Comparison of opioid prescribing by dentists in the United States and England

Importance: The United States consumes most of the opioids worldwide despite representing a small portion of the world\u27s population. Dentists are one of the most frequent US prescribers of opioids despite data suggesting that nonopioid analgesics are similarly effective for oral pain. While oral health and dentist use are generally similar between the United States and England, it is unclear how opioid prescribing by dentists varies between the 2 countries. Objective: To compare opioid prescribing by dentists in the United States and England. Design, Setting, and Participants: Cross-sectional study of prescriptions for opioids dispensed from outpatient pharmacies and health care settings between January 1 and December 31, 2016, by dentists in the United States and England. Data were analyzed from October 2018 to January 2019. Exposures: Opioids prescribed by dentists. Main Outcomes and Measures: Proportion and prescribing rates of opioid prescriptions. Results: In 2016, the proportion of prescriptions written by US dentists that were for opioids was 37 times greater than the proportion written by English dentists. In all, 22.3% of US dental prescriptions were opioids (11.4 million prescriptions) compared with 0.6% of English dental prescriptions (28 082 prescriptions) (difference, 21.7%; 95% CI, 13.8%-32.1%; P \u3c .001). Dentists in the United States also had a higher number of opioid prescriptions per 1000 population (35.4 per 1000 US population [95% CI, 25.2-48.7 per 1000 population] vs 0.5 per 1000 England population [95% CI, 0.03-3.7 per 1000 population]) and number of opioid prescriptions per dentist (58.2 prescriptions per dentist [95% CI, 44.9-75.0 prescriptions per dentist] vs 1.2 prescriptions per dentist [95% CI, 0.2-5.6 prescriptions per dentist]). While the codeine derivative dihydrocodeine was the sole opioid prescribed by English dentists, US dentists prescribed a range of opioids containing hydrocodone (62.3%), codeine (23.2%), oxycodone (9.1%), and tramadol (4.8%). Dentists in the United States also prescribed long-acting opioids (0.06% of opioids prescribed by US dentists [6425 prescriptions]). Long-acting opioids were not prescribed by English dentists. Conclusions and Relevance: This study found that in 2016, dentists in the United States prescribed opioids with significantly greater frequency than their English counterparts. Opioids with a high potential for abuse, such as oxycodone, were frequently prescribed by US dentists but not prescribed in England. These results illustrate how 1 source of opioids differs substantially in the United States vs England. To reduce dental opioid prescribing in the United States, dentists could adopt measures similar to those used in England, including national guidelines for treating dental pain that emphasize prescribing opioids conservatively

Genetic and environmental influences on eating behavior - a study of twin pairs reared apart or reared together

This study examined the relative influence of genetic versus environmental factors on specific aspects of eating behavior. Adult monozygotic twins (22 pairs and 3 singleton reared apart, 38 pairs and 9 singleton reared together, age 18-76 years, BMI 17-43 kg/m2) completed the Three Factor Eating Questionnaire. Genetic and environmental variance components were determined for the three eating behavior constructs and their subscales using model-fitting univariate and multivariate analyses. Unique environmental factors had a substantial influence on all eating behavior variables (explaining 45-71% of variance), and most strongly influenced external locus for hunger and strategic dieting behavior of restraint (explaining 71% and 69% of variance, respectively). Genetic factors had a statistically significant influence on only 4 variables: restraint, emotional susceptibility to disinhibition, situational susceptibility to disinhibition, and internal locus for hunger (heritabilities were 52%, 55%, 38% and 50%, respectively). Common environmental factors did not statistically significantly influence any variable assessed in this study. In addition, multivariate analyses showed that disinhibition and hunger share a common influence, while restraint appears to be a distinct construct. These findings suggest that the majority of variation in eating behavior variables is associated with unique environmental factors, and highlights the importance of the environment in facilitating specific eating behaviors that may promote excess weight gain.R01 AR046124 - NIAMS NIH HHS; R01 MH065322 - NIMH NIH HHS; T32 HL069772 - NHLBI NIH HHS; R37 DA018673 - NIDA NIH HHS; R01 DK073321 - NIDDK NIH HHS; R01 DA018673 - NIDA NIH HH

ICME Observations During the Ulysses Fast Latitude Scan

Between November 2000 and October 2001 the Ulysses spacecraft performed a fast traversal of the heliospheric latitudes between 80°S and 80°N, a period close to the activity maximum of the current solar cycle. This paper provides an overview of the Ulysses observations of the transient solar wind structures associated with coronal mass ejections (ICMEs) during this period. Compared to the previous Ulysses fast latitude scan near solar minimum in 1995, many more ICME related signatures were observed in the present data set. Events were encountered spread over the full latitude range between 80°S and 80°N. Those at high northern latitudes, where fast solar wind from a northern polar coronal hole had become re‐established, were of the over‐expanding type first identified in Ulysses data at mid‐latitudes near solar minimum. The signatures of these events and their latitude dependence are discussed and some ongoing and possible future studies with this data set are described. © 2003 American Institute of PhysicsPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87651/2/715_1.pd

Natural killer cell dysfunction is a distinguishing feature of systemic onset juvenile rheumatoid arthritis and macrophage activation syndrome

Macrophage activation syndrome (MAS) has been reported in association with many rheumatic diseases, most commonly in systemic juvenile rheumatoid arthritis (sJRA). Clinically, MAS is similar to hemophagocytic lymphohistiocytosis (HLH), a genetic disorder with absent or depressed natural killer (NK) function. We have previously reported that, as in HLH, patients with MAS have profoundly decreased NK activity, suggesting that this abnormality might be relevant to the pathogenesis of the syndrome. Here we examined the extent of NK dysfunction across the spectrum of diseases that comprise juvenile rheumatoid arthritis (JRA). Peripheral blood mononuclear cells (PBMC) were collected from patients with pauciarticular (n = 4), polyarticular (n = 16), and systemic (n = 20) forms of JRA. NK cytolytic activity was measured after co-incubation of PBMC with the NK-sensitive K562 cell line. NK cells (CD56(+)/T cell receptor [TCR]-αβ(-)), NK T cells (CD56(+)/TCR-αβ(+)), and CD8(+ )T cells were also assessed for perforin and granzyme B expression by flow cytometry. Overall, NK cytolytic activity was significantly lower in patients with sJRA than in other JRA patients and controls. In a subgroup of patients with predominantly sJRA, NK cell activity was profoundly decreased: in 10 of 20 patients with sJRA and in only 1 of 20 patients with other JRA, levels of NK activity were below two standard deviations of pediatric controls (P = 0.002). Some decrease in perforin expression in NK cells and cytotoxic T lymphocytes was seen in patients within each of the JRA groups with no statistically significant differences. There was a profound decrease in the proportion of circulating CD56(bright )NK cells in three sJRA patients, a pattern similar to that previously observed in MAS and HLH. In conclusion, a subgroup of patients with JRA who have not yet had an episode of MAS showed decreased NK function and an absence of circulating CD56(bright )population, similar to the abnormalities observed in patients with MAS and HLH. This phenomenon was particularly common in the systemic form of JRA, a clinical entity strongly associated with MAS

High Resolution Spectroscopy of the Pulsating White Dwarf G29-38

We present the analysis of time-resolved, high resolution spectra of the cool white dwarf pulsator, G29-38. From measuring the Doppler shifts of the H-alpha core, we detect velocity changes as large as 16.5 km/s and conclude that they are due to the horizontal motions associated with the g-mode pulsations on the star. We detect seven pulsation modes from the velocity time-series and identify the same modes in the flux variations. We discuss the properties of these modes and use the advantage of having both velocity and flux measurements of the pulsations to test the convective driving theory proposed for DAV stars. Our data show limited agreement with the expected relationships between the amplitude and phases of the velocity and flux modes. Unexpectedly, the velocity curve shows evidence for harmonic distortion, in the form of a peak in the Fourier transform whose frequency is the exact sum of the two largest frequencies. Combination frequencies are a characteristic feature of the Fourier transforms of light curves of G29-38, but before now have not been detected in the velocities, nor does published theory predict that they should exist. We compare our velocity combination frequency to combination frequencies found in the analysis of light curves of G29-38, and discuss what might account for the existence of velocity combinations with the properties we observe. We also use our high-resolution spectra to determine if either rotation or pulsation can explain the truncated shape observed for the DAV star's line core. We are able to eliminate both mechanisms: the average spectrum does not fit the rotationally broadened model and the time-series of spectra provides proof that the pulsations do not significantly truncate the line.Comment: 24 pages, 9 figures, Accepted for publication in ApJ (June

Oxygen Concentration Flammability Thresholds of Selected Aerospace Materials Considered for the Constellation Program

Materials selection for spacecraft is based on an upward flammability test conducted in a quiescent environment in the highest expected oxygen concentration environment. The test conditions and its pass/fail test logic do not provide sufficient quantitative materials flammability information for an advanced space exploration program. A modified approach has been suggested determination of materials self-extinguishment limits. The flammability threshold information will allow NASA to identify materials with increased flammability risk from oxygen concentration and total pressure changes, minimize potential impacts, and allow for development of sound requirements for new spacecraft and extraterrestrial landers and habitats. This paper provides data on oxygen concentration self-extinguishment limits under quiescent conditions for selected materials considered for the Constellation Program