Quarter 1 Research Articles

National and regional trends in seizures of shrooms (psilocybin) in the United States, 2017–2022

BackgroundPsilocybin, the principle psychoactive component in “shrooms”, is regaining acceptance in therapeutic settings, leading to media coverage of medical benefits associated with use. Possession is also becoming increasingly decriminalized throughout the United States. There is a lack of data on prevalence of shroom use, but trends in law enforcement seizure data can provide one indicator of shroom availability in US communities. We determined whether seizures of shrooms have shifted between 2017 and 2022. MethodsThis study examined national and regional trends in counts and total weight of shroom seizures reported to High Intensity Drug Trafficking Areas in the US between 2017 and 2022 (N=4526). ResultsThere were 402 seizures in 2017 compared to 1396 in 2022 with the plurality occurring in the Midwest (36.0%), followed by the West (33.5%). Between 2017 Quarter 1 (Q1) and 2022 Quarter 4 (Q4), the number of seizures increased by 368.9% (AQPC=7.0; 95 CI: 5.9–8.1) and there were significant increases in all four regions. In terms of weight, 226.0kg was seized in 2017 vs. 844.0kg in 2022, and the greatest total weight in seizures was in the West (1864.2kg, 42.6%), followed by the South (1831.9kg, 41.8%). Between 2017 Q1 and 2022 Q4, the total weight seized in the US increased by 2749.7% (AQPC=6.2, 95% CI: 0.3–12.4) and there were significant increases in all four regions. ConclusionsSeizures of shrooms have increased, suggesting that availability may be escalating; thus, increases in prevention efforts and harm reduction education are warranted.

The real-world analysis of adverse events with teduglutide: a pharmacovigilance study based on the FAERS database.

Teduglutide, the first glucagon-like peptide 2 analogue, has been demonstrated to facilitate the absorption of gut nutrient and lessen the need for parenteral assistance in patients with Short Bowel Syndrome (SBS). However, its adverse drug events (AEs) are primarily documented in clinical trials, with a deficit in real-world data. This study evaluates the AEs profile of teduglutide based on Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) data. A disproportionality analysis of FAERS data from Quarter 1 (Q1) 2013 to Quarter 3 (Q3) 2023 was conducted to examine the association between teduglutide and adverse events, employing Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) methods. Out of 13,809,302 reports in the FAERS database, 10,114 reports identified teduglutide as the "primary suspect" in AEs identification. During the dosing observation period, the median occurrence of adverse events was 393 days (interquartile range [IQR] 97-996 days). Teduglutide-associated AEs occurred in 27 System Organ Classes (SOC), of which renal and urinary disorders is not mentioned in the specification. Based on the four algorithms, a total of 260 major disproportionality preferred terms (PTs) were filtered out, including previously unreported AEs including weight decreased (n = 805), vascular device infection (n = 683), dehydration (n = 596) and nephrolithiasis (n = 146). Our findings corroborate the AEs listed in the teduglutide prescribing information and additionally unveil new adverse reaction signals such as nephrolithiasis. These discoveries could aid in clinical monitoring and risk identification for teduglutide.

The influence of COVID-19 pandemic on PM2.5 air quality in Northern Taiwan from Q1 2020 to Q2 2021

The study aimed to investigate the PM2.5 variations in different periods of COVID-19 control measures in Northern Taiwan from Quarter 1 (Q1) 2020 to Quarter 2 (Q2) 2021. PM2.5 sources were classified based on long-range transport (LRT) or local pollution (LP) in three study periods: one China lockdown (P1), and two restrictions in Taiwan (P2 and P3). During P1 the average PM2.5 concentrations from LRT (LRT-PM2.5-P1) were higher at Fuguei background station by 27.9% and in the range of 4.9–24.3% at other inland stations compared to before P1. The PM2.5 from LRT/LP mix or pure LP (Mix/LP-PM2.5-P1) was also higher by 14.2–39.9%. This increase was due to higher secondary particle formation represented by the increase in secondary ions (SI) and organic matter in PM2.5-P1 with the largest proportion of 42.17% in PM2.5 from positive matrix factorization (PMF) analysis. A similar increasing trend of Mix/LP-PM2.5 was found in P2 when China was still locked down and Taiwan was under an early control period but the rapidly increasing infected cases were confirmed. The shift of transportation patterns from public to private to avoid virus infection explicated the high correlation of the increasing infected cases with the increasing PM2.5. In contrast, the decreasing trend of LP-PM2.5-P3 was observed in P3 with the PM2.5 biases of ∼45% at all the stations when China was not locked down but Taiwan implemented a semi-lockdown. The contribution of gasoline vehicle sources in PM2.5 was reduced from 20.3% before P3 to 10% in P3 by chemical signatures and source identification using PMF implying the strong impact of strict control measures on vehicle emissions. In summary, PM2.5 concentrations in Northern Taiwan were either increased (P1 and P2) or decreased (P3) during the COVID-19 pandemic depending on control measures, source patterns and meteorological conditions.

Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics

ObjectiveTo implement complex, PINCER (pharmacist led information technology intervention) prescribing indicators, on a national scale with general practice data to describe the impact of the covid-19 pandemic on safe prescribing.DesignPopulation...

Fatal drug use in the COVID-19 pandemic response: Changing trends in drug-involved deaths before and after stay-at-home orders in Louisiana.

The effect of disaster events on increasing drug-involved deaths has been clearly shown in previous literature. As the COVID-19 pandemic led to stay-at-home orders throughout the United States, there was a simultaneous spike in drug-involved deaths around the country. The landscape of a preexisting epidemic of drug-involved deaths in the United States is one which is not geographically homogenous. Given this unequal distribution of mortality, state-specific analysis of changing trends in drug use and drug-involved deaths is vital to inform both care for people who use drugs and local policy. An analysis of public health surveillance data from the state of Louisiana, both before and after the initial stay-at-home order of the COVID-19 pandemic, was used to determine the effect the pandemic may have had on the drug-involved deaths within this state. Using the linear regression analysis of total drug-involved deaths, as well as drug-specific subgroups, trends were measured based on quarterly (Qly) deaths. With the initial stay-at-home order as the change point, trends measured through quarter 1 (Q1) of 2020 were compared to trends measured from quarter 2 (Q2) of 2020 through quarter 3 (Q3) of 2021. The significantly increased rate of change in Qly drug-involved deaths, synthetic opioid-involved deaths, stimulant-involved deaths, and psychostimulant-involved deaths indicates a long-term change following the initial response to the COVID-19 pandemic. Changes in the delivery of mental health services, harm reduction services, medication for opioid use disorder (MOUD), treatment services, withdrawal management services, addiction counseling, shelters, housing, and food supplies further limited drug-involved prevention support, all of which were exacerbated by the new stress of living in a pandemic and economic uncertainty.

PD39-01 PROSTATE CANCER SCREENING DURING THE COVID-19 PANDEMIC ACROSS DEMOGRAPHIC GROUPS

You have accessJournal of UrologyCME1 Apr 2023PD39-01 PROSTATE CANCER SCREENING DURING THE COVID-19 PANDEMIC ACROSS DEMOGRAPHIC GROUPS Shyam Patnaik, Danielle Sharbaugh, Brian Chun, Robin Vasan, Benjamin Davies, Jonathan Yabes, Lindsay Sabik, and Bruce Jacobs Shyam PatnaikShyam Patnaik More articles by this author , Danielle SharbaughDanielle Sharbaugh More articles by this author , Brian ChunBrian Chun More articles by this author , Robin VasanRobin Vasan More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , Jonathan YabesJonathan Yabes More articles by this author , Lindsay SabikLindsay Sabik More articles by this author , and Bruce JacobsBruce Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003342.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic led to the delay of routine medical care, including cancer screening, beginning in March of 2020. While screening rates for several cancers, including prostate cancer, rapidly recovered after the first wave of the COVID-19 pandemic, the degree to which this recovery was realized in different populations remains unknown. We sought to determine the association of the COVID-19 pandemic with prostate cancer screening, particularly for traditionally underserved patients. METHODS: We performed a retrospective cohort study using electronic health records (EHR) data from the Optum EHR database for male patients between the ages of 55-69 eligible for prostate cancer screening from quarter 1 (Q1) of 2016 through Q2 of 2021. We excluded men with a prior diagnosis of prostate cancer. We performed multivariable analysis to estimate screening over time, adjusting for patient age, race, ethnicity, Census division of residence, and insurance status. RESULTS: A total of 7,361,765 patients were included. After adjusting for patient demographics, the percentage of eligible patients with prostate cancer screening decreased from 2.2% in Q4 of 2019 to 1.3% in Q2 of 2020. There was a rebound in screening to 2.4% in Q3 of 2020, which is similar to baseline levels, and a subsequent decline to 1.6% in Q2 of 2021. This trend was seen even after stratifying based on age, race, ethnicity, division, and insurance status (Figure 1). CONCLUSIONS: A 40% decline in prostate cancer screening in Q2 of 2020 was observed during the first wave of the pandemic. This returned to baseline by Q3 of 2020. Subsequent decline was seen again through Q2 of 2021, which also coincides with the second wave of COVID-19. This trend was unaffected by patient characteristics, such as age, race, insurance status, or division of residence. While these data suggest that the peak of the pandemic impacted prostate cancer screening trends similarly across different patient demographic groups, further study is required to breakdown if this was due to social distancing, decreased clinic volumes, or other factors. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1044 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shyam Patnaik More articles by this author Danielle Sharbaugh More articles by this author Brian Chun More articles by this author Robin Vasan More articles by this author Benjamin Davies More articles by this author Jonathan Yabes More articles by this author Lindsay Sabik More articles by this author Bruce Jacobs More articles by this author Expand All Advertisement PDF downloadLoading ...

HIV Services and Outcomes During the COVID-19 Pandemic - United States, 2019-2021.

Increasing HIV testing, preexposure prophylaxis (PrEP), and antiretroviral therapy (ART) are pillars of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, with a goal of decreasing new HIV infections by 90% by 2030.* In response to the COVID-19 pandemic, a national emergency was declared in the United States on March 13, 2020, resulting in the closure of nonessential businesses and most nonemergency health care venues; stay-at-home orders also limited movement within communities (1). As unemployment increased during the pandemic (2), many persons lost employer-sponsored health insurance (3). HIV testing and PrEP prescriptions declined early in the COVID-19 pandemic (4-6); however, the full impact of the pandemic on use of HIV prevention and care services and HIV outcomes is not known. To assess changes in these measures during 2019-2021, quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data - Longitudinal Prescription Database (IQVIA),† and the National HIV Surveillance System (NHSS)§ were analyzed. During quarter 1 (Q1)¶ 2020, a total of 2,471,614 HIV tests were performed, 190,955 persons were prescribed PrEP, and 8,438 persons received a diagnosis of HIV infection. Decreases were observed during quarter 2 (Q2), with 1,682,578 HIV tests performed (32% decrease), 179,280 persons prescribed PrEP (6% decrease), and 6,228 persons receiving an HIV diagnosis (26% decrease). Partial rebounds were observed during quarter 3 (Q3), with 2,325,554 HIV tests performed, 184,320 persons prescribed PrEP, and 7,905 persons receiving an HIV diagnosis. The proportion of persons linked to HIV care, the number who were prescribed ART, and proportion with a suppressed viral load test (<200 copies of HIV RNA per mL) among those tested were stable during the study period. During public health emergencies, delivery of HIV services outside of traditional clinical settings or that use nonclinical delivery models are needed to facilitate access to HIV testing, ART, and PrEP, as well as to support adherence to ART and PrEP medications.

The Relative Age Effect on Physical Fitness of School Children

This study aims to investigate the existence of the relative age effect among school children in Perak, Malaysia. A total of 3143 boys and 2700 girls aged seven years old in Perak, Malaysia were involved in this study. Within each year group, four-quarter birth-month groups were formed. There are quarter 1 (Q1), school children born from January to March; Quarter 2 (Q2), from April to June; Quarter 3 (Q3), from July to September; Quarter 4 (Q4), from October to December. They underwent body weight and standing height measurements with fitness tests that included standing broad jump, sit and reach, hand wall toss, and 20-meter run. A one-way ANOVA test with a Tukey post hoc test was used to determine whether there were any significant differences between the birth quartiles and children's physical fitness. Present findings found anthropometrics, leg power, coordination, and speed are different significantly between birth-quartile groups in boys and girls school children. In summary, there is a relative age effect that contributes to children born early in the year having a physical and physiological advantage. There are naturally different levels of fitness depending on age. This information is useful for researchers, teachers, and education policymakers to consider the month of birth, both in terms of practicality and the impact of physical fitness assessment.

Characteristics and Outcomes of Critically Ill Children With Multisystem Inflammatory Syndrome.

To characterize the prevalence of pediatric critical illness from multisystem inflammatory syndrome in children (MIS-C) and to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain on outcomes. Retrospective cohort study. Database evaluation using the Virtual Pediatric Systems Database. All children with MIS-C admitted to the PICU in 115 contributing hospitals between January 1, 2020, and June 30, 2021. Of the 145,580 children admitted to the PICU during the study period, 1,338 children (0.9%) were admitted with MIS-C with the largest numbers of children admitted in quarter 1 (Q1) of 2021 ( n = 626). The original SARS-CoV-2 viral strain and the D614G Strain were the predominant strains through 2020, with Alpha B.1.1.7 predominating in Q1 and quarter 2 (Q2) of 2021. Overall, the median PICU length of stay (LOS) was 2.7 days (25-75% interquartile range [IQR], 1.6-4.7 d) with a median hospital LOS of 6.6 days (25-75% IQR, 4.7-9.3 d); 15.2% received mechanical ventilation with a median duration of mechanical ventilation of 3.1 days (25-75% IQR, 1.9-5.8 d), and there were 11 hospital deaths. During the study period, there was a significant decrease in the median PICU and hospital LOS and a decrease in the frequency of mechanical ventilation, with the most significant decrease occurring between quarter 3 and quarter 4 (Q4) of 2020. Children admitted to a PICU from the general care floor or from another ICU/step-down unit had longer PICU LOS than those admitted directly from an emergency department. Overall mortality from MIS-C was low, but the disease burden was high. There was a peak in MIS-C cases during Q1 of 2021, following a shift in viral strains in Q1 of 2021. However, an improvement in MIS-C outcomes starting in Q4 of 2020 suggests that viral strain was not the driving factor for outcomes in this population.

Comparative pharmacovigilance assessment of mortality with pimavanserin in Parkinson disease-related psychosis.

BACKGROUND: Pimavanserin is approved for treatment of Parkinson disease (PD)-related psychosis, but its use has been associated with an increased risk of death during clinical trials, as well as during postmarketing surveillance. Previous reports on the association between pimavanserin and mortality have not taken into account limitations of data sources nor included comparable populations or comparisons to relevant treatment alternatives. OBJECTIVE: To conduct a comparative pharmacovigilance assessment of pimavanserin vs treatment alternatives and by restricting surveillance data to more representative populations. METHODS: This was a retrospective analysis of adverse event case reports submitted to the FDA's Adverse Event Reporting System (FAERS) from 2016 through 2019 quarter 3 (Q3). FAERS data are collected from the full population, were further restricted to only those with PD, and were based on PD medication use. Reports were assessed for exposure to pimavanserin, clozapine, quetiapine, haloperidol, and other atypical antipsychotics. The outcome of interest was all-cause death. A proportional reporting ratio (PRR) and 95% confidence limits were calculated for each 2 by 2 contingency of outcome (death) and exposure (pimavanserin and others). For each outcome/exposure pair, the baseline population was altered to include the full FAERS sample, only reports with PD, reports with PD treated with levodopa, and reports with PD treated with multiple PD medications. The sample was also stratified by time period before April 2018 and after September 2018 to capture periods of public knowledge and federal response. A lower 95% CI (Lower95CI) ≥ 2 for the PRR was considered as the accepted threshold for a drug safety signal. RESULTS: As of 2019 Q3, there were 2,287 reports of death associated with pimavanserin. Compared within the full FAERS base population, pimavanserin yielded a PRR Lower95CI = 2.08 but was smaller when restricted to comparison among only a base population with PD (Lower95CI = 1.09), PD treated with levodopa (Lower95CI = 1.15), or PD treated with multiple PD medications (Lower95CI = 1.63). Metrics for quetiapine, clozapine, and other atypical antipsychotics were similar in magnitude. Stratification by time showed a possible reporting bias associated with pimavanserin, since no safety signal was detected before April 2018; however, a signal was present thereafter. CONCLUSIONS: Compared in context with treatment alternatives for patients with PD, pimavanserin was not associated with excess reports of death in the FAERS data. This information should be used in shared decision making between physicians and PD patients to balance the risks and benefits of pimavanserin and other treatments for PD psychosis. DISCLOSURES: No outside funding supported this study. The authors report no disclosures or conflicts of interest relevant to this study. Armstrong receives research support from the NIA (P30AG047266, R01AG068128) and the Florida Department of Health (grant 20A08). She is the local principal investigator of a Lewy Body Dementia Association Research Center of Excellence. She also receives compensation from the American Academy of Neurology for work as an evidence-based medicine methodology consultant. She is on the level of evidence editorial board for Neurology and related publications (uncompensated), receives publishing royalties for Parkinson's Disease: Improving Patient Care (Oxford University Press, 2014), and has received an honorarium for presenting for Medscape CME in 2018. Okun serves as a consultant for the Parkinson's Foundation and has received research grants from NIH, Parkinson's Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Okun has participated as a site principal investigator and/or co-investigator for several NIH-, foundation-, and industry-sponsored trials over the years but has not received honoraria. Malaty has participated in research funded by the Parkinson Foundation, Tourette Association, Dystonia Coalition, Abbvie, Boston Scientific, Eli Lilly, Neuroderm, Pfizer, Revance, and Teva. She has received travel compensation and/or honoraria from the Tourette Association of America, NeuroChallenge Foundation and NIH/Neurobiology of Disease in Children, Parkinson Foundation, Medscape, International Association of Parkinsonism and Related Disorders, and Cleveland Clinic, and royalties from Robert Rose publishers. The other authors have no disclosures.

Is Quarter of Birth a Risk Factor for Developmental Coordinator Disorder in Preschool Children?

The purpose of this study was to determine the probability that preschool children have severe motor difficulties or are at risk of motor difficulties, according to quarter of birth and gender. Five hundred and eighty-eight preschool-age children were evaluated, of which 318 (54.08%) were boys and 270 (45.92%) were girls, with a mean age of 4.66 years (SD = 0.53). The Movement Assessment Battery for Children-2 (MABC-2) was used to collect the data. The results obtained were the following: Regarding students with severe motor difficulties: 6.7% born in quarter 1 (Q1); 13.3% born in the second quarter (Q2); 20.0% born in the third quarter (Q3); and 60.0% born in the fourth quarter (Q4). The probabilities found (OR) were: Q1 vs. Q2 (OR = 3.15; p < 0.05); Q1 vs. Q3 (OR = 4.68; p < 0.005); Q1 vs. Q4 (OR = 12.40; p < 0.001); Q2 vs. Q4 (OR = 4.04; p < 0.001); and Q3 vs. Q4 (OR = 2.65; p < 0.005). The adjusted ORs, with respect to the probabilities of having severe motor difficulties, were the following: Being born in Q4 is 13.03 times more likely than being born in Q1 (p < 0.001); those born in Q3 are 4.85 times more likely than those born in Q1 (p < 0.05); and those born in Q2 4.14 times more than those born in Q1 (p < 0.05). The conclusion is that children born in Q4 are more likely to be classified as children with severe difficulties compared to children born in the other quarters of the same year.

Large Reductions in Match Play Physical Performance Variables Across a Professional Football Season With Control for Situational and Contextual Variables.

This investigation examined match play physical performance across a professional football season using a multicamera computerized tracking system. A linear mixed-effects model, controlling for situational and contextual variables, identified decreases in team average total distance (TD): season quarter 1 (Q1) (11,047 m) > season quarter 2 (Q2) (10,473 m) (P = 0.002; ES = Small), season quarter 3 (Q3) (10,449 m) (P < 0.001; ES = Moderate), and season quarter 4 (Q4) (10,385 m) (P < 0.001; ES = Moderate); work rate (WR): Q1 (115 m/min) > Q3 (108 m/min) (P < 0.001; ES = Moderate), Q4 (107 m/min) (P < 0.001; ES = Moderate); Q2 (109 m/min) > Q4 (107 m/min) (P = 0.003; ES = Small); high-speed running distance (HSR): Q1 (1,051 m) > Q2 (813 m) (P = 0.006; ES = Small); number of high-speed runs (NHSR): Q1 (87) > Q2 (65) (P < 0.001; ES = Small), Q3 (64) (P = 0.002; ES = Small); sprint distance (SD): Q1 (202 m) > Q4 (130 m) (P < 0.001; ES = Moderate), Q2 (179 m) > Q3 (165 m) (P = 0.035; ES = Small), Q4 (130 m) (P < 0.001; ES = Moderate) and number of sprints (NS): Q1 (20.4) > Q3 (10.2) (P < 0.001; ES = Moderate), Q4 (8.3) (P < 0.001; ES = Large); Q2 (14.9) > Q3 (10.2) (P < 0.001; ES = Moderate), Q4 (8.3) (P < 0.001; ES = Large). Within-position changes were observed for WR: Q1 (122 m/min) > Q4 (113 m/min) (P = 0.002; ES = Large) in central midfielders and for NS: Q1 > Q3 in wide defenders (21.7 vs. 10.8) (P = 0.044; ES = Large) and central midfielders (18.1 vs. 8.3) (P = 0.002; ES = Large); Q1 > Q4 in central defenders (13.1 vs. 5.3) (P = 0.014; ES = Large), wide defenders (21.6 vs. 7.1) (P < 0.001; ES = Very Large), central midfielders (18.1 vs. 8.5) (P = 0.005; ES = Large), and wide midfielders (20.8 vs. 12.2) (P = 0.012; ES = Large); Q2 > Q3 in central midfielders (16.9 vs. 8.3) (P = 0.002; ES = Large) and Q2 > Q4 in wide defenders (16.3 vs. 7.1) (P = 0.005; ES = Very Large), central midfielders (16.9 vs. 8.5) (P = 0.004; ES = Large), and wide midfielders (20.8 vs. 12.2) (P = 0.007; ES = Large). The match-play physical performance was reduced across the competitive season. The most notable reductions were observed in wide defenders, central midfielders, and wide midfielders in sprint performance indices.

Towards Monitoring of Nutrient Pollution in Coastal Lake Using Remote Sensing and Regression Analysis

The last few decades have witnessed a tremendous increase in nutrient levels (phosphorus and nitrogen) in coastal water leading to excessive algal growth (Eutrophication). The presence of large amounts of algae turns the water’s color into green or red, in the case of algal blooms. Chlorophyll-a is often used as an indicator of algal biomass. Due to increased human activities surrounding Dubai creek, there have been eutrophication concerns given the levels of nutrients in that creek. This study aims to map chlorophyll-a in Dubai Creek from WorldView-2 imagery and explore the relationship between chlorophyll-a and other eutrophication indicators. A geometrically- and atmospherically-corrected WorldView-2 image and in-situ data have been utilized to map chlorophyll-a in the creek. A spectral model, developed from the WorldView-2 multispectral image to monitor Chlorophyll-a concentration, yielded 0.82 R2 with interpolated in-situ chlorophyll-a data. To address the time lag between the in-situ data and the image, Landsat 7 Enhanced Thematic Mapper Plus (ETM+) images were used to demonstrate the accuracy of the WorldView-2 model. The images, acquired on 20 May and 23 July 2012, were processed to extract chlorophyll-a band ratios (Band 4/Band 3) following the standard approach. Based on the availability, the 20 May image acquisition date is the closest to the middle of Quarter 2 (Q2) of the in-situ data (15 May). The 23 July 2012 image acquisition date is the closest to the WorldView-2 image date (24 July). Another model developed to highlight the relationship between spectral chlorophyll-a levels, and total nitrogen and orthophosphate levels, yielded 0.97 R2, which indicates high agreement. Furthermore, the generated models were found to be useful in mapping chlorophyll-a, total nitrogen, and orthophosphate, without the need for costly in-situ data acquisition efforts.

Alterations in Team Physical Performance and Possession in Elite Gaelic Football Competition

Differences in performance between winning and losing were examined in 1 elite Gaelic football team in 20 games across 2 complete competitive seasons. Possession was codified using Dartfish TeamPro software and distance covered; walking, jogging, running, and running at high and maximum speeds, was evaluated using Catapult OptimEye S5 player tracking devices. Distance covered in low intensity activity (LIA, ˂4.0 m.s-1), high intensity running (HIR, ≥4.0 m•s-1) and very high intensity running (VHIR, ≥5.5 m•s-1) was also examined along with PlayerLoad™, which represented a composite of all accelerations. Data from 53 players (n=405 files) was collated into specific match periods to facilitate a temporal analysis between the first and second halves and from quarter 1 (Q1) to quarter 4 (Q4), with significance accepted at p ≤ 0.05. Total distance and running was higher in games lost, whereas total distance, walking and LIA was higher in halves lost. Only walking was higher in quarters lost. The percentage of possession declined in halves and quarters lost. In games lost, high speed running declined in the second half. From Q1 to Q4; PlayerLoad™, total distance, jogging, high speed running, HIR and VHIR, decreased in all games combined and in games lost. Possession frequency declined in Q4 in all games and in games won. Overall, total distance was higher in games lost and physical performance declines were more pronounced when examined by match quarter compared to half and were only apparent in games lost. Similarly, reductions in possession frequency and percentage were more evident when examined by quarter or period lost, respectively. These findings can inform the prescription of conditioning and field-training strategies to mitigate the reductions in performance observed in losing and towards the end of games.

P47. Trends in pain medication prescriptions and satisfaction scores in spine surgery patients at a single institution

BACKGROUND CONTEXT As the opioid crisis has gained national attention, there has been an increasing effort to decrease opioid usage. Simultaneously, patient satisfaction is a crucial metric in the American health care system, and has been closely linked to effective pain management in surgical patients. PURPOSE Examine rates of pain medication prescription and concurrent patient satisfaction in spine surgery patients. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 1,729 patients undergoing any spine surgery. OUTCOME MEASURES Rates of non-opioid pain medication prescriptions during hospitalization as part of a multimodal analgesia regimen, morphine milligram equivalents (MME) of opioids used during hospitalization, Press Ganey Satisfaction Survey data. METHODS Patients ≥18yo undergoing spine surgery between 6/25/2017-6/30/2018 at a single institution by spine surgeons performing ≥20 surgeries/quarter and who had medication data during hospitalization available included. Additional data collected included physician and procedure type. All data analyzed by quarter. Chi-squared test to compare percentages and ANOVA to compare means across quarters. Multivariate regression used to compare procedure-specific trends, controlling for age, revision and level of pain. Significance set at p RESULTS A total of 1,759 patients were included, 427 in Quarter 1 (Q1), 439 in Q2, 453 in Q3 and 440 in Q4. Mean total MME per patient hospitalization was 574.46, no significant difference between quarters (p=0.116). Mean MME/day per patient decreased between quarters (p=0.048), with highest mean 91.84 in Q2 and lowest 77.50 in Q4. From Q1 to Q4, three physicians had decreased mean MME/day (75.47→50.92, p=0.023; 115.70→46.05, p=0.013; 92.89→69.53, p=0.42, respectively) and two physicians had decreased total MME (815.88→243.15, p=0.004; 706.79→451.72, p=0.014, respectively). MME/day decreased (74.78→52.37, p=0.046) for discectomy cases. Controlling for age, revision and level of pain, total MME decreased for discectomies (p=0.006). Among all procedures, acetaminophen, NSAID and steroid prescription rates increased (9.13%→17.05%, p=0.001; 6.32%→9.77%, p=0.048; 9.13%→17.05%, p=0.001, respectively). This was also the case in fusion patients specifically (9.09%→17.99%, p=0.002; 2.77%→5.76%, p=0.024; 9.09%→17.99%, p=0.002, respectively). NSAID prescription in laminectomy patients also increased (3.23%→4.89%, p=0.041). Concurrently, benzodiazepine and GABA analog prescriptions decreased among all procedures (19.20%→10.68%, p CONCLUSIONS Over the studied time period, opioid use decreased and nonopioid prescriptions increased during hospitalization, while satisfaction scores remained unchanged. These findings indicate an increasing effort in reducing opioid use amongst providers, and suggest the ability to do so without impacting overall satisfaction rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Evaluating the July Effect in Oral and Maxillofacial Surgery: Part I—Mandibular Fractures

The purpose of this study was to determine whether the timing of mandibular fracture repair within the academic year affects the complication rate using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The ACS-NSQIP database was accessed and queried from 2008 to 2017 forall Current Procedural Terminology codes pertaining to open treatment of mandibular fractures. The cases were stratified into 2 groups based on academic quarter: the quarter 1 (Q1) group (July-September) and the remaining-quarters group. The inclusion criteria encompassed all Current Procedural Terminology codes in the ACS-NSQIP registry that defined mandibular fractures and age greater than 18years. Demographic characteristics, as well as medical and surgical complications, were compared between the 2 cohorts. Descriptive statistics were calculated to characterize and compare patient cohorts, and Fisher exact test and χ2 analyses were performed to compare complication rates between groups. The Q1 group included 614 cases, and the remaining-quarters group included 1,454. The most common individual complications included wound dehiscence (1.6% overall; 2.1% in Q1 group vs 1.4% in remaining-quarters group, P=.22), combined superficial and deep-space infection (4.9% overall; 4.4% in Q1 group vs 3.3% in remaining-quarters group; P=.91 and P=.21, respectively), and reoperation (3.9%overall; 4.6% in Q1 group vs 3.6% in remaining-quarters group, P=.29). Medical complications including acute kidney injury, venous thromboembolism, urinary tract infection, and sepsis or septic shock were rare (<1%). Complication rates did not significantly differ between the third quarter and the remainder of the year on bivariate analysis. Our results do not support the idea of a "July effect" regarding postoperative outcomes after mandibular fracture repair. Further studies are needed to elucidate this phenomenon within all procedures under the wide umbrella of the specialty.

Enhanced Surveillance of Nonfatal Emergency Department Opioid Overdoses in California

ObjectiveTo track and monitor nonfatal emergency department opioid overdoses in California for use in the statewide response in the opioid epidemic.IntroductionThe opioid epidemic is a multifaceted public health issue that requires a coordinated and dynamic response to address the ongoing changes in the trends of opioid overdoses. Access to timely and accurate data allows more targeted and effective programs and policies to prevent and reduce fatal and nonfatal drug overdoses in California. As a part of a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance grant, the goals of this surveillance are to more rapidly identify changes in trends of nonfatal drug overdose, opioid overdose, and heroin overdose emergency department visits; identify demographic groups or areas within California that are experiencing these changes; and to provide these data and trends to state and local partners addressing the opioid crisis throughout California. Emergency department (ED) visit data are analyzed on an ongoing quarterly basis to monitor the proportion of all ED visits that are attributed to nonfatal drug, opioid, and heroin overdoses as a portion of the statewide opioid overdose surveillance.MethodsCalifornia emergency department data were obtained from the California Office of Statewide Health Planning and Development. Data were (and continue to be) analyzed by quarter as the data become available, starting in quarter 1 (Q1) 2016 through Q1 2018. Quarters were defined as standard calendar quarters; January-March (Q1), April-June (Q2), July-September (Q3), and October-December (Q4). Counts of nonfatal ED visits for all drug overdoses, all opioid overdoses, and heroin overdoses were defined by the following ICD-10 codes in the principle diagnosis or external cause of injury fields respectively; T36X-T50X (all drug), T40.0X-T40.4X T40.6 and T40.69 (all opioid), and T40.1X (heroin). Eligible ED visits were limited to CA residents, patients greater than 10 years of age, initial encounters, and were classified as unintentional overdoses or overdoses of undetermined intent. Overdose ED visits are described by quarter, drug, sex, and age for Q1 2016 – Q1 2018.ResultsOn average, 6,450 emergency department visits in California are attributed to drug overdose every quarter. Between Q1 2016 and Q1 2018, on average 1,785 (range: 1,559-2,011 ED visits) of those visits were due to opioid overdoses and a further 924 (52%) of those ED visits were due to heroin overdoses. About 26-30% of all drug overdose ED visits were for opioid overdoses in California during Q1 2016 – Q1 2018. Quarterly, that is around 6.00-7.64 opioid overdose ED visits for every 10,000 ED visits (Table 1), with about half those (3.09-4.30 ED visits) being heroin overdose ED visits. Males accounted for approximately 52% of all drug overdose ED visits, 65% of all opioid overdose ED visits, and 76% of all heroin overdose ED visits per quarter. Across all quarters, 25-34 year olds had the highest proportion of emergency department visits attributed to opioid and heroin overdose compared to all other age groups. However, 11-24 year olds had the highest proportion of emergency department visits attributed to all drug overdoses compared to all other age groups for all quarters except one. Between Q1 2016 and Q1 2018, the proportion of emergency department visits attributed to all drug overdoses increased by 1.8%, all opioid overdoses increased 3.1%, and heroin overdoses increased by 13.5%.ConclusionsOverall trends for the proportion of all emergency department visits for all drug overdoses and all opioid overdoses are relatively stable over this time period, however the proportion of heroin overdose ED visits shows a more substantial increase between Q1 2016 and Q1 2018. In addition, heroin overdose ED visits account for over half of all opioid overdose ED visits during this time in California. Ongoing surveillance of drug, opioid, and heroin overdose ED visits is a crucial component of assessing and responding to the opioid overdose crisis in California and helps to better understand the demographics of those who could be at risk of a future fatal opioid overdose. Timely data such as these (in addition to prescribing, hospitalization, and death data) can inform local and statewide efforts to reduce opioid overdoses and deaths.

Suspected Heroin Overdoses in US Emergency Departments, 2017-2018.

To describe changes in suspected heroin overdose emergency department (ED) visits. Methods. We analyzed quarterly and yearly changes in heroin overdoses during 2017-2018 by using data from 23 states and jurisdictions (including the District of Columbia) funded by the Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance program. The analyses included the Pearson χ 2 test to detect significant changes. Results. Both sexes, all age groups, and some states exhibited increases from quarter 1 (Q1) 2017 to Q2 2017 and significant decreases in both quarters from Q3 2017 to Q1 2018 in heroin overdose ED visits. Overall, there was a significant yearly decline of 21.5% in heroin overdose ED visits. Three states had significant yearly increases (Illinois, Indiana, and Utah), and 9 states (Kentucky, Maryland, Massachusetts, New Hampshire, Ohio, Pennsylvania, Rhode Island, West Virginia, and Wisconsin) and the District of Columbia had significant decreases. Conclusions. We identified decreases in heroin overdose ED visits from 2017 through 2018, but these declines were not consistent among states. Even with the possibility of a stabilization or slowing of this epidemic, it is important that the field of public health and its partners implement strategies to prevent overdoses and target emerging hot spots.

Implementation of a Novel Adherence Monitoring Strategy in a Phase III, Blinded, Placebo-Controlled, HIV-1 Prevention Clinical Trial

Placebo-controlled HIV-1 prevention trials of pre-exposure prophylaxis (PrEP) have not generally used concurrent measurement of adherence because of the potential risk of unblinding. However, several pre-exposure prophylaxis trials for HIV-1 prevention among women failed to show effectiveness because of low product adherence. Evaluation of product adherence objectively during a study provides the opportunity for strengthening adherence activities at sites having low adherence. During MTN-020/ASPIRE, a phase III, placebo-controlled trial of the dapivirine intravaginal ring, we implemented an adherence monitoring system. Monitoring began in quarter 1 (Q1) 2013 and continued through the conclusion of the trial. Blood plasma was collected quarterly and tested for dapivirine concentrations while maintaining blinding among study team members involved in participant management. Dapivirine concentrations >95 pg/mL, reflecting >8 hours of continuous use, were assessed as signaling product use. Study leadership monitored results on a monthly basis and provided feedback to site investigators. Experiences were shared across sites to motivate staff and counsel participants to strive toward higher adherence levels. An upward trend in adherence was observed (P < 0.0001); the proportion of samples from subjects in the active arm with dapivirine >95 pg/mL increased from 63% in Q1 2013 to 84% by Q1 2015. Ongoing drug level testing as a marker of adherence in MTN-020/ASPIRE demonstrates the feasibility of real-time adherence monitoring while maintaining study blinding at the level of participants, sites, and study leadership. This approach is novel for large-scale effectiveness studies for HIV-1 prevention.

BANKERS’ FORECASTS OF FARMLAND VALUES: A QUALITATIVE AND QUANTITATIVE EVALUATION

AbstractThis study evaluates the farmland price forecasts provided by the Federal Reserve Bank of Chicago's Land Values and Credit Conditions Survey from 1991: quarter 1 (Q1) through 2016: Q1. Prior studies have demonstrated that similar surveys of agricultural bankers provide accurate predictions of the direction of future farm real estate values through qualitative forecast evaluation. This study extends the existing knowledge base by converting the qualitative responses to quantitative expectations. The quantified expectations are then subjected to additional forecast optimality tests, which suggest that the forecasts are unbiased but inefficient.