Effect of the New York City Overdose Prevention Program on Unintentional Heroin-related Overdose Death, 2000-2012

Background: Drug overdose mortality is the leading cause of injury death in both the United States (US) and New York City (NYC). Heroin-related overdoses make up the majority of overdoses in NYC. Since 2006, when a law was passed that allowed for layperson administration of naloxone, an opioid antagonist, heroin-related overdose deaths have decreased in NYC. No studies to date have investigated a possible association between the implementation of this intervention and heroin-related overdose mortality. Objectives: To investigate the possible association between overdose prevention programs (OPPs) and heroin-related overdose mortality in NYC, using interrupted time series and geospatial analytic techniques. Methods: Using surveillance of NYC accidental drug poisoning deaths (2000-2012), a demographic profile of heroin-related overdose deaths was described prior to implementation of OPP (January 2000 - June 2006) and after implementation (July 2006 - December 2012). Interrupted time series (ITS) analyses tested for a difference in level and trend of heroin-related mortality, comparing the post-OPP period with the pre-OPP period, for NYC as a whole. Geospatial patterns of heroin-related overdose mortality were described before and after implementation of OPP. After mapping OPP sites, NYC neighborhoods were stratified by naloxone penetration level, and using multivariable regression, we tested the hypothesis that neighborhoods with greater naloxone penetration experienced steeper declines in heroin-related overdose mortality, after controlling for neighborhood characteristics. We calculated street walking distance from the OPP to the location of each overdose fatality in one neighborhood, the Lower East Side of Manhattan, to test the hypothesis that risk increases with increasing distance. We mapped overdose rate by census tract and conducted Poisson regression. Results: 2,142 heroin-related overdose deaths occurred in the 6.5 years prior to implementation of NYC\u27s OPP, and 1,764 occurred in the 6.5 years after implementation, representing a 22.4% reduction in the age-adjusted mortality rate. We found, using ITS, that the level of heroin-related overdose mortality decreased by 16% (not statistically significantly different from no decrease) following implementation. When analyses were limited to only those parts of NYC with OPP, we found that neighborhoods with greatest OPP penetration saw greater decreases in overdose mortality rates, compared to neighborhoods without OPPs (-3.1 compared with -0.8). In the Lower East Side, we found that census tracts located furthest from the OPP had statistically significantly higher overdose mortality rates compared with census tracts closer to the OPP. The census tract where the OPP was located experienced the greatest decrease in heroin-related overdose death from pre-OPP to post (from 7.8 to 1.31 per 100,000 population). An individual is 1.22 times more likely to die from a heroin overdose for every 1,000 feet away from the OPP (p=0.0002). Conclusions: While time series analysis of NYC as a whole did not find a statistically significant change in the level of heroin-related overdose mortality after implementation of OPP, when OPP locations were geocoded, only one-third of NYC neighborhoods had any OPP in the six years following implementation. In analyses limited to those neighborhoods of NYC with OPPs, we found statistically significant associations between OPP and heroin-related overdose mortality risk. This suggests that OPP may be contributing to decreased heroin-related overdose mortality in NYC

They\u27ve Come a Long Way since P.L. 94-142: Standards-based Instruction and Its Impact on Increasing School Attendance Rates for Students with Disabilities

Students with disabilities have a higher rate of missed days of school as compared to their nondisabled peers. This dissertation will examine the effect Standards-based Instruction has on the school attendance rates of children with disabilities. The purpose is to determine whether rates of attendance will increase for students with disabilities who receive standards-based instruction over the period of the 2003 -2004, 2004 -2005, and 2006-2007 school years. The Commonwealth of Pennsylvania implemented standards in mathematics and reading, writing, speaking, and listening in 1999. The Commonwealth of Pennsylvania has 500 public school districts. The Pennsylvania Department of Education has designated the districts into the categories of urban, suburban and rural. The study will be a quasi-experimental design because it will examine differences between pre-existing populations of students with disabilities attendance rates for each school district in Pennsylvania. The independent variables are time and density (urban, suburban, and rural) and the dependent variable is attendance records. To determine the effect of standards-based instruction on student attendance, the researcher will conduct a simple analysis on student attendance. A means comparison will be conducted using Average Daily Attendance (ADA) percentages for each school district for the school years of 2003-2004, 2004-2005, and 2006-2007. Data will be collected to compare ADA percentages between urban, suburban, and rural school districts. A 3 by 2 ANOVA will be conducted with density and time being the variable compared. This will be a repeated measures mixed design. Attendance rates will be obtained for a period of time; the school years of 2003-2004, 2004-2005, and 2006-2007 to determine if more exposure to Standards-based Instruction will increase school attendance rates for students with disabilities. Attendance rates will be obtained to determine if there is any improvement in the frequency of attendance after the implementation of SBI. Attendance records will be examined for the 2003-2004, 2004-2005, and 2006-2007 school years to determine the effect Standards-based Instruction has on attendance rates for children with disabilities. These school years are being examined to allow time for all the 500 districts to have developed curriculum plans which reflect the state standards in mathematics and reading

Identifying the cognitive predictors of early counting and calculation skills: Evidence from a longitudinal study.

The extent that phonological, visual-spatial STM and non-symbolic quantitative skills support the development of counting and calculation skills was examined in this 14-month longitudinal study of 125 children. Initial assessments were made when the children were 4:8. Phonological awareness, visual-spatial STM and non-symbolic approximate discrimination predicted growth in early calculation skills. These results suggest that both the approximate number system and domain-general phonological and visual-spatial skills support early calculation. In contrast, only performance on a small non-symbolic quantity discrimination task (where the presented quantities were always within the subitising range) predicted growth in cardinal counting skills. These results suggest that the development of counting and calculation are supported by different cognitive abilities

Learning an energy-demanding and biomechanically constrained motor skill, racewalking: movement reorganization and contribution of metabolic efficiency and sensory information

Manuscript accepté pour publication dans la revue Human Movement Science (http://www.journals.elsevier.com/human-movement-science/)This study investigated how novices learn an energy-demanding and biomechanically constrained task such as racewalking. The first aim was to examine if movement reorganizes according to some fundamental strategies, proceeding in different stages (Newell, 1985). The second aim was to investigate the link between movement reorganization, metabolic efficiency and perceived exertion. Seven participants undertook seven racewalking learning sessions on a motorized treadmill, with increased velocity as experiment progressed, in order to reach a goal performance speed of 10km.h-1. Peripheral/central perceived exertion ratings, kinematic and metabolic data were collected during the 1st, 4th, 6th and 7th sessions. Repeated-measures ANOVAs (learning session speed) on kinematic data showed a proximal-to-distal directional trend in movement reorganization, with significant practice-related changes in pattern coordination and decreased variability. Early movement reorganization occurred at the 1st session ("coordination stage") and progressed till the 4th session ("control stage") to reach a plateau. In contrast, metabolic efficiency and peripheral perceived exertion continued optimizing till the last session, probably occurring in concurrence with the control stage. Peripheral perceived exertion presented the highest correlation with the global movement reorganization suggesting that it could play a key role in guiding movement reorganization in the learning process, improving efficiency as a result

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City

Abstract Background Programmatic data from New York City syringe exchange programs suggest that many clients visit the programs infrequently and take few syringes per transaction, while separate survey data from individuals using these programs indicate that frequent injecting – at least daily – is common. Together, these data suggest a possible "syringe gap" between the number of injections performed by users and the number of syringes they are receiving from programs for those injections. Methods We surveyed a convenience sample of 478 injecting drug users in New York City at syringe exchange programs to determine whether program syringe coverage was adequate to support safer injecting practices in this group. Results Respondents reported injecting a median of 60 times per month, visiting the syringe exchange program a median of 4 times per month, and obtaining a median of 10 syringes per transaction; more than one in four reported reusing syringes. Fifty-four percent of participants reported receiving fewer syringes than their number of injections per month. Receiving an inadequate number of syringes was more frequently reported by younger and homeless injectors, and by those who reported public injecting in the past month. Conclusion To improve syringe coverage and reduce syringe sharing, programs should target younger and homeless drug users, adopt non-restrictive syringe uptake policies, and establish better relationships with law enforcement and homeless services. The potential for safe injecting facilities should be explored, to address the prevalence of public injecting and resolve the 'syringe gap' for injecting drug users.</p

Human arm impedance estimation in dynamic human-robot interaction, a preliminary study

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