scholarly journals Gabapentin in Mixed Drug Fatalities: Does this Frequent Analyte Deserve More Attention?

2017 ◽  
Vol 7 (1) ◽  
pp. 99-111 ◽  
Author(s):  
Grant Finlayson ◽  
Michael Chavarria ◽  
Stephanie Chang ◽  
Tyler Gardner ◽  
Abigail Grande ◽  
...  
Keyword(s):  
Item Analysis ◽  
The United States ◽  
Prescribing Practices ◽  
Very High Frequency ◽  
Related Drug ◽  
Drug Fatalities ◽  
Multiple Drugs ◽  
Overdose Deaths ◽  
Very High

From 2000 to 2014, drug overdose deaths increased 137% in the United States, and 61% of these deaths included some form of opiate. The vast majority of opiate-related drug fatalities include multiple drugs, although there is scant data quantitatively describing the exact drugs that contribute to deaths due to multiple drugs. In the present study, we sought to quantitatively identify the drugs that occur with opiates in accidental multidrug-related fatalities. We retrospectively explored fatal drug trends in four Michigan counties, with a focus on profiling drugs present concurrently with opiates. Blood and urine toxicology reports for mixed drug fatalities (N=180) were analyzed using frequent item analysis approaches to identify common analyte trends in opiate-related fatalities. Within our cohort, the most prevalent serum analytes included caffeine (n=147), morphine (n=90), alprazolam (n=69), gabapentin (n=46), and tetrahydrocannabinol (n=44). In 100% of cases where gabapentin was present (n=46), an opiate was also present in the serum or urine. The average gabapentin serum concentration was 13.56 μg/mL (SEM =0.33 μg/mL), with a range of 0.5-88.7 μg/mL. Gabapentin was found at very high frequency in accidental mixed drug fatalities. Gabapentin concentrations were generally within the normal therapeutic range (2-20 μg/mL). It is unknown whether a synergistic effect with opioids may contribute to central respiratory depression. Further research is warranted to determine any contributory role of gabapentin in these deaths. Confirmed interactions could have broad implications for future reporting by forensic pathologists as well as prescribing practices by clinicians.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

Role of very-high-frequency excitation in single-bubble sonoluminescence

2000 ◽  
Vol 62 (2) ◽  
pp. 2233-2237 ◽  
Author(s):  
Francisco J. Moraga ◽  
Rusi P. Taleyarkhan ◽  
Richard T. Lahey ◽  
Fabian J. Bonetto
Keyword(s):  
High Frequency ◽  
Single Bubble ◽  
Very High Frequency ◽  
High Frequency Excitation ◽  
Frequency Excitation ◽  
Single Bubble Sonoluminescence ◽  
Very High

Some Thoughts on Sican Marked Adobes and Labor Organization

1988 ◽  
Vol 53 (1) ◽  
pp. 75-101 ◽  
Author(s):  
Raffael Cavallaro ◽  
Izumi Shimada
Keyword(s):  
Large Scale ◽  
North Coast ◽  
Labor Organization ◽  
Very High Frequency ◽  
Monumental Architecture ◽  
Moche Valley ◽  
Labor Tax ◽  
The Difference ◽  
Very High

This paper explores the applicability of the segmentary construction-labor tax model of marked adobe distribution proposed for the solid adobe Mochica pyramids in the Moche Valley on the Peruvian North Coast for Middle Sican monumental architecture in Batan Grande farther north. The model is found inadequate to account for the Middle Sican brick-marking pattern characterized by, among other things, a very high frequency of marking and lack of a one-to-one correspondence between brick size/shape and mark. The difference seems due in part to the chamber-fill building technique of the Middle Sican pyramids which required large scale, unitary construction. Cluster analysis was carried out to assess the relative merits of various alternative models. The most plausible models are those that posit a relatively complex labor organization and specify the role of local, lower-level administrators.

scholarly journals Genomic surveillance of Nevada patients revealed prevalence of unique SARS-CoV-2 variants bearing mutations in the RdRp gene

2020 ◽  
Author(s):  
Paul D. Hartley ◽  
Richard L. Tillett ◽  
David P. AuCoin ◽  
Joel R. Sevinsky ◽  
Yanji Xu ◽  
...  
Keyword(s):  
High Frequency ◽  
Geographic Location ◽  
The United States ◽  
The State ◽  
Very High Frequency ◽  
Viral Loads ◽  
Northern Nevada ◽  
Nasal Swabs ◽  
Novel Variant ◽  
Very High

ABSTRACTPatients with signs of COVID-19 were tested with CDC approved diagnostic RT-PCR for SARS-CoV-2 using RNA extracted from nasopharyngeal/nasal swabs. In order to determine the variants of SARS-CoV-2 circulating in the state of Nevada, 200 patient specimens from COVID-19 patients were sequenced through our robust protocol for sequencing SARS-CoV-2 genomes. Our protocol enabled sequencing of SARS-CoV-2 genome directly from the specimens, with even very low viral loads, without the need of culture-based amplification. This allowed the identification of specific nucleotide variants including those coding for D614G and clades defining mutations. These sequences were further analyzed for determining SARS-CoV-2 variants circulating in the state of Nevada and their phylogenetic relationships with other variants present in the united states and the world during the same period of the outbreak. Our study reports the occurrence of a novel variant in the nsp12 (RNA dependent RNA Polymerase) protein at residue 323 (314aa of orf1b) to Phenylalanine (F) from Proline (P), present in the original isolate of SARS-CoV-2 (Wuhan-Hu-1). This 323F variant is found at a very high frequency (46% of the tested specimen) in Northern Nevada. Functional significance of this unique and highly prevalent variant of SARS-CoV-2 with RdRp mutation is currently under investigation but structural modeling showed this 323aa residue in the interface domain of RdRp, which is required for association with accessory proteins. In conclusion, we report the introduction of specific SARS-CoV-2 variants at a very high frequency within a distinct geographic location, which is important for clinical and public health perspectives in understanding the evolution of SARS-CoV-2 while in circulation.

scholarly journals Administration of and Prescribing Opioids in Emergency Departments: A Retrospective Study

2021 ◽  
Vol 14 ◽  
pp. 1-4
Author(s):  
Casey McNeil ◽  
Alma Habib ◽  
Hayrettin Okut ◽  
Sheryl Beard ◽  
Elizabeth Ablah ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Overdose ◽  
Emergency Departments ◽  
The United States ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Medication ◽  
Opioid Prescribing ◽  
Opioid Administration ◽  
Overdose Deaths

Opioid overdose was a cause of 42,249 deaths in the United States in 2016 (13.3 deaths per 100,000) and contributed to 67.8% of all drug overdose deaths in the USA in 2017.1,2 The rate of drug overdose resulting in death in Kansas in 2016 was 11.8 per 100,000, (333 total drug overdose deaths).2 Emergency departments (EDs) are a key intermediary in opioid prescriptions.  In 2010, 31% of ED visits nationally resulted in an opioid prescription.3 The number of opioid prescriptions from an ED varies greatly even for a single medical indication.  For example, states varied from 40% to 2.8% of patients being prescribed an opioid medication from the ED for ankle sprains among opioid-naive patients treated from 2011 to 2015.4 In Kansas, 35.7% of ankle sprain patients received an opioid prescription from an ED.4  Guidelines for acute pain, including the Alternatives To Opioids protocol (ALTO)5 and the Center for Disease Control and Prevention’s Chronic Pain Guidelines (CDC-CPG)6 are available to guide opioid medication decisions.  The ALTO protocol can be used to guide administration and prescription of analgesics for indications that include headache/migraine, musculoskeletal pain, renal colic, abdominal pain, bone fracture, and joint dislocation. The protocol encourages the use of analgesics such as acetaminophen, ibuprofen, and ketorolac prior to opioid administration.5 The CDC-CPG guides the provider into setting goals for pain control, discussing appropriate risks and benefits with the patients, and setting criteria for minimizing long-term opioid use,6 but defers to the American College of Emergency Physician’s 2012 clinical policy guideline for opioid management of chronic pain in the ED. The ACEP recommends against prescribing opioids for acute exacerbation of chronic pain in the ED [Level C recommendation].7 Adopting opioid prescribing guidelines has drastically reduced opioid prescribing rates in some locations.8  For example, a study performed in both a community and an academic medical center tested the implementation of an opioid prescribing guideline that resulted in a decline of opioid prescriptions from 52.7% to 29.8% of patient visits.8  Even in a hospital with less frequent opioid prescribing practices, adopting guidelines has reduced opioid administration in the ED from 22.5% to 17.7%.9  In 2017, 17 states had adopted opioid prescription guidelines10; however, Kansas is not one of those states. Knowing little of opioid prescribing practices in Wichita, Kansas, the purpose of this study was to identify factors that are associated with opioid administration and prescriptions in EDs in Wichita, Kansas, and to evaluate what methods are used by local prescribers to limit opioid administration and prescription in a locality without an opioid prescribing guideline.

A Phylogenetic Approach to the Uneven Global Distribution of the COVID-19 Pandemic

2022 ◽  
pp. 105-126
Author(s):  
Ole Bernt Lenning ◽  
Ronny Myhre ◽  
May Sissel Vadla ◽  
Geir Sverre Braut
Keyword(s):  
Eastern Europe ◽  
Western Europe ◽  
Molecular Mechanisms ◽  
Sex Bias ◽  
Very High Frequency ◽  
Receptor Modulation ◽  
Different Populations ◽  
Second Wave ◽  
Very High

A possible role of Y chromosomal haplogroups in COVID-19 mortality is discussed without claiming causality. The mortality of COVID-19 seems unequally distributed in different populations and statistically significant regional covariation is presented between COVID-19 mortality and the haplogroup Y-R1b. Y-R1b is suggested as a possible marker for mortality in the first wave of the pandemic affecting the Western Europe. September 2020 the pandemic involved also Eastern Europe severely in a second wave, while South East Asia, with a very high frequency of Y-0, had strikingly low COVID-19 mortality rate. Eastern Europe is dominated by Y-haplogroups (i.e., Y-R1a), with close ancestry to Y-R1b. Molecular mechanisms mediated by the Y chromosome involved in COVID-19 mortality are discussed, presenting a possible role of KDM5D in androgen receptor modulation and regulation of TMPRSS2 known to enable SARS-CoV-2 binding to ACE2 and facilitating virus entrance into the cell and virus replication. Sex bias and comorbidities point at the role of variations in the Y-chromosomal phylogeny.

Prescription drug fatalities among women in rural Virginia: A study of medical examiner cases

2018 ◽  
Vol 5 (4) ◽  
pp. 228 ◽  
Author(s):  
Martha J. Wunsch, MD ◽  
Kent Nakamoto, PhD ◽  
Paul A. Nuzzo, MA ◽  
George Behonick, PhD ◽  
William Massello, MD ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Illicit Drugs ◽  
Medical Examiner ◽  
Qualitative And Quantitative ◽  
Therapeutic Drugs ◽  
Drug Classes ◽  
Drug Fatalities ◽  
Multiple Drugs ◽  
Overdose Deaths ◽  
Frequent Presence

Objective: To evaluate female drug overdose deaths from the Office of the Chief Medical Examiner, Western Virginia (1997-2003) for demographics, medical history, toxicology results, and prescribed medications.Design: Autopsy reports, death investigations, and hospital/physician notes were reviewed for 330 fatal drug poisonings among women. Data were evaluated with both qualitative and quantitative methods.Results: Most decedents were Caucasian (95 percent), their average age was 42.8 years, and the predominant manner and cause of death was accidental and polydrug toxicity, respectively. Drugs were identified on toxicology or assigned as a cause of death in all 330 cases. The three most common drug classes detected on toxicology were opioids (n = 239; 72.4 percent), antidepressants (n = 201; 60.9 percent), and sedative/anxiolytic/muscle relaxant (SAMR) (n = 161; 48.8 percent) with all three drug classes detected in 89 (27 percent) cases. Illicit drugs identified included cocaine (n = 33; 10 percent) and heroin (n = 3; 0.9 percent). Prescriptions for opioids, SAMR, and antidepressants were found in decedent name in 48 percent, 67.1 percent, and 58 percent of cases, respectively, and 46.1 percent of cases were prescribed at least one medication from each of those three drug classes.Conclusion: Although many decedents held prescriptions, and often for multiple drugs, toxicological findings indicate the frequent presence of other therapeutic drugs in the absence of a prescription. Moreover, many of these cases held simultaneous prescriptions for which there are known drug interactions. It is likely that misuse, fatal medication errors, abuse, and addiction were factors in the increased numbers of these deaths. Interventions to prevent prescription overdose deaths must involve education of both physicians and patients.

The Role of Gender and Sensation Seeking in Film Choice

2008 ◽  
Vol 20 (3) ◽  
pp. 97-105 ◽  
Author(s):  
Smita C. Banerjee ◽  
Kathryn Greene ◽  
Marina Krcmar ◽  
Zhanna Bagdasarov ◽  
Dovile Ruginyte
Keyword(s):  
United States ◽  
Undergraduate Students ◽  
Sensation Seeking ◽  
Negative Mood ◽  
Positive Mood ◽  
The United States ◽  
High Arousal ◽  
Subject Design ◽  
Happy Mood

This study demonstrates the significance of individual difference factors, particularly gender and sensation seeking, in predicting media choice (examined through hypothetical descriptions of films that participants anticipated they would view). This study used a 2 (Positive mood/negative mood) × 2 (High arousal/low arousal) within-subject design with 544 undergraduate students recruited from a large northeastern university in the United States. Results showed that happy films and high arousal films were preferred over sad films and low-arousal films, respectively. In terms of gender differences, female viewers reported a greater preference than male viewers for happy-mood films. Also, male viewers reported a greater preference for high-arousal films compared to female viewers, and female viewers reported a greater preference for low-arousal films compared to male viewers. Finally, high sensation seekers reported a preference for high-arousal films. Implications for research design and importance of exploring media characteristics are discussed.

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