important in fueling efforts to close cybersecurity capability gaps, low levels of resources could be compensated for by setting a high target level of cybersecurity.Conclusions: To enhance cybersecurity capabilities at hospitals, the main focus of chief information officers and chief information security officers should be on reducing end point complexity and improving internal stakeholder alignment. These strategies can solve cybersecurity problems more effectively than blindly pursuing more resources. On a macro level, the cyber vulnerability of a countrytextquoterights hospital infrastructure is affected by the vulnerabilities of all individual hospitals. In this large system, reducing variation in resource availability makes the whole system less vulnerable—a few hospitals with low resources for cybersecurity threaten the entire infrastructure of health care. In other words, hospitals need to move forward together to make the industry less attractive to cybercriminals. Moreover, although compliance is essential, it does not equal security. Hospitals should set their target level of cybersecurity beyond the requirements of current regulations and policies. As of today, policies mostly address data privacy, not data security. Thus, policy makers need to introduce policies that not only raise the target level of cybersecurity capabilities but also reduce the variability in resource availability across the entire health care system. |
2017 |
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 | Madnick, Stuart; Jalali, Mohammad S; Siegel, Michael; Lee, Yang; Strong, Diane; Wang, Richard; Ang, Wee Horng; Deng, Vicki; Mistree, Dinsha Measuring Stakeholders' Perceptions of Cybersecurity for Renewable Energy Systems Proceeding Springer Springer, 2017. @proceedings{631220, title = {Measuring Stakeholders' Perceptions of Cybersecurity for Renewable Energy Systems}, author = {Stuart Madnick and Mohammad S Jalali and Michael Siegel and Yang Lee and Diane Strong and Richard Wang and Wee Horng Ang and Vicki Deng and Dinsha Mistree}, year = {2017}, date = {2017-01-01}, booktitle = {Lecture Notes in Artificial Intelligence 10097}, pages = {67–77}, publisher = {Springer}, organization = {Springer}, keywords = {}, pubstate = {published}, tppubtype = {proceedings} } |
 | Rad, Armin A; Jalali, Mohammad S; Rahmandad, Hazhir How Exposure to Different Opinions Impacts the Life Cycle of Social Media Journal Article Annals of Operations Research, 268 , pp. 63–91, 2017. @article{631221, title = {How Exposure to Different Opinions Impacts the Life Cycle of Social Media}, author = {Armin A Rad and Mohammad S Jalali and Hazhir Rahmandad}, url = {https://scholar.harvard.edu/files/jalali/files/exposure_to_different_opinions.pdf}, year = {2017}, date = {2017-01-01}, journal = {Annals of Operations Research}, volume = {268}, pages = {63–91}, abstract = {As a lot of communication and media consumption moves online, people may be exposed to a wider population and more diverse opinions. However, individuals may act differently when faced with opinions far removed from their own. Moreover, changes in the frequency of visits, posting, and other forms of expression could lead to narrowing of the opinions that each person observes, as well as changes in the customer base for online platforms. Despite increasing research on the rise and fall of online social media outlets, user activity in response to exposure to otherstextquoteright opinions has received little attention. In this study, we first introduce a method that maps opinions of individuals and their generated content on a multi-dimensional space by factorizing an individual–object interaction (e.g., user-news rating) matrix. Using data on 6151 users interacting with 287,327 pieces of content over 21 months on a social media platform we estimate changes in individualstextquoteright activities in response to interaction with content expressing a variety of opinions. We find that individuals increase their online activities when interacting with content close to their own opinions, and interacting with extreme opinions may decrease their activities. Finally, developing an agent-based simulation model, we study the effect of the estimated mechanisms on the future success of a simulated platform.}, keywords = {}, pubstate = {published}, tppubtype = {article} } As a lot of communication and media consumption moves online, people may be exposed to a wider population and more diverse opinions. However, individuals may act differently when faced with opinions far removed from their own. Moreover, changes in the frequency of visits, posting, and other forms of expression could lead to narrowing of the opinions that each person observes, as well as changes in the customer base for online platforms. Despite increasing research on the rise and fall of online social media outlets, user activity in response to exposure to otherstextquoteright opinions has received little attention. In this study, we first introduce a method that maps opinions of individuals and their generated content on a multi-dimensional space by factorizing an individual–object interaction (e.g., user-news rating) matrix. Using data on 6151 users interacting with 287,327 pieces of content over 21 months on a social media platform we estimate changes in individualstextquoteright activities in response to interaction with content expressing a variety of opinions. We find that individuals increase their online activities when interacting with content close to their own opinions, and interacting with extreme opinions may decrease their activities. Finally, developing an agent-based simulation model, we study the effect of the estimated mechanisms on the future success of a simulated platform. |
| Rahmandad, Hazhir; Jalali, Mohammad S; Paynabar, Kamran A Flexible Method for Aggregation of Prior Statistical Findings Journal Article PLOS ONE, 12 , pp. e0175111, 2017, (More info about GMA). @article{631222, title = {A Flexible Method for Aggregation of Prior Statistical Findings}, author = {Hazhir Rahmandad and Mohammad S Jalali and Kamran Paynabar}, url = {https://mj-lab.mgh.harvard.edu/wordpress/research/}, year = {2017}, date = {2017-01-01}, journal = {PLOS ONE}, volume = {12}, pages = {e0175111}, abstract = {Rapid growth in scientific output requires methods for quantitative synthesis of prior research, yet current meta-analysis methods limit aggregation to studies with similar designs. Here we describe and validate Generalized Model Aggregation (GMA), which allows researchers to combine prior estimated models of a phenomenon into a quantitative meta-model, while imposing few restrictions on the structure of prior models or on the meta-model. In an empirical validation, building on 27 published equations from 16 studies, GMA provides a predictive equation for Basal Metabolic Rate that outperforms existing models, identifies novel nonlinearities, and estimates biases in various measurement methods. Additional numerical examples demonstrate the ability of GMA to obtain unbiased estimates from potentially mis-specified prior studies. Thus, in various domains, GMA can leverage previous findings to compare alternative theories, advance new models, and assess the reliability of prior studies, extending meta-analysis toolbox to many new problems.}, note = {More info about GMA}, keywords = {}, pubstate = {published}, tppubtype = {article} } Rapid growth in scientific output requires methods for quantitative synthesis of prior research, yet current meta-analysis methods limit aggregation to studies with similar designs. Here we describe and validate Generalized Model Aggregation (GMA), which allows researchers to combine prior estimated models of a phenomenon into a quantitative meta-model, while imposing few restrictions on the structure of prior models or on the meta-model. In an empirical validation, building on 27 published equations from 16 studies, GMA provides a predictive equation for Basal Metabolic Rate that outperforms existing models, identifies novel nonlinearities, and estimates biases in various measurement methods. Additional numerical examples demonstrate the ability of GMA to obtain unbiased estimates from potentially mis-specified prior studies. Thus, in various domains, GMA can leverage previous findings to compare alternative theories, advance new models, and assess the reliability of prior studies, extending meta-analysis toolbox to many new problems. |
 | Songhori, Mohsen Jafari; Jalali, Mohammad S; Terano, Takao The Effects of Teams' Initial Characterizations of Interactions on Product Development Performance Proceeding IEEE, 2017. @proceedings{631217, title = {The Effects of Teams' Initial Characterizations of Interactions on Product Development Performance}, author = {Mohsen Jafari Songhori and Mohammad S Jalali and Takao Terano}, year = {2017}, date = {2017-01-01}, journal = {Winter Simulation Conference}, publisher = {IEEE}, keywords = {}, pubstate = {published}, tppubtype = {proceedings} } |
 | Jalali, Mohammad S; Rahmandad, Hazhir; Bullock, Sally Lawrence; Ammerman, Alice Dynamics of Implementation and Maintenance of Organizational Health Interventions Journal Article Int. J. Environ. Res. Public Health, 14 , pp. 917, 2017. @article{631219, title = {Dynamics of Implementation and Maintenance of Organizational Health Interventions}, author = {Mohammad S Jalali and Hazhir Rahmandad and Sally Lawrence Bullock and Alice Ammerman}, url = {https://scholar.harvard.edu/files/jalali/files/dynamics_of_implementation.pdf}, year = {2017}, date = {2017-01-01}, journal = {Int. J. Environ. Res. Public Health}, volume = {14}, pages = {917}, abstract = {In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes. }, keywords = {}, pubstate = {published}, tppubtype = {article} } In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes. |
2016 |
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 | Jalali, MS; Sharafi-Avarzaman, Z; Rahmandad, H; Ammerman, A S Social influence in childhood obesity interventions: a systematic review Journal Article Obesity Reviews, 17 , pp. 820-832, 2016. @article{631216, title = {Social influence in childhood obesity interventions: a systematic review}, author = {MS Jalali and Z Sharafi-Avarzaman and H Rahmandad and A S Ammerman}, url = {https://scholar.harvard.edu/files/jalali/files/social_influence_in_childhood_obesity_interventions.pdf}, year = {2016}, date = {2016-01-01}, journal = {Obesity Reviews}, volume = {17}, pages = {820-832}, abstract = {The objective of this study is to understand the pathways through which social influence at the family level moderates the impact of childhood obesity interventions. We conducted a systematic review of obesity interventions in which parentstextquoteright behaviours are targeted to change childrentextquoterights obesity outcomes, because of the potential social and environmental influence of parents on the nutrition and physical activity behaviours of children. PubMed (1966-2013) and the Web of Science (1900-2013) were searched, and 32 studies satisfied our inclusion criteria. Results for existing mechanisms that moderate parentstextquoteright influence on childrentextquoterights behaviour are discussed, and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations for leveraging family-based social influence mechanisms to increase the efficacy of obesity intervention programmes.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The objective of this study is to understand the pathways through which social influence at the family level moderates the impact of childhood obesity interventions. We conducted a systematic review of obesity interventions in which parentstextquoteright behaviours are targeted to change childrentextquoterights obesity outcomes, because of the potential social and environmental influence of parents on the nutrition and physical activity behaviours of children. PubMed (1966-2013) and the Web of Science (1900-2013) were searched, and 32 studies satisfied our inclusion criteria. Results for existing mechanisms that moderate parentstextquoteright influence on childrentextquoterights behaviour are discussed, and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations for leveraging family-based social influence mechanisms to increase the efficacy of obesity intervention programmes. |
 | Hashmi, Sahar; D'Ambrosio, Lisa; Diamond, David V; Jalali, Mohammad S; Finkelstein, Stan N; Larson, Richard C Preventive behaviors and perceptions of influenza vaccination among a university student population Journal Article Journal of Public Health, 38 (4), pp. 739–745, 2016. @article{631214, title = {Preventive behaviors and perceptions of influenza vaccination among a university student population}, author = {Sahar Hashmi and Lisa D'Ambrosio and David V Diamond and Mohammad S Jalali and Stan N Finkelstein and Richard C Larson}, url = {https://scholar.harvard.edu/files/jalali/files/preventive_behaviors_and_perceptions_of_vaccination.pdf}, year = {2016}, date = {2016-01-01}, journal = {Journal of Public Health}, volume = {38}, number = {4}, pages = {739–745}, abstract = {Background: Every year during influenza season, preventable illnesses occur due to lack of vaccination and failure to adopt the preventive behaviors known as non-pharmaceutical interventions (NPIs). In an effort to study the impact of preventive strategies and policies on behavioral changes during the spread of the H1N1 pandemic in 2009, we examined a sample of undergraduate, graduate and business students at the Massachusetts Institute of Technology (MIT).Methods: An online survey was completed by 653 students to assess NPI use, perceptions of influenza vaccinations and effectiveness of preventive health policy strategies during the 2009 H1N1 outbreak. Strategies included e-mails and text messages, posters in corridors and restrooms, and videos. These strategies were implemented during both the first and second waves of the 2009 H1N1 pandemic.Results: Despite the widespread campaign, fewer than half of the respondents reported modifying their behaviors. We discovered that >70% of the respondents did not practice any NPIs, and more than half showed lack of knowledge of flu vaccinations.Conclusions: Our study results indicate a need for more effective strategies to encourage NPI practices in student populations during outbreaks of infection.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background: Every year during influenza season, preventable illnesses occur due to lack of vaccination and failure to adopt the preventive behaviors known as non-pharmaceutical interventions (NPIs). In an effort to study the impact of preventive strategies and policies on behavioral changes during the spread of the H1N1 pandemic in 2009, we examined a sample of undergraduate, graduate and business students at the Massachusetts Institute of Technology (MIT).Methods: An online survey was completed by 653 students to assess NPI use, perceptions of influenza vaccinations and effectiveness of preventive health policy strategies during the 2009 H1N1 outbreak. Strategies included e-mails and text messages, posters in corridors and restrooms, and videos. These strategies were implemented during both the first and second waves of the 2009 H1N1 pandemic.Results: Despite the widespread campaign, fewer than half of the respondents reported modifying their behaviors. We discovered that >70% of the respondents did not practice any NPIs, and more than half showed lack of knowledge of flu vaccinations.Conclusions: Our study results indicate a need for more effective strategies to encourage NPI practices in student populations during outbreaks of infection. |
 | Hosseinichimeh, Niyousha; Rahmandad, Hazhir; Jalali, Mohammad S; Wittenborn, Andrea K Estimating the parameters of system dynamics models using indirect inference Journal Article System Dynamics Review, 32 , pp. 156-180, 2016, ISBN: 0883-7066. @article{631215, title = {Estimating the parameters of system dynamics models using indirect inference}, author = {Niyousha Hosseinichimeh and Hazhir Rahmandad and Mohammad S Jalali and Andrea K Wittenborn}, url = {https://scholar.harvard.edu/files/jalali/files/parameter_estimation_using_indirect_inference.pdf}, isbn = {0883-7066}, year = {2016}, date = {2016-01-01}, journal = {System Dynamics Review}, volume = {32}, pages = {156-180}, abstract = {There is limited methodological guidance for estimating system dynamics (SD) models using datasets common to social sciences that include few data points over time for many units under analysis. Here, we introduce indirect inference, a simulation-based estimation method that can be applied to common datasets and is applicable to SD models that often include intractable likelihood functions. In this method, the model parameters are found by ensuring that simulated data from the model and available empirical data produce similar auxiliary statistics. The method requires few assumptions about the structure of the model and error-generating processes and thus can be used in a variety of applications. We demonstrate the method in estimating an SD model of depression and rumination using a panel dataset. The overall results suggest that indirect inference can extend the application of SD models to new topics and leverage common panel datasets to provide unique insights.}, keywords = {}, pubstate = {published}, tppubtype = {article} } There is limited methodological guidance for estimating system dynamics (SD) models using datasets common to social sciences that include few data points over time for many units under analysis. Here, we introduce indirect inference, a simulation-based estimation method that can be applied to common datasets and is applicable to SD models that often include intractable likelihood functions. In this method, the model parameters are found by ensuring that simulated data from the model and available empirical data produce similar auxiliary statistics. The method requires few assumptions about the structure of the model and error-generating processes and thus can be used in a variety of applications. We demonstrate the method in estimating an SD model of depression and rumination using a panel dataset. The overall results suggest that indirect inference can extend the application of SD models to new topics and leverage common panel datasets to provide unique insights. |
| Ghaffarzadegan, Navid; Ebrahimvandi, Alireza; Jalali, Mohammad S A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans Journal Article PLOS ONE, 11 , pp. e0161405, 2016. @article{631213, title = {A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans}, author = {Navid Ghaffarzadegan and Alireza Ebrahimvandi and Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/a_dynamic_model_for_ptsd.pdf}, year = {2016}, date = {2016-01-01}, journal = {PLOS ONE}, volume = {11}, pages = {e0161405}, abstract = {Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a textquotedblleftsystem of systems.textquotedblright This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a textquotedblleftsystem of systems.textquotedblright This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed. |
2015 |
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 | Jalali, Mohammad S; Rahmandad, Hazhir; Ghoddusi, Hamed Using the method of simulated moments for system identification Book Chapter pp. 39-69, 2015. @inbook{631211, title = {Using the method of simulated moments for system identification}, author = {Mohammad S Jalali and Hazhir Rahmandad and Hamed Ghoddusi}, url = {https://scholar.harvard.edu/files/jalali/files/msm_book_chapter.pdf}, year = {2015}, date = {2015-01-01}, journal = {Analytical Methods for Dynamic Modelers}, pages = {39-69}, keywords = {}, pubstate = {published}, tppubtype = {inbook} } |
 | Jalali, Mohammad S; Ashouri, Armin; Herrera-Restrepo, Oscar; Zhang, Hui Information diffusion through social networks: The case of an online petition Journal Article Expert Systems with Applications, 44 , pp. 187–197, 2015. @article{631210, title = {Information diffusion through social networks: The case of an online petition}, author = {Mohammad S Jalali and Armin Ashouri and Oscar Herrera-Restrepo and Hui Zhang}, url = {https://scholar.harvard.edu/files/jalali/files/information_diffusion.pdf}, year = {2015}, date = {2015-01-01}, journal = {Expert Systems with Applications}, volume = {44}, pages = {187–197}, abstract = {People regularly use online social networks due to their convenience, efficiency, and significant broadcasting power for sharing information. However, the diffusion of information in online social networks is a complex and dynamic process. In this research, we used a case study to examine the diffusion process of an online petition. The spread of petitions in social networks raises various theoretical and practical questions: What is the diffusion rate? What actions can initiators take to speed up the diffusion rate? How does the behavior of sharing between friends influence the diffusion process? How does the number of signatures change over time? In order to address these questions, we used system dynamics modeling to specify and quantify the core mechanisms of petition diffusion online; based on empirical data, we then estimated the resulting dynamic model. The modeling approach provides potential practical insights for those interested in designing petitions and collecting signatures. Model testing and calibration approaches (including the use of empirical methods such as maximum-likelihood estimation, the Akaike information criterion, and likelihood ratio tests) provide additional potential practices for dynamic modelers. Our analysis provides information on the relative strength of push (i.e., sending announcements) and pull (i.e., sharing by signatories) processes and insights about awareness, interest, sharing, reminders, and forgetting mechanisms. Comparing push and pull processes, we found that diffusion is largely a pull process rather than a push process. Moreover, comparing different scenarios, we found that targeting the right population is a potential driver in spreading information (i.e., getting more signatures), such that small investments in targeting the appropriate people have textquoteleftdisproportionatetextquoteright effects in increasing the total number of signatures. The model is fully documented for further development and replications.}, keywords = {}, pubstate = {published}, tppubtype = {article} } People regularly use online social networks due to their convenience, efficiency, and significant broadcasting power for sharing information. However, the diffusion of information in online social networks is a complex and dynamic process. In this research, we used a case study to examine the diffusion process of an online petition. The spread of petitions in social networks raises various theoretical and practical questions: What is the diffusion rate? What actions can initiators take to speed up the diffusion rate? How does the behavior of sharing between friends influence the diffusion process? How does the number of signatures change over time? In order to address these questions, we used system dynamics modeling to specify and quantify the core mechanisms of petition diffusion online; based on empirical data, we then estimated the resulting dynamic model. The modeling approach provides potential practical insights for those interested in designing petitions and collecting signatures. Model testing and calibration approaches (including the use of empirical methods such as maximum-likelihood estimation, the Akaike information criterion, and likelihood ratio tests) provide additional potential practices for dynamic modelers. Our analysis provides information on the relative strength of push (i.e., sending announcements) and pull (i.e., sharing by signatories) processes and insights about awareness, interest, sharing, reminders, and forgetting mechanisms. Comparing push and pull processes, we found that diffusion is largely a pull process rather than a push process. Moreover, comparing different scenarios, we found that targeting the right population is a potential driver in spreading information (i.e., getting more signatures), such that small investments in targeting the appropriate people have textquoteleftdisproportionatetextquoteright effects in increasing the total number of signatures. The model is fully documented for further development and replications. |
2014 |
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 | Abdel-Hamid, Tarek; Ankel, Felix; Battle-Fisher, Michele; Gibson, Bryan; Gonzalez-Parra, Gilberto; Jalali, Mohammad; Kaipainen, Kirsikka; Kalupahana, Nishan; Karanfil, Ozge; Marathe, Achla Public and health-professionals' misconceptions about the dynamics of body weight gain/loss Journal Article System Dynamics Review, 30 (1-2), pp. 58–74, 2014. @article{631207, title = {Public and health-professionals' misconceptions about the dynamics of body weight gain/loss}, author = {Tarek Abdel-Hamid and Felix Ankel and Michele Battle-Fisher and Bryan Gibson and Gilberto Gonzalez-Parra and Mohammad Jalali and Kirsikka Kaipainen and Nishan Kalupahana and Ozge Karanfil and Achla Marathe}, url = {https://scholar.harvard.edu/files/jalali/files/misconceptions_about_obesity.pdf}, year = {2014}, date = {2014-01-01}, journal = {System Dynamics Review}, volume = {30}, number = {1-2}, pages = {58–74}, abstract = {Human body energy storage operates as a stock-and-flow system with inflow (food intake) and outflow (energy expenditure). In spite of the ubiquity of stock-and-flow structures, evidence suggests that human beings fail to understand stock accumulation and rates of change, a difficulty called the stock–flow failure. This study examines the influence of health care training and cultural background in overcoming stock–flow failure. A standardized protocol assessed lay peopletextquoterights and health care professionalstextquoteright ability to apply stock-and-flow reasoning to infer the dynamics of weight gain/loss during the holiday season (621 subjects from seven countries). Our results indicate that both types of subjects exhibited systematic errors indicative of use of erroneous heuristics. Indeed 76% of lay subjects and 71% of health care professionals failed to understand the simple dynamic impact of energy intake and energy expenditure on body weight. Stock–flow failure was found across cultures and was not improved by professional health training. The problem of stock–flow failure as a transcultural global issue with education and policy implications is discussed. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Human body energy storage operates as a stock-and-flow system with inflow (food intake) and outflow (energy expenditure). In spite of the ubiquity of stock-and-flow structures, evidence suggests that human beings fail to understand stock accumulation and rates of change, a difficulty called the stock–flow failure. This study examines the influence of health care training and cultural background in overcoming stock–flow failure. A standardized protocol assessed lay peopletextquoterights and health care professionalstextquoteright ability to apply stock-and-flow reasoning to infer the dynamics of weight gain/loss during the holiday season (621 subjects from seven countries). Our results indicate that both types of subjects exhibited systematic errors indicative of use of erroneous heuristics. Indeed 76% of lay subjects and 71% of health care professionals failed to understand the simple dynamic impact of energy intake and energy expenditure on body weight. Stock–flow failure was found across cultures and was not improved by professional health training. The problem of stock–flow failure as a transcultural global issue with education and policy implications is discussed. |
 | Jalali, Mohammad S How individuals weigh their previous estimates to make a new estimate in the presence or absence of social influence Book Chapter pp. 67-74, Springer, Cham, 2014. @inbook{631209, title = {How individuals weigh their previous estimates to make a new estimate in the presence or absence of social influence}, author = {Mohammad S Jalali}, url = {https://scholar.harvard.edu/files/jalali/files/social_influence_on_making_estimations.pdf}, year = {2014}, date = {2014-01-01}, journal = {International Conference on Social Computing, Behavioral-Cultural Modeling, and Prediction}, pages = {67-74}, publisher = {Springer, Cham}, abstract = {Individuals make decisions every day. How they come up with estimates to guide their decisions could be a result of a combination of different information sources such as individual beliefs and previous knowledge, random guesses, and social cues. This study aims to sort out individual estimate assessments over multiple times with the main focus on how individuals weigh their own beliefs vs. those of others in forming their future estimates. Using dynamics modeling, we build on data from an experiment conducted by Lorenz et al. [1] where 144 subjects made five estimates for six factual questions in an isolated manner (no interaction allowed between subjects). We model the dynamic mechanisms of changing estimates for two different scenarios: 1) when individuals are not exposed to any information and 2) when they are under social influence.}, keywords = {}, pubstate = {published}, tppubtype = {inbook} } Individuals make decisions every day. How they come up with estimates to guide their decisions could be a result of a combination of different information sources such as individual beliefs and previous knowledge, random guesses, and social cues. This study aims to sort out individual estimate assessments over multiple times with the main focus on how individuals weigh their own beliefs vs. those of others in forming their future estimates. Using dynamics modeling, we build on data from an experiment conducted by Lorenz et al. [1] where 144 subjects made five estimates for six factual questions in an isolated manner (no interaction allowed between subjects). We model the dynamic mechanisms of changing estimates for two different scenarios: 1) when individuals are not exposed to any information and 2) when they are under social influence. |
 | Jalali, Mohammad; Rahmandad, Hazhir; Bullock, Sally; Ammerman, Alice Dynamics of Obesity Interventions inside Organizations Proceeding System Dynamics Society, 2014. @proceedings{631208, title = {Dynamics of Obesity Interventions inside Organizations}, author = {Mohammad Jalali and Hazhir Rahmandad and Sally Bullock and Alice Ammerman}, year = {2014}, date = {2014-01-01}, journal = {The 32nd International Conference of the System Dynamics Society}, pages = {69}, publisher = {System Dynamics Society}, keywords = {}, pubstate = {published}, tppubtype = {proceedings} } |