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Daniel Ciccarone - One of the best experts on this subject based on the ideXlab platform.
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us regional and demographic differences in prescription opioid and heroin related overdose hospitalizations
International Journal of Drug Policy, 2017Co-Authors: George J Unick, Daniel CiccaroneAbstract:Abstract Background US opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescription opioid overdose-related (Pod) and heroin overdose-related (HOD) hospitalizations. Methods Data come from the National Inpatient Sample (NIS) for the years 2000 through 2014. Pod and HOD hospitalizations were abstracted from ICD-9 codes. Rates of Pod and HOD by census region and census division were constructed along with separate rates for age and race. Regression analysis analyzing trends across region were estimated along with graphs for documenting differences in Pod and HOD rates. Results Pod hospitalization rates were highest in the South and lowest in the Northeast. HOD hospitalization rates were highest in the Northeast region and grew the fastest in the Midwest. There was statistically significant heterogeneity in HOD trends but not Pod trends across the four regions between 2000 and 2014. Between 2012 and 2014 Pod rates decreased in eight of the nine census divisions, with only New England showing an increase. HOD hospitalization rates increased in all nine census divisions between 2012 and 2014. Both Pod and HOD rates show different demographic patterns across the nine census divisions. Conclusion Comparing Pod and HOD hospitalization trends reveals significant disparities in geographic as well as demographic distributions. These epidemics are evolving and the simple opioid-to-heroin transition story is both supported and challenged by this paper. The opioid pill, heroin and fentanyl crises are intertwined yet increasingly have drivers and outcomes that support examining them as distinct. Addressing these complex and interrelated epidemics will require innovative public health research and interventions which need to consider local and regional contexts.
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intertwined epidemics national demographic trends in hospitalizations for heroin and opioid related overdoses 1993 2009
PLOS ONE, 2013Co-Authors: George J Unick, Daniel Rosenblum, Sarah G Mars, Daniel CiccaroneAbstract:The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (Pod) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of Pod and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between Pod and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in Pod and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals Pod predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years Pod by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.
George J Unick - One of the best experts on this subject based on the ideXlab platform.
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us regional and demographic differences in prescription opioid and heroin related overdose hospitalizations
International Journal of Drug Policy, 2017Co-Authors: George J Unick, Daniel CiccaroneAbstract:Abstract Background US opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescription opioid overdose-related (Pod) and heroin overdose-related (HOD) hospitalizations. Methods Data come from the National Inpatient Sample (NIS) for the years 2000 through 2014. Pod and HOD hospitalizations were abstracted from ICD-9 codes. Rates of Pod and HOD by census region and census division were constructed along with separate rates for age and race. Regression analysis analyzing trends across region were estimated along with graphs for documenting differences in Pod and HOD rates. Results Pod hospitalization rates were highest in the South and lowest in the Northeast. HOD hospitalization rates were highest in the Northeast region and grew the fastest in the Midwest. There was statistically significant heterogeneity in HOD trends but not Pod trends across the four regions between 2000 and 2014. Between 2012 and 2014 Pod rates decreased in eight of the nine census divisions, with only New England showing an increase. HOD hospitalization rates increased in all nine census divisions between 2012 and 2014. Both Pod and HOD rates show different demographic patterns across the nine census divisions. Conclusion Comparing Pod and HOD hospitalization trends reveals significant disparities in geographic as well as demographic distributions. These epidemics are evolving and the simple opioid-to-heroin transition story is both supported and challenged by this paper. The opioid pill, heroin and fentanyl crises are intertwined yet increasingly have drivers and outcomes that support examining them as distinct. Addressing these complex and interrelated epidemics will require innovative public health research and interventions which need to consider local and regional contexts.
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intertwined epidemics national demographic trends in hospitalizations for heroin and opioid related overdoses 1993 2009
PLOS ONE, 2013Co-Authors: George J Unick, Daniel Rosenblum, Sarah G Mars, Daniel CiccaroneAbstract:The historical patterns of opiate use show that sources and methods of access greatly influence who is at risk. Today, there is evidence that an enormous increase in the availability of prescription opiates is fuelling a rise in addiction nationally, drawing in new initiates to these drugs and changing the geography of opiate overdoses. Recent efforts at supply-based reductions in prescription opiates may reduce harm, but addicted individuals may switch to other opiates such as heroin. In this analysis, we test the hypothesis that changes in the rates of Prescription Opiate Overdoses (Pod) are correlated with changes in the rate of heroin overdoses (HOD). ICD9 codes from the Nationwide Inpatient Sample and population data from the Census were used to estimate overall and demographic specific rates of Pod and HOD hospital admissions between 1993 and 2009. Regression models were used to test for linear trends and lagged negative binomial regression models were used to model the interrelationship between Pod and HOD hospital admissions. Findings show that whites, women, and middle-aged individuals had the largest increase in Pod and HOD rates over the study period and that HOD rates have increased in since 2007. The lagged models show that increases in a hospitals Pod predict an increase in the subsequent years HOD admissions by a factor of 1.26 (p<0.001) and that each increase in HOD admissions increase the subsequent years Pod by a factor of 1.57 (p<0.001). Our hypothesis of fungibility between prescription opiates and heroin was supported by these analyses. These findings suggest that focusing on supply-based interventions may simply lead to a shift in use to heroin rather minimizing the reduction in harm. The alternative approach of using drug abuse prevention resources on treatment and demand-side reduction is likely to be more productive at reducing opiate abuse related harm.
Robert C. Elston - One of the best experts on this subject based on the ideXlab platform.
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Distribution and magnitude of type I error of model‐based multipoint lod scores: implications for multipoint mod scores
Genetic Epidemiology, 2006Co-Authors: Chao Xing, Robert C. ElstonAbstract:The multipoint lod score and mod score methods have been advocated for their superior power in detecting linkage. However, little has been done to determine the distribution of multipoint lod scores or to examine the properties of mod scores. In this paper we study the distribution of multipoint lod scores both analytically and by simulation. We also study by simulation the distribution of maximum multipoint lod scores when maximized over different penetrance models. The multipoint lod score is approximately normally distributed with mean and variance that depend on marker informativity, marker density, specified genetic model, number of pedigrees, pedigree structure, and pattern of affection status. When the multipoint lod scores are maximized over a set of assumed penetrances models, an excess of false positive indications of linkage appear under dominant analysis models with low penetrances and under recessive analysis models with high penetrances. Therefore, caution should be taken in interpreting results when employing multipoint lod score and mod score approaches, in particular when inferring the level of linkage significance and the mode of inheritance of a trait. Genet. Epidemiol. 2006. © 2006 Wiley-Liss, Inc.
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Lods, wrods, and mods: The interpretation of lod scores calculated under different models
Genetic Epidemiology, 2005Co-Authors: Susan E. Hodge, Robert C. ElstonAbstract:In this paper we examine the relationships among classical lod scores, “wrod” scores (lod scores calculated under the wrong genetic model), and “mod” scores (lod scores maximized over genetic model parameters). We compare the behavior of these scores when the state of nature is linkage to their behavior when the state of nature is no linkage. We describe sufficient conditions for mod scores to be valid and discuss their use to determine the correct genetic model. We show that lod scores represent a likelihood-ratio test for independence. We explain the “ascertainment-assumption-free” aspect of using mod scores to determine mode of inheritance and we set this aspect into a well-established statistical framework. Finally, we summarize practical guidelines for the use of mod scores.
Philippe Druault - One of the best experts on this subject based on the ideXlab platform.
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About the convergence of Pod and EPod modes computed from CFD simulation
Computers and Fluids, 2011Co-Authors: Abbas Hekmati, Denis Ricot, Philippe DruaultAbstract:In most fluid mechanic applications, the dominant high energy content Pod modes are generally well converged justifying the great use of Pod to extract the associated large scale flow structures of a turbulent flow. However for particular studies related to the characterization of smaller flow structures, it is necessary to take into account high order Pod modes. In this paper based on a particular numerical database available on a finite-discrete spatio-temporal domain, the sensibility of Pod modes to both spatial discretization and independent temporal samples is highlighted as a function of integral time and space scale content. A systematic procedure is then proposed in order to verify the spatial convergence of Pod modes for a given number of points per integral space scale and per integral time scale and also for a given number of uncorrelated samples that is the number of integral time scale contained in the original signal. The convergence of Extended Pod modes is also verified by an error threshold definition that permits to avoid any misinterpretation of the results. A new extension of the EPod procedure based on the snapshot Pod technique is then proposed aiming at using only the converged EPod modes to characterize the correlated part of the signal.
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Time-Resolved PIV investigations of the flow field around cod-end net structures
Fisheries Research, 2011Co-Authors: Elkhadim Bouhoubeiny, Grégory Germain, Philippe DruaultAbstract:Flow field measurements past a fixed rigid cod-end structure and past a porous fishing net structure are conducted using Time-Resolved PIV method. The rigid cod-end is first used to characterize finely the wake flow. Proper Orthogonal Decomposition (Pod) is then applied in order to extract the large scale energetic vortices of the flow from the measured velocity field. It is then observed that the first Pod modes are associated to the Karman's type flow structure of vortex shedding. It is shown that the characteristics of the wake flow behind the rigid cod-end flow configuration compare quite well with previous ones obtained from bluff cylinder or sphere wake analyzes. Second, PIV measurements are performed around a non-rigid bottom trawl which is free to move. Preliminary analyses show that the frequencies associated with the oscillatory motion of the porous structure are the same as the ones detected in the near wake flow demonstrating the lock-in regime. It is then expected that these preliminary results provide some interesting informations about future investigations on the drag force acting on fishing net structure.
Adam M Leventhal - One of the best experts on this subject based on the ideXlab platform.
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adolescents use of Pod mod e cigarettes urgent concerns
The New England Journal of Medicine, 2018Co-Authors: Jessica L Barringtontrimis, Adam M LeventhalAbstract:Adolescents’ Use of “Pod Mod” E-Cigarettes Use of a new e-cigarette product class called “Pod mods” is rampant among young people. There is reason to be concerned that adolescents’ use of these products could bring a host of adverse health consequences to the current generation of adolescents and young adults.