Bulletin No. 12: System dynamics modelling using a stocks and flows approach

One of the key components of the first phase of the DPMP project has been to develop a quantitative dynamic model of drug use in Australia. Using a stocks and flows approach, derived from similar work undertaken in the US on cocaine prevalence by Caulkins and collaborators, the key aim of this component of the DPMP has been to examine whether methods can be applied to the Australian context using available data. If a plausible model could be developed, then the subsequent aims were to use the model to describe: 1.The prevalence of drug use in Australia over time; and 2. the effects of changes in model parameters upon the prevalence of injecting drug use and the associated social costs

Bulletin No. 6: Illicit drugs in Australia: What do we know about the role of price?

There has been an increasing awareness of the importance of using price information to understand illicit drug markets. Internationally, researchers have found relationships between illicit drug prices and other market characteristics such as the numbers of drug users, the proportion of arrestees testing positive to drugs and the number of drug-related emergency department incidents. This work aimed to assess whether the Australian heroin market shares the same basic characteristics (e.g. real prices falling over time, significant price variability) as other illicit drug markets where more price analysis has been done; and begin to explore the relationship between price and harm. It is hard to measure how much heroin is being consumed with any precision, making it extremely difficult to understand the relationship between drug use and the harmful consequences that result from use. On the other hand other market characteristics, such as price, can be better measured. If there are relationships between price (as an indirect measure of consumption) and harms, we can use price (and potentially other market data) to assess harms and policy responses

Outcomes from an Addiction Medicine Elective for 2nd Year PCOM DO Students

Introduction: According to the 2020 National Survey on Drug Use and Health, 40.3 million people aged 12 or older had a past-year substance use disorder (SUD). However, the median number of hours of content discussing this clinical issue in medical schools is seven hours. At the PCOM Philadelphia campus, 50 Second Year students (allowable limit) participated in the first Addiction Medicine Elective course in Winter 2022. This was a 6-week long program with one 2-hour session at night (6–8 pm) per week. Classes consisted of sessions with physicians having experience with SUD patients, testimony from those with SUD, Narcan training, direct involvement in a related community experience (e.g., Prevention Point), and as observers in group sessions (e.g., Alcoholics Anonymous). Methods: All students were in good academic standing, and enrolled electively. There were no quizzes or exams but attendance was mandatory. Students were given a pre- and post-survey assessing their understanding of SUD, and their comfort level in talking to patients about their substance use. The survey questions were in the following format: “As a medical student I…” and were asked to give a ‘Yes’ or ‘No’ option; completion was not compulsory. However, submission of a ‘reflection’ paper was mandatory. Students who successfully participated received one course credit for their transcript. Results: All 50 students responded to the survey. Twenty percent stated prior to the course that they felt comfortable in assessing a patient for addiction which increased to 100% at the end. Forty-one percent reported feeling comfortable talking to their patients about their addiction prior to the course which rose to 95% after 6 weeks. In regard to understanding the disease concept of addiction, 66% felt comfortable at the beginning which increased to 100% at the end. On Day 1 of the course, only 2% reported knowing how to access community resources for referral regarding treatment or 12-step programs; after Day 6, 91% indicated that they now knew how to access these community resources. Discussion: The pre- and post-surveys given during this addiction medicine elective showed promising results that it was effective in teaching students about SUD. Students felt more comfortable identifying patients with this serious medical condition, and in talking to their future patients about substance use. They also reported a better understanding of the disease process of addiction. This course is a viable option to increase the knowledge and confidence of future physicians when it comes to treating patients with SUD

Sequence data and association statistics from 12,940 type 2 diabetes cases and controls

To investigate the genetic basis of type 2 diabetes (T2D) to high resolution, the GoT2D and T2D-GENES consortia catalogued variation from whole-genome sequencing of 2,657 European individuals and exome sequencing of 12,940 individuals of multiple ancestries. Over 27M SNPs, indels, and structural variants were identified, including 99% of low-frequency (minor allele frequency [MAF] 0.1–5%) non-coding variants in the whole-genome sequenced individuals and 99.7% of low-frequency coding variants in the whole-exome sequenced individuals. Each variant was tested for association with T2D in the sequenced individuals, and, to increase power, most were tested in larger numbers of individuals (\u3e80% of low-frequency coding variants in ~82 K Europeans via the exome chip, and ~90% of low-frequency non-coding variants in ~44 K Europeans via genotype imputation). The variants, genotypes, and association statistics from these analyses provide the largest reference to date of human genetic information relevant to T2D, for use in activities such as T2D-focused genotype imputation, functional characterization of variants or genes, and other novel analyses to detect associations between sequence variation and T2D

Mathematical programming modelling tools for resource-poor countries and organisations

In recent years, powerful mathematical modelling languages have enabled Operational Research practitioners to rapidly develop prototype tools capable of modelling complex managerial decisions such as staff shift scheduling, or production and supply chain planning. However, such tools have often required expensive commercial optimisation solvers that are sometimes beyond the financial reach of small companies and organisations, particularly in the low-income and emerging economies. Fortunately, the worldwide scope of the internet has put powerful free optimisation tools within the reach of anyone with a modest PC and even a slow internet connection. This article will present examples showing just how beneficial such an approach can be for resource-poor organisations

How long should the COVID-19 lockdown continue?

Nations struggled to decide when and how to end COVID-19 inspired lockdowns, with sharply divergent views between those arguing for a resumption of economic activity and those arguing for continuing the lockdown in some form. We examine the choice between continuing or ending a full lockdown within a simple optimal control model that encompasses both health and economic outcomes, and pays particular attention to when need for care exceeds hospital capacity. The model shows that very different strategies can perform similarly well and even both be optimal for the same relative valuation on work and life because of the presence of a so-called Skiba threshold. Qualitatively the alternate strategies correspond to trying essentially to eradicate the virus or merely to flatten the curve so fewer people urgently need healthcare when hospitals are already filled to capacity

How Long Should the COVID-19 Lockdown Continue?

Nations are struggling to decide when to end COVID-19 inspired lockdowns, with sharply divergent views between those arguing for a resumption of economic activity and those arguing for continuing the lockdown. We examine this choice within a simple optimal dynamic control model that encompasses both health and economic outcomes, and pays particular attention to when need for care exceeds hospital capacity. The model shows that very di_erent strategies can perform similarly well and even both be optimal for the same relative valuation on work and life because of the presence of a so-called Skiba threshold. Qualitatively the alternate strategies correspond to trying to essentially eradicate the virus or merely to atten the curve so fewer people urgently need healthcare when hospitals are already _lled to capacity