Harmonizing healthcare and other resource measures for evaluating economic costs in substance use disorder research

Background Standardization and harmonization of healthcare resource utilization data can improve evaluations of the economic impact of treating people with substance use disorder (SUD), including reductions in use of expensive hospital and emergency department (ED) services, and can ensure consistency with current cost-effectiveness and cost-benefit analysis guidelines. Methods We examined self-reported healthcare and other resource utilization data collected at baseline from three National Institute on Drug Abuse (NIDA)-funded Seek, Test, Treat, and Retain intervention studies of individuals living with/at risk for HIV with SUD. Costs were calculated by multiplying mean healthcare resource utilization measures by monetary conversion factors reflecting cost per unit of care. We normalized baseline recall timeframes to past 30 days and evaluated for missing data. Results We identified measures that are feasible and appropriate for estimating healthcare sector costs including ED visits, inpatient hospital and residential facility stays, and outpatient encounters. We also identified two self-reported measures to inform societal costs (days experiencing SUD problems, participant spending on substances). Missingness was 8% or less for all study measures and was lower for single questions measuring utilization in a recall period. Conclusions We recommend including measures representing units of service with specific recall periods (e.g., 6 months vs. lifetime), and collecting healthcare resource utilization data using single-question measures to reduce missingness

Surface processes recorded by rocks and soils on Meridiani Planum, Mars: Microscopic Imager observations during Opportunity's first three extended missions

The Microscopic Imager (MI) on the Mars Exploration Rover Opportunity has returned images of Mars with higher resolution than any previous camera system, allowing detailed petrographic and sedimentological studies of the rocks and soils at the Meridiani Planum landing site. Designed to simulate a geologist's hand lens, the MI is mounted on Opportunity's instrument arm and can resolve objects 0.1 mm across or larger. This paper provides an overview of MI operations, data calibration, and analysis of MI data returned during the first 900 sols (Mars days) of the Opportunity landed mission. Analyses of Opportunity MI data have helped to resolve major questions about the origin of observed textures and features. These studies support eolian sediment transport, rather than impact surge processes, as the dominant depositional mechanism for Burns formation strata. MI stereo observations of a rock outcrop near the rim of Erebus Crater support the previous interpretation of similar sedimentary structures in Eagle Crater as being formed by surficial flow of liquid water. Well-sorted spherules dominate ripple surfaces on the Meridiani plains, and the size of spherules between ripples decreases by about 1 mm from north to south along Opportunity's traverse between Endurance and Erebus craters

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

The Archive Thief

Sunday, September 11, 2016 -- 2:00-3:30pm The Archive Thief by Lisa Moses Leff Facilitated by Dr. Elizabeth Drummond, History Dept. In the aftermath of the Holocaust, the Jewish historian Zosa Szajkowski stole tens of thousands of archival documents related to French Jewish history from public archives and collections in France and moved them, illicitly, to New York. Why did this respectable historian become a thief? And why did librarians in the United States and Israel accept these materials from him, turning a blind eye to the signs of ownership they bore? In The Archive Thief, Lisa Moses Leff reconstructs Szajkowski\u27s gripping story in all its ambiguity. Born into poverty in Russian Poland in 1911, Szajkowski was a self-made man who managed to make a life for himself as an intellectual, first as a journalist in 1930s Paris, and then, after a harrowing escape to New York in 1941, as a scholar. Although he never taught at a university or even earned a PhD, Szajkowski became one of the world\u27s foremost experts on the history of the Jews in modern France, publishing in Yiddish, English, and Hebrew. His work opened up new ways of thinking about Jewish emancipation, economic and social modernization, and the rise of modern anti-Semitism. But beneath Szajkowski\u27s scholarly accomplishments lay his shameful secret: his pathbreaking articles were based upon documents that he moved illicitly to New York. Eventually, he sold these documents, piecemeal, to American and Israeli research libraries where they still remain. Leff takes us into the backstage of the archives, revealing the powerful ideological, economic, and psychological forces that made Holocaust-era Jewish scholars care more deeply than ever before about preserving the remnants of their past. As Leff shows, it is only when we understand the issues at the heart of his story, in all their ambiguity and complexity, that we can begin to address the larger questions of the rightful ownership of Jewish archives, as well as other contested archives, that are still at issue today.https://digitalcommons.lmu.edu/jewishbookgroup/1000/thumbnail.jp

Raman Spectroscopy: A Sensitive and Specific Technique for Determining the Accuracy of Compounded Pharmaceutical Formulations

El presente trabajo tiene por objeto analizar y seleccionar las partes de un sistema de control distribuido para una instalación de concentradores solares. El sistema consta de una red de microcontroladores encargados de realizar las tareas de control supervisados por una computadora central. En este trabajo se comparan las prestaciones de microcontroladores, microprocesadores y las distintas opciones de conectividad. El trabajo selecciona al microcontrolador PIC18F4550 para llevar adelante las tareas de control, se analizan las opciones de conectividad I2C y Zigbee. También se toman en cuenta los errores de medición referidos a los tiempos.This paper aims to examine and select the parts of a distributed control system for an installation of solar concentrators. The system consists of a microcontroller network responsible for carrying out control tasks supervised by a central computer. In this paper compares the performance of microcontrollers, microprocessors and various connectivity options. The PIC18F4550 microcontroller selects the work to carry out the tasks of monitoring, analyzing the I2C connectivity options and Zigbee. It also takes into account measurement errors relating to the times.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Editorial: Mapping Maternal Subjectivities, Identities and Ethics

Editorial with embedded short articles including:- "Maternal Studies: The Why and Wherefore"(Hollway) highlighted as "unconscious intersubjective dynamics" "Why Study the Maternal Now?"(Jensen) highlighted as "parenting" "Thoughts around the Maternal: A Sociological Viewpoint" (T Miller) highlighted as "social locations and structural contexts within which women mother

Neuroplasticity and aphasia treatments: New approaches for an old problem

Given the profound impact of language impairment after stroke (aphasia), neuroplasticity research is garnering considerable attention as means for eventually improving aphasia treatments and how they are delivered. Functional and structural neuroimaging studies indicate that aphasia treatments can recruit both residual and new neural mechanisms to improve language function and that neuroimaging modalities may hold promise in predicting treatment outcome. In relatively small clinical trials, both non-invasive brain stimulation and behavioural manipulations targeting activation or suppression of specific cortices can improve aphasia treatment outcomes. Recent language interventions that employ principles consistent with inducing neuroplasticity also are showing improved performance for both trained and novel items and contexts. While knowledge is rapidly accumulating, larger trials emphasising how to select optimal paradigms for individualised aphasia treatment are needed. Finally, a model of how to incorporate the growing knowledge into clinical practice could help to focus future research

Physician Satisfaction with Chronic Care Processes: A Cluster-Randomized Trial of Guided Care

PURPOSE Chronically ill older patients with multiple conditions are challenging to care for, and new models of care for this population are needed. This study evaluates the effect of the Guided Care model on primary care physicians’ impressions of processes of care for chronically ill older patients

The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States

Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US$46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US$16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US$40,700 without counseling and a cost of US $98,000 to US$153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered