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PURPOSE: Suicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death. METHODS: Logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021). RESULTS: Decedents with a known mental health condition were 1.2–1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death. DISCUSSION: A comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.

Illicit or ‘designer’ benzodiazepines are a growing contributor to overdose deaths. We employed natural language processing (NLP) to study benzodiazepine mentions over 10 years on 270 online drug forums (subreddits) on Reddit. Using NLP, we automatically detected mentions of illicit and prescription benzodiazepines, including their misspellings and non-standard names, grouping relative mentions by quarter. On a collection of 17 861 755 posts between 2012 and 2021, we searched for 26 benzodiazepines (8 prescription; 18 illicit), detecting 173 275 mentions. The rate of posts about both prescription and illicit benzodiazepines increased consistently with increases in deaths involving both drug classes, illustrating the utility of surveillance via Reddit.

OBJECTIVE: To quantify discrepancies between opioid prescribing and dispensing via the percentage of patients with Electronic Medical Record (EMR) prescriptions who subsequently filled the prescription within 90 days, defined as congruence, and compared opioid congruence with related medications. DATA SOURCES: Deidentified data from the IBM MarketScan Explorys Claims‐EMR Dataset. STUDY DESIGN: In this retrospective, observational study, we examined congruence for commonly prescribed controlled substances—opioids, stimulants, and benzodiazepines. Congruence was stratified by age group and sex. DATA COLLECTION/EXTRACTION METHODS: Continuously enrolled adults aged 18‐64 years with an EMR encounter (excluding inpatient settings) and ≥ 1 prescription for selected classes between 1/1/2016 and 10/2/2017. PRINCIPAL FINDINGS: During the study period, 1,353,478 adults had ≥1 EMR encounter. Patients with stimulants prescriptions had the highest congruence (83%) corresponding to 7151 claims for 8,635 EMR prescriptions, followed by opioids (66%; 62,766/95,690) and benzodiazepines (64%; 30,181/47,408). Chi‐square testing showed congruence differed by age group within opioids (P

BackgroundDespite recent increasing focus on fatal overdoses involving multiple substances, there is a paucity of knowledge about stimulant co-use patterns among people who use opioids (PWUO) or people being treated with medication for opioid use disorder (PTMOUD). This study examines stimulant co-mention trends among PWUO/PTMOUD on social media.MethodsWe collected publicly-available data from 14 prescription and illicit opioid and MOUD-related forums on Reddit (subreddits) between 2011-2020 and timelines comprising past posts from a sample of Reddit users (Redditors) on these forums. We applied natural language processing to detect mentions of opioids, opioid-related medications, and stimulants and described trends and patterns in co-mentions. ResultsPosts collected for 13,812 Redditors indicated 12,306 (89.1%) mentioned ≥1 opioid, opioid-related medication or stimulant. Analyses showed the number and proportion of Redditors mentioning both opioids and/or opioid-related medications and stimulants steadily increased over time. Relative rates of co-mentions of heroin and methamphetamine, substances most commonly co-mentioned, decreased in recent years while those of fentanyl and MOUD with methamphetamine increased. ConclusionData from Reddit reflect increasing mentions of stimulants, particularly methamphetamine, among PWUO/PTMOUD and closely resemble the growth in overdose deaths involving both opioids and stimulants. These findings are consistent with recent reports suggesting increasing stimulant use among people receiving treatment for opioid use disorder. These data offer insights on emerging trends in the overdose epidemic and underscore the importance of scaling efforts to address co-occurring opioid and stimulant use including harm reduction and comprehensive healthcare access spanning mental-health services and substance use disorder treatment.

Introduction U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose. Methods In 2018, survey-weighted analysis of hospital stays in the 2016 Healthcare Cost and Utilization Project National Readmissions Database yielded the national estimated proportion of patients with opioid overdose stays that had all-cause readmissions within ≤90 days. A multivariable logistic regression model assessed index stay factors associated with readmission by type (opioid overdose or not). Number of readmissions per patient was assessed. Results More than 24% (n=14,351/58,850) of patients with non-fatal index stays for opioid overdose had at least one all-cause readmission ≤90 days of index stay discharge and 3% (n=1,658/58,850) of patients had at least one opioid overdose readmission. Less than 0.2% (n=104/58,850) of patients had more than one readmission for opioid overdose. Patient demographic characteristics (e.g., male, older age), comorbidities diagnosed during the index stay (e.g., drug use disorder, chronic pulmonary disease, psychoses), and other index stay factors (Medicare or Medicaid primary payer, discharge against medical advice) were significantly associated with both opioid overdose and non-opioid overdose readmissions. Nearly 30% of index stays for opioid overdose included heroin, which was significantly associated with opioid overdose readmissions. Conclusions A quarter of opioid overdose patients have ≤90 days all-cause readmissions, although opioid overdose readmission is uncommon. Effective strategies to reduce readmissions will address substance use disorder as well as comorbid physical and mental health conditions.

Objective Despite recent decreases in opioid prescribing rates, evidence suggests there is substantial variation in the way opioids are prescribed by providers. This study aims to identify patterns in high-volume opioid prescribing. Methods We conducted partitioning-around-medoids cluster analysis using the IQVIA Prescriber Profile dataset, including the number of opioid prescriptions filled at US retail pharmacies aggregated at the prescriber-level from July 2016 through June 2017. Clustering was used to identify prescription patterns within a sample of 10,000 high-volume opioid prescribers (defined as the top 10% of prescribers by number of opioid prescriptions during the 12-month period). Clustering variables included prescription counts by opioid type, and prescriber specialty, age, and region. Results Family medicine (32%), internal medicine (23%), and orthopedics (11%) were the most common high-volume prescribing specialties. Across specialties, hydrocodone and oxycodone were the most-frequently prescribed opioid types. Thirty-five clusters of prescribers were obtained, consistently comprised of a single majority specialty and region. All majority high-prescribing specialties were represented in Southern clusters, indicating consistently high volume opioid prescribing across specialties in the region. Prescribing patterns varied by drug type and region - across every Northeastern cluster, oxycodone prescribing was higher than hydrocodone. While clusters of pain medicine specialists had the highest median total prescriptions, emergency medicine specialist clusters had some of the lowest. Conclusions These results provide a clearer picture of current patterns among high-volume prescribers, who accounted for almost two-thirds of all opioid prescriptions. In light of the ongoing opioid overdose epidemic, this knowledge is critical for prevention activities.

Results from preclinical sepsis studies using rodents are often criticized as not being reproducible in humans. Using a murine model, we previously reported that visceral adipose tissues (VAT) are highly active during the acute inflammatory response, serving as a major source of inflammatory and coagulant mediators. The purpose of this study was to determine whether these findings are recapitulated in patients with sepsis and to evaluate their clinical significance. VAT and plasma were obtained from patients undergoing intra-abdominal operations with noninflammatory conditions (control), local inflammation, or sepsis. In mesenteric and epiploic VAT, gene expression of pro-inflammatory (TNFα, IL-6, IL-1α, IL-1β) and pro-coagulant (PAI-1, PAI-2, TSP-1, TF) mediators was increased in sepsis compared with control and local inflammation groups. In the omentum, increased expression was limited to IL-1β, PAI-1, and PAI-2, showing a depot-specific regulation. Histological analyses showed little correlation between cellular infiltration and gene expression, indicating a resident source of these mediators. Notably, a strong correlation between PAI-1 expression in VAT and circulating protein levels was observed, both being positively associated with markers of acute kidney injury (AKI). In another cohort of septic patients stratified by incidence of AKI, circulating PAI-1 levels were higher in those with versus without AKI, thus extending these findings beyond intra-abdominal cases. This study is the first to translate upregulation of VAT mediators in sepsis from mouse to human. Collectively, the data suggest that development of AKI in septic patients is associated with high plasma levels of PAI-1, likely derived from resident cells within VAT.

Decision-making to satisfy the basic human needs of health, food, and education is complex, accomplishing this in such a way that solutions are personalized to the needs of the individual has been the focus of my research. This chapter will present an overview of my research with several of my former students in the area of decision-making under conditions of uncertainty with a focus on human-centric decision problems in three primary areas: health care, humanitarian logistics, and education. This research seeks to inform decision-making with the goal of improving decision quality. To this end, this research utilizes and develops theory in the areas of Markov decision processes (MDPs), semi-Markov decision processes (SMDPs), partially observable Markov decision processes (POMDPs), optimization, simulation, and Bayesian decision analysis to address these real-world problems. This research has made an impact on how researchers and practitioners address complex societal issues, such as health disparities, public health preparedness, hunger relief, student performance, and personalized medical decision-making.

In the US, one in four adults has two or more chronic conditions; this population accounts for two thirds of healthcare spending. Comorbidity, the presence of multiple simultaneous health conditions in an individual, is increasing in prevalence and has been shown to impact patient outcomes negatively. Comorbidities associated with diabetes are correlated with increased incidence of preventable hospitalizations, longer lengths of stay (LOS), and higher costs. This study focuses on sex and race disparities in outcomes for hospitalized adult patients with and without diabetes. The objective is to characterize the impact of comorbidity burden, measured as the Charlson Weighted Index of Comorbidities (WIC), on outcomes including LOS, total charges, and disposition (specifically, probability of routine discharge home). Data from the National Inpatient Sample (2006-2011) were used to build a cluster-analytic framework which integrates cluster analysis with multivariate and logistic regression methods, for several goals: (i) to evaluate impact of these covariates on outcomes; (ii) to identify the most important comorbidities in the hospitalized population; and (iii) to create a simplified WIC score. Results showed that, although hospitalized women had better outcomes than men, the impact of diabetes was worse for women. Also, non-White patients had longer lengths of stay and higher total charges. Furthermore, the simplified WIC performed equivalently in the generalized linear models predicting standardized total charges and LOS, suggesting that this new score can sufficiently capture the important variability in the data. Our findings underscore the need to evaluate the differential impact of diabetes on physiology and treatment in women and in minorities.

Endometriosis is a known cause of infertility in reproductive-aged women. Most treatment plans target pain caused by the disease, and may overlook the possibility that the patient may want to conceive. This review assesses current studies on fertility preservation in endometriosis patients and outlines the seven best methods to preserve fertility. We propose the following seven ways to preserve fertility in patients with endometriosis: choosing the best surgical techniques; avoiding unnecessary surgery; measuring ovarian reserve before surgery; emergency IVF before laparoscopic surgery; using a gonadotropin-releasing hormone agonist; maintaining a healthy lifestyle; and cryopreservation. Each endometriotic patient should be assessed on an individual basis, using these seven methods as guidelines, in order to maximize fertility preservation.

In home health care (our motivating application), consistency is representative of the general health care principle of continuity of care, which is often correlated with quality of care. Much of the existing research involving consistency in routing uses planning horizons that are a week or shorter. Yet in many settings the relationship between an organization and its customers lasts much longer. Hence, this paper looks at how one should plan when seeking consistency in routes extends the impact of caregiver-patient assignments. Specifically, the paper examines appropriate planning horizon length and, with an extensive computational study, demonstrates that a long planning horizon can have significant potential for savings in terms of transportation costs and staffing levels. Initially, a deterministic setting is considered, with all patient requests during the planning horizon known a priori, and the routing cost of planning for two to three months is compared with the cost when planning is done on a weekly basis. With uncertainty inherent in planning for such a long time horizon, a methodology is presented that anticipates future patient requests that are unknown at the time of planning. Computational evidence shows that its use is superior to planning on a weekly, rolling horizon basis.