Out of Control: The Flawed Regulation of Schedule II Drugs and Its Impact on Pain and Addiction

This paper explores the current state of regulation of controlled substances at the federal and state level and analyzes how such regulations impact the undertreatment of pain and prescription drug abuse. Taking a historical view of the pain treatment movement and using the recent OxyContin crisis as a case study, the future of controlled substance policy as it relates to painkillers is analyzed. It argues that any successful policy will have to do a better job of balancing law enforcement and health care goals

Automated quantification and evaluation of motion artifact on coronary CT angiography images

Abstract Purpose This study developed and validated a Motion Artifact Quantification algorithm to automatically quantify the severity of motion artifacts on coronary computed tomography angiography (CCTA) images. The algorithm was then used to develop a Motion IQ Decision method to automatically identify whether a CCTA dataset is of sufficient diagnostic image quality or requires further correction. Method The developed Motion Artifact Quantification algorithm includes steps to identify the right coronary artery (RCA) regions of interest (ROIs), segment vessel and shading artifacts, and to calculate the motion artifact score (MAS) metric. The segmentation algorithms were verified against ground‐truth manual segmentations. The segmentation algorithms were also verified by comparing and analyzing the MAS calculated from ground‐truth segmentations and the algorithm‐generated segmentations. The Motion IQ Decision algorithm first identifies slices with unsatisfactory image quality using a MAS threshold. The algorithm then uses an artifact‐length threshold to determine whether the degraded vessel segment is large enough to cause the dataset to be nondiagnostic. An observer study on 30 clinical CCTA datasets was performed to obtain the ground‐truth decisions of whether the datasets were of sufficient image quality. A five‐fold cross‐validation was used to identify the thresholds and to evaluate the Motion IQ Decision algorithm. Results The automated segmentation algorithms in the Motion Artifact Quantification algorithm resulted in Dice coefficients of 0.84 for the segmented vessel regions and 0.75 for the segmented shading artifact regions. The MAS calculated using the automated algorithm was within 10% of the values obtained using ground‐truth segmentations. The MAS threshold and artifact‐length thresholds were determined by the ROC analysis to be 0.6 and 6.25 mm by all folds. The Motion IQ Decision algorithm demonstrated 100% sensitivity, 66.7% ± 27.9% specificity, and a total accuracy of 86.7% ± 12.5% for identifying datasets in which the RCA required correction. The Motion IQ Decision algorithm demonstrated 91.3% sensitivity, 71.4% specificity, and a total accuracy of 86.7% for identifying CCTA datasets that need correction for any of the three main vessels. Conclusion The Motion Artifact Quantification algorithm calculated accurate

The Short Rotation Period of Hi'iaka, Haumea's Largest Satellite

Hi'iaka is the larger outer satellite of the dwarf planet Haumea. Using relative photometry from the Hubble Space Telescope and Magellan and a phase dispersion minimization analysis, we have identified the rotation period of Hi'iaka to be ~9.8 hrs (double-peaked). This is ~120 times faster than its orbital period, creating new questions about the formation of this system and possible tidal evolution. The rapid rotation suggests that Hi'iaka could have a significant obliquity and spin precession that could be visible in light curves within a few years. We then turn to an investigation of what we learn about the (presently unclear) formation of the Haumea system and family based on this unexpectedly rapid rotation rate. We explore the importance of the initial semi-major axis and rotation period in tidal evolution theory and find they strongly influence the time required to despin to synchronous rotation, relevant to understanding a wide variety of satellite and binary systems. We find that despinning tides do not necessarily lead to synchronous spin periods for Hi'iaka, even if it formed near the Roche limit. Therefore the short rotation period of Hi'iaka does not rule out significant tidal evolution. Hi'iaka's spin period is also consistent with formation near its current location and spin up due to Haumea-centric impactors.Comment: 21 pages with 6 figures, to be published in The Astronomical Journa

An Environmental Analysis of Illinois Coal Entry into the Transportation Market

Using Illinois coal in transportation has varied environmental consequences. This study calculated the total CO2 emissions from gasoline and eight other vehicle propulsion methods (VPMs) involving Illinois coal. VPMs of Ultra Super Critical electrical cycle (USC), Integrated Gasification Combined electrical Cycle (IGCC), Pulverized coal in a Sub-Critical electrical cycle (PSC), and electricity from a hydrogen fuel cell emitted the lowest CO2. VPMs using Illinois coal to produce ethanol, butanol, and IGCC/ethanol emitted CO2 comparable to gasoline. The VPM of Fischer-Tropsch (FT) diesel emitted the most CO2. It was concluded that energy efficiency and CO2 offset from agricultural growth and by-products were the most influential factors of CO2 emissions

Nowhere to Run; Nowhere to Hide: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges

This is an edited version of remarks presented at \u27Nowhere to Run, Nowhere to Hide\u27: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges, January 5, 2015, at the Association of American Law Schools Annual Meeting, Washington, D.C

Survey of Pharmacist-Managed Primary Care Clinics Using Healthcare Failure Mode and Effect Analysis (HFMEA)

Objectives: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. Methods: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. Results: Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were “Told you the name of each of your medicines and what they are used for”, “Answered your questions fully,” and “Explained what your medicines do”. Conclusions: Educational components provided during pharmacist-managed clinic appointments are aligned with patients’ needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists’ self-efficacy, which may further improve patient care

Architecture of Kepler's Multi-transiting Systems: II. New investigations with twice as many candidates

We report on the orbital architectures of Kepler systems having multiple planet candidates identified in the analysis of data from the first six quarters of Kepler data and reported by Batalha et al. (2013). These data show 899 transiting planet candidates in 365 multiple-planet systems and provide a powerful means to study the statistical properties of planetary systems. Using a generic mass-radius relationship, we find that only two pairs of planets in these candidate systems (out of 761 pairs total) appear to be on Hill-unstable orbits, indicating ~96% of the candidate planetary systems are correctly interpreted as true systems. We find that planet pairs show little statistical preference to be near mean-motion resonances. We identify an asymmetry in the distribution of period ratios near first-order resonances (e.g., 2:1, 3:2), with an excess of planet pairs lying wide of resonance and relatively few lying narrow of resonance. Finally, based upon the transit duration ratios of adjacent planets in each system, we find that the interior planet tends to have a smaller transit impact parameter than the exterior planet does. This finding suggests that the mode of the mutual inclinations of planetary orbital planes is in the range 1.0-2.2 degrees, for the packed systems of small planets probed by these observations.Comment: Accepted to Ap

A First Comparison of Kepler Planet Candidates in Single and Multiple Systems

In this letter we present an overview of the rich population of systems with multiple candidate transiting planets found in the first four months of Kepler data. The census of multiples includes 115 targets that show 2 candidate planets, 45 with 3, 8 with 4, and 1 each with 5 and 6, for a total of 170 systems with 408 candidates. When compared to the 827 systems with only one candidate, the multiples account for 17 percent of the total number of systems, and a third of all the planet candidates. We compare the characteristics of candidates found in multiples with those found in singles. False positives due to eclipsing binaries are much less common for the multiples, as expected. Singles and multiples are both dominated by planets smaller than Neptune; 69 +2/-3 percent for singles and 86 +2/-5 percent for multiples. This result, that systems with multiple transiting planets are less likely to include a transiting giant planet, suggests that close-in giant planets tend to disrupt the orbital inclinations of small planets in flat systems, or maybe even to prevent the formation of such systems in the first place.Comment: 13 pages, 13 figures, submitted to ApJ Letter