Burden of Substance Abuse-Related Admissions to the Medical ICU

Background Admissions to the ICU related to alcohol, prescription drugs, and illicit drugs are shown to be widespread and costly. In 1993, a study revealed 28% of ICU admissions at Johns Hopkins Hospital were related to substance abuse and accrued 39% of costs. Since then, health-care expenditures have increased, and substance abuse treatment admissions have risen. We conducted a study to provide updated data on ICU utilization and costs related to licit and illicit abuse at a large county hospital in Indianapolis, Indiana. Methods All admissions to the medical ICU at Eskenazi Hospital from March to October 2017 were reviewed. Demographics, reason for admission, relation to substance abuse and specific substance, ICU and hospital length of stay, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mortality, insurance status, and hospital charges were collected based on chart review. Results A total of 611 admissions generated $74,587,280.35 in charges. A total of 25.7% of admissions related to substance abuse accounted for 23.1% of total charges. Illicit drugs were 13% of total admissions, generating 11% of charges. Alcohol-related admissions were 9.5% of total admissions, generating 7.6% of charges. Prescription drugs were 2.9% of admissions, generating 4.2% of charges. Of the substance abuse admissions, patients were generally men and 40 to 64 years of age, with longer ICU stay, higher APACHE II scores, and higher mortality. Conclusions Substance abuse admissions make up almost a one-quarter of resources used by our ICU. Patients tend to be younger and sicker with a higher risk of death. Identifying and accurately describing the landscape of this current health crisis will help us take appropriate action in the future

Association between Pitch Break on the 4-Seam Fastball and Slider and Shoulder Injury in Major League Baseball Pitchers: A Case-Control Study

Background: Few specific risk factors are known for shoulder injury in professional pitchers. New pitch-tracking data allow for risk stratification based on advanced metrics. Purpose/Hypothesis: The purpose of this study was to determine the association between shoulder injury, pitch frequency, and pitch metrics (velocity, total break, break angle, and spin rate) for the 4-seam fastball, curveball, and slider. We hypothesized that more frequent use of the 4-seam fastball would be associated with shoulder injury. Study Design: Case-control study; Level of evidence, 3. Methods: The Major League Baseball (MLB) database was queried for pitchers who had been placed on the injury list (IL) with a shoulder injury between 2015 and 2019. Injured pitchers were matched 1:1 with controls (pitchers not on the IL with a shoulder injury during the study period), based on age (±1 year), history of ulnar collateral ligament reconstruction, position (starter vs reliever), and pitches thrown during the injury season (±500). Pitch frequency, velocity, horizontal break, vertical break, total break, and spin rate for the season were collected from the Baseball Savant website for the 4-seam fastball, curveball, and slider. Univariate analysis was used to determine group differences for individual variables. Multiple logistic regression was performed to determine odds ratios (ORs) for shoulder injury associated with pitch frequency, velocity, total break, break angle, and spin rate. Covariates included age, position, ulnar collateral ligament reconstruction status, expected weighted on-base average, and total pitches thrown. Results: Overall, 233 injured pitchers were evaluated. The most common reason for IL placement was inflammation (78/233; 33.5%) followed by strain or sprain (61/233; 26.2%). Increased total pitch break was associated with an increased risk of shoulder injury for the 4-seam fastball (OR, 1.340 [95% confidence interval (CI), 1.199-1.509]; P \u3c .001) and slider (OR, 1.360 [95% CI, 1.206-1.554]; P \u3c .001). For the slider, a decreased spin rate (OR = 0.998 [95% CI, 0.997-0.999]; P = .026) and a more vertical break angle (OR = 1.170 [95% CI: 1.073-1.278]; P = .004) were associated with increased risk of injury. Conclusion: Increased pitch break of the 4-seam fastball and slider was associated positively with shoulder injury in MLB pitchers. These findings add to the understanding of throwing injury and ability to detect risk using ball-tracking technology

A Scalable and Extensible Earth System Model for Climate Change Science

The objective of this award was to build a scalable and extensible Earth System Model that can be used to study climate change science. That objective has been achieved with the public release of the Community Earth System Model, version 1 (CESM1). In particular, the development of the CESM1 atmospheric chemistry component was substantially funded by this award, as was the development of the significantly improved coupler component. The CESM1 allows new climate change science in areas such as future air quality in very large cities, the effects of recovery of the southern hemisphere ozone hole, and effects of runoff from ice melt in the Greenland and Antarctic ice sheets. Results from a whole series of future climate projections using the CESM1 are also freely available via the web from the CMIP5 archive at the Lawrence Livermore National Laboratory. Many research papers using these results have now been published, and will form part of the 5th Assessment Report of the United Nations Intergovernmental Panel on Climate Change, which is to be published late in 2013

Distance from Home to Study Clinic and Risk of Follow-Up Interruption in a Cohort of HIV-1-Discordant Couples in Nairobi, Kenya

Background: Longitudinal studies of HIV-1-infected individuals or those at risk of infection are subject to missed study visits that may have negative consequences on the care of participants and can jeopardize study validity due to bias and loss of statistical power. Distance between participant residence and study clinic, as well as other socioeconomic and demographic factors, may contribute to interruptions in patient follow-up. Methods: HIV-1-serodiscordant couples were enrolled between May 2007 and October 2009 and followed for two years in Nairobi, Kenya. At baseline, demographic and home location information was collected and linear distance from each participant’s home to the study clinic was determined. Participants were asked to return to the study clinic for quarterly visits, with follow-up interruptions (FUI) defined as missing two consecutive visits. Cox proportional hazards regression was used to assess crude and adjusted associations between FUI and home-to-clinic distance, and other baseline characteristics. Results: Of 469 enrolled couples, 64% had a female HIV-1-infected partner. Overall incidence of FUI was 13.4 per 100 person-years (PY), with lower incidence of FUI in HIV-1-infected (10.8 per 100 PY) versus -uninfected individuals (16.1 per 100 PY) (hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.50, 0.88). Among HIV-1-infected participants, those living between 5 and 10 kilometers (km) from the study clinic had a two-fold increased rate of FUI compared to those living <5 km away (HR = 2.17; 95% CI: 1.09, 4.34). Other factors associated with FUI included paying higher rent (HR = 1.67; 95% CI: 1.05, 2.65), having at least primary school education (HR = 1.96; 95% CI: 1.02, 3.70), and increased HIV-1 viral load (HR = 1.23 per log10 increase; 95% CI: 1.01, 1.51). Conclusions: Home-to-clinic distance, indicators of socioeconomic status, and markers of disease progression may affect compliance with study follow-up schedules. Retention strategies should focus on participants at greatest risk of FUI to ensure study validity

Shock Breakout from Type Ia Supernova

The mode of explosive burning in Type Ia SNe remains an outstanding problem. It is generally thought to begin as a subsonic deflagration, but this may transition into a supersonic detonation (the DDT). We argue that this transition leads to a breakout shock, which would provide the first unambiguous evidence that DDTs occur. Its main features are a hard X-ray flash (~20 keV) lasting ~0.01 s with a total radiated energy of ~10^{40} ergs, followed by a cooling tail. This creates a distinct feature in the visual light curve, which is separate from the nickel decay. This cooling tail has a maximum absolute visual magnitude of M_V = -9 to -10 at approximately 1 day, which depends most sensitively on the white dwarf radius at the time of the DDT. As the thermal diffusion wave moves in, the composition of these surface layers may be imprinted as spectral features, which would help to discern between SN Ia progenitor models. Since this feature should accompany every SNe Ia, future deep surveys (e.g., m=24) will see it out to a distance of approximately 80 Mpc, giving a maximum rate of ~60/yr. Archival data sets can also be used to study the early rise dictated by the shock heating (at about 20 days before maximum B-band light). A similar and slightly brighter event may also accompany core bounce during the accretion induced collapse to a neutron star, but with a lower occurrence rate.Comment: Submitted for publication in The Astrophysical Journal on June 12, 2009; 7 pages, 5 figure

Radioactively-Powered Rising Lightcurves of Type Ia Supernovae

The rising luminosity of the recent, nearby supernova 2011fe shows a quadratic dependence with time during the first 0.5-4 days. In addition, the composite lightcurves formed from stacking together many Type Ia supernovae (SNe Ia) show a similar power-law index of 1.8+-0.2 with time. I explore what range of power-law rises are possible due to the presence of radioactive material near the surface of the exploding white dwarf (WD). I summarize what constraints such a model places on the structure of the progenitor and the distribution and velocity of ejecta. My main conclusion is that the rise of SN 2011fe requires a mass fraction 0.03 of 56Ni (or some other heating source like 48Cr) distributed between a depth of ~0.004-0.1Msun below the WD's surface. Radioactive elements this shallow are not found in simulations of a single C/O detonation. Scenarios that may produce this material include helium-shell burning during a double-detonation ignition, a gravitationally confined detonation, and a subset of deflagration to detonation transition models. In general, the power-law rise can differ from quadratic depending on the details of the event, so comparisons of this work with observed bolometric rises of SNe Ia would place strong constraints on the distribution of shallow radioactive material, providing important clues for identifying the elusive progenitors of SNe Ia.Comment: 7 pages, 4 figures, submitted for publication in The Astrophysical Journa