The Prescription Opioid Epidemic: an Evidence-Based Approach

A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, issued this report aimed at stemming the prescription opioid epidemic, a crisis that kills an average of 44 people a day in the U.S. The report calls for changes to the way medical students and physicians are trained, prescriptions are dispensed and monitored, first responders are equipped to treat overdoses, and those with addiction are identified and treated. The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation. The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in developing the recommendations. The report breaks its recommendations into seven categories:Prescribing GuidelinesPrescription Drug Monitoring Programs (PDMPs)Pharmacy Benefit Managers (PBMs) and PharmaciesEngineering Strategies (i.e., packaging)Overdose Education and Naloxone Distribution ProgramsAddiction TreatmentCommunity-Based Prevention Strategie

Using a Cadaveric Model of Lumbar Scoliosis to Determine Optimal Patient Positioning for Reliable Bone Mineral Density Measures Using a Hologic DEXA Scanner

Introduction: Osteoporosis and osteopenia affect roughly 10 million and 43 million older adults, respectively, in the United States. The primary way to detect osteoporosis and osteopenia is through a bone mineral density (BMD) scan, as is often done using dual energy x-ray absorptiometry (DEXA). However, previous research shows DEXA to be unreliable when assessing BMD in individuals with lumbar scoliosis. The purpose of this study was to test the effect of spine orientation on the DEXA scanning bed on lumbar BMD measures, using a cadaver spine as a model. Methods: One female cadaver was dissected to the skeletal level. The articulating joints of the lumbar vertebrae were dissected and reattached to cause right lateral bending and a Cobb angle of 35 degrees, falling into the moderate scoliosis categorization. The cadaver spine was scanned in an identical location on the scanning bed five times each in 10 different orientations. The mean values from each position were calculated and compared across orientations through the Friedman non-parametric rank sum test, and standard error of the mean and coefficient of variation were calculated to assess reliability within each orientation. Results: Across the 10 orientations, mean BMD ranged from 0.634 and 0.965 g/cm3 (t-scores ranged from -0.7 to -3.7), and 95.6% of pairwise comparisons were statistically significantly different. However, across the five scans taken for each orientation, the standard error of the mean was ≤0.003 g/cm3 and coefficient of variation was ≤0.83%. A subanalysis with three spine orientations where the spine was moved up or down by 3 cm on the scanning bed (while maintaining orientation) had little effect on BMD (mean absolute difference ≤0.025 g/cm3). Conclusion: BMD data were highly reliable when scanned multiple times in the same orientation. However, changing spine orientation resulted in dramatic changes in BMD. Future studies should seek to identify methods to best replicate spine orientation in those with lumbar scoliosis to optimize reliability across multiple scans

The use of a plant capacity model for production scheduling and operations analysis

Thesis (S.M.)--Massachusetts Institute of Technology, Sloan School of Management; and, Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1998.Includes bibliographical references (p. 65).by Caleb A. Dailey.S.M

Nanosatellite optical downlink experiment: design, simulation, and prototyping

The nanosatellite optical downlink experiment (NODE) implements a free-space optical communications (lasercom) capability on a CubeSat platform that can support low earth orbit (LEO) to ground downlink rates>10  Mbps. A primary goal of NODE is to leverage commercially available technologies to provide a scalable and cost-effective alternative to radio-frequency-based communications. The NODE transmitter uses a 200-mW 1550-nm master-oscillator power-amplifier design using power-efficient M-ary pulse position modulation. To facilitate pointing the 0.12-deg downlink beam, NODE augments spacecraft body pointing with a microelectromechanical fast steering mirror (FSM) and uses an 850-nm uplink beacon to an onboard CCD camera. The 30-cm aperture ground telescope uses an infrared camera and FSM for tracking to an avalanche photodiode detector-based receiver. Here, we describe our approach to transition prototype transmitter and receiver designs to a full end-to-end CubeSat-scale system. This includes link budget refinement, drive electronics miniaturization, packaging reduction, improvements to pointing and attitude estimation, implementation of modulation, coding, and interleaving, and ground station receiver design. We capture trades and technology development needs and outline plans for integrated system ground testing.United States. National Aeronautics and Space Administration. Research Fellowship ProgramLincoln Laboratory (Lincoln Scholars)Lincoln Laboratory (Military Fellowship Program)Fundación Obra Social de La Caixa (Fellowship)Samsung FellowshipUnited States. Air Force (Assistant Secretary of Defense for Research & Engineering. Contract FAs872105C0002

Perovskites oxides for metal-air batteries and pseudocapacitor applications

Wind and solar energy’s rapid development has created a significant need for low-cost energy storage to enable renewables at grid level. To meet these challenges, metal-air batteries and fuel cells are being considered for base-load energy storage while high power applications like frequency regulation and uninterruptable power supplies (UPS) can be addressed using high energy pseudocapacitors. The major bottleneck to metal-air battery and fuel cell commercialization is the sluggish oxygen reactions at the positive electrode that are industrially catalyzed using expensive precious metal catalysts like Pt and IrO₂. Here, the aim is to replace precious metal-catalysts with low-cost LaNiO₃ perovskites and N-doped CNTs in alkaline conditions and study their synergistic interactions and composite stability. The work is continued by studying the anion-intercalation pseudocapacitance in a perovskite oxide library with composition La [subscript 1-x] Sr [subscript x] BO [subscript 3-δ] (B = Mn, Fe, Co; 0 ≤ x ≤ 1) and found that increasing oxygen vacancy content universally increases the pseudocapacitance while the B-site element controlled the redox potential. The most pseudocapacitive materials were then used to make the first all perovskite asymmetric pseudocapacitors with a maximum energy density of 31 Wh kg⁻¹. This work was followed by using the principles learned to further extent the redox voltage potential difference using LaNi [subscript 1-x] Fe [subscript x] O [subscript 3-δ] and brownmillerite-SrFeO [subscript 2.5] to make an asymmetric pseudocapacitor. Doing this, the redox discharge potential was pushed all the way to 1.1 V which is the highest asymmetric pseudocapacitor discharge peak potential reported to date.Chemical Engineerin

The impact of Medicare Part D on Medicare-Medicaid Dual-eligible Beneficiaries' Prescription Utilization and Expenditures

Features of Part D gave rise to broad concern that the drug benefit would negatively impact prescription utilization among the six million dual eligible beneficiaries, either during the transition from state Medicaid to Part D coverage, or in the long-run. At the same time, Part D contained other features, such as its auto-enrollment and premium subsidization policies, which were designed to safeguard utilization for this vulnerable group. Using national retail pharmacy claims, we examine the experience of dual eligibles during the first 18 months of Part D. We find no evidence that Part D adversely affected pharmaceutical utilization or out-of-pocket expenditures in the transition period, or in the 18 months subsequent to Part D implementation.

Promotion of Prescription Drugs to Consumers and Providers, 2001–2010

Background: Pharmaceutical firms heavily promote their products and may have changed marketing strategies in response to reductions in new product approvals, restrictions on some forms of promotion, and the expanding role of biologic therapies. Methods: We used descriptive analyses of annual cross-sectional data from 2001 through 2010 to examine direct-to-consumer advertising (DTCA) (Kantar Media) and provider-targeted promotion (IMS Health and SDI), including: (1) inflation-adjusted total promotion spending ($and percent of sales); (2) distribution by channel (consumer v. provider); and (3) provider specialty both for the industry as a whole and for top-selling biologic and small molecule therapies. Results: Total promotion peaked in 2004 at US$36.1 billion (13.4% of sales). By 2010 it had declined to $27.7B (9.0$370 million (8.8% of sales) spent on promotion, top biologics were promoted less, with only $33 million (1.4% of sales) spent per product. Little change occurred in the composition of promotion between primary care physicians and specialists from 2001–2010. Conclusions: These findings suggest that pharmaceutical companies have reduced promotion following changes in the pharmaceutical pipeline and patent expiry for several blockbuster drugs. Promotional strategies for biologic drugs differ substantially from small molecule therapies

Does Access to Market Information Determine the Choice of Marketing Channel among Smallholder Yam Farmers in the Brong Ahafo Region of Ghana? A Multinomial Logit Regression Analysis

Asymmetric or missing information is likely to cause market failure and greater access of farmers to knowledge about markets and prices, is a key element in the efforts of breaking the cycle of poverty. This study describes the yam marketing distribution channel in Brong-Ahafo region. It also quantifies the magnitude and direction of the effect of market information access on the choice of yam marketing channel using the Multinomial Logit regression analysis. The study is cross sectional in designs. A total of 250 smallholder yam farmers participated in the survey. Data collected was analyzed using StataSE 11. Results indicate that there are six main channels of yam distribution comprising of producers, assemblers, wholesalers and retailers. The study observes, inter alia, that age of household head, access to cell phone, farm size and output price determine the choice of rural market relative to urban market whilst gender of household head, number of years of formal education and distance to tarred road significantly influences the choice of cooperative market relative to urban market. Access to cell phone and the interactive term (cell phone access*location of household head) are the most influential determinants of rural market and market cooperative choice both statistically and numerically respectively. These results have implications for agricultural policy in Ghana. Key words: Multinomial Logit, Brong-Ahafo, Market channel, Cell Phone, Market informatio

Adjustable Load on CVT Driven Project

SAE Baja, also known as Baja SAE (Society of Automotive Engineers Baja), is a series of collegiate design competitions organized by the Society of Automotive Engineers (SAE). These competitions challenge teams of students to design, build, and race off-road vehicles that can withstand rough terrain and perform in various dynamic events. The objective of this Senior Design Project is to design, manufacture, and test an adjustable driven Continuous Variable Transmission (CVT) pulley to adjust the preload on the spring. This will allow easier adjustment on the CVT preload at smaller increments. This design could be used for future Zips Baja vehicles and multiple CVT tuning combinations. An adjustable CVT driven system can offer several benefits for SAE Baja applications including optimized power delivery, improved efficiency for different dynamic events, and adaptability to various driving conditions