Effectiveness of osteoporosis medication on site‐specific fracture‐risk attenuation among adults with epilepsy

ObjectiveThe objective of this propensity score‐matched, observational cohort study was to determine the effectiveness of osteoporosis medication on reducing the risk of non‐trauma fracture (NTFx) among adults with epilepsy.MethodsData from 01/01/2012 to 09/30/2015 was extracted from Optum Clinformatics Data Mart. NTFx risk attenuation from 12 months prior to 12 months after the individual’s index date was examined for each group of adults ≥50 years of age as risk ratios (RRs with 95% confidence intervals [CIs]). Groups were stratified based on: (1) epilepsy status, as with vs without epilepsy (EP); and (2) if and when osteoporosis medication was first prescribed, as new users (treatment naive), consistent users (osteoporosis medication prescribed in pre‐index period), and no users. Comparison groups were matched 1:1 to EP new users (n = 828/group) for demographics, glucocorticoid and antiseizure medication, and the Elixhauser comorbidity index. Difference‐in‐difference analysis compared the change in pre‐ to post‐index NTFx risk among groups as the ratio of the RR (RRR).ResultsThe pre‐ to post‐index NTFx risk at any site was reduced for EP new users (RR = 0.49; 95% CI = 0.40‐0.61) and EP consistent users (RR = 0.70; 95% CI = 0.38‐0.98), but nonsignificantly elevated for EP no users (RR = 1.39; 95% CI = 0.93‐2.07)—findings were consistent for most sites (eg, vertebral column). EP new users had a larger NTFx risk attenuation at any site compared to EP no users (RRR = 0.35; 95% CI = 0.23‐0.54) and EP consistent users (RRR = 0.70; 95% CI = 0.51‐0.97). EP consistent users had a larger NTFx risk attenuation at any site compared to EP no users (RRR = 0.50; 95% CI = 0.32‐0.79). The extent of NTFx risk attenuation at any site was similar for new users with vs without epilepsy (RRR = 0.99; 95% CI = 0.73‐1.34) and consistent users with vs without epilepsy (RRR = 0.81; 95% CI = 0.55‐1.17). There was evidence of site‐specific effects (eg, hip).ConclusionOsteoporosis medication is associated with a clinically meaningful 12‐month NTFx risk attenuation for adults with epilepsy, especially for those just starting osteoporosis medication.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163930/1/epi16700_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163930/2/epi16700.pd

Prevalence of High-Burden Medical Conditions Among Young and Middle-Aged Adults With Pediatric-Onset Medical Conditions: Findings From US Private and Public Administrative Claims Data

Adults with pediatric-onset medical conditions (POMCs) are susceptible to early development of high-burden medical conditions. However, research pertaining to this topic is lacking, which is vital information that could assist in health benefit planning and administration. The purpose of this study was to determine the prevalence of high-burden medical conditions among privately and publicly insured adults with POMCs, as compared to adults without POMCs, from the US. Data from 2016 were extracted from Optum Clinformatics® Data Mart (private insurance) and a random 20% sample from Medicare fee-for-service (public insurance). International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes were used to identify 18–64-year-old beneficiaries with POMCs, as well as several high-burden medical conditions, including pain, fracture, mood affective disorders, anxiety disorders, ischemic heart diseases, cerebrovascular diseases, hypertensive and other cardiovascular diseases, type 2 diabetes, osteoporosis, osteoarthritis, chronic obstructive pulmonary diseases, liver diseases, and cancer. Privately and publicly insured adults with POMCs had higher prevalence of all medical conditions compared to adults without POMCs. Publicly insured adults with POMCs had higher prevalence of all medical conditions compared to privately insured adults with POMCs, except for the lower prevalence of pain and cancer. When stratified by the category of POMCs (eg, musculoskeletal, circulatory), privately and publicly insured groups tended to have higher prevalence of most (private) or all (public) medical conditions compared to adults without POMCs. Adults with POMCs have higher prevalence of several high-burden medical conditions compared to adults without POMCs. This health disparity was present regardless of insurance coverage, but was generally more pronounced for public vs. private insured adults with POMCs

Mental health disorders and physical risk factors in children with cerebral palsy: a cross‐sectional study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149254/1/dmcn14083.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149254/2/dmcn14083_am.pd

Mental health disorders, participation, and bullying in children with cerebral palsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150524/1/dmcn14175_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150524/2/dmcn14175.pd

Osteoporosis Epidemiology Among Adults With Cerebral Palsy: Findings From Private and Public Administrative Claims Data

Individuals with cerebral palsy (CP) have an increased risk for the early development of osteoporosis; however, little is known about the epidemiology of osteoporosis for adults with CP, which is vital to inform clinical practice for osteoporosis prevention, treatment, and management. The purpose of this cross‐sectional study was to determine sex‐stratified prevalence of osteoporosis among adults with CP, as compared with adults without CP. Data from 2016 were extracted from Optum Clinformatics Data Mart (private insurance administrative claims data) and a random 20% sample from the fee‐for‐service Medicare (public insurance administrative claims data). Diagnostic codes were used to identify CP and osteoporosis diagnoses. Sex‐stratified prevalence of osteoporosis was compared between adults with and without CP for the following age groups: 18 to 30, 31 to 40, 41 to 50, 51 to 60, 61 to 70, and >70 years of age. The overall prevalence of osteoporosis was 4.8% for adults without CP (n = 8.7 million), 8.4% for privately insured adults with CP (n = 7,348), and 14.3% for publicly insured adults with CP (n = 21,907). Women and men with CP had a higher prevalence of osteoporosis compared with women and men without CP for all age groups. Finally, publicly insured women and men with CP had a higher prevalence of osteoporosis compared with privately insured women and men with CP for all age groups, except for the similar prevalence among the 18‐ to 30‐year age group. These findings suggest that osteoporosis is more prevalent among adults with CP compared with adults without CP. Study findings highlight the need for earlier screening and preventive medical services for osteoporosis management among adults with CP. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral ResearchPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152612/1/jbm410231_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152612/2/jbm410231.pd

The mortality burden attributable to nontrauma fracture for privately insured adults with epilepsy

ObjectiveIndividuals with epilepsy have poor bone development and preservation throughout the lifespan and are vulnerable to nontrauma fracture (NTFx) and post‐NTFx complications. However, no studies have examined the contribution of NTFx to mortality among adults with epilepsy. The objective was to determine whether NTFx is a risk factor for mortality among adults with epilepsy.MethodsData from 2011 to 2016 were obtained from Optum Clinformatics Data Mart, a nationwide claims database from a single private payer in the United States. Diagnosis codes were used to identify adults (≥18 years old) with epilepsy, NTFx, and covariates (demographics and pre‐NTFx cardiovascular disease, respiratory disease, diabetes, chronic kidney disease, cancer). Crude mortality rate per 100 person‐years was estimated. Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) were determined for mortality, comparing epilepsy and NTFx (EP + NTFx; n = 11 471), epilepsy without NTFx (EP without NTFx; n = 50 384), without epilepsy and with NTFx (without EP + NTFx; n = 423 041), and without epilepsy and without NTFx (without EP without NTFx; n = 6.8 million) after adjusting for covariates.ResultsThe 3‐, 6‐, and 12‐month crude mortality rates were highest among EP + NTFx (12‐month mortality rate = 8.79), followed by without EP + NTFx (12‐month mortality rate = 4.80), EP without NTFx (12‐month mortality rate = 3.06), and without EP without NTFx (12‐month mortality rate = 0.47). After adjustments, the mortality rate was elevated for EP + NTFx for all time points compared to EP without NTFx (eg, 12‐month HR = 1.70, 95% CI = 1.58‐1.85), without EP + NTFx (eg, 12‐month HR = 1.41, 95% CI = 1.32‐1.51), and without EP without NTFx (eg, 12‐month HR = 5.23, 95% CI = 4.88‐5.60). Stratified analyses showed higher adjusted HRs of 12‐month mortality for EP + NTFx for all NTFx sites (ie, vertebral column, hip, extremities), all age categories (young, middle‐aged, older), and for both women and men.SignificanceAmong adults with epilepsy and compared to adults without epilepsy, NTFx is associated with a higher 12‐month mortality rate. Findings suggest that NTFx may be a robust risk factor for mortality among adults with epilepsy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154895/1/epi16465.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154895/2/epi16465_am.pd

The Association Between Differing Grip Strength Measures and Mortality and Cerebrovascular Event in Older Adults: National Health and Aging Trends Study

The purpose of this study was to compare the predictive capacity of different post-processing methods of hand grip strength (GS) for mortality and incident cerebrovascular events in older adults. A sample of 4,143 participants aged 65 years and older was included from the National Health and Aging Trends Study (NHATS) and followed for 6 years. GS measures included baseline (i.e., round 1) (1) absolute GS, (2) GS divided by body mass (NGSmass), and (3) GS divided by body mass index (NGSBMI), as well as (4) change in absolute GS from round 1 to round 2 (GS1-2). Cox proportional hazards regression models were used to examine the association between sex- and age group-specific tertiles of GS measures (weak, moderate-strength, strong) with mortality (n = 641) and incident cerebrovascular events (n = 329). Absolute GS (hazard ratio [HR] = 1.83; 95% confidence interval [CI] = 1.51–2.22), NGSmass (HR = 1.46; 95% CI = 1.21–1.76), and NGSBMI (HR = 1.50; 95% CI = 1.24–1.82) were each associated with mortality among weak participants, but not GS1-2 (HR = 1.10; 95% CI = 0.99–1.46). NGSmass (HR = 1.54; 95% CI = 1.19–2.01) and NGSBMI (HR = 1.37; 95% CI = 1.06–1.79) were both associated with incident cerebrovascular event among weak participants, but not absolute GS (HR = 1.12; 95% CI = 0.86–1.47) or GS1-2 (HR = 1.11; 95% CI = 0.85–1.44). Absolute GS, NGSmass, and NGSBMI were each associated with mortality, whereas only NGSmass and NGSBMI were associated with cerebrovascular event. These findings suggest that different post-processing methods of GS may have differing predictive capacity in the elderly depending on the outcome of interest; however, since NGS measures were associated with both mortality and cerebrovascular events, they may be considered advantageous for screening in older adults

Wind Effects on Near- and Midfield Mixing in Tidally Pulsed River Plumes

River plumes transport and mix land-based tracers into the ocean. In tidally pulsed river plumes, wind effects have long been considered negligible in modulating interfacial mixing in the energetic nearfield region. This research tests the influence of variable, realistic winds on mixing in the interior plume. A numerical model of the Merrimack River plume-shelf system is utilized, with an application of the salinity variance approach employed to identify spatial and temporal variation in advection, straining, and dissipation (mixing) of vertical salinity variance (stratification). Results indicate that moderate wind stresses (∼0.5 Pa) with a northward component countering the downcoast rotation of the plume are most effective at decreasing stratification in the domain relative to other wind conditions. Northward winds advect plume and ambient shelf stratification offshore, allowing shelf water salinity to increase in the nearshore, which strengthens the density gradient at the plume base. Straining in the plume increases with winds enhancing offshore-directed surface velocities, leading to increased shear at the plume base. Increased straining and larger density gradients at the plume base enhance variance dissipation in the near- and midfield plume, and dissipation remains enhanced if the shelf is clear of residual stratification. The smaller spatial and temporal scales of the Merrimack plume allow the mechanisms to occur at tidal time scales in direct response to instantaneous winds. This is the first study to show tidal time scale wind-induced straining and advection as controlling factors on near- and midfield mixing rates in river plumes under realistic winds

Freshwater Composition and Connectivity of the Connecticut River Plume During Ambient Flood Tides

The Connecticut River plume interacts with the strong tidal currents of the ambient receiving waters in eastern Long Island Sound. The plume formed during ambient flood tides is studied as an example of tidal river plumes entering into energetic ambient tidal environments in estuaries or continental shelves. Conservative passive freshwater tracers within a high-resolution nested hydrodynamic model are applied to determine how source waters from different parts of the tidal cycle contribute to plume composition and interact with bounding plume fronts. The connection to source waters can be cut off only under low-discharge conditions, when tides reverse surface flow through the mouth after max ambient flood. Upstream plume extent is limited because ambient tidal currents arrest the opposing plume propagation, as the tidal internal Froude number exceeds one. The downstream extent of the tidal plume always is within 20 km from the mouth, which is less than twice the ambient tidal excursion. Freshwaters in the river during the preceding ambient ebb are the oldest found in the new flood plume. Connectivity with source waters and plume fronts exhibits a strong upstream-to- downstream asymmetry. The arrested upstream front has high connectivity, as all freshwaters exiting the mouth immediately interact with this boundary. The downstream plume front has the lowest overall connectivity, as interaction is limited to the oldest waters since younger interior waters do not overtake this front. The offshore front and inshore boundary exhibit a downstream progression from younger to older waters and decreasing overall connectivity with source waters. Plume-averaged freshwater tracer concentrations and variances both exhibit an initial growth period followed by a longer decay period for the remainder of the tidal period. The plume-averaged tracer variance is increased by mouth inputs, decreased by entrainment, and destroyed by internal mixing. Peak entrainment velocities for younger waters are higher than values for older waters, indicating stronger entrainment closer to the mouth. Entrainment and mixing time scales (1–4 h at max ambient flood) are both shorter than half a tidal period, indicating entrainment and mixing are vigorous enough to rapidly diminish tracer variance within the plume

Layered architecture for quantum computing

We develop a layered quantum computer architecture, which is a systematic framework for tackling the individual challenges of developing a quantum computer while constructing a cohesive device design. We discuss many of the prominent techniques for implementing circuit-model quantum computing and introduce several new methods, with an emphasis on employing surface code quantum error correction. In doing so, we propose a new quantum computer architecture based on optical control of quantum dots. The timescales of physical hardware operations and logical, error-corrected quantum gates differ by several orders of magnitude. By dividing functionality into layers, we can design and analyze subsystems independently, demonstrating the value of our layered architectural approach. Using this concrete hardware platform, we provide resource analysis for executing fault-tolerant quantum algorithms for integer factoring and quantum simulation, finding that the quantum dot architecture we study could solve such problems on the timescale of days.Comment: 27 pages, 20 figure