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Keshwani K, Richards TM, Seddon BM, Gaze MN. New Guidance From The Royal College of Radiologists on Incidental Irradiation of the Spleen: What Does it Say and Why Does it Matter? Clin Oncol (R Coll Radiol) 2022; 34:436-438. [PMID: 35305886 DOI: 10.1016/j.clon.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Affiliation(s)
- K Keshwani
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - T M Richards
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - B M Seddon
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - M N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
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Krawczyk N, Schneider KE, Eisenberg MD, Richards TM, Ferris L, Mojtabai R, Stuart EA, Casey Lyons B, Jackson K, Weiner JP, Saloner B. Opioid overdose death following criminal justice involvement: Linking statewide corrections and hospital databases to detect individuals at highest risk. Drug Alcohol Depend 2020; 213:107997. [PMID: 32534407 DOI: 10.1016/j.drugalcdep.2020.107997] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Persons who interact with criminal justice and hospital systems are particularly vulnerable to negative health outcomes, including overdose. However, the relationship between justice involvement, healthcare utilization and overdose risk is not well-understood. This data linkage study seeks to improve our understanding of the link between different types of justice involvement as well as hospital interaction and risk of fatal opioid overdose among persons with incarcerations, arrests and parole/probation records for drug and property crimes in Maryland. METHODS Maryland statewide criminal justice records were obtained for 2013-2016. Data were linked at the person-level to an all-payer hospitalization database and overdose death records for the same years. Logistic regression was performed to determine which criminal justice and hospital characteristics were associated with greatest risk of overdose death. RESULTS 89,591 adults had criminal-justice records and were included in the study. During the 2013-2016 study period, 4108 (4.59 %) were hospitalized for a non-fatal opioid overdose, and 519 (0.58 %) died of opioid overdose. Strongest risk factors for death included being older, being white, having had an inpatient or emergency hospitalization, having had more arrests, having been arrested for a drug charge (vs. property charge), having a misdemeanor drug charge (vs. a felony charge), and having been released from incarceration during the study period. CONCLUSION Linking corrections and healthcare information can help advance understanding of risk and target overdose prevention interventions directed at justice-involved individuals with greatest need.
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Affiliation(s)
- Noa Krawczyk
- NYU Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, New York NY 10016, USA; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Kristin E Schneider
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Matthew D Eisenberg
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Tom M Richards
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Lindsey Ferris
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA; The Chesapeake Regional Information System for our Patients, 7160 Columbia Gateway Drive, Suite 100, Columbia MD 21046, USA
| | - Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway, Baltimore, MD, 21205, USA
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 North Broadway, Baltimore, MD, 21205, USA; Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - B Casey Lyons
- Maryland Department of Health, 55 Wade Avenue, Catonsville, MD, 21228 USA
| | - Kate Jackson
- Maryland Department of Health, 55 Wade Avenue, Catonsville, MD, 21228 USA
| | - Jonathan P Weiner
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
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Krawczyk N, Eisenberg M, Schneider KE, Richards TM, Lyons BC, Jackson K, Ferris L, Weiner JP, Saloner B. Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study. Ann Emerg Med 2020; 75:1-12. [PMID: 31515181 PMCID: PMC6928412 DOI: 10.1016/j.annemergmed.2019.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/22/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE Persons with substance use disorders frequently utilize emergency department (ED) services, creating an opportunity for intervention and referral to addiction treatment and harm-reduction services. However, EDs may not have the appropriate tools to distinguish which patients are at greatest risk for negative outcomes. We link hospital ED and medical examiner mortality databases in one state to identify individual-level risk factors associated with overdose death among ED patients with substance-related encounters. METHODS This retrospective cohort study linked Maryland statewide ED hospital claims records for adults with nonfatal overdose or substance use disorder encounters in 2014 to 2015 with medical examiner mortality records in 2015 to 2016. Logistic regression was used to identify factors in hospital records associated with risk of opioid overdose death. Predicted probabilities for overdose death were calculated for hypothetical patients with different combinations of overdose and substance use diagnostic histories. RESULTS A total of 139,252 patients had substance-related ED encounters in 2014 to 2015. Of these patients, 963 later experienced an opioid overdose death, indicating a case fatality rate of 69.2 per 10,000 patients, 6 times higher than that of patients who used the ED for any cause. Factors most strongly associated with death included having both an opioid and another substance use disorder (adjusted odds ratio 2.88; 95% confidence interval 2.04 to 4.07), having greater than or equal to 3 previous nonfatal overdoses (adjusted odds ratio 2.89; 95% confidence interval 1.54 to 5.43), and having a previous nonfatal overdose involving heroin (adjusted odds ratio 2.24; 95% confidence interval 1.64 to 3.05). CONCLUSION These results highlight important differences in overdose risk among patients receiving care in EDs for substance-related conditions. The findings demonstrate the potential utility of incorporating routine data from patient records to assess risk of future negative outcomes and identify primary targets for initiation and linkage to lifesaving care.
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Affiliation(s)
- Noa Krawczyk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Matthew Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tom M Richards
- Johns Hopkins Center for Population and Health and Information Technology, Baltimore, MD
| | - B Casey Lyons
- Behavioral Health Administration, Maryland Department of Health, Columbia, MD
| | - Kate Jackson
- Behavioral Health Administration, Maryland Department of Health, Columbia, MD
| | - Lindsey Ferris
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Chesapeake Regional Information System for Our Patients, Columbia, MD
| | - Jonathan P Weiner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins Center for Population and Health and Information Technology, Baltimore, MD
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Ferris LM, Saloner B, Krawczyk N, Schneider KE, Jarman MP, Jackson K, Lyons BC, Eisenberg MD, Richards TM, Lemke KW, Weiner JP. Predicting Opioid Overdose Deaths Using Prescription Drug Monitoring Program Data. Am J Prev Med 2019; 57:e211-e217. [PMID: 31753274 PMCID: PMC7996003 DOI: 10.1016/j.amepre.2019.07.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Prescription Drug Monitoring Program data can provide insights into a patient's likelihood of an opioid overdose, yet clinicians and public health officials lack indicators to identify individuals at highest risk accurately. A predictive model was developed and validated using Prescription Drug Monitoring Program prescription histories to identify those at risk for fatal overdose because of any opioid or illicit opioids. METHODS From December 2018 to July 2019, a retrospective cohort analysis was performed on Maryland residents aged 18-80 years with a filled opioid prescription (n=565,175) from January to June 2016. Fatal opioid overdoses were identified from the Office of the Chief Medical Examiner and were linked at the person-level with Prescription Drug Monitoring Program data. Split-half technique was used to develop and validate a multivariate logistic regression with a 6-month lookback period and assessed model calibration and discrimination. RESULTS Predictors of any opioid-related fatal overdose included male sex, age 65-80 years, Medicaid, Medicare, 1 or more long-acting opioid fills, 1 or more buprenorphine fills, 2 to 3 and 4 or more short-acting schedule II opioid fills, opioid days' supply ≥91 days, average morphine milligram equivalent daily dose, 2 or more benzodiazepine fills, and 1 or more muscle relaxant fills. Model discrimination for the validation cohort was good (area under the curve: any, 0.81; illicit, 0.77). CONCLUSIONS A model for predicting fatal opioid overdoses was developed using Prescription Drug Monitoring Program data. Given the recent national epidemic of deaths involving heroin and fentanyl, it is noteworthy that the model performed equally well in identifying those at risk for overdose deaths from both illicit and prescription opioids.
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Affiliation(s)
- Lindsey M Ferris
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Chesapeake Regional Information System for our Patients, Baltimore, Maryland
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Noa Krawczyk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Molly P Jarman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kate Jackson
- Maryland Department of Health, Behavioral Health Administration, Office of PDMP and Overdose Prevention Applied Data Programs, Baltimore, Maryland
| | - B Casey Lyons
- Maryland Department of Health, Behavioral Health Administration, Office of PDMP and Overdose Prevention Applied Data Programs, Baltimore, Maryland
| | - Matthew D Eisenberg
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tom M Richards
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins Center for Population Health Information Technology, Baltimore, Maryland
| | - Klaus W Lemke
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins Center for Population Health Information Technology, Baltimore, Maryland
| | - Jonathan P Weiner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins Center for Population Health Information Technology, Baltimore, Maryland
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Chang HY, Krawczyk N, Schneider KE, Ferris L, Eisenberg M, Richards TM, Lyons BC, Jackson K, Weiner JP, Saloner B. A predictive risk model for nonfatal opioid overdose in a statewide population of buprenorphine patients. Drug Alcohol Depend 2019; 201:127-133. [PMID: 31207453 PMCID: PMC6713520 DOI: 10.1016/j.drugalcdep.2019.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Predicting which individuals who are prescribed buprenorphine for opioid use disorder are most likely to experience an overdose can help target interventions to prevent relapse and subsequent consequences. METHODS We used Maryland prescription drug monitoring data from 2015 to identify risk factors for nonfatal opioid overdoses that were identified in hospital discharge records in 2016. We developed a predictive risk model for prospective nonfatal opioid overdoses among buprenorphine patients (N = 25,487). We estimated a series of models that included demographics plus opioid, buprenorphine and benzodiazepine prescription variables. We applied logistic regression to generate performance measures. RESULTS About 3.24% of the study cohort had ≥1 nonfatal opioid overdoses. In the model with all predictors, odds of nonfatal overdoses among buprenorphine patients were higher among males (OR = 1.39, 95% CI:1.21-1.62) and those with more buprenorphine pharmacies (OR = 1.19, 95% CI:1.11-1.28), 1+ buprenorphine prescription paid by Medicaid (OR = 1.21, 95% CI:1.02-1.48), Medicare (OR = 1.93, 95% CI:1.63-2.43), or a commercial plan (OR = 1.98, 95% CI:1.30-2.89), 1+ opioid prescription paid by Medicare (OR = 1.30, 95% CI:1.03-1.68), and more benzodiazepine prescriptions (OR = 1.04, 95% CI:1.02-1.05). The odds were lower among those with longer days of buprenorphine (OR = 0.64, 95% CI:0.60-0.69) or opioid (OR = 0.79, 95% CI:0.65-0.95) supply. The model had moderate predictive ability (c-statistic = 0.69). CONCLUSIONS Several modifiable risk factors, such as length of buprenorphine treatment, may be targets for interventions to improve clinical care and reduce harms. This model could be practically implemented with common prescription-related information and allow payers and clinical systems to better target overdose risk reduction interventions, such as naloxone distribution.
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Affiliation(s)
- Hsien-Yen Chang
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA; Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, USA; Johns Hopkins Center for Drug Safety and Effectiveness, Baltimore, MD, USA.
| | - Noa Krawczyk
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.
| | - Kristin E Schneider
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.
| | - Lindsey Ferris
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA; The Chesapeake Regional Information System for our Patients, Baltimore, MD, USA.
| | - Matthew Eisenberg
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.
| | - Tom M Richards
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA; Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, USA.
| | - B Casey Lyons
- Maryland Department of Health, Public Health Services, Office of PDMP and Overdose Prevention Applied Data Programs, Baltimore, MD, USA.
| | - Kate Jackson
- Maryland Department of Health, Public Health Services, Office of PDMP and Overdose Prevention Applied Data Programs, Baltimore, MD, USA.
| | - Jonathan P Weiner
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA; Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, USA.
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.
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Richards TM, Hurley T, Grove L, Harrington KJ, Carpenter GH, Proctor GB, Nutting CM. The effect of parotid gland-sparing intensity-modulated radiotherapy on salivary composition, flow rate and xerostomia measures. Oral Dis 2017; 23:990-1000. [PMID: 28434191 DOI: 10.1111/odi.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/11/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe parotid gland (PG) saliva organic and inorganic composition and flow rate changes, after curative intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and analyse the relationship between PG saliva analytes and xerostomia measures. METHODS AND MATERIALS Twenty-six patients recruited to five prospective phase 2 or 3 trials which assessed toxicity and efficacy of IMRT by HNC subsite, provided longitudinal PG saliva. Salivary flow rate, and subjective and objective xerostomia measures were prospectively collected and saliva tested for inorganic and organic analytes. Statistical comparisons of longitudinal analyte changes and analysis for a relationship between dichotomized xerostomia score and saliva analytes were performed. RESULTS One hundred and forty-two PG saliva samples from 26 patients were analysed. At 3-6 months after IMRT, stimulated and unstimulated saliva showed significantly decreased flow rate, total protein (TP) secretion rate, phosphate concentration and increased lactoferrin (LF) concentration. Stimulated saliva alone had elevated LF secretion rate and beta-2-microglobulin (B2 M) concentration with decreased calcium (Ca2+ ) and magnesium (Mg2+ ) concentrations and Ca2+ secretion rate. At >12 months, under stimulated and unstimulated conditions, increased LF concentration and decreased Mg2+ and phosphate concentration persisted and, in stimulated saliva, there was decreased potassium (K+ ) and Mg2+ concentration. Unstimulated TP secretion rate was lower in the presence of high-grade xerostomia. Otherwise, no relationship between xerostomia grade and PG salivary flow rate, TP and Ca2+ secretion rate was found. CONCLUSION Fewer significant differences in PG saliva analytes >12 months after IMRT indicate good functional recovery. Residual xerostomia after IMRT will only be further reduced by addressing the sparing of subsites of the PG or other salivary gland tissues, in addition to the PG.
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Affiliation(s)
- T M Richards
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK
| | - T Hurley
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK
| | - L Grove
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK
| | - K J Harrington
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK.,The Institute of Cancer Research, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, Dental Institute, Kings College London, London, UK
| | - G B Proctor
- Mucosal & Salivary Biology Division, Dental Institute, Kings College London, London, UK
| | - C M Nutting
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK.,The Institute of Cancer Research, London, UK
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Sharpley CF, Christie DRH, Bitsika V, Agnew LL, Andronicos NM, McMillan ME, Richards TM. Neurobiological and psychological evidence of chronic stress in prostate cancer patients. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28252237 DOI: 10.1111/ecc.12671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Abstract
To measure the prevalence and severity of Generalised Anxiety Disorder (GAD), hypo- and hypercortisolaemia, and their association in a sample of prostate cancer (PCa) patients, 97 Australian PCa patients completed a background questionnaire and the GAD-7, and provided a sample of saliva collected 30-45 min after waking. The mean GAD7 score was 9.67 (SD = 3.09), and prevalence rates for current anxiety were higher than those reported for non-PCa males of a similar age. Mean salivary cortisol concentrations (30.78 nmol/L, SD = 13.97 nmol/L) were also higher than for age-comparative non-PCa men. There was a significant inverse correlation between GAD and cortisol (r = -. 209, p < .05), and four subgroups of GAD-cortisol patients were able to be identified, with evidence of both hyper- and hypocortisolaemia. These findings provide initial neurobiological evidence of the chronic and profound nature of stress experienced by PCa patients, and also suggest a possible measure that might be used to identify most at-risk PCa patients.
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Affiliation(s)
- C F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia
| | - D R H Christie
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia.,Genesiscare, Tugun, Qld, Australia
| | - V Bitsika
- Centre for Autism Spectrum Disorders, Bond University, Robina, Qld, Australia
| | - L L Agnew
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia
| | - N M Andronicos
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia
| | - M E McMillan
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia
| | - T M Richards
- Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia
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Briggs KB, Craig JK, Shivarudrappa S, Richards TM. Macrobenthos and megabenthos responses to long-term, large-scale hypoxia on the Louisiana continental shelf. Mar Environ Res 2017; 123:38-52. [PMID: 27912074 DOI: 10.1016/j.marenvres.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
The macrobenthos and megabenthos responses to long-term, recurring hypoxia on the Louisiana continental shelf were compared at four locations with different historical (2000-2010) episodes of annual exposure to bottom-water hypoxia. Measurements of abundance, biomass, species diversity, and community composition of the two size classes of benthos suggested that the macrobenthic response is driven chiefly by tolerance to hypoxia, whereas the megabenthic response was affected by the ability to migrate and the availability/unavailability of macrobenthos prey at the sediment surface. The site exposed to the historically lowest average bottom-water dissolved oxygen (BWDO) concentration exhibited the lowest species diversity for macrobenthos and the highest species diversity for megabenthos, exemplifying the differential effects of hypoxia on different size classes. The high diversity and smaller average size of the megabenthos at the lowest DO site was due to high abundance of invertebrates and a preponderance of small, less vagile fishes that appeared to remain in the area after larger dominant sciaenids had presumably emigrated. The average size and the depth of habitation in the sediment of macrobenthos prey may have also influenced the abundance and biomass of megabenthos foragers.
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Affiliation(s)
- Kevin B Briggs
- Seafloor Sciences Branch, Naval Research Laboratory, Stennis Space Center, MS 39529, USA.
| | - J Kevin Craig
- Southeast Fisheries Science Center, National Marine Fisheries Service, Beaufort Laboratory, Beaufort, NC 28516, USA
| | - S Shivarudrappa
- Louisiana Universities Marine Consortium, 8124 Highway 56, Chauvin, LA 70344, USA
| | - T M Richards
- Marine Biology Department, Texas A&M University at Galveston, Galveston, TX 77554, USA
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Rawlinson J, Richards TM, Stevens D, Macfie JM, McDowell I, Macdougall PD, Rice HM, Mason J, Bisley GG, Walt F, Rimington J, Tibbetts E. Robert David Alexander ("Sandy") Coxon William Erik Norman Cummings Nigel John Hunter James MacMaster Macfie Frank McDowell James Barr McWhinnie David Rice John Cornelius Blair Serjeant Joseph Taylor Maurice Lionel Walt Robert James Alan Webb John Frederick ("Jock") Wilkinson. West J Med 1998. [DOI: 10.1136/bmj.316.7133.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parente ST, Weiner JP, Garnick DW, Richards TM, Fowles J, Lawthers AG, Chandler P, Palmer RH. Developing a quality improvement database using health insurance data: a guided tour with application to Medicare's National Claims History file. Am J Med Qual 1995; 10:162-76. [PMID: 8547795 DOI: 10.1177/0885713x9501000402] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Health policy researchers are increasingly turning to insurance claims to provide timely information on cost, utilization, and quality trends in health care markets. This research offers an in-depth description of how to systematically transform raw inpatient and ambulatory claims data into useful information for health care management and research using the Health Care Financing Administration's National Claims History file as an example. The topics covered include: (a) understanding the contents and architecture of claims data, (b) creating analytic files from raw claims, (c) technical innovations for health policy studies, (d) assessing data accuracy, (d) the costs of using claims data, and (e) ensuring confidentiality. In summary, claims data are found to have great potential for quality of care analysis. As in any analysis, careful development of a database is required for scientific research. The methods outlined in this study offer health data novices as well as experienced analysts a series of strategies to maximize the value of claims data for health policy analysis.
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Affiliation(s)
- S T Parente
- Center for Health Affairs, Project HOPE, Bethesda, MD 20814, USA
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12
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Burton LC, Steinwachs DM, German PS, Shapiro S, Brant LJ, Richards TM, Clark RD. Preventive services for the elderly: would coverage affect utilization and costs under Medicare? Am J Public Health 1995; 85:387-91. [PMID: 7892924 PMCID: PMC1614868 DOI: 10.2105/ajph.85.3.387] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study was undertaken to determine whether adding a benefit for preventive services to older Medicare beneficiaries would affect utilization and costs under Medicare. METHODS The demonstration used an experimental design, enrolling 4195 older, community-dwelling Medicare recipients. Medicare claims data for the 2 years in which the preventive visits occurred were compared for the intervention (n = 2105) and control (n = 2090) groups. Monthly allowable charges for Part A and Part B services and number of hospital discharges and ambulatory visits were compared. RESULTS There were no significant differences in the charges between the groups owing to the intervention, although total charges were somewhat lower for the intervention group even when the cost of the intervention was included. Charges for both groups rose significantly as would be expected for an aging population. A companion paper describes a modest health benefit. CONCLUSIONS There appears to be a modest health benefit with no negative cost impact. This finding gives an early quantitative basis for the discussion of whether to extend Medicare benefits to include a general preventive visit from a primary care clinician.
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Affiliation(s)
- L C Burton
- Health Services Research and Development Center, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205
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Porayko MK, Textor SC, Krom RA, Hay JE, Gores GJ, Richards TM, Crotty PH, Beaver SJ, Steers JL, Wiesner RH. Nephrotoxic effects of primary immunosuppression with FK-506 and cyclosporine regimens after liver transplantation. Mayo Clin Proc 1994; 69:105-11. [PMID: 7508536 DOI: 10.1016/s0025-6196(12)61034-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We conducted a treatment trial to determine the relative toxicity of FK-506 and cyclosporine A (CSA) in liver transplant recipients. DESIGN Between October 1990 and October 1991, 37 patients were enrolled in an open-labeled, randomized study of two immunosuppressive regimens after liver transplantation. MATERIAL AND METHODS Of the 23 men and 14 women, 20 received FK-506 plus prednisone, and 17 received CSA plus prednisone and azathioprine. Renal function was assessed before and after transplantation (day 1, month 1, month 4, and month 12) by measurements of serum creatinine (SCr) and glomerular filtration rate (GFR) as determined by urinary iothalamate or creatinine clearance (or both). FK-506 trough plasma levels (enzyme immunoassay) were to be maintained between 0.2 and 5.0 ng/mL, and CSA trough blood levels (whole blood high-performance liquid chromatography) were to be maintained between 250 and 400 ng/mL. Severe nephrotoxicity was defined as sudden decreases in urine output to less than 10 mL/h or rapid increases in SCr (more than 0.5 mg/dL daily) that necessitated withdrawal of study medication for more than 48 hours. Mean patient age and values for SCr and GFR were comparable between the two groups at entry. RESULTS Both study groups demonstrated a similar deterioration in renal function during a 12-month follow-up, although patients who received FK-506 had a significantly (P < 0.05) lower GFR when measured at 12 months than did patients treated with CSA (45 +/- 4 versus 64 +/- 6 mL/min per body surface area). Mild nephrotoxicity that responded to decreased drug doses was noted in 9 CSA-treated patients (53%) and 10 FK-506-treated patients (50%). Severe nephrotoxicity that necessitated drug withdrawal occurred in only four patients, all of whom were in the FK-506 group. These severe nephrotoxic reactions to FK-506 occurred early after transplantation, often during intravenous administration of the drug, and were not associated with poor liver allograft function or drug levels outside the therapeutic range. CONCLUSION Both FK-506 and CSA are significantly nephrotoxic in liver transplant recipients. In this trial, however, we observed an early development of severe nephrotoxic reactions only in some patients who received FK-506.
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Affiliation(s)
- M K Porayko
- Division of Gastroenterology and Internal Medicine, Mayo Clinic Rochester, MN 55905
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Harasaki H, Moritz A, Uchida N, Chen JF, McMahon JT, Richards TM, Smith WA, Murabayashi S, Kambic HE, Kiraly RJ. Initiation and growth of calcification in a polyurethane-coated blood pump. ASAIO Trans 1987; 33:643-9. [PMID: 3675999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- H Harasaki
- Department of Artificial Organs, Cleveland Clinic Foundation, OH 44106
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Ray CD, Bickford RG, Clark LC, Johnston RE, Richards TM, Rogers D, Russert WE. A new multicontact, multipurpose, brain depth probe: details of construction. Mayo Clin Proc 1965; 40:771-80. [PMID: 5834779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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