Prevalence, Incremental Cost and Resource Utilization Associated with Opioid Overdoses

Background – An increase in opioid prescribing has led to an increase in opioid overdoses.1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”. Objectives – The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated with opioid overdoses in these groups. Methods – This study is a retrospective analysis using claims data from SelectHealth, a not-for-profit health insurance organization in Utah and southern Idaho. We estimated the prevalence of opioid overdoses in the sample population, as well as in each group, by year. For the cost estimation we collapsed family members and others into one category – “non-medical users”. To estimate costs we used an incremental cost approach whereby we used propensity scores to match cases (patients who suffered from an opioid overdose) to appropriate controls (patients who did not suffer from an opioid overdose) and estimated the direct medical costs incurred in each group in the year following an overdose. Generalized Linear Models were used to estimate incremental costs and resource utilization. Sensitivity analyses were conducted to measure the robustness of the estimates. Results – The prevalence of opioid overdoses increased by 84.8% in prescription opioid users (from 55.6 per 100,000 in 2011 to 102.8 per 100,000 in 2014), increased by 37.9% in family members of prescription opioid users (from 5.9 per 100,000 in 2011 to 8.2 per 100,000 in 2014) and increased by 179.9% in others (from 8.2 per 100,000 in 2011 to 23.1 per 100,000 in 2014). The prevalence of opioid overdoses in acute users increased by 14.7% (from 43.8 per 100,000 in 2011 to 50.3 per 100,000 in 2014) as compared to 165.9% in chronic users (from 187.0 per 100,000 in 2011 to 497.3 per 100,000 in 2014). The incremental direct medical costs per patient per year were estimated to be $65,277 (p-value\u3c0.05) in prescription opioid users who suffered from an overdose and$41,102 (p-value\u3c0.05) in non-medical users who suffered from an overdose. Overdose-specific costs were estimated to be $12,111 for prescription opioid users and$11,070 in non-users. Conclusions – Our study found that the prevalence of opioid overdoses increased steadily from 2011 to 2014 in the sample population. The prevalence of overdoses was much higher in chronic opioid users as compared to acute users. Differences between overdose-specific costs and total incremental costs may suggest that overdoses are associated with substantial costs in addition to costs for the initial treatment of the overdose. While the cost to payers due to overdoses in prescription opioid users is substantial, payers also incur costs from diversion of opioids

Characterization of a Phosphonate-Specific Cytidylyltransferase

Antibiotic resistance is a major global health concern that requires new therapeutic approaches. Furthermore, a lack of narrow spectrum antibiotics on the market produces unintended consequences with respect to changes in our microbial make up. Phosphonates are reduced versions of phosphates that possess a C-P bond which is more resistant to enzymatic and chemical degradation. The role of phosphonate containing macromolecules (e.g. cell surface polysaccharides) remains enigmatic, however their presence suggests that they may confer an advantage. The biosynthesis of phosphonate-containing macromolecules is unknown, but a pathway is proposed involving aLicC type cytidylyltransferase-catalyzed conjugation to a phosphonate followed by a LicD type phosphotransferase- catalyzed attachment to a macromolecule. This proposed pathway is analogous to the partially characterized phosphocholine (PC) tailoring pathway in teichoic acid biosynthesis in Streptococcus pneumoniae. In this study, the LicC homolog PngC from Atopobium rimae (Ari-PngC) was purified and its activity was compared to LicC from S. pneumoniae (Spn-LicC). Significantly, Ari-PngC preferred the phosphonate substrate 2-aminoethylphosphonate (AEP) over PC, and vice versa for Spn-LicC. Specifically, the KM and kcat values for Spn-LicC towards PC were 0.020 ±0.011 mM and 1.52 ± 0.243 s-1 respectively, yielding kcat/KM of 77.9 M-1 s-1. In contrast, the KM value for Spn-LicC towards AEP was 0.318 ± 0.126 mM and kcat of 0.722 ± 0.053 s-1, yielding kcat/km of 2.27 M-1 s-1 and revealing a 34-fold preference for PC. The opposite was seen for Ari-PngC, where AEP gave a KM value of 0.011 ± 0.001 mM , kcat of 2.72 ± 0.079 s-1 and kcat/KM of 239 M-1 s-1, while towards PC Ari-PngC yielded specificity constants of 1.67 and 0.74 when modelled by the Michaelis-Menten or substrate inhibition equation, respectively. Regardless of the correct fit, PngC clearly preferred AEP over PC. Overall, these results establish clear substrate selectivity of phosphonate versus PC tailoring pathways and set the stage for developing narrow spectrum antimicrobials

PENGEMBANGAN MEDIA PEMBELAJARAN POHON PINTAR PADA KOMPETENSI DASAR MENERAPKAN PROMOSI PRODUK KELAS X BISNIS DARING DAN PEMASARAN SMK NEGERI 2 BLITAR

Tujuan penelitian ini adalah mengembangkan media pembelajaran Pohon Pintar pada kompetensi dasar Menerapkan Promosi Produk kelas X BDP di SMK Negeri 2 Blitar, mengetahui kelayakan media pembelajaran Pohon Pintar, dan respons peserta didik terhadap media pembelajaran Pohon Pintar. Jenis penelitian ini adalah penelitian dan pengembangan dengan model pengembangan 4D yang dibatas pada tiga tahap yaitu define, design dan develop. Uji coba dilakukan dua kali, yaitu uji kelompok kecil pada 8 siswa dan uji lapangan pada 20 siswa. Hasil validasi media diperoleh saran perbaikan yaitu dari ahli media berupa perbaikan pada kotak pintar, kartu daun dan buku panduan, sedangkan dari ahli materi berupa melengkapi materi sesuai dengan silabus. Hasil penelitian menunjukkan bahwa nilai rata-rata persentase dari validasi ahli media adalah 84,6% dengan kategori sangat layak dan rata-rata persentase dari validasi ahli materi adalah 82,7% dengan kategori sangat layak. Sedangkan hasil angket respons peserta didik dari uji coba kelompok kecil memperoleh nilai rata-rata persentase 93,06% dengan kategori sangat layak dan uji coba lapangan memperoleh nilai rata-rata persentase 93,89% dengan kategori sangat layak. Sehingga dapat disimpulkan bahwa media pembelajaran Pohon Pintar layak digunakan dalam kegiatan pembelajaran.Kata Kunci: Media Pembelajaran, Pohon Pintar, Promosi Produ

Modified Excisional Biopsy Technique for Confirmed or Highly Suspected Melanomas

There are a variety of biopsy techniques for sampling confirmed or highly suspicious melanomas, including excisional, scoop-shave or “saucerization”, shave, and punch biopsy. Herein, we present a case in which a combination approach of saucerization and excisional biopsy was used for a patient with an inadequately sampled melanoma. In the literature, excisional biopsy remains the gold standard for diagnosing melanoma. This technique is accomplished with a full-thickness, fusiform removal of the lesion with a scalpel to the level of adipose tissue (2). The drawback to this technique is the slightly distorted anatomy that can occur during wound closure. Albeit rare, residual melanoma after an excisional biopsy is associated with increased mortality. Because of the nature of this technique, the entire length of the scar will be treated as a tumor, making re-excision more challenging and may lead to extensive scarring (3). The saucerization technique is another modality useful in sampling atypical pigmented skin lesions and is accomplished by using a bendable, curved blade which extends into the deeper dermis. This method is typically reserved for smaller lesions due to fears of incomplete removal or transection of the deeper base, which may affect tumor staging and management. (1) A shave biopsy is performed with a flat blade or razor and results in a partial-thickness sample. This modality is often reserved for more superficial lesions of the skin, such as suspected lentigo maligna (2). A punch biopsy is performed with a round punch tool penetrating the subcutaneous fat layer. The size limitation for this method should be considered as the largest tool available is 10 millimeters; thus, the lesion to be sampled should be 6 mm or less (2). Multiple “scouting” punch biopsies are sometimes used for sampling larger lesions but do not allow for examination of the entire lesion

Information Literacy among Educational Academic Members of Zabol University of Medical Sciences, Zabol, Iran

Introduction: Development of information literacy is considered a required factor for instructors of higher education system due to its impact on educational and research activities, and performance of educational academic members is a main factor that affects the output of system. The aim of this study was to report and compare the information literacy among the academic members of departments of clinical and basic biomedical sciences in 2011. Methods: A cross-sectional survey was performed using a valid and reliable questionnaire distributed among 48 full-time equivalent academic members of Zabol University of Medical Sciences in both clinical (19 members) and basic biomedical departments (29 members). Data were analyzed using Fisher, Mann-Whitney and Chi-square statistics in SPSS 17. Results: Information literacy of the members was at an average level at both knowledge and attitude levels but it was low at the practice. There was a significant difference between two groups in terms of awareness about information resources; however, the difference was not significant for the utilization of information resources. Conclusion: Members of department of basic biomedical sciences were more aware than those of clinical department about the information resources but such awareness has not resulted in more use of resources in the educational and research activities. Despite positive attitude of all members towards the application of electronic information resources in both educational and research activities, their awareness of information literacy skills and practicing were not satisfying in educational and research sections. As a final point, Information literacy is hence suggested as a part of continuing medical education courses

Perubahan Konsep Dapur Hunian Akibat Kebutuhan Pengguna pada Perumahan (Studi Kasus : Perumahan Vila Bukit Tidar Malang)

Dapur merupakan salah satu ruang pada hunian yang memiliki peranan penting pada suatu rumah. Berdasar kebiasaan orang Indonesia, umumnya kegiatan memasak di dapur memerlukan waktu sekitar 8 jam perhari sehingga dalam penggunaannya diperlukan Kenyamanan dan kesesuaian dengan kebutuhan pengguna. Fenomena yang terjadi saat ini banyak rumah Perumahan yang melakukan Perubahan pada desain dapur rumahnya. Hal ini mengindikasikan belum terpenuhinya kebutuhan dan belum ada kesesuaian dengan pengguna. Penelitian ini dilakukan pada 12 sampel Perumahan yang mengalami fenomena tersebut dengan metode analisis deskriptif kualitatif. Hal yang diteliti adalah aspek dapur apa saja yang paling banyak mengalami Perubahan dan faktor kebutuhan pengguna apa yang menjadi penyebab terjadinya Perubahan tersebut. Temuan penelitian ini diharapkan dapat menjadi bahan evaluasi dalam perancangan dapur rumah Perumahan bagi developer Perumahan di masa mendatang dan perancangan dapur bagi masyarakat umum, untuk melihat kebutuhan pengguna sebagai faktor pertimbangan dalam perancangan desain dapur

The educational and learning benefits of play

The Children Act 2004 has heralded a new era in the planning and delivery of services for children and young people in Wandsworth