Guilford County Solution to the Opioid Problem (GCSTOP): A Model for University/Community Partnerships

There were over 700 overdoses and 180 deaths from opioids in Guilford County, NC in 2017. The Guilford Solution to the Opioid Problem (GSTOP) project leverages funds allocated by the STOP-Act to design, implement, and evaluate a rapid response program intended to decrease mortality from opioid overdoses. The program engages citizens who overdose in harm reduction practices, distributes naloxone kits to high-risk users, conducts community health education, coordinates community resources through the CURE Triad collaborative, and builds relationships focused on ending opioid overdose. This presentation will review the development of the partnership between Guilford County Emergency Medical Services and the University of North Carolina at Greensboro that has resulted in the GSTOP demonstration project. The presentation included background on the opioid epidemic in Guilford County, the development of CURE Triad (a community coalition to address overdoses) and the implementation of GSTOP, the unique features of hosting such a program within a university, the evaluation design, and preliminary outcomes of the program

Selection Factors in Housing Among Rural Low-To-Moderate Income Residents

Growth in rural areas has increased the need to examine more closely the quality and acceptability of different types of existing housing. This study focuses on the reasons rural residents moved to their housing and whether their needs were satisfied by their selections. Comparisons of reasons for moving among conventional home, mobile home, and apartment residents indicated similar motivations for housing choices. Comparisons of present housing satisfaction revealed that a large majority of all respondents selected housing that met their needs. The results suggest that despite the predominant preference for single-family conventionally built homes, a substantial portion of future housing demand for low-to-moderately priced housing in rural areas could be accommodated quite adequately with nonconventional housing such as mobile homes and apartments

Entropy-driven phase transition in a polydisperse hard-rods lattice system

We study a system of rods on the 2d square lattice, with hard-core exclusion. Each rod has a length between 2 and N. We show that, when N is sufficiently large, and for suitable fugacity, there are several distinct Gibbs states, with orientational long-range order. This is in sharp contrast with the case N=2 (the monomer-dimer model), for which Heilmann and Lieb proved absence of phase transition at any fugacity. This is the first example of a pure hard-core system with phases displaying orientational order, but not translational order; this is a fundamental characteristic feature of liquid crystals

Severe brain injury ICU outcomes are associated with Cranial-Arterial Pressure Index and noninvasive Bispectral Index and transcranial oxygen saturation: a prospective, preliminary study

INTRODUCTION: The purpose of this study was to determine if noninvasive transcranial oxygen saturation (StcO(2)) and Bispectral Index (BIS) correlate with severe traumatic brain injury intensive care unit (ICU) outcomes. METHODS: This is a prospective observational study. Values of intracranial pressure (ICP), mean arterial pressure (MAP), BIS, and StcO(2 )were recorded hourly for the first six, post-injury days in 18 patients with severe brain injury. Included in the analyses was the Cranial-Arterial Pressure (CAP) Index, which is ICP/(MAP - ICP). RESULTS: After 1,883 hours of data were analyzed, we found that StcO(2 )and BIS are associated with survival, good neurological outcome, ICP ≤20, cerebral perfusion pressure (CPP) ≥60, and CAP index ≤0.30 (p ≤ 0.001). Survival and good outcome are independently associated with BIS ≥60, StcO(2 )≥70, and ICP ≤20 (p < 0.0001). BIS ≥60 or StcO(2 )≥70 is associated with survival, good outcome, CPP ≥60, ICP ≤20, CAP index ≤0.30, and fewer ICP interventions (p < 0.0001). With BIS ≥60 or StcO(2 )≥70, the rate of CPP ≥60 is 97.2% and the rate of ICP≤ 25 is 97.1%. An increased CAP index is associated with death, poor neurological outcome, and increased ICP interventions (p < 0.0001). With CAP index >0.25, MAP is not related to ICP (p = 0.16). CONCLUSION: Numerous significant associations with ICU outcomes indicate that BIS and StcO(2 )are clinically relevant. The independent associations of BIS, StcO(2), and ICP with outcomes suggest that noninvasive multi-modal monitoring may be beneficial. Future studies of patients with BIS ≥60 or StcO(2 )≥70 will determine if select patients can be managed without ICP monitoring and whether marginal ICP can be observed. An increased CAP index is associated with poor outcome

An evaluation of the FDA's analysis of the costs and benefits of the graphic warning label regulation

The Family Smoking Prevention and Tobacco Control Act of 2009 gave the Food and Drug Administration (FDA) regulatory authority over cigarettes and smokeless tobacco products and authorised it to assert jurisdiction over other tobacco products. As with other Federal agencies, FDA is required to assess the costs and benefits of its significant regulatory actions. To date, FDA has issued economic impact analyses of one proposed and one final rule requiring graphic warning labels (GWLs) on cigarette packaging and, most recently, of a proposed rule that would assert FDA’s authority over tobacco products other than cigarettes and smokeless tobacco. Given the controversy over the FDA's approach to assessing net economic benefits in its proposed and final rules on GWLs and the importance of having economic impact analyses prepared in accordance with sound economic analysis, a group of prominent economists met in early 2014 to review that approach and, where indicated, to offer suggestions for an improved analysis. We concluded that the analysis of the impact of GWLs on smoking substantially underestimated the benefits and overestimated the costs, leading the FDA to substantially underestimate the net benefits of the GWLs. We hope that the FDA will find our evaluation useful in subsequent analyses, not only of GWLs but also of other regulations regarding tobacco products. Most of what we discuss applies to all instances of evaluating the costs and benefits of tobacco product regulation and, we believe, should be considered in FDA's future analyses of proposed rules.Robert Wood Johnson Foundation (Grant 71484

Sequencing of a Chinese tetralogy of Fallot cohort reveals clustering mutations in myogenic heart progenitors

Tetralogy of Fallot (TOF) is the most common cyanotic heart defect, yet the underlying genetic mechanisms remain poorly understood. Here, we performed whole-genome sequencing analysis on 146 nonsyndromic TOF parent-offspring trios of Chinese ethnicity. Comparison of de novo variants and recessive genotypes of this data set with data from a European cohort identified both overlapping and potentially novel gene loci and revealed differential functional enrichment between cohorts. To assess the impact of these mutations on early cardiac development, we integrated single-cell and spatial transcriptomics of early human heart development with our genetic findings. We discovered that the candidate gene expression was enriched in the myogenic progenitors of the cardiac outflow tract. Moreover, subsets of the candidate genes were found in specific gene coexpression modules along the cardiomyocyte differentiation trajectory. These integrative functional analyses help dissect the pathogenesis of TOF, revealing cellular hotspots in early heart development resulting in cardiac malformations

Do Hospitals Respond to Increasing Prices by Supplying Fewer Services?

Medical providers often have a significant influence on treatment decisions which they can use in their own financial interest. Classical models of supplier-induced demand predict that medical providers will supply fewer services if they face increasing prices. We test this prediction based on a reform of hospital financing in Germany. Uniquely, this reform changed the overall level of reimbursement - with increasing prices for some hospitals and decreasing prices for others - without affecting the relative prices for different types of patients. Based on administrative data, we find that hospitals do indeed react to increasing prices by reducing service supply.Anbieter von medizinischen Leistungen treffen häufig Behandlungsentscheidungen für ihre Patienten und haben die Möglichkeit, bei diesen Entscheidungen ihre eigenen finanziellen Interessen zu berücksichtigen. Klassische Modelle der Theorie der 'angebotsinduzierten Nachfrage' prognostizieren, dass medizinische Anbieter auf höhere Preise reagieren, indem sie weniger Leistungen erbringen. Wir testen diese Vorhersage auf Grundlage einer Reform der Krankenhausfinanzierung in Deutschland. Das Besondere an der Finanzierungsreform in Deutschland ist, dass die Reform die Preise für Krankenhäuser verändert hat - mit steigenden Preisen für einige Krankenhäuser und sinkenden Preisen für andere - ohne dabei die relativen Preise für die Behandlung unterschiedlicher Patientengruppen oder unterschiedlicher Krankheiten zu beeinflussen. Unter Nutzung administrativer Daten finden wir, dass Krankenhäuser tatsächlich weniger Leistungen erbringen, wenn die Preise steigen

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes