Association of Current Opioid Use With Serious Adverse Events Among Older Adult Survivors of Breast Cancer

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Importance National efforts to improve safe opioid prescribing focus on preventing misuse, overdose, and opioid use disorder. This approach overlooks opportunities to better prevent other serious opioid-related harms in complex populations, such as older adult survivors of cancer. Little is known about the rates and risk factors for comprehensive opioid-related harms in this population. Objective To determine rates of multiple opioid-related adverse drug events among older adults who survived breast cancer and estimate the risk of these events associated with opioid use in the year after completing cancer treatment. Design, Setting, and Participants This retrospective cohort study used 2007 to 2016 Surveillance, Epidemiology and End Results-Medicare data from fee-for-service Medicare beneficiaries with first cancer diagnosis of stage 0 to III breast cancer at age 66 to 90 years from January 1, 2008, through December 31, 2015, who completed active breast cancer treatment. Data were analyzed from October 31, 2019, to June 10, 2020. Exposures Repeated daily measure indicating possession of any prescription opioid supply in Medicare Part D prescription claims. Main Outcomes and Measures Adjusted risk ratios (aRRs), estimated using modified Poisson generalized estimating equation models, for adverse drug events related to substance misuse (ie, diagnosed opioid abuse, dependence, or poisoning), other adverse drug events associated with opioid use (ie, gastrointestinal events, infections, falls and fractures, or cardiovascular events), and all-cause hospitalization associated with opioid supply the prior day, controlling for patient characteristics. Results Among 38 310 women included in the study (mean [SD] age, 74.3 [6.3] years), there were 0.010 (95% CI, 0.008-0.011) adverse drug events related to substance misuse per 1000 person-days, 0.237 (95% CI, 0.229-0.245) other adverse drug events associated with opioid use per 1000 person-days, and 0.675 (95% CI, 0.662-0.689) all-cause hospitalizations per 1000 person-days. Opioid use was associated with increased risk of adverse drug events related to substance misuse (aRR, 14.62; 95% CI, 9.69-22.05; P < .001), other adverse drug events related to opioid use (aRR, 2.50; 95% CI, 2.11-2.96; P < .001), and all-cause hospitalization (aRR, 2.77; 95% CI, 2.55-3.02; P < .001). In a dose-response effect, individuals with high daily opioid doses had consistently higher risks of all study outcomes compared with individuals who had low opioid doses. Compared with days with no opioid exposure, the risk of any adverse drug event related to substance misuse was 3.4-fold higher for individuals with a current opioid supply ≥50 mg morphine equivalent dose per day (aRR, 3.40; 95% CI, 2.47-4.68; P < .001), while the risk was 2.3-fold higher for individuals with 1 to 49 mg morphine equivalent dose per day (aRR, 2.29; 95% CI, 1.89-2.77; P < .001). Conclusions and Relevance These findings suggest that among older adults who survived breast cancer, continued prescription opioid use in the year after completing active cancer treatment was associated with an immediate increased risk of a broad range of serious adverse drug events related to substance misuse and other adverse drug events associated with opioid use. Clinicians should consider the comprehensive risks of managing cancer pain with long-term opioid therapy

Psychosocial correlates of attitudes towards male sexual violence in a sample of financial crime, property crime, general violent, and homicide offenders

Whilst those currently serving prison sentences for sexual violence can be identified and receive treatment, the number of prisoners with a history of sexual violence against female partners is unknown. Methods to identify prisoners with a proclivity for such violence and accurately assess the risk they pose before and after incarceration are therefore required. Here, we aimed to assess the level of sexually violent attitudes within dating relationships and to examine their associations with experiences of child abuse and neglect (CAN), psychopathic personality traits, prisonization, number of incarcerations, age, years of schooling, relationship status, and parenting among different types of offenders (financial crime, property crime, general violent, and homicide offenders). Data were collected among a large systematically selected sample of adult male inmates (N = 1,123). We demonstrated that sexual violence-supportive attitudes appear to be a function of child sexual abuse, psychopathic personality traits, and may be developed through early socialisation experiences as well as incarceration. Practical implications of current findings are discussed

Simultaneous identification of long similar substrings in large sets of sequences

<p>Abstract</p> <p>Background</p> <p>Sequence comparison faces new challenges today, with many complete genomes and large libraries of transcripts known. Gene annotation pipelines match these sequences in order to identify genes and their alternative splice forms. However, the software currently available cannot simultaneously compare sets of sequences as large as necessary especially if errors must be considered.</p> <p>Results</p> <p>We therefore present a new algorithm for the identification of almost perfectly matching substrings in very large sets of sequences. Its implementation, called ClustDB, is considerably faster and can handle 16 times more data than VMATCH, the most memory efficient exact program known today. ClustDB simultaneously generates large sets of exactly matching substrings of a given minimum length as seeds for a novel method of match extension with errors. It generates alignments of maximum length with a considered maximum number of errors within each overlapping window of a given size. Such alignments are not optimal in the usual sense but faster to calculate and often more appropriate than traditional alignments for genomic sequence comparisons, EST and full-length cDNA matching, and genomic sequence assembly. The method is used to check the overlaps and to reveal possible assembly errors for 1377 <it>Medicago truncatula </it>BAC-size sequences published at <url>http://www.medicago.org/genome/assembly_table.php?chr=1</url>.</p> <p>Conclusion</p> <p>The program ClustDB proves that window alignment is an efficient way to find long sequence sections of homogenous alignment quality, as expected in case of random errors, and to detect systematic errors resulting from sequence contaminations. Such inserts are systematically overlooked in long alignments controlled by only tuning penalties for mismatches and gaps.</p> <p>ClustDB is freely available for academic use.</p

Immersion Lithography Defectivity Analysis at DUV Inspection Wavelength

ABSTRACT Significant effort has been directed in recent years towards the realization of immersion lithography at 193nm wavelength. Immersion lithography is likely a key enabling technology for the production of critical layers for 45nm and 32nm design rule (DR) devices. In spite of the significant progress in immersion lithography technology, there remain several key technology issues, with a critical issue of immersion lithography process induced defects. The benefits of the optical resolution and depth of focus, made possible by immersion lithography, are well understood. Yet, these benefits cannot come at the expense of increased defect counts and decreased production yield. Understanding the impact of the immersion lithography process parameters on wafer defects formation and defect counts, together with the ability to monitor, control and minimize the defect counts down to acceptable levels is imperative for successful introduction of immersion lithography for production of advanced DR&apos;s. In this report, we present experimental results of immersion lithography defectivity analysis focused on topcoat layer thickness parameters and resist bake temperatures. Wafers were exposed on the 1150i-α-immersion scanner and 1200B Scanner (ASML), defect inspection was performed using a DUV inspection tool (UVision TM , Applied Materials). Defect material analysis was performed for different defects. Higher sensitivity was demonstrated at DUV through detection of small defects not detected at the visible wavelength, indicating on the potential high sensitivity benefits of DUV inspection for this layer. The analysis indicates that certain types of defects are associated with different immersion process parameters. This type of analysis at DUV wavelengths would enable the optimization of immersion lithography processes, thus enabling the qualification of immersion processes for volume production

Early Lyme disease with spirochetemia - diagnosed by DNA sequencing

<p>Abstract</p> <p>Background</p> <p>A sensitive and analytically specific nucleic acid amplification test (NAAT) is valuable in confirming the diagnosis of early Lyme disease at the stage of spirochetemia.</p> <p>Findings</p> <p>Venous blood drawn from patients with clinical presentations of Lyme disease was tested for the standard 2-tier screen and Western Blot serology assay for Lyme disease, and also by a nested polymerase chain reaction (PCR) for <it>B. burgdorferi </it>sensu lato 16S ribosomal DNA. The PCR amplicon was sequenced for <it>B. burgdorferi </it>genomic DNA validation. A total of 130 patients visiting emergency room (ER) or Walk-in clinic (WALKIN), and 333 patients referred through the private physicians' offices were studied. While 5.4% of the ER/WALKIN patients showed DNA evidence of spirochetemia, none (0%) of the patients referred from private physicians' offices were DNA-positive. In contrast, while 8.4% of the patients referred from private physicians' offices were positive for the 2-tier Lyme serology assay, only 1.5% of the ER/WALKIN patients were positive for this antibody test. The 2-tier serology assay missed 85.7% of the cases of early Lyme disease with spirochetemia. The latter diagnosis was confirmed by DNA sequencing.</p> <p>Conclusion</p> <p>Nested PCR followed by automated DNA sequencing is a valuable supplement to the standard 2-tier antibody assay in the diagnosis of early Lyme disease with spirochetemia. The best time to test for Lyme spirochetemia is when the patients living in the Lyme disease endemic areas develop unexplained symptoms or clinical manifestations that are consistent with Lyme disease early in the course of their illness.</p

Synthetic biology in society: learning from past experience?

Drawing an analogy to past debates over biotechnology, some stakeholders fear that synthetic biology (SB) could raise public concerns. Accordingly, ‘lessons from the past’ should be applied to avoid controversies. However, biotechnology in the 1990s is not the only possible comparator. The potential to become contested has been attributed to a number of other novel technologies. Looking at nanotechnology for example, controversies have not materialised to the extent predicted. The article discusses factors relevant for controversies over technologies as well as differences to the situation when modern biotechnology began to proliferate. Certain properties attributed to SB in the discussion so far indeed suggest a potential for controversies of its own, but perceptions may follow those on other aspects of biotechnology subject to local contingencies. Finally, it is questioned whether ELSI research should see its task in applying lessons from the past to ease technology introduction. Today, rather than seeing themselves being embedded in a linear model of technology development, social scientists take an interest in developments ‘upstream’ where technologies take shape

Full scale pedestrian impact testing with PMHS: A pilot study

The complexity of vehicle-pedestrian collisions necessitates extensive validation of pedestrian computational models. While body components can be individually simulated, overall validation of human pedestrian models requires full-scale testing with post mortem human surrogates (PMHS). This paper presents the development of a full-scale pedestrian impact test plan and experimental design, and some results from a pilot experiment. The test plan and experimental design are developed based on the analysis of a combination of literature review, multi-body modeling, and epidemiologic studies. The proposed system has proven effective in testing an anthropometrically correct rescue dummy in multiple instances, and in one test with a PMHS.Postprint (published version

Retroviral DNA Integration: ASLV, HIV, and MLV Show Distinct Target Site Preferences

The completion of the human genome sequence has made possible genome-wide studies of retroviral DNA integration. Here we report an analysis of 3,127 integration site sequences from human cells. We compared retroviral vectors derived from human immunodeficiency virus (HIV), avian sarcoma-leukosis virus (ASLV), and murine leukemia virus (MLV). Effects of gene activity on integration targeting were assessed by transcriptional profiling of infected cells. Integration by HIV vectors, analyzed in two primary cell types and several cell lines, strongly favored active genes. An analysis of the effects of tissue-specific transcription showed that it resulted in tissue-specific integration targeting by HIV, though the effect was quantitatively modest. Chromosomal regions rich in expressed genes were favored for HIV integration, but these regions were found to be interleaved with unfavorable regions at CpG islands. MLV vectors showed a strong bias in favor of integration near transcription start sites, as reported previously. ASLV vectors showed only a weak preference for active genes and no preference for transcription start regions. Thus, each of the three retroviruses studied showed unique integration site preferences, suggesting that virus-specific binding of integration complexes to chromatin features likely guides site selection