Characteristics and patterns of opioid-related overdoses among veterans

BACKGROUND AND OBJECTIVES: The United States is in the midst of an opioid overdose crisis and is now considered a public health emergency. Given the alarming rise in opioid overdose deaths, there is an urgent need to understand the characteristics and risks associated with opioid overdoses. The objectives of this study were 1) to compare factors associated with different type of opioid overdose, 2) to determine the conditional probability of repeat overdose among veterans with a prior overdose event and corresponding probability of mortality for each overdose event and, 3) to identify cause-specific mortality rate of those who experienced a nonfatal overdose during our study period. METHODS: Using clinical records and mortality files of more than 10.5 million veterans, we extracted data among those with a documented opioid overdose between January 1, 2011 and December 31, 2015. During this time, 13,333 veterans had at least one documented opioid overdose of any intent. RESULTS: Study 1. Patients who were younger in age (18-44 OR [odds ratio] 7.19, 45-64 OR 4.78) had significantly higher odds of a fatal index overdose and experiencing a repeat overdose (18-44 OR 2.13, 45-64 OR 1.78). Having one or more chronic pain diagnoses was both associated with experiencing a fatal index overdose (OR 3.96) or repeat overdose (OR 1.15). A diagnosis associated with mental health or substance abuse or dependence was significantly associated with experiencing a repeat overdose, (OR 1.54 and 1.25 respectively). Receipt of medication-assisted therapy (MAT) more than one year prior (OR 1.28) to the first (i.e. index) overdose was significantly associated with increased odds of a fatal overdose whereas receiving counseling services prior to index overdose was protective of experiencing a fatal index overdose. Study 2. One fifth of the study sample had a repeat overdose during the study period, with a conditional probability that increased linearly for each subsequent overdose event. The conditional probability of repeat overdose went from 21.1% on the second overdose to 43.2% for five or more overdoses. Mortality was highest among the first documented overdose. Study 3. Overall, veterans with a prior nonfatal overdose more often died from any cause in comparison to their veteran peers and had approximately 26 times the mortality rate to the general U.S. population. Veterans with a prior nonfatal overdose had a higher risk of death from substances (aHR [adjusted Hazard Ratio] 5.0, 95% CI [confidence interval]: 4.4-5.8), including a higher risk of death from drugs (aHR 6.9; 95% CI 5.8-8.1) and alcohol (aHR 2.7, 95% CI 2.1-3.6). For cause-specific mortalities assessed between veterans in our cohort and the general U.S. population, the standardized mortality rate ratio (SMR) was 114 times higher for deaths associated with substances (95% CI: 98.8-128.7), 107 times higher for deaths associated with hepatitis (95% CI: 65.5-152.7) and 68 times higher for deaths associated with liver cancers (95% CI: 47.9-88.7). Overall, veterans in our overdose cohort had an elevated mortality rate than the general public for all the specific causes of death assessed. CONCLUSION: Although risk factors for opioid overdoses are well studied, there appears to be differences between the type of opioid overdoses documented in a clinical setting. Given that mortality is highest on the first documented overdose suggests that prevention efforts should be further support to reach those patients at highest risk. Furthermore, given that the probability of iii experiencing a repeat overdose increases with each overdose event suggest that healthcare settings should be prepared to handle an influx in patients, specifically those with mental health diagnoses. Moreover, given the elevated risk of death from all-causes, specifically those associated with substances suggests the need for an integrated healthcare approach. Understanding risks factors, type of overdose, and cause-specific mortality among patients with an opioid overdose could help to inform healthcare interventions and potentially lead to better patient outcomes

Groundswell

Student Literary Magazine Publicatio

An analysis of technology gaps and priorities in support of probe-scale coronagraph and starshade missions

This paper provides a survey of the state-of-the-art in coronagraph and starshade technologies and highlights areas where advances are needed to enable future NASA exoplanet missions. An analysis is provided of the remaining technology gaps and the relative priorities of technology investments leading to a mission that could follow JWST. This work is being conducted in support of NASAs Astrophysics Division and the NASA Exoplanet Exploration Program (ExEP), who are in the process of assessing options for future missions. ExEP has funded Science and Technology Definition Teams to study coronagraphs and starshade mission concepts having a lifecycle cost cap of less than $1B. This paper provides a technology gap analysis for these concepts

A importância da abordagem da linguagem teatral na escola e nas aulas de Educação Física

TCC (Graduação) - Universidade Federal de Santa Catarina. Centro de Desportos. Educação Física Licenciatura.Essa monografia buscou destacar a importância da inclusão da linguagem teatral na escola e fomentá-la como conteúdo nas aulas de Educação Física. O problema que norteou essa pesquisa foi de tentar responder como esse conteúdo teatral pode ser abordado nas aulas de Educação Física e se é possível sua inclusão. O objetivo principal estabelecido foi de propor a expressão/linguagem teatral como conteúdo possível e necessário de ser desenvolvido nas aulas de Educação Física. O estudo teve como ferramenta de pesquisa a revisão de literatura do tipo exploratória e qualitativa, pois procurou conhecer, analisar, explicar e discutir o tema com base em referências teóricas publicadas em livros, revistas, periódicos e outros. Além de que, esse estudo apresenta também uma análise documental, já que envolve seleção, tratamento e interpretação da informação existente em documentos. O que se concluiu dessa pesquisa foi que se torna necessário o desenvolvimento de formas de se trabalhar com a linguagem teatral nas escolas e torná-las mais acessíveis para os professores e futuros professores.This monograph sought to highlight the importance of including theatrical language in school and to foster it as content in Physical Education classes. The problem that guided this research was to try to answer how this theatrical content can be approached in the classes of Physical Education and if its possible inclusion. The main objective was to propose the expression / theatrical language as possible and necessary content to be developed in the Physical Education classes. The study had as a research tool the literature review of the exploratory and qualitative type, since it sought to know, analyze, explain and discuss the theme based on theoretical references published in books, magazines, periodicals and others. Besides that, this study also presents a documentary analysis, since it involves selection, treatment and interpretation of existing information in documents. What was concluded from this research was that it becomes necessary to develop ways of working with theatrical language in schools and make them more accessible to teachers and future teachers

Habitable Exoplanet Observatory (HabEx)

The Habitable-Exoplanet Observatory (HabEx) is a candidate flagship mission being studied by NASA and the astrophysics community in preparation of the 2020 Decadal Survey. The first HabEx mission concept that has been studied is a large (~4m) diffraction-limited optical space telescope, providing unprecedented resolution and contrast in the optical, with extensions into the near ulttraviolet and near infrared domains. We report here on our team’s efforts in defining a scientifically compelling HabEx mission that is technologically executable, affordable within NASA’s expected budgetary envelope, and timely for the next decade. We also briefly discuss our plans to explore less ambitious, descoped missions relative to the primary mission architecture discussed here

The Habitable Exoplanet (HabEx) Imaging Mission: preliminary science drivers and technical requirements

HabEx is one of four candidate flagship missions being studied in detail by NASA, to be submitted for consideration to the 2020 Decadal Survey in Astronomy and Astrophysics for possible launch in the 2030s. It will be optimized for direct imaging and spectroscopy of potentially habitable exoplanets, and will also enable a wide range of general astrophysics science. HabEx aims to fully characterize planetary systems around nearby solar-type stars for the first time, including rocky planets, possible water worlds, gas giants, ice giants, and faint circumstellar debris disks. In particular, it will explore our nearest neighbors and search for signs of habitability and biosignatures in the atmospheres of rocky planets in the habitable zones of their parent stars. Such high spatial resolution, high contrast observations require a large (roughly greater than 3.5m), stable, and diffraction-limited optical space telescope. Such a telescope also opens up unique capabilities for studying the formation and evolution of stars and galaxies. We present some preliminary science objectives identified for HabEx by our Science and Technology Definition Team (STDT), together with a first look at the key challenges and design trades ahead

Habitable Exoplanet Observatory (HabEx)

The Habitable-Exoplanet Observatory (HabEx) is a candidate flagship mission being studied by NASA and the astrophysics community in preparation of the 2020 Decadal Survey. The first HabEx mission concept that has been studied is a large (~4m) diffraction-limited optical space telescope, providing unprecedented resolution and contrast in the optical, with extensions into the near ulttraviolet and near infrared domains. We report here on our team’s efforts in defining a scientifically compelling HabEx mission that is technologically executable, affordable within NASA’s expected budgetary envelope, and timely for the next decade. We also briefly discuss our plans to explore less ambitious, descoped missions relative to the primary mission architecture discussed here

The Habitable Exoplanet Observatory (HabEx) Mission Concept Study Final Report

The Habitable Exoplanet Observatory, or HabEx, has been designed to be the Great Observatory of the 2030s. For the first time in human history, technologies have matured sufficiently to enable an affordable space-based telescope mission capable of discovering and characterizing Earthlike planets orbiting nearby bright sunlike stars in order to search for signs of habitability and biosignatures. Such a mission can also be equipped with instrumentation that will enable broad and exciting general astrophysics and planetary science not possible from current or planned facilities. HabEx is a space telescope with unique imaging and multi-object spectroscopic capabilities at wavelengths ranging from ultraviolet (UV) to near-IR. These capabilities allow for a broad suite of compelling science that cuts across the entire NASA astrophysics portfolio. HabEx has three primary science goals: (1) Seek out nearby worlds and explore their habitability; (2) Map out nearby planetary systems and understand the diversity of the worlds they contain; (3) Enable new explorations of astrophysical systems from our own solar system to external galaxies by extending our reach in the UV through near-IR. This Great Observatory science will be selected through a competed GO program, and will account for about 50% of the HabEx primary mission. The preferred HabEx architecture is a 4m, monolithic, off-axis telescope that is diffraction-limited at 0.4 microns and is in an L2 orbit. HabEx employs two starlight suppression systems: a coronagraph and a starshade, each with their own dedicated instrument

The Habitable Exoplanet Observatory (HabEx) Mission Concept Study Final Report

The Habitable Exoplanet Observatory, or HabEx, has been designed to be the Great Observatory of the 2030s. For the first time in human history, technologies have matured sufficiently to enable an affordable space-based telescope mission capable of discovering and characterizing Earthlike planets orbiting nearby bright sunlike stars in order to search for signs of habitability and biosignatures. Such a mission can also be equipped with instrumentation that will enable broad and exciting general astrophysics and planetary science not possible from current or planned facilities. HabEx is a space telescope with unique imaging and multi-object spectroscopic capabilities at wavelengths ranging from ultraviolet (UV) to near-IR. These capabilities allow for a broad suite of compelling science that cuts across the entire NASA astrophysics portfolio. HabEx has three primary science goals: (1) Seek out nearby worlds and explore their habitability; (2) Map out nearby planetary systems and understand the diversity of the worlds they contain; (3) Enable new explorations of astrophysical systems from our own solar system to external galaxies by extending our reach in the UV through near-IR. This Great Observatory science will be selected through a competed GO program, and will account for about 50% of the HabEx primary mission. The preferred HabEx architecture is a 4m, monolithic, off-axis telescope that is diffraction-limited at 0.4 microns and is in an L2 orbit. HabEx employs two starlight suppression systems: a coronagraph and a starshade, each with their own dedicated instrument.Comment: Full report: 498 pages. Executive Summary: 14 pages. More information about HabEx can be found here: https://www.jpl.nasa.gov/habex