Raven’s Work in Tlingit Ethno-geography

Chapter in the publication: Holton, Gary and Thomas F.Thornton. (Eds.) Language and Toponymy in Alaska and Beyond: Papers in Honor of James Kari. Language Documentation & Conservation Special Publication no. 17. Honolulu: University of Hawai‘i Press.Ye

Transitions Within Opioid Therapy and Their Impact on Morbidity, Healthcare Utilization, and Costs

In the United States (US), chronic non-cancer pain (CNCP) is prevalent among adults with costs exceeding half a billion dollars annually and can be especially burdensome for working age adults due to lost productivity and negative impacts on quality of life.An estimated 43% of adults experience pain, and the majority of them are working age (22--64 years). Despite lack of robust evidence on the efficacy and effectiveness of opioids relieving CNCP, and currently-available effective non-opioid treatments, many patients still receive opioid therapy. Opioids are associated with significant negative health consequences up to and including addiction to opioids which further increases their risk for overdose and death.10 Effective clinical, policy, and community responses to solve the opioid epidemic focus on a continuum beginning with appropriate initiation of opioids and ending with harm reduction efforts. The first step is the appropriate initiation of opioids because as many as 46% of adults who were initiated on opioids transition into chronic opioid users. Chronic opioid therapy (COT) can exacerbate current conditions and lead to development of new chronic physical and mental health conditions, and other opioid-related adverse effects including overdose. These negative consequences related to opioids lead to high economic burden through increased emergency room, inpatient, and other healthcare utilization and healthcare expenditures. Analysis of COT and its economic burden is especially important among working-age adults who receive opioids more frequently when they experience pain.;This study was conducted to (1) assess factors which predict the transition to COT, (2) estimate the changes in healthcare utilization and expenditure associated with the transition to COT, and (3) to identify educational strategies that can be used to fill knowledge gaps about opioids, naloxone, and opioid use disorder treatment medications for a group of healthcare professionals who are well suited to help alleviate the opioid epidemic.;First, we identified leading predictors associated with incident COT among adults without cancer in the US using a 10% random sample of working-age adults (age 28--63 years) insured in commercial plans, who were initiated on opioids between January 2007 through May 2015. The four leading predictors of COT were opioid duration-of-action [AOR= 12.28; 95%CI= 8.06-18.72], parent opioid tramadol vs. codeine, [AOR= 7.26; 95%CI= 5.20-10.13], the presence of conditions highly likely to cause chronic pain [AOR= 5.47; 95%CI=3.89-7.68] and drug use disorders [AOR= 4.02; 95%CI= 2.53-6.40]. Next, using the same data source, we assessed the association between transitioning from incident opioid use to chronic opioid therapy (COT), on the trajectories of health utilization and expenditures. Patients who transitioned to COT were more likely to use inpatient services [AOR=1.11, 95%CI(1.01,1.21)] compared to those who did not transition. While expenditures peaked during the transition period (t4) for all users, differences in unadjusted average, 120-day expenditures between COT and no COT users were highest in t4 for total ({dollar}4,607) and inpatient expenditures ({dollar}2,453). COT users had significantly higher total (beta=0.183, p\u3c0.01) and inpatient expenditures (beta=0.448, p\u3c0.001). For these first two aims, we found that initial opioid regimen characteristics are powerful predictors of COT, and the period after incident opioid prescription, but before COT, is an important time for intervention for payers.;Patients who have already transitioned to COT, or even opioid misuse or abuse need increased levels of care. The third aim sought to identify educational strategies related to opioids, buprenorphine products, and naloxone, for pharmacists, and to determine geographic locations to reduce the risk of opioid overdose in West Virginia (WV). A mixed-methods design included a prospective cross-sectional survey administered in two phases to increase coverage of the whole state, then results were weighted based on a census of all pharmacists in WV. Most pharmacists perceived high risk of opioid misuse in their area and high perceived efficacy about naloxone as a treatment for opioid overdose, but many did not feel comfortable selling naloxone. Opioid attitudes significantly differed between pharmacists in different EPPM-assigned categories. Filling practices differed; 73% stocked buprenorphine/naloxone and only 58% stocked buprenorphine. Pharmacists with higher perceived efficacy of buprenorphine products were more likely to be willing to fill non-local prescriptions. County-level disparities between actual and perceived risk for opioid misuse were observed. In the qualitative evaluation, pharmacists listed many barriers to caring for patients prescribed opioids or buprenorphine products. By tailoring educational strategies and objectives to pharmacists in specific geographic locations, more effective CPE can be delivered to community pharmacists in WV to improve access to naloxone and buprenorphine products as well as improve their understanding of addiction and psychosocial treatments

Hard Collisions in Rubidium using Sub-Doppler Spectroscopy

To better understand the laser kinetics of an alkali gain medium, hard collisions, or velocity-changing collisions, has been studied and a velocity-changing collisional rate has been calculated. Previous works have studied these collisions, but no rate has been calculated. Using the precise tool of sub-Doppler spectroscopy, atomic hard collisions can be observed. The collected spectra are fitted with two different line shapes to demonstrate the accuracy of this method. From the fits, the number of hard collisions can be extracted. The time scale of the hard collisions in rubidium is interpolated by varying the chopping frequency of the pump beam, or how long the collisions are being observed. Using the time scale and the collisional information from the fits, the velocity-changing collision rate was determined to be 1020.7 ± 26.3s-1mTorr-1 for the first line shape and 758.81 ± 13.90s-1mTorr-1 for the second line shape, which is a 17% and 13% difference, respectively, of the chemical kinetic hard sphere collisional model rate, 872.78 ± 13.73s-1mTorr-1

Studies of finite element analysis of composite material structures

Research in the area of finite element analysis is summarized. Topics discussed include finite element analysis of a picture frame shear test, BANSAP (a bandwidth reduction program for SAP IV), FEMESH (a finite element mesh generation program based on isoparametric zones), and finite element analysis of a composite bolted joint specimens

Will a palliative care course enhance competencies of medical students delivering bad news to patients?

Home care/end-of-life training for medical students begins with a medical home visit to an elder and a small group case presentation after. Later that day, this group is called to assist with one of their patients who had been rushed to the emergency department. The elder (now a simulation mannequin) requires resuscitation. Advance Directive (AD) is available, which might inform their decision about whether to discontinue their efforts; however, despite everything, the elder dies. Following pronouncement of death, each student completes a death certificate and informs family members (actors) of the death; they are met with different reactions. Prior to 2010 students had not had a Palliative Care course in their previous year. But after medical students participated in a one-week Palliative Care course, our thesis is that Palliative Care education will improve crucial end-of-life care competencies, such as Knowledge/understanding of Advance Directives and enhanced communication skills/ability to deliver bad news. To test this, videos of students informing family members were reviewed by 3 raters including one clinician and data was analyzed by Chi-Square and Independent Samples t-test. Student cohorts from 2008-10 (Pre) and 2010-11 (Post) were compared for statistically significant differences

Use of Selective-Serotonin Reuptake Inhibitors and Platelet Aggregation Inhibitors Among Individuals with Co-Occurring Atherosclerotic Cardiovascular Disease and Depression or Anxiety

Objective: Medications commonly used to treat heart disease, anxiety, and depression can interact resulting in an increased risk of bleeding, warranting a cautious approach in medical decision making. This retrospective, descriptive study examined the prevalence and the factors associated with the use of both selective-serotonin reuptake inhibitor and platelet aggregation inhibitor among individuals with co-occurring atherosclerotic cardiovascular disease and anxiety or depression. Methods: Respondents aged 22 years and older, alive throughout the study period, and diagnosed with co-occurring atherosclerotic cardiovascular disease and anxiety or depression (n=1507) in years 2007 through 2013 of the Medical Expenditures Panel Survey were included. The use of treatment was grouped as follows: selective-serotonin reuptake inhibitor and platelet aggregation inhibitor, selective-serotonin reuptake inhibitor or platelet aggregation inhibitor, and neither selective-serotonin reuptake inhibitor nor platelet aggregation inhibitor. Results: Overall, 16.5% used both selective-serotonin reuptake inhibitor and platelet aggregation inhibitor, 61.2% used selective-serotonin reuptake inhibitor or platelet aggregation inhibitor, and 22.3% used neither selective-serotonin reuptake inhibitor nor platelet aggregation inhibitor. Respondents aged over 65years (adjusted odds ratio=1.93 (95% confidence interval=1.08–3.45)) and having a diagnosis of diabetes (adjusted odds ratio=1.63 (95% confidence interval=1.15–2.31)) and hypertension (adjusted odds ratio=1.84 (95% confidence interval=1.04–3.27)) were more likely to be prescribed the combination. Conclusion: The drug interaction was prevalent in patients who are already at higher risk of health disparities and worse outcomes thus requiring vigilant evaluation

Deep-turbulence Wavefront Sensing using Digital Holography in the On-axis Phase Shifting Recording Geometry with Comparisons to the Self-referencing Interferometer

In this paper, we study the use of digital holography in the on-axis phase-shifting recording geometry for the purposes of deep-turbulence wavefront sensing. In particular, we develop closed-form expressions for the field-estimated Strehl ratio and signal-to-noise ratio for three separate phase-shifting strategies—the four-, three-, and two-step methods. These closed-form expressions compare favorably with our detailed wave-optics simulations, which propagate a point-source beacon through deep-turbulence conditions, model digital holography with noise, and calculate the Monte Carlo averages associated with increasing turbulence strengths and decreasing focal-plane array sampling. Overall, the results show the four-step method is the most efficient phase-shifting strategy and deep-turbulence conditions only degrade performance with respect to insufficient focal-plane array sampling and low signal-to-noise ratios. The results also show the strong reference beam from the local oscillator provided by digital holography greatly improves performance by tens of decibels when compared with the self-referencing interferometer

Direct and indirect cost of managing alzheimer\u27s disease and related dementias in the United States

Introduction—Care of individuals with Alzheimer’s Disease and Related Dementias (ADRD) poses special challenges. As the disease progresses, individuals with ADRD require increasing levels of medical care, caregiver support, and long-term care which can lead to substantial economic burden. Areas covered—In this expert review, we synthesized findings from studies of costs of ADRD in the United States that were published between January 2006 and February 2017, highlighted major sources of variation in costs, identified knowledge gaps and briefly outlined directions for future research and implications for policy and program planning. Expert commentary—A consistent finding of all studies comparing individuals with and without ADRD is that the average medical, non-medical, and indirect costs of individuals with ADRD are higher than those without ADRD, despite the differences in the methods of identifying ADRD, duration of the study, payer type and settings of study population. The economic burden of ADRD may be underestimated because many components such as direct non-medical costs for home safety modifications and adult day care services and indirect costs due to the adverse impact of ADRD on caregivers’ health and productivity are not included in cost estimates

Subaperture sampling for digital-holography applications involving atmospheric turbulence

Using wave-optics simulations, this paper defines what subaperture sampling effectively means for digital-holography applications involving atmospheric turbulence. Throughout, we consider the on-axis phase shifting recording geometry (PSRG) and off-axis PSRG, both with the effects of sensor noise. The results ultimately show that (1) insufficient subaperture sampling manifests as an efficiency loss that limits the achievable signal-to-noise ratio and field-estimated Strehl ratio; (2) digital-holography applications involving atmospheric turbulence require at least three focal-plane array (FPA) pixels per Fried coherence length to meet the Maréchal criterion; and (3) off-axis PSRG is a valid and efficient implementation with minor losses, as compared to on-axis PSRG. Such results will inform future research efforts on how to efficiently use the available FPA pixels