Drug Overdose Morbidity and Mortality in Kentucky, 2000-2010: An Examination of Statewide Data, Including the Rising Impact of Prescription Drug Overdose on Fatality Rates, and the Parallel Rise in Associated Medical Costs

From Foreword: Kentucky has seen an explosion in fatal poisonings, particularly prescription drug related fatalities, in the last decade. In 2009, Kentucky had the 5th highest drug overdose rate in the US, increased from the 6th highest drug overdose fatality rate determined in 2008 (CDC WONDER). Kentucky also had the 5th highest nonmedical use of opioid pain relievers, and 11th highest for opioid pain reliever sales in the nation (CDC, MMWR Report November 4, 2011). These drug overdose mortality statistics are extremely startling and only begin to reveal the devastating mental, emotional, and economic toll and pain on families who will forever grieve for their lost loved one. This report was designed to gain a comprehensive understanding of the drug overdose problem in Kentucky through the analysis of multiple statewide public health data sets-- emergency department admissions of Kentucky residents in Kentucky healthcare facilities, inpatient hospitalizations of Kentucky residents in Kentucky non-federal acute care hospitals, and deaths of Kentucky residents within and outside the Commonwealth of Kentucky. The operational definitions for the underlying and multiple causes coding of drug overdose mortality within death certificates were modeled on the CDC method of Dr. Leonard Paulozzi (Morbidity and Mortality Weekly Report, Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United States, 1999 - 2008). Drug overdose morbidity definition was based on a new Safe States publication entitled “Consensus Recommendations for National and State Poisoning Surveillance”, recently produced by the Safe States Injury Surveillance Workgroup on Poisoning in April 2012. The information contained within this report is intended to inform and assist practitioners, lawmakers, and public health professionals in the development of targeted interventions for multi-pronged approaches to reduce the heavy burden of prescription drug abuse in Kentucky. It is hoped that public health professionals and lawmakers armed with the data and recommendations contained within this report on drug overdoses can better target those populations with the greatest need for substance abuse services, prevention programs, and legislation

Motor Vehicle Injuries among Semi Truck Drivers and Sleeper Berth Passengers

Introduction: Injuries and fatalities due to large truck and other vehicle crashes have decreased over the last decade, but motor vehicle injuries remain a leading cause of death for both the working and general populations. The present study was undertaken to determine semi truck driver and sleeper berth passenger injury risk in a moving semi truck collision using a matched-pair cohort study. Method: Study data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000 - 2010. A matched-pair cohort study was used to compare the odds of injury of both drivers and sleeper berth passengers within the same semi truck controlling for variables specific to the crash or the semi truck. The crude odds ratio of injury was estimated and a statistical model for a correlated outcome using generalized estimating equations was utilized. Results: In a moving semi truck collision, the odds for an injury were increased by 2.25 times for both semi truck drivers and sleeper berth passengers who did not use occupant safety restraints compared to semi truck drivers and sleeper berth passengers who used occupant safety restraints at the time of the collision. The driver seat or sleeper berth position in the vehicle was not a significant factor (p-value= 0.31) associated with a moving semi truck collision injury. Conclusion: Nonuse of occupant safety restraints by either drivers or sleeper berth passengers significantly increased the odds of an injury in a moving semi truck collision; semi truck seating position (driver’s seat or sleeper berth) did not increase the odds for an injury in moving collisions. Impact on Industry: Trucking companies should include the mandatory use of occupant safety restraints by both semi truck drivers and sleeper berth passengers in their company safety policies

Workers Compensation-Reported Injuries Among Security and Law Enforcement Personnel in the Private Versus Public Sectors

Background: Private and Public security and law enforcement (SLE) sectors perform multiple overlapping job duties. Methods: Workers’ compensation (WC) SLE first reports of injury (FROI) data (2005–2015) were analyzed to describe injuries, identify differences in awarded WC benefits, and compare the probability of a FROI resulting in awarded benefits between Public and Private SLE. A Pearson’s chi-square test was utilized and reverse selection logistic regression was performed to estimate the odds ratio that a FROI would result in an awarded benefit for Private vs. Public SLE, while adjusting for relevant covariates. Results: Private SLE had higher FROI percentages for younger and for older workers, fall injuries, and back injuries, compared to Public SLE. The adjusted odds that a FROI resulted in an awarded benefit was 1.4 times higher for Private SLE compared to Public SLE; (95% confidence interval [CI] = 1.09,1.69). Middle-aged SLE employee adjusted odds of awarded benefits was 3.3 times (95% CI [1.96, 5.39]) higher compared to younger employees. Adjusted odds of awarded benefits was 3.8 times (95% CI [1.34, 10.61]) higher for gunshots and 1.7 times (95% CI [1.22, 2.39]) higher for fractures/dislocations compared to other nature of injuries. Motor vehicle injury, fall/slip, and strain related FROIs had elevated adjusted odds of awarded benefits compared to other injury causes. Conclusions: Results highlight the importance of injury prevention education and worker safety training for Private and Public SLE sector workers on fall prevention (especially in Private SLE) and strain prevention (especially in Public SLE), as well as motor vehicle safety

Drug Overdose Deaths, Hospitalizations, and Emergency Department Visits in Kentucky, 2000‐2012

This report presents drug overdose morbidity and mortality data for Kentucky residents, using multiple data sources: Kentucky Death Certificate Files, Kentucky Office of Vital Statistics, 2000‐2012 (data captured as of October 21, 2013). The 2009‐2012 files are provisional and subject to change. Kentucky Inpatient Hospitalization (IH) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2000‐2012 (data for 2010‐2012 are provisional and subject to change). Kentucky Emergency Department (ED) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2008‐2012 (data for 2010‐2012 are provisional and subject to change)

Child Maltreatment Outpatient Visits to Kentucky Non-Federal Acute Care Hospitals, 2008-2010

The Kentucky Injury Prevention and Research Center (KIPRC) is a unique collaboration between th

Timely Linkage of Individuals to Substance Use Disorder Treatment: Development, Implementation, and Evaluation of FindHelpNowKY.org

Background: Substance use disorders (SUD) have steadily increased over the last two decades. Seeking SUD treatment involves searching SUD treatment facility types (inpatient, outpatient and intensive outpatient, residential and family residential, and detoxification facilities) that offer specialized SUD treatment depending on individual needs and preferences. Referrals to SUD treatment require innovative strategies that rapidly link individuals to SUD treatment when they are at the critical stage of readiness. The aim of this study was to develop, implement, and evaluate a user-friendly SUD treatment facility opening availability website called FindHelpNowKY.org. The objectives of the study were to 1) recruit SUD treatment facility and partner participation; 2) develop platform, content, and analytics for the FindHelpNowKY.org website intervention with an information repository; 3) assess barriers and facilitators to implementation; and 4) evaluate the development and implementation of FindHelpNowKY.org. Methods: Website development stakeholders were identified and the website concept was developed. The logic model for FindHelpNowKY.org outlined resources, activities, and outputs as well as the associated short-term, medium-term, and long-term objectives, along with a website evaluation plan. Website usability and focus group testing was conducted. Information repository resource documents were compiled and categorized. An inventory of Kentucky-based SUD treatment facilities was compiled using various state and federal resources. Results: Development/implementation barriers were addressed, facilitators were identified, and the website was implemented; 83% of SUD treatment facilities were indexed on the website, and average website user time was 7 min. From February to October 2018, there were 29,000 visitors, and 30,000 unique searches. The most common website query was a friend or family member seeking long-term residential or outpatient treatment facilities accepting Medicaid or Medicare. Conclusions: FindHelpNowKY.org has the potential to fill a critical need for timely access to available SUD treatment in the state. The website may be a valuable resource for health professionals that can enhance clinical workflow and reduce staff time conducting phone and website searches for available SUD treatment. The website is a promising tool for assessing current SUD treatment capacity vs. SUD treatment need. The FindHelpNow model can be used by other states to increase timely access to SUD treatment

Enhancing Timeliness of Drug Overdose Mortality Surveillance: A Machine Learning Approach

BACKGROUND: Timely data is key to effective public health responses to epidemics. Drug overdose deaths are identified in surveillance systems through ICD-10 codes present on death certificates. ICD-10 coding takes time, but free-text information is available on death certificates prior to ICD-10 coding. The objective of this study was to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance. METHODS: Using 2017–2018 Kentucky death certificate data, free-text fields were tokenized and features were created from these tokens using natural language processing (NLP). Word, bigram, and trigram features were created as well as features indicating the part-of-speech of each word. These features were then used to train machine learning classifiers on 2017 data. The resulting models were tested on 2018 Kentucky data and compared to a simple rule-based classification approach. Documented code for this method is available for reuse and extensions: https://github.com/pjward5656/dcnlp. RESULTS: The top scoring machine learning model achieved 0.96 positive predictive value (PPV) and 0.98 sensitivity for an F-score of 0.97 in identification of fatal drug overdoses on test data. This machine learning model achieved significantly higher performance for sensitivity (p \u3c 0.001) than the rule-based approach. Additional feature engineering may improve the model’s prediction. This model can be deployed on death certificates as soon as the free-text is available, eliminating the time needed to code the death certificates. CONCLUSION: Machine learning using natural language processing is a relatively new approach in the context of surveillance of health conditions. This method presents an accessible application of machine learning that improves the timeliness of drug overdose mortality surveillance. As such, it can be employed to inform public health responses to the drug overdose epidemic in near-real time as opposed to several weeks following events

Measurements and analyses of transposable element activity inside living cells

Transposable elements (TEs) are DNA elements that move into different places in the DNA. Through their activity, they can restructure genomes and play crucial roles in evolution, development, and genetic disease. However, characterization of their detailed in vivo dynamics has been limited by a lack of direct observational methods. Here, we present novel methods that quantify biophysical characteristics of TEs in unprecedented detail. For the first study, we modify the bacterial transposable element IS608 to quantify its activity in single cells via fluorescence microscopy. The system can reveal single events, cell-to-cell variations, and temporal and environmental variabilities in real time and individual living cells. With this system, we characterize the relationship of the level of transposase protein with TE activity for different orientations of the TE in the genome. We also perform real-time activity detection and find that the activity is highly variable depending on the growth phase, local environment, and growth history of host cells. Secondly, we copy from the human genome a long interspersed nuclear element, LINE-1, one of the most prevalent and active transposable elements in humans. We introduce LINE-1 into the bacteria Escherichia coli (E. coli) and Bacillus subtilis (B. subtilis) and demonstrate that it is active in the bacteria and successfully integrates into the bacterial host genomes. The LINE-1 activity decreases the bulk growth rate of bacteria exponentially in response to its increasing expression. Our work suggests that E. coli can be a simple and useful model system to investigate the biophysical properties of LINE-1 element dynamics and their effects on host cells. In the last chapter, we present the technical development of a novel method for versatile and precise genome editing of E. coli, based on the Landing Pad intermediate method suited for the integration of large size DNA fragments at arbitrary locations in E. coli chromosome. Various genome modifications were made to show the power of this method, which include antibiotic-free selection methods, exact integration of long sequences (~6.5kbp) to any given target location, scar-less deletions, and gene fusion to native genes in situ

Testing for Fictive Learning in Decision-Making Under Uncertainty

We conduct two experiments where subjects make a sequence of binary choices between risky and ambiguous binary lotteries. Risky lotteries are defined as lotteries where the relative frequencies of outcomes are known. Ambiguous lotteries are lotteries where the relative frequencies of outcomes are not known or may not exist. The trials in each experiment are divided into three phases: pre-treatment, treatment and post-treatment. The trials in the pre-treatment and post-treatment phases are the same. As such, the trials before and after the treatment phase are dependent, clustered matched-pairs, that we analyze with the alternating logistic regression (ALR) package in SAS. In both experiments, we reveal to each subject the outcomes of her actual and counterfactual choices in the treatment phase. The treatments differ in the complexity of the random process used to generate the relative frequencies of the payoffs of the ambiguous lotteries. In the first experiment, the probabilities can be inferred from the converging sample averages of the observed actual and counterfactual outcomes of the ambiguous lotteries. In the second experiment the sample averages do not converge. If we define fictive learning in an experiment as statistically significant changes in the responses of subjects before and after the treatment phase of an experiment, then we expect fictive learning in the first experiment, but no fictive learning in the second experiment. The surprising finding in this paper is the presence of fictive learning in the second experiment. We attribute this counterintuitive result to apophenia: “seeing meaningful patterns in meaningless or random data.” A refinement of this result is the inference from a subsequent Chi-squared test, that the effects of fictive learning in the first experiment are significantly different from the effects of fictive learning in the second experiment

Tailored education for older patients to facilitate engagement in falls prevention strategies after hospital discharge—A pilot randomized controlled trial

Background The aims of the study were to evaluate the effect of providing tailored falls prevention education in hospital on: i) engagement in targeted falls prevention behaviors in the month after discharge: ii) patients’ self-perceived risk and knowledge about falls and falls prevention strategies after receiving the education. Methods A pilot randomized controlled trial (n = 50): baseline and outcome assessments conducted by blinded researchers. Participants: hospital inpatients 60 years or older, discharged to the community. Participants were randomized into two groups. The intervention was a tailored education package consisting of multimedia falls prevention information with trained health professional follow-up, delivered in addition to usual care. Outcome measures were engagement in falls prevention behaviors in the month after discharge measured at one month after discharge with a structured survey, and participants’ knowledge, confidence and motivation levels before and after receiving the education. The feasibility of providing the intervention was examined and falls outcomes (falls, fall-related injuries) were also collected. Results Forty-eight patients (98%) provided follow-up data. The complete package was provided to 21 (84%) intervention group participants. Participants in the intervention group were significantly more likely to plan how to safely restart functional activities [Adjusted odds ratio 3.80, 95% CI (1.07, 13.52), p = 0.04] and more likely to complete other targeted behaviors such as completing their own home exercise program [Adjusted odds ratio 2.76, 95% CI (0.72, 10.50), p = 0.14] than the control group. The intervention group was significantly more knowledgeable, confident and motivated to engage in falls prevention strategies after receiving the education than the control group. There were 23 falls (n = 5 intervention; n = 18 control) and falls rates were 5.4/1000 patient days (intervention); 18.7/1000 patient days (control). Conclusion This tailored education was received positively by older people, resulted in increased engagement in falls prevention strategies after discharge and is feasible to deliver to older hospital patients. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry; ACTRN12611000963921 on 8th November 2011