Modeling the dynamical interaction between epidemics on overlay networks

Epidemics seldom occur as isolated phenomena. Typically, two or more viral agents spread within the same host population and may interact dynamically with each other. We present a general model where two viral agents interact via an immunity mechanism as they propagate simultaneously on two networks connecting the same set of nodes. Exploiting a correspondence between the propagation dynamics and a dynamical process performing progressive network generation, we develop an analytic approach that accurately captures the dynamical interaction between epidemics on overlay networks. The formalism allows for overlay networks with arbitrary joint degree distribution and overlap. To illustrate the versatility of our approach, we consider a hypothetical delayed intervention scenario in which an immunizing agent is disseminated in a host population to hinder the propagation of an undesirable agent (e.g. the spread of preventive information in the context of an emerging infectious disease).Comment: Accepted for publication in Phys. Rev. E. 15 pages, 7 figure

Brownian Dynamics of a Sphere Between Parallel Walls

We describe direct imaging measurements of a colloidal sphere's diffusion between two parallel surfaces. The dynamics of this deceptively simple hydrodynamically coupled system have proved difficult to analyze. Comparison with approximate formulations of a confined sphere's hydrodynamic mobility reveals good agreement with both a leading-order superposition approximation as well as a more general all-images stokeslet analysis.Comment: 4 pages, 3 figures, REVTeX with PostScript figure

Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages

OBJECTIVES: To describe the use of atypical antipsychotic medications in a Medicaid-enrolled population composed primarily of elderly and disabled patients. Our analyses focused upon the frequency of use of polytherapy with multiple antipsychotic medications and the prescribing of off-label dosages. METHODS: We conducted a cross-sectional retrospective analysis of oral antipsychotic medication use, as prescribed for this population in 2003. The unit of analysis was the patient. We determined the prevalence of use of each type of antipsychotic medication according to gender and age group and determined the extent of use of combination therapies with multiple oral antipsychotic medications. Using the dosage ranges described in the product labeling, we identified the percentage of patients prescribed in-range dosages, overall and for each atypical antipsychotic medication studied. Those identified as receiving out-of-range (off-label) dosages were further stratified by gender and age group. The statistical significance of differences between these proportions was assessed using the chi-square test. RESULTS: Of the 8,616 patients meeting our inclusion criteria, 7,748 (90%) received monotherapy with an oral antipsychotic medication and 868 patients (10%) received polytherapy with multiple oral antipsychotic medications. Approximately 2 of 3 patients receiving atypical antipsychotic medications were prescribed a dosage that was within the range recommended in the product labeling. Dosages lower than recommended in the product labeling were prescribed for 27% of patients receiving atypical antipsychotics, while 6% of patients received an above-range dosage. The frequency of patients receiving in-range dosages varied substantially among medications. Younger patients and male patients were more frequently prescribed above-range dosages while older patients and female patients were more frequently prescribed below-range dosages of these medications (P less than 0.001 for both findings). CONCLUSION: In this subpopulation of Medicaid enrollees who were prescribed antipsychotic medications, we found a 10% incidence of use of antipsychotic polytherapy and a 33% incidence of prescribing of dosages outside the range listed in the product labeling. These findings suggest that physicians commonly prescribe antipsychotic medications in a manner that differs from the recommendations described in the prescribing information. The off-label use of atypical antipsychotic medications raises important questions regarding the purpose and applicability of the product labeling and the role and ability of the pharmacist to provide information regarding the risks and benefits of therapy as commonly prescribed

The Deformation of an Elastic Substrate by a Three-Phase Contact Line

Young's classic analysis of the equilibrium of a three-phase contact line ignores the out-of-plane component of the liquid-vapor surface tension. While it has long been appreciated that this unresolved force must be balanced by elastic deformation of the solid substrate, a definitive analysis has remained elusive because conventional idealizations of the substrate imply a divergence of stress at the contact line. While a number of theories of have been presented to cut off the divergence, none of them have provided reasonable agreement with experimental data. We measure surface and bulk deformation of a thin elastic film near a three-phase contact line using fluorescence confocal microscopy. The out-of-plane deformation is well fit by a linear elastic theory incorporating an out-of-plane restoring force due to the surface tension of the gel. This theory predicts that the deformation profile near the contact line is scale-free and independent of the substrate elastic modulus.Comment: 4 pages, 3 figure

A shadowing problem in the detection of overlapping communities: lifting the resolution limit through a cascading procedure

Community detection is the process of assigning nodes and links in significant communities (e.g. clusters, function modules) and its development has led to a better understanding of complex networks. When applied to sizable networks, we argue that most detection algorithms correctly identify prominent communities, but fail to do so across multiple scales. As a result, a significant fraction of the network is left uncharted. We show that this problem stems from larger or denser communities overshadowing smaller or sparser ones, and that this effect accounts for most of the undetected communities and unassigned links. We propose a generic cascading approach to community detection that circumvents the problem. Using real and artificial network datasets with three widely used community detection algorithms, we show how a simple cascading procedure allows for the detection of the missing communities. This work highlights a new detection limit of community structure, and we hope that our approach can inspire better community detection algorithms.Comment: 14 pages, 12 figures + supporting information (5 pages, 6 tables, 3 figures

Kappa opioid receptor antagonism: Are opioids the answer for treatment resistant depression?

Introduction: Past trials of buprenorphine (BUP) in the treatment of major depressive disorder (MDD) have displayed favorable results, although its clinical utility was limited by the risk of abuse or physical dependence. By combining BUP with samidorphan (SAM), the euphoric high is negated by an opposing mechanism, which theoretically reduces addictive-like properties while allowing the antidepressant properties to remain. As such, the objective of this article is to analyze the results of BUP/SAM premarketing clinical trials as adjunctive treatment for treatment-resistant MDD. Methods: A comprehensive PubMed/MEDLINE search was conducted through November 9, 2017, using the following search terms: depression, samidorphan, buprenorphine, ALKS-5461. Additional data were obtained from Clinicaltrials.gov and resources included in the present study. All English-language clinical trials evaluating the combination of BUP/SAM in the treatment of MDD were included. Results: A few premarketing studies have evaluated the efficacy and safety of BUP/SAM combination as adjunctive treatment in patients with treatment-resistant MDD. The FORWARD-1 through FORWARD-5 trials concluded (1) the most effective dosing ratio of BUP/SAM to reduce abuse potential was 1:1; (2) statistically significant changes in scores from baseline on the Montgomery-Asberg Depression Rating Scale were noted for the 2 mg/2 mg dose compared with placebo; and (3) the most commonly reported adverse effects were nausea, dizziness, and fatigue. Discussion: Buprenorphine/samidorphan has shown favorable results for efficacy and tolerability in premarketing studies evaluating its use as adjunctive therapy for treatment-resistant MDD. Its novel mechanism targeting the opioid pathway may serve as a promising antidepressant devoid of abuse potential

Closing the Gap: Raising Medical Professionals\u27 Transgender Awareness and Medical Proficiency through Pharmacist-led Education

Introduction: Patients who are transgender have unique population-specific needs and risk factors. Nationwide surveys of health profession school administrators indicate a gap in coverage of lesbian, gay, bisexual, and transgender health content in their curricula. To address this gap, a pharmacist-developed transgender–health care focused seminar was presented to medical professionals, trainees, and students accompanied by a novel education assessment scale. Methods: The seminar was presented by a psychiatric pharmacy resident to health care professionals and trainees in various settings. Subjects covered during the seminar included terminology, diagnostic criteria and prevalence of gender dysphoria, nonhormonal treatment, gender-affirming hormone therapy, and other considerations. The Trans* Health Education Evaluation Scale (THEES) was developed to assess participants’ self-perceived proficiency regarding care of patients who are transgender immediately before and after attending a seminar. Total scale scores were compared preseminar and postseminar using a repeated- measures t-test, and sign tests with Bonferroni correction were used for individual scale items. Psychometric properties of this scale were examined. Results: Five seminars were given, and a total of 100 scales were completed by health care–associated workers and students. The majority of participants were in the pharmacy or medical professions. Attending 1 seminar significantly improved THEES total and individual item scores (P,.001). Additionally, 90% of participants felt the seminar was directly applicable to their practice, and 84% felt more confident in providing care to patients who are transgender. Discussion: A single, pharmacist-led, trans health–focused education session significantly improved the confidence level and self-perceived proficiency of health care–associated personnel as measured by THEES