scholarly journals Temporal Trends in Prescribing of Bone-Directed Therapies in the United States, 2009–2020

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A250-A250
Author(s):  
Sara Cromer ◽  
Kristin M D’Silva ◽  
Elaine Wei-Yin Yu ◽  
Joan Landon ◽  
Rishi Desai ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Temporal Trends ◽  
The United States ◽  
Medication Administration ◽  
First Line ◽  
Data Mart ◽  
The Past ◽  
First Line Therapy ◽  
Icd Codes ◽  
Over Time

Abstract Multiple new osteoporosis therapies, including some with novel mechanisms of action, have been introduced in the past decade. However, little is known about temporal trends in prescribing these new medications. Using claims data from the Clinformatics Data Mart (Optum, Inc.), we determined the number of enrolled individuals over age 50 who were prescribed any osteoporosis medication during each quarter between January 1, 2009 and March 31, 2020. Of all individuals receiving therapy, we then calculated the percent receiving each medication. In subgroup analyses, we limited the population to (1) only those with ICD codes for osteoporosis in the current or previous three quarters and without codes for active malignancy during the current or previous quarter, and (2) only those with ICD codes from an oncology provider for active malignancy likely to metastasize to bone during the current or previous quarter. In the all-user cohort, a total of 15.48 million unique prescription or medication administration claims from 1.46 million unique individuals during the study period were analyzed. Of these, 89% were women and 71% over the age of 65, with a mean age of 69. Alendronate was the most common medication used, representing >50% of all treated individuals, and its use increased over time. Percent of users receiving zoledronic acid doubled during this period but remained <5%. Use of other bisphosphonates declined steadily. By comparison, after its approval in 2010, denosumab use increased rapidly, reaching 10% of users in 2015 and 15% of users in 2018. Percent of individuals treated with raloxifene declined after 2013. Use of teriparatide, abaloparatide, and romosozumab remained less than 2% throughout the study period. Trends in the osteoporosis cohort paralleled those in the all-user cohort. In the malignancy cohort, alendronate and zoledronic acid were each used in approximately 30% of individuals at the onset of the study, and both declined over the decade. By contrast, denosumab use rapidly increased after introduction and surpassed use of either bisphosphonate by 2013. Denosumab use continued to increase over time and reached approximately 50% of all bone-directed medication use in the malignancy cohort. Use of other medications, mainly alternate bisphosphonates, was low and declined throughout the study period. In a privately insured cohort between 2009–2020, denosumab use increased significantly in both osteoporosis and malignancy populations, outpacing gains in use of other agents, despite guidelines suggesting that either bisphosphonates or denosumab could be considered first-line therapy for osteoporosis.

Ideal body position for epinephrine autoinjector administration

2020 ◽  
Author(s):  
Qing Wang ◽  
Luke Pittman ◽  
Andrew Healey ◽  
James Chang ◽  
T. Ted Song
Keyword(s):  
Body Position ◽  
Vastus Lateralis ◽  
The United States ◽  
Thigh Muscle ◽  
First Line ◽  
Medical Treatment Facility ◽  
First Line Therapy ◽  
Epinephrine Autoinjector ◽  
Ideal Body ◽  
The Ideal

Background: Epinephrine is the first-line therapy for patients with anaphylaxis, and intramuscular (IM) delivery is shownto be superior to subcutaneous (SC) delivery. There currently is no consensus on the ideal body position for epinephrine autoinjector (EAI) administration.Objective: We designed this study to investigate whether SC tissue depth (SCTD) is affected by body position (e.g., standing, sitting, supine), which can potentially impact delivery of EAI into the IM space.Methods: Volunteer adults (ages >/= 18 years) from a military medical treatment facility in the United States were recruitedto participate in this study. SCTD of the vastus lateralis was measured via ultrasound at standing, sitting, and supine bodypositions. Subjects’ age, sex, and body mass index (BMI) were collected. Statistical analysis was performed to compare averageSCTD between body positions, sex, and BMI.Results: An analysis of variance of 51 participants (33 men and 18 women) did not reveal statistically significant differencein SCTD among standing, sitting, and supine body positions. It did show a significantly greater SCTD in women than in men (2.72 +/- 1.36 cm versus 1.10 +/- 0.38 cm; p < 0.001). There was no significant association observed between BMI and SCTD in this study.Conclusion: Body position did not seem to significantly change the distance between skin and thigh muscle in adults. Thiswould suggest that there might not be an ideal body position for EAI administration. Therefore, in case of anaphylaxis, promptadministration of epinephrine is recommended at any position.

scholarly journals Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248702
Author(s):  
Brian Neelon ◽  
Fedelis Mutiso ◽  
Noel T. Mueller ◽  
John L. Pearce ◽  
Sara E. Benjamin-Neelon
Keyword(s):  
Social Vulnerability ◽  
Primary Care Physicians ◽  
Negative Binomial ◽  
Temporal Trends ◽  
The United States ◽  
Social Vulnerability Index ◽  
Crossover Effect ◽  
Death Rates ◽  
The Impact ◽  
Over Time

Background Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time. Methods We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19. Results At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties. Conclusions The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.

scholarly journals A cross-sectional study of neurosurgical department chairs in the United States

2018 ◽  
Vol 129 (5) ◽  
pp. 1342-1348 ◽  
Author(s):  
Patrick M. Flanigan ◽  
Arman Jahangiri ◽  
Joshua L. Golubovsky ◽  
Jaret M. Karnuta ◽  
Francis J. May ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
San Francisco ◽  
Residency Program ◽  
Department Chair ◽  
Department Chairs ◽  
Temporal Trends ◽  
The United States ◽  
Advanced Degrees ◽  
Over Time

OBJECTIVEThe position of neurosurgery department chair undergoes constant evolution as the health care landscape changes. The authors’ aim in this paper was to characterize career attributes of neurosurgery department chairs in order to define temporal trends in qualities being sought in neurosurgical leaders. Specifically, they investigated the hypothesis that increased qualifications in the form of additional advanced degrees and research acumen are becoming more common in recently hired chairs, possibly related to the increased complexity of their role.METHODSThe authors performed a retrospective study in which they collected data on 105 neurosurgeons who were neurosurgery department chairs as of December 31, 2016, at accredited academic institutions with a neurosurgery residency program in the United States. Descriptive data on the career of neurosurgery chairs, such as the residency program attended, primary subspecialty focus, and age at which they accepted their position as chair, were collected.RESULTSThe median age and number of years in practice postresidency of neurosurgery chairs on acceptance of the position were 47 years (range 36–63 years) and 14 years (range 6–33 years), respectively, and 87% (n = 91) were first-time chairs. The median duration that chairs had been holding their positions as of December 31, 2016, was 10 years (range 1–34 years). The most common subspecialties were vascular (35%) and tumor/skull base (27%), although the tendency to hire from these specialties diminished over time (p = 0.02). More recently hired chairs were more likely to be older (p = 0.02), have more publications (p = 0.007), and have higher h-indices (p < 0.001) at the time of hire. Prior to being named chair, 13% (n = 14) had a PhD, 4% (n = 4) had an MBA, and 23% (n = 24) were awarded a National Institutes of Health R01 grant, tendencies that were stable over time (p = 0.09–0.23), although when additional degrees were analyzed as a binary variable, chairs hired in 2010 or after were more likely to have an MBA and/or PhD versus those hired before 2010 (26% vs 10%, p = 0.04). The 3 most common residency programs attended by the neurosurgery chairs were Massachusetts General Hospital (n = 8, 8%), University of California, San Francisco (n = 8, 8%), and University of Michigan (n = 6, 6%). Most chairs (n = 63, 61%) attended residency at the institution and/or were staff at the institution before they were named chair, a tendency that persisted over time (p = 0.86).CONCLUSIONSMost neurosurgery department chairs matriculated into the position before the age of 50 years and, despite selection processes usually involving a national search, most chairs had a previous affiliation with the department, a phenomenon that has been relatively stable over time. In recent years, a large increase has occurred in the proportion of chairs with additional advanced degrees and more extensive research experience, underscoring how neurosurgical leadership has come to require scientific skills and the ability to procure grants, as well as the financial skills needed to navigate the ever-changing financial health care landscape.

Abstract 13169: US Prevalence Estimates of Individuals With Diabetes and Chronic Kidney Disease Indicated for SGLT-2 Inhibitor Initiation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rahul Aggarwal ◽  
Kimberly Lu ◽  
Nicholas Chiu ◽  
George Bakris ◽  
Deepak L Bhatt
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
The United States ◽  
Stage Iii ◽  
First Line ◽  
First Line Therapy ◽  
Urine Albumin ◽  
The Us ◽  
Patients With Diabetes

Introduction: Since the CREDENCE trial results, the American Diabetes Association (ADA) recommends SGLT-2 inhibitors as first line therapy for patients with stage III Chronic Kidney Disease (CKD) or proteinuric CKD, regardless of baseline A1C. We project the number of US individuals with diabetes and renal disease that meets inclusion into the CREDENCE trial and that are recommended for SGLT-2 inhibitors based on the guidelines. Methods: Our initial cohort consisted of 48,710 individuals from the 2007-2016 National Health and Nutrition Examination Survey with survey weights designed to estimate the US population. CREDENCE eligible patients were patients with diabetes who had an eGFR of 30-90 and urine albumin-to-creatinine ratio (UACR) of >300 mg/g. Guideline eligible patients were stage III CKD individuals and those with a UACR > 30 mg/g. Results: In the US population, 21,411,059 (+/-708,233) individuals are >=18 years and have diabetes. Of these individuals, 578,514 (+/-72,385) are CREDENCE eligible. Based on the ADA recommendations, 7,504,508 (+/- 342,139) adults with CKD and diabetes are recommended for an SGLT-2 inhibitor, representing 35.0% of individuals with diabetes. The mean age of guideline eligible individuals is 64.4 years, with 3,886,904 males (51.8%) and 3,617,604 females (48.2%). Conclusions: In the United States, a large number of individuals--approximately 35% of adults with diabetes--have renal disease characteristics that give them a first-line indication for SGLT-2 inhibitor initiation.

Persuasion and Propaganda in War and Terrorism

2019 ◽  
pp. 1048-1071
Author(s):  
Thomas Steinfatt ◽  
Dana Janbek
Keyword(s):  
United States ◽  
World War I ◽  
The United States ◽  
Islamic State ◽  
World War ◽  
The Past ◽  
Political Unrest ◽  
Actual Use ◽  
Time Part ◽  
Over Time

This chapter focuses on the use of propaganda during times of war, prejudice, and political unrest. Part one distinguishes between persuasion and one of its forms, propaganda. The meaning-in-use of the term ‘propaganda' is essential to understanding its use over time. Part two presents relevant examples of propaganda from the past several centuries in the United States and Europe. These examples include episodes from World War I and II, among others. Propaganda is not a new tool of persuasion, and learning about its use in the past provides a comparison that helps in understanding its use in the present and future. Part three looks at recent examples of how propaganda occurs in actual use in online terrorist mediums by Al-Qaeda and by the Islamic State in Iraq and Syria (ISIS).

A matrix-variate dirichlet process to model earthquake hypocentre temporal patterns

2020 ◽  
pp. 1471082X2093976
Author(s):  
Meredith A. Ray ◽  
Dale Bowman ◽  
Ryan Csontos ◽  
Roy B. Van Arsdale ◽  
Hongmei Zhang
Keyword(s):  
Dirichlet Process ◽  
Temporal Pattern ◽  
Temporal Trends ◽  
Temporal Patterns ◽  
The United States ◽  
Seismic Zone ◽  
Clustering Methods ◽  
Dirichlet Process Prior ◽  
And Performance ◽  
Over Time

Earthquakes are one of the deadliest natural disasters. Our study focuses on detecting temporal patterns of earthquakes occurring along intraplate faults in the New Madrid seismic zone (NMSZ) within the middle of the United States from 1996–2016. Based on the magnitude and location of each earthquake, we developed a Bayesian clustering method to group hypocentres such that each group shared the same temporal pattern of occurrence. We constructed a matrix-variate Dirichlet process prior to describe temporal trends in the space and to detect regions showing similar temporal patterns. Simulations were conducted to assess accuracy and performance of the proposed method and to compare to other commonly used clustering methods such as Kmean, Kmedian and partition-around-medoids. We applied the method to NMSZ data to identify clusters of temporal patterns, which represent areas of stress that are potentially migrating over time. This information can then be used to assist in the prediction of future earthquakes.

scholarly journals Trends in factors indicating increased risk for STI among key subpopulations in the United States, 2002–2015

2019 ◽  
Vol 96 (2) ◽  
pp. 121-123 ◽  
Author(s):  
Jami S Leichliter ◽  
Patricia J Dittus ◽  
Casey E Copen ◽  
Sevgi O Aral
Keyword(s):  
Risk Factors ◽  
National Survey ◽  
Temporal Trends ◽  
Male Partner ◽  
The United States ◽  
High Risk Factors ◽  
Increased Risk ◽  
The Usa ◽  
Sex With Men ◽  
Over Time

ObjectivesWithin the context of rising rates of reportable STIs in the USA, we used national survey data to examine temporal trends in high-risk factors that indicate need for STI/HIV preventive services among key subpopulations with disproportionate STI rates.MethodsWe used data from the 2002 (n=12 571), 2006–2010 (n=22 682) and 2011–2015 (n=20 621) National Survey of Family Growth (NSFG). NSFG is a national probability survey of 15–44 year olds living in US households. We examined STI risk factors among sexually active men who have sex with men (MSM) and Hispanic, non-Hispanic black, 15–19 year old, 20–24 year old, and 25–29 year old women who have sex with men (WSM) and men who have sex with women (MSW). Risk behaviours included: received money or drugs for sex, gave money or drugs for sex, partner who injected drugs, partner who has HIV, non-monogamous partner (WSM, MSW only) and male partner who had sex with other men (WSM only). Endorsement of any of these behaviours was recoded into a composite variable focusing on factors indicating increased STI risk (yes/no). We used chi-squares and logistic regression (calculating predicted marginals to estimate adjusted prevalence ratios (aPRs)) to examine STI risk factors over time among the key subpopulations.ResultsFrom 2002 to 2011–2015, reported STI risk factors did not change or declined over time among key subpopulations in the USA. In adjusted analyses comparing 2002 to 2011–2015, we identified significant declines among WSM: Hispanics (aPR=0.84 (0.68–1.04), non-Hispanic blacks (aPR=0.69 (0.58–0.82), adolescents (aPR=0.71 (0.55–0.91) and 25–29 year olds (aPR=0.76 (0.58–0.98); among MSW: Hispanics (aPR=0.53 (0.40–0.70), non-Hispanic blacks (aPR=0.74 (0.59–0.94) and adolescents (aPR=0.63 (0.49–0.82); and among MSM (aPR=0.53 (0.34–0.84).ConclusionsWhile reported STIs have increased, STI risk factors among key subpopulations were stable or declined. Condom use related to these risk factors, sexual mixing patterns and STI testing should be examined.

Causal and Dialectical Models of Deviance: The Case of Marijuana Use in the United States

1980 ◽  
Vol 10 (1) ◽  
pp. 29-44 ◽  
Author(s):  
William R. Faulkner ◽  
Marvin Krohn ◽  
Richard A. Mathers
Keyword(s):  
United States ◽  
Marijuana Use ◽  
The United States ◽  
The Past ◽  
Historical Model ◽  
Over Time

A historical dialectical model of deviance is presented and contrasted with the empiricist conception of unidirectional causation. This historical model, focusing on the interaction over time between culture or ideology and socially structured reality is used to organize data on marijuana use in America over the past 50 years. It is argued that only a historical model of this sort can adequately account for the changing ideology and reality of deviant phenomena, including the findings of and conclusions drawn from empiricist research.

scholarly journals Equity and length of lifespan are not the same

2016 ◽  
Vol 113 (30) ◽  
pp. 8420-8423 ◽  
Author(s):  
Benjamin Seligman ◽  
Gabi Greenberg ◽  
Shripad Tuljapurkar
Keyword(s):  
Life Expectancy ◽  
Health Equity ◽  
Causes Of Death ◽  
The United States ◽  
Past Century ◽  
The Past ◽  
The United Kingdom ◽  
Mortality Improvement ◽  
Over Time ◽  
Age Of Death

Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

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