Preventing Unintentional Drug Overdose in North Carolina by Advocating for Policies that Support Overdose Prevention

The main purpose of this Capstone project was to develop and promote a policy, which became the 911 Good Samaritan and Naloxone Access bill, to reduce unintentional drug overdose deaths in North Carolina (NC). The team's partner organization, North Carolina Harm Reduction Coalition (NCHRC), solicited the Capstone team's help in raising awareness about NC's overdose problem, developing a policy solution, and advocating for state-level policy change. The Capstone project increased NCHRC's capacity to advocate for the 911 Good Samaritan and Naloxone Access bill, strengthened NCHRC's relationship with the North Carolina General Assembly (NCGA) and community stakeholders, raised awareness of the problem of drug overdose, and resulted in the passage of the policy into law. In 2010, unintentional poisoning, which typically involves drugs, became the second leading cause of injury death for all ages in the United States. Between 1997 and 2001, drug overdose deaths more than doubled in NC. Opioid pain relievers (OPR) accounted for 88% of the increase in drug-related deaths. Many overdose prevention efforts have focused on the supply side, with policies dictating prescribing practice or drug abuse screening and prevention. Although these efforts can prevent an overdose from happening, overdoses will still occur even with the best prevention efforts. Achieving a broader reduction in fatal overdose requires a more targeted policy-level intervention. For this Capstone project, the team produced five deliverables. Deliverable 1 was a literature review of the impact of drug overdose in NC and a fact sheet for distribution to stakeholders. Deliverable 2 consisted of policy recommendations, based on the literature review, intended to guide legislative sponsors in drafting a bill. Deliverable 3 was a presentation to the John Locke Foundation (JLF), a policy think tank, to educate their members and elicit support for the policy. Deliverable 4 was a drug overdose prevention summit in Raleigh to raise awareness and support among various stakeholders, including legislators, for the 911 Good Samaritan and Naloxone Access bill. Lastly, Deliverable 5 included the development of educational materials to raise awareness about the new law.Master of Public Healt

Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis

Objective To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Design Retrospective cohort study. Participants Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017. Methods Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery. Main Outcome Measures Incidence and risk factors for RRD or RT within 1 year of cataract surgery. Results Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99–3.32; P \u3c 0.001 and 1.79; 95% CI, 1.70–1.89; P \u3c 0.001), and younger ages compared with patients aged \u3e 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74–9.58; P \u3c 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52–2.98; P \u3c 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82–11.28; P \u3c 0.001), hypermature cataract (1.61; 95% CI, 1.06–2.45; P = 0.03), complex cataract surgery (1.52; 95% CI, 1.4–1.66; P \u3c 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15–1.34; P \u3c 0.001), and high myopia (1.2; 95% CI, 1.14–1.27; P \u3c 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39–46.49; P \u3c 0.001). Conclusion In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged \u3e 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Validation of the Automated Diagnosis, Intractability, Risk, Efficacy (DIRE) Opioid Risk Assessment Tool

Background/Aims: Despite the drastic increases in prescription opioid misuse and abuse, risk assessment for aberrant drug-related behaviors prior to initiating opioid therapy for chronic noncancer pain management continues to be underutilized in clinical practice. The purpose of the study was to investigate availability of data elements in the electronic health record that could be used to assess risk for aberrant drug-related behaviors with the automated Diagnosis, Intractability, Risk, Efficacy (DIRE) opioid risk assessment tool. Methods: DIRE is a 7-item tool usually administered by a clinician and used to predict efficacy of analgesia and patient compliance with long-term opioid therapy. Each factor is rated from 1 (least favorable case) to 3 (more favorable case for opioid prescribing). The total score is used for risk stratification with scores \u3c 14 being an unsuitable candidate and scores ≥ 14 being possible candidate for opioid therapy. The validation of the automated process versus clinician-administered rating was conducted using kappa analysis and test characteristics (sensitivity, specificity, positive and negative predictive values). Results: We developed structured data queries, natural language processing (NLP) algorithms for unstructured data, and data mapping strategies to populate the DIRE for a cohort of chronic noncancer pain patients who were on long-term opioid therapy and who had a clinician-administered DIRE documented in the electronic health record prior to signing the most recent opioid agreement. We used ICD-9 diagnosis codes and NLP to populate diagnosis, psychological and chemical risk items. Encounter data and NLP were used for the reliability item. Intractability and social support items were populated using NLP only. Information on oral morphine equivalents, length of treatment, changes in pain scores and NLP were used to populate the efficacy item. If no information was found, most items were scored as 3 and efficacy as 2. The results of the NLP versus clinician-administered validation kappa analysis and test characteristics are pending. Conclusion: Among major barriers to appropriate management of chronic noncancer pain with opioids are inadequate time and resources available to clinicians at a point of care for risk assessment. Novel approaches, such as NLP, may support clinical decision-making by automating the process of data extraction

Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery

Objective: To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Design: Retrospective cohort study. Participants: Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017. Methods: Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery. Main Outcome Measures: Incidence and risk factors for RRD or RT within 1 year of cataract surgery. Results: Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99–3.32; P 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74–9.58; P 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article