Research Triangle Institute Research Articles

The Relationship Between Range of Motion and Injuries in Adolescent Dancers and Sportspersons: A Systematic Review.

Background: The frequent and intensive training and performance of pre-professional ballet dancers and sportspersons is offered at a time when young ballet dancers and young athletes may be vulnerable to injury due to the progress through adolescence and growth spurts.Hypothesis: There are changes in range of motion during the progress through adolescence and growth periods in dancers and sportspersons. These changes in ROM can be linked to the increase of injury.Objectives: The primary aim of this systematic review is to determine whether there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. The secondary aim is to determine whether these changes can predict the risk of injuries for adolescent dancers and sportspersons.Search strategy: Pubmed, Cochrane Register of Controlled Trails (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), EBSCO Host databases: CINAHL Plus, MEDLINE, SPORTDiscus, Embase were searched using MeSH terms. Manual search in the Journal of Dance Medicine and Science and screening of the reference lists of identified studies and reviews was conducted.Selection criteria: Studies included adolescent dancers and sportspersons, aged 8–18, both sexes, growth spurt related to changes in ROM and injury incidence.Data collection and analysis: Search strategy was performed in the flow diagram of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently appraised each included study using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for methodological quality of the included studies. For data extraction, the following information was systematically extracted: first author and year of publication, study design, participants (sample size of mean age), age, maturation (if assessed), intervention, outcome(s), and some notes of each study. For evaluation of the risk of bias and precision the Research Triangle Institute Item Bank (RTI-IB) is included.Main results: Seven observational studies met the inclusion criteria of this current review. The results of this review suggest that there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes may lead to an increase in injury incidence.Conclusion: There is evidence linking to changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes in ROM may be related to injury incidence.

Rise in Antidepressant Prescriptions for Youth Raises Questions About Why

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessRise in Antidepressant Prescriptions for Youth Raises Questions About WhyNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:31 Jan 2018https://doi.org/10.1176/appi.pn.2018.2a10AbstractAfter an initial decline in the use of antidepressants by youth following actions taken by the Food and Drug Administration in 2004, one study finds antidepressant use among youth has rebounded.In October 2004, the Food and Drug Administration (FDA) directed pharmaceutical companies to issue a black-box warning about the potential link between the use of antidepressants and increased suicidal ideation among youth. Following this directive, the number of depression diagnoses and antidepressant prescriptions for children and adolescents—which had been on the rise—fell over the next few years.Though there is an extensive body of research exploring this initial decline in prescriptions, fewer studies have looked at long-term prescribing trends. A study published last December in Psychiatric Services in Advance found that following that initial decline, the rate of antidepressant prescribing to children eventually returned to pre-2004 levels. Nilay Kafali, Ph.D., of RTI International and colleagues found that 2.26 percent of children aged 5 to 17 were prescribed antidepressants in 2009, similar to the 2003 level of 2.29 percent. Between 2004 and 2008, that rate had dropped to below 2 percent.The authors calculated these rates using data from the Medical Expenditure Panel Survey (a set of nationally representative surveys of individuals, medical providers, and employers that detail the use and costs of health care services and health insurance coverage). They included available data on children aged 5 to 17 between 2000 and 2011. To estimate how the impact of the black-box warning on antidepressant use among children changed over time, the authors divided the entire sample period into four periods: early prewarning (2000–2001), prewarning (2002–2003), early postwarning (2004–2007), and late postwarning (2008–2011). They found that there was a 0.5 percent statistically significant decline in antidepressant use during the early postwarning years compared with prewarning years, with a particularly strong decrease among children rated as having non-severe psychological impairment. (The authors defined non-severe psychological impairment as a Columbia impairment Scale score of <16). Antidepressant use was 1.1 percent for this group in 2003, dropped to around 0.7 percent between 2004-2007, and rose to 1.09 percent in 2008. Rates of antidepressant use for children with severe psychological impairment showed a gradual decline from 2003 to 2007, but then also rose to pre-2004 levels. “These findings suggest that providers and families of youth may have reacted to the black-box warning in an appropriate manner, weighing the warning with the risks and benefits of the treatment,” Kafali and colleagues wrote. “A return to the rates of antidepressant use before the black-box warning raises concern that this thoughtful accounting of the risks and benefits may have dissipated over time.”A central question for future research is what factors drove this rise in use after 2008. “It is possible that over time physicians have become somewhat inured to the safety warnings,” said Mark Olfson, M.D., M.P.H., a professor of psychiatry and epidemiology at Columbia University Medical Center. “However, it is also possible that increasing prevalence of depression or anxiety among young people during the great recession played a role,” he added.Olfson, who was not involved with this study, noted that other community surveys including the Youth Risk Behavior Survey, the National Survey on Drug Use and Health, and the Monitoring the Future surveys have revealed a recent increase in depressed mood and major depressive episodes among children and adolescents. “An important policy implication of our findings could be that more frequent updates of FDA risk warnings might be necessary to prevent patients and the providers from ‘forgetting’ the potential risks outlined in the original warning,” Kafali and colleagues wrote. ■An abstract of “Long-Run Trends in Antidepressant Use Among Youths After the FDA Black Box Warning” can be accessed here. ISSUES NewArchived

Clariant to supply unique sorbent to RTI International for its warm gas desulfurization technology.

The fan's cooling is critical to the overall safety and efficiency of an open-cathode proton exchange membrane fuel cell (PEMFC). The power of the fan directly determines the temperature, parasitic power, and electrical efficiency. Existing experimental research and simulations are still insufficient for the optimization of the electrical efficiency by adjusting the power of the fan in an open-cathode PEMFC. This paper develops a hybrid optimization strategy based on the team-designed open-cathode PEMFC combined with ultra-thin vapor chambers (UTVC) to search for the optimal fan power at a specific temperature and maximize the stack's electrical efficiency. The dynamic model of the PEMFC-UTVC system is established and validated by experiments by analyzing the heat dissipation structure of the PEMFC-UTVC system and combining the electrochemical principle with the thermodynamic theory. To maximize the electrical efficiency of the PEMFC-UTVC stack, a neural network method is integrated with a meta-heuristic algorithm with mutation. The penalty function method is used to transform the problem constraints throughout the optimization process. The optimization strategy demonstrates the advantages of a powerful optimal capacity, high precision, and high robustness. The results of optimization show that the electrical efficiency of PEMFC-UTVC can be maximized by adjusting the power of the fan. Under the current conditions of 20A, 30A, and 40A, the maximum rates of rise in electrical efficiency are 2.65%, 3.29%, and 4.35%, respectively. The proposed hybrid optimization strategy is expected to provide insights into the control and optimization of the open-cathode PEMFC system.

Marketplace Coverage and Limited Access to Care Among Employed Beneficiaries? Evidence From Ohio.

This article examines the initial effect of Affordable Care Act (ACA) Health Insurance Marketplace (Exchange) insurance on access to care among employed beneficiaries in a highly populated US state. Does Exchange insurance lead to better/worse health care access for employed beneficiaries, compared with similar individuals covered through standard employer-sponsored insurance (ESI) coverage? This retrospective study uses data from the 2015 Ohio Medicaid Assessment Survey, a dual-frame and computer-assisted telephone survey administered by the Ohio Colleges of Medicine Graduate Resource Center, the Ohio Department of Medicaid, the Ohio Department of Health, and Ohio State University, in conjunction with RTI International. This study examines a sub-sample of employed adults (age 18-64) covered by either an Exchange plan or ESI, extracted from the full sample of n = 42 876. We use linear propensity score matching using Euclidean distance to balance treatment groups and logistic regression models to estimate the treatment effect of Exchange coverage on all outcome variables. McNemar tests, Rosenbaum sensitivity analysis, and Benjamini-Hochberg procedure adjustments are also conducted. Compared with ESI insurance, Exchange insurance has no significant effect on outcomes measuring either perceived access to care or, more specifically, perceived financial barriers to accessing care. Exchange plan viability remains a hot topic of debate across the United States, given the potential repeal of the individual mandate. We use risk-adjustment methods to demonstrate that Exchange plan beneficiaries do not experience worse access to care than ESI beneficiaries. That said, several key limitations are discussed.

Assessing the Impact of Early Learning Programs in Africa.

We present results from early learning programs in six African countries: Ethiopia, Kenya, Liberia, Malawi, Tanzania, and Uganda. In partnership with ministries of education, RTI International has worked within government systems to support the design and deployment of locally contextualized materials, training, and assessment tools, with the goal of improving outcomes for early learners in primary schools, and in Kenya and Tanzania preprimary as well. Here we report on the experience and evidence of impact from specific programs in each country, including summary assessment results when available. In several countries with completed impact evaluations, there are significant and important learning gains of between 0.2 and 2.57 SD in effect size; in one case the percentage of students reaching grade‐level reading proficiency increased from 12% to 47%. In the context of increased urgency surrounding what UNESCO has called a “global learning crisis,” these experiences provide useful lessons for policymakers and practitioners alike.

Bisphenol A (BPA) hazard assessment protocol

Bisphenol A (BPA) hazard assessment protocol

RTI's Solid Sorbent-Based CO2 Capture Process: Technical and Economic Lessons Learned for Application in Coal-fired, NGCC, and Cement Plants

RTI International has developed an advanced solid sorbent-based CO2 capture process for application to exhaust gas from various industrial sources – including coal-fired power plants, NGCC power plants, and cement plants. The technical and economic hurdles to solid sorbent CO2 capture are being addressed through transitioning a promising sorbent chemistry (based on supported amines) to a low-cost sorbent suitable for use in a fluidized-bed process. This sorbent has been scaled for bench- and prototype testing in both simulated coal-fired flue gas at RTI's test facility and actual cement plant flue gas at Norcem's cement plant in Brevik, Norway. Parametric testing has shown how CO2 capture performance is impacted by changing process variables. Long-term testing has generated data needed to set process conditions for operating a solids-based system for optimal performance, with continuous 90% CO2 capture, and no operational interruptions. Data collected from all phases of testing has been used to develop detailed techno-economic assessments of RTI's technology for the various CO2 emission sources applications. These detailed analyses show that RTI's technology has significant economic advantages over current amine scrubbing and potential to achieve the U.S. DOE's Carbon Capture Program's goal of >90% CO2 capture rate at a cost of < $40/T-CO2 captured by 2025.

Review the top 5 changes to IPEDS data to stay current for the new academic year

MINNEAPOLIS — What are the updates to the Integrated Postsecondary Education Data System that are important for you to know in your role at your institution? James Isaac, senior survey director at RTI International, shared updates to IPEDS and the most important things to know about IPEDS at the American Association of Collegiate Registrars and Admissions Officers annual conference. “If you work in the Registrar's Office, you're dealing most with the public face of IPEDS — College Navigator, the FAFSA form, the College Scorecard, it goes on. If you deal with any of those things, you'll be dealing with IPEDS,” Isaac said.

Featured Collection Introduction: North Carolina Ecological Flows

Featured Collection Introduction: North Carolina Ecological Flows

Comparison of PM2.5 Exposure in Hazy and Non-Hazy Days in Nanjing, China.

Fine particulate matter (PM2.5), levels of which are about 6 times the 2014 WHO air quality guidelines for 190 cities in China, has been found to be associated with various adverse health outcomes. In this study, personal PM2.5 exposures were monitored along a fixed routine that included 19 types of non-residential micro-environments (MEs) on 4 hazy days (ambient PM2.5 292 ± 70 μg m-3) and 2 non-hazy days (55 ± 16 μg m-3) in Nanjing, China using miniaturized real-time portable particulate sensors that also collect integrated filters of PM2.5 (MicroPEMs, Research Triangle Institute (RTI), NC). Gravimetric correction is necessary for nephelometer devices in calculating real-time PM levels. During both hazy and non-hazy days, personal PM2.5 levels were generally higher in MEs with noticeable PM2.5 sources than MEs serving as receptor sites, higher in open MEs than indoor MEs, and higher in densely populated MEs than MEs with few people. Personal PM2.5 levels measured during hazy and non-hazy days were 242 ± 91 μg m-3 and 103 ± 147 μg m-3, respectively. The ratio of personal exposure to ambient PM2.5 levels (rp/a ) was less than 1.0 and less variable on hazy days (0.85 ± 0.31); while it was larger than 1.0 and more variable on non-hazy days (1.71 ± 1.93), confirming the importance of local sources other than ambient during non-hazy days. Air handling methods (e.g., ventilation/filtration) impacted personal exposures in enclosed locations on both types of days. Street food vendors with cooking emissions were MEs with the highest personal PM2.5 levels while subway cars in Nanjing were relatively clean due to good air filtration on both hazy and non-hazy days. In summary, on hazy days, personal exposure was mainly affected by the regional ambient levels, while on non-hazy days, local sources together with ambient levels determined personal exposure levels.

What Do Patients Prioritize in Selecting Chronic Lymphocytic Leukemia (CLL) Treatments?

Background: Over 15,000 new cases of CLL are diagnosed each year in the U.S. Different treatment options exist, which vary in efficacy, side effects, and mode of administration. Little is known about the value patients place upon the different attributes of available CLL treatments.Objectives: To estimate patient preferences for CLL treatments and investigate the relationship between treatment preferences and cost.Methods: Patients with a self-reported physician diagnosis of CLL were recruited through a patient advocacy group to complete an online discrete-choice experiment (DCE) survey. The survey included 8 DCE questions in which respondents chose between pairs of hypothetical treatments for CLL. Each hypothetical treatment was defined by 5 attributes with several predefined levels; the attributes were progression-free survival (PFS; 10-60 months), diarrhea (none to severe), chance of severe infection (0-30%), chance of organ damage (0-8%), and mode and schedule of administration (pill versus intravenous administration). Treatment duration was not addressed independently and treatment cost was not included in the DCE. Random-parameters logit (RPL) was used to analyze the data and estimate patient preference weights for each attribute level in the survey. An importance score and minimum acceptable benefit score were calculated using results from the RPL model. Later, a cost attribute was added that included 2 hypothetical treatment profiles (Treatment A: 26 months of PFS, no diarrhea, 15% chance of serious infection, 8% chance of organ damage, IV once a month for 6 months, and lower cost; Treatment B: 60 months of PFS, mild/moderate diarrhea, 30% chance of serious infection, no chance of organ damage, daily pill for 60 months, and higher cost). Results from the RPL model were used to predict the share of respondents who would choose each treatment based on the DCE questions when cost was not a consideration, as compared with respondents' choices when cost was included.Results: 384 respondents recruited through LLS: 53% were female, 94% were white, and the mean age was 65 years. 57% had Medicare insurance, 53% of respondents had received financial aid and 40% reported difficulty in paying out-of-pocket costs for their medicines. In the DCE results, the attribute levels were ordered as expected, with respondents preferring better outcomes to worse. Within each attribute, all levels were statistically significantly different from each other (P ≤ 0.05). Attributes in the order of importance to patients as determined by DCE were PFS, chance of infection, chance of organ damage and the occurrence and severity of diarrhea. Mode of administration was the least important attribute. Although PFS had the highest importance score, the risk of adverse events was also highly important to patients; significant additional PFS was needed to offset patients’ acceptance of worsening adverse events. For example, an increase in the chance of infection from 0% to 30% required an offset of 36 months of additional PFS. An increase in the chance of organ damage from 0% to 8% required an additional 26 months of PFS by the respondents. A tradeoff of 22 additional months in PFS is needed for a change from no diarrhea to severe diarrhea.Using results from the RPL model, it was predicted that 91% of respondents would choose Treatment B when cost is excluded from the treatment profile description. This was mainly driven by the better PFS attribute of Treatment B. When a modest cost difference was introduced ($75 more per month for treatment B), half of the patients chose treatment A. When this difference became larger ($400 more per month), the change in patient preference was even more pronounced; 74% chose option A.Conclusions: The most important attribute in the survey was PFS, however patients also indicated that increases in the risk of adverse events would require significant increase in PFS to offset that risk. Patients with CLL are sensitive to treatment costs and many reported difficulty in paying for their medications. Given the choice of treatments available to patients and the high cost of some treatments, physicians may want to explore their patients' preferences for different treatment features, including benefit-risk tradeoffs and out-of-pocket cost when selecting the best treatment strategies for patients. DisclosuresMansfield:RTI Health Solutions: Other: Research for this abstract was performed in the course of my employment at Research Triangle Institute d/b/a RTI Health Solutions, pursuant to a contract between my employer and the study sponsor, Genentech. RTI was compensated by the sponsor.. Masaquel:Roche: Equity Ownership; Genentech: Employment. Sutphin:RTI Health Solutions: Other: Research for this abstract was performed in the course of my employment at Research Triangle Institute d/b/a RTI Health Solutions, pursuant to a contract between my employer and the study sponsor, Genentech. RTI was compensated by the sponsor.. Li:Genentech: Employment; Roche: Equity Ownership. Reyes:Genentech: Employment; Roche: Equity Ownership.

Supported Education (SEd): State of the Practice [English and Spanish versions

Investigators at the Transitions Research and Training Center at the University of Massachusetts Medical School partnered with RTI International to conduct the "Feasibility Study for Demonstration of Supported Education to Promote Educational Attainment and Employment among Individuals with Serious Mental Illness". The study was funded by the Assistant Secretary for Planning and Evaluation (ASPE). A Spanish translation of this publication is available for download.

Energy Department funds bioproducts

Three early-stage projects to advance biochemical and biofuel production have won up to $11.3 million, combined, from the U.S. Department of Energy. In one project, Dow Chemical, LanzaTech, and Northwestern University will develop a process for the bioconversion of biomass-derived syngas to C6-C14 fatty alcohols. Separately, Amyris will cooperate with Renmatix and Total New Energies on converting cellulosic sugar-based farnesene into consumer products and fuels. And Research Triangle Institute will partner with Arkema and engineering firm AECOM to investigate recovering mixed methoxyphenols from biocrude.

Criteria for Evaluating Ophthalmology Departments Based on the U.S. News &amp; World Report Ranking System

Purpose To propose a methodology for ranking U.S. clinical ophthalmology programs which utilizes an existing framework of both objective structural (or resource) information and outcome data as well as subjective reputational scores currently used by U.S. News & World Report for most clinical specialties. Design Evidence-based manuscript. Topic The U.S. News & World Report annual “Best Hospital Rankings by Specialty” provides the public with information regarding the relative strengths of U.S. medical and surgical departments in providing care and treatments for patients with complex diseases. For most medical and surgical specialties, these rankings are determined by considering a combination of objective structural (or resource) information and outcome data along with subjective reputational scores. Clinical Relevance In ophthalmology, U.S. News & World Report annual rankings are currently generated only from subjective reputational scores submitted by a small number of voting ophthalmologists. No objective clinical or outcome data are considered. Literature Reviewed Methodology for determining “Best Hospital Rankings by Specialty” utilized by RTI International on behalf of U.S. News & World Report. Results The ranking system of U.S. departments of ophthalmology presently employed by U.S. News & World Report presents an incomplete picture of the relative strengths and weaknesses of the departments listed. Conclusion With the changes in health insurance that increasingly shift decision-making responsibility and cost to consumers, providing mechanisms to allow the public to make informed decisions is an emerging imperative for ophthalmology and other specialties. Revision of the current “reputation-only” ranking system used for ophthalmology to also include objective clinical and outcome data would benefit patients by providing more accurate and impartial information on which to base their eye care decisions.

The right prescriptions for reducing diagnostic errors?: Institute of Medicine report issues wakeup call on errors, but questions remain concerning key recommendations.

The right prescriptions for reducing diagnostic errors?: Institute of Medicine report issues wakeup call on errors, but questions remain concerning key recommendations.

Sex differences in the risk of hospitalization among patients presenting to US emergency departments with asthma exacerbation, 2010-2012

In the USA, asthma continues to be a major health burden, affecting 26 million Americans in 2010. Asthma exacerbations contribute to a substantial portion of the burden, accounting for 2 million emergency department (ED) visits and 330,000 hospitalizations annually. Previous studies have reported considerable sex differences in asthma prevalence and several measures of chronic and acute morbidity—for example, higher risks of hospitalization in women with asthma exacerbation. Although national surveys have reported the sex differences in asthma, there have been no recent nationwide studies that examine sex differences in hospitalization risk in ED patients. In this context, we used a nationally representative database to investigate sex differences in the risk of hospitalization in children and adults presenting to US EDs with asthma exacerbation. We analyzed data from the 2010-2012 Nationwide Emergency Department Sample (NEDS). Details of the study design, setting, measured variables, and analysis may be found in this article’s Online Repository at www.jaci-inpractice.org. Briefly, the NEDS represents all ED visits regardless of disposition and contains information on short-term outcomes for patients admitted through all nonfederal hospital-based EDs in the USA. The NEDS is the largest all-payer ED and inpatient database in the USA. In 2012, the NEDS contained 31 million records of ED visits from 950 hospitals; this provided nationally representative data on approximately 134 million ED visits. In this study, we identified all ED visits for younger children (aged 4-11 years), older children (aged 12-17 years), and adults (aged 18-54 years), who had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for asthma (493.xx) in the primary diagnosis field during 20102012. Details of the study design, setting, data collections, and analysis may be found in this article’s Online Repository at www. jaci-inpractice.org. We excluded patients with chronic obstructive pulmonary disease. To examine the association of sex (female vs male) with risk of hospitalization, we constructed 2 logistic regression models for 3 age groups separately. First, we fitted an unadjusted model that included only sex as the independent variable, with male sex as the reference. Next, we constructed multivariable logistic models adjusting for patient-level characteristics and calendar year, with the generalized estimating equations to account for potential clustering of patients within EDs. All analyses used SAS-callable SUDAAN, version 11.0 (Research Triangle Institute, Research Triangle Park, NC) to obtain proper variance estimations that accounted for the complex sampling design. The institutional review board of Massachusetts General Hospital approved this analysis. During 2010-2012, we identified a total of 966,676 ED visits for asthma exacerbation in the USA, corresponding to a weighted estimate of 4,286,701 visits. Both in younger and older children, patient characteristics were similar between girls and boys. In adults, women were more likely to have public health insurance and chronic comorbidities (Table E1, available in this article’s Online Repository at www.jaci-inpractice.org). In younger children presenting to the ED with asthma exacerbation, the hospitalization rate was higher in girls than boys (10.8% vs 10.3%; P 1⁄4 .003). By contrast, in older children, the hospitalization rate was lower in girls than boys (6.5% vs 6.9%; P 1⁄4 .04). These results did not change materially in the multivariable models. In adults, the hospitalization rate was higher in women than men (13.6% vs 10.1%; P< .001). After adjustment for patient-level characteristics and calendar year, this association was meaningfully attenuated but remained statistically significant (OR, 1.07; 95% CI, 1.02-1.11; P 1⁄4 .004; Table I). Across all age groups, private insurance status as compared with self-pay, presence of comorbidities, and metropolitan residence as compared with rural residence were associated with a higher risk of hospitalization. Among adults, older age and higher income were also associated with a higher risk of hospitalization. To our knowledge, this is the first national study to investigate sex differences in risk of hospitalization among ED patients with asthma exacerbation. During 2010-2012, we found that women had a 35% higher hospitalization rate compared with men; however, much of this difference was attributable to patient-level characteristics that were associated with both sex and hospitalization risk. For example, women had more comorbidities on average than men and were more likely to have health insurance. Interestingly, there were disparities in magnitude of sex differences compared with previous studies. 4 However, direct comparisons of these disparities in magnitude are challenging because of the difference in study design (eg, an analysis of administrative dataset vs chart review study), setting, and patient population (eg, a nationally representative ED sample vs urban, academic EDs). Notwithstanding with the differences in study design, these data collectively indicate a disproportionate burden in acute asthma morbidity among US female adults. This observed sex disparity is consistent with previous single center studies and our recent multicenter study of ED patients with asthma exacerbation. Thus, multiple studies arrived at a similar conclusion despite different study designs, settings, and

Unintended pregnancy risk and contraceptive use among women 45-50 years old: Massachusetts, 2006, 2008, and 2010

Little is known about unintended pregnancy risk and current contraceptive use among women ≥45 years old in the United States. The purpose of this study was to describe the prevalence of women ages 45-50 years old at risk for unintended pregnancy and their current contraceptive use, and to compare these findings to those of women in younger age groups. We analyzed 2006, 2008, and 2010 Massachusetts Behavioral Risk Factor Surveillance System data, the only state in the United States to collect contraceptive data routinely from women >44 years old. Women 18-50 years old (n= 4930) were considered to be at risk for unintended pregnancy unless they reported current pregnancy, hysterectomy, not being sexually active in the past year, having a same-sex partner, or wanting to become pregnant. Among women who were considered to be at risk (n= 3605), we estimated the prevalence of current contraceptive use by age group. Among women who were considered to be at risk and who were 45-50 years old (n= 940), we examined characteristics that were associated with current method use. Analyses were conducted on weighted data using SAS-callable SUDAAN (RTI International, Research Triangle Park, NC). Among women who were 45-50 years old, 77.6% were at risk for unintended pregnancy, which was similar to other age groups. As age increased, hormonal contraceptive use (shots, pills, patch, or ring) decreased, and permanent contraception (tubal ligation or vasectomy) increased as did non-use of contraception. Of women who were 45-50 years old and at risk for unintended pregnancy, 66.9% reported using some contraceptive method; permanent contraception was the leading method reported by 44.0% and contraceptive non-use was reported by 16.8%. A substantial proportion of women who were 45-50 years old were considered to be at risk for unintended pregnancy. Permanent contraception was most commonly used by women in this age group. Compared with other age groups, more women who were 45-50 years old were not using any contraception. Population-based surveillance efforts are needed to follow trends among this age group and better meet their family planning needs. Although expanding surveillance systems to include women through 50 years old requires additional resources, fertility trends that show increasingly delayed childbearing, uncertain end of fecundity, and potential adverse consequences of unplanned pregnancy in older age may justify these expenditures.

The rationale for patient-reported outcomes surveillance in cancer and a reproducible method for achieving it.

Patient-reported outcomes (PROs) measure quality of life, symptoms, patient functioning, and patient perceptions of care; they are essential for gaining a full understanding of cancer care and the impact of cancer on people's lives. Repeatedly captured facility-level and/or population-level PROs (PRO surveillance) could play an important role in quality monitoring and improvement, benchmarking, advocacy, policy making, and research. This article describes the rationale for PRO surveillance and the methods of the Patient Reported Outcomes Symptoms and Side Effects Study (PROSSES), which is the first PRO study to use the American College of Surgeons Commission on Cancer's Rapid Quality Reporting System to identify patients and manage study data flow. The American Cancer Society, the National Cancer Institute, the Commission on Cancer, and RTI International collaborated on PROSSES. PROSSES was conducted at 17 cancer programs that participated in the National Cancer Institute Community Cancer Centers Program among patients diagnosed with locoregional breast or colon cancer. The methods piloted in PROSSES were successful as demonstrated by high eligibility (93%) and response (61%) rates. Differences in clinical and demographic characteristics between respondents and nonrespondents were mostly negligible, with the exception that non-white individuals were somewhat less likely to respond. These methods were consistent across cancer centers and reproducible over time. If repeated and expanded, they could provide PRO surveillance data from patients with cancer on a national scale.

Novel psychoactive substance use in the European Union

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e165 Novel psychoactive substance use in the European Union Scott P. Novak1, Anders Hakansson2, Jens Reimer5, Jose Martinez-Raga4, Jennifer Lorvick3 1 Behavioral Epidemiology, RTI International, Research Triangle Park, NC, United States 2 Division of Psychiatry, U of Lund, Lund, Sweden 3 RTI International, RTI, San Francisco, CA, United States 4 Teaching Unit of Psychiatry and Psychological Medicine, U of Valencia, Valencia, Spain 5 Centre for Interdisciplinary Addiction Research, Hamburg Medical, Hamburg, Germany Aims: Novel psychoactive substances (e.g., bath salts, Krokodil, synthetic marijuana) are synthetic, semi-synthetic or natural compounds, often advertised and sold as ‘legal’ alternatives to illicit drugs. The current study is among the first population-based studies in the EU to identify their prevalence and characteristics. Methods:General population surveys,modeled after theUnited States’ National Survey of Drug Use and Health, were conducted by RTI International in seven European countries (29 metropolitan strata, sample n=22,057) in 2014. Self-report (in English or native language) surveys among persons aged 12 or older were collected andweighted to achieve country-specific representative estimates. Results: The lifetime estimates for NPS ranged from 0.7% (Denmark) to 2.2% (Great Britain), with a mean of 1.8% and a population estimate of 5.5 million. An estimated 500,000 (0.5%) persons reported past-yearNPS. Controlling for country, latent classmodels indicated six classes of past-year illicit drug use, with NPS present in a homogenous class characterized by males (AOR=2.5, p< .001), whites at higher risk relative to black/African descent (AOR=1.6, p< .05), and Asian (AOR=3.3, p< .001). Youth (ages 18–24) were at higher risk for NPS relative to those ages 12–17 (AOR=1.5, p< .001) and 35+ (AOR=1.6, p< .001). Mood/anxiety disorders conferred higher risk of NPS compared to those with no disorder (AOR=2.5, p< .001), or subthreshold symptom levels (AOR=1.6, p< .001). NPS users also reported a greater use of social media. Conclusions: With the increasing erosion of geographic boundaries and increased increased communication, studies are desperately needed to identify the international landscape of drug use.Additionalwavesareplanned to identify trends in transmission patterns between countries and population sub-groups. Financial support: Shire, NIH, RTI International, the European Drug Union. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.448 Effects of withdrawal from chronic nicotine on emotional and cognitive behaviors in adult and adolescent mice Paul A. Nucero2, Erica Holliday1, Munir G. Kutlu1, Thomas Gould1, Ellen Unterwald3 1 Psychology, Temple University, Philadelphia, PA, United States 2 Center for Substance Abuse Research, Temple University School of Medicine, Ambler, PA, United States 3 Center for Substance Abuse Research, Temple University School of Medicine, Philadelphia, PA,

Effects of withdrawal from chronic nicotine on emotional and cognitive behaviors in adult and adolescent mice

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e165 Novel psychoactive substance use in the European Union Scott P. Novak1, Anders Hakansson2, Jens Reimer5, Jose Martinez-Raga4, Jennifer Lorvick3 1 Behavioral Epidemiology, RTI International, Research Triangle Park, NC, United States 2 Division of Psychiatry, U of Lund, Lund, Sweden 3 RTI International, RTI, San Francisco, CA, United States 4 Teaching Unit of Psychiatry and Psychological Medicine, U of Valencia, Valencia, Spain 5 Centre for Interdisciplinary Addiction Research, Hamburg Medical, Hamburg, Germany Aims: Novel psychoactive substances (e.g., bath salts, Krokodil, synthetic marijuana) are synthetic, semi-synthetic or natural compounds, often advertised and sold as ‘legal’ alternatives to illicit drugs. The current study is among the first population-based studies in the EU to identify their prevalence and characteristics. Methods:General population surveys,modeled after theUnited States’ National Survey of Drug Use and Health, were conducted by RTI International in seven European countries (29 metropolitan strata, sample n=22,057) in 2014. Self-report (in English or native language) surveys among persons aged 12 or older were collected andweighted to achieve country-specific representative estimates. Results: The lifetime estimates for NPS ranged from 0.7% (Denmark) to 2.2% (Great Britain), with a mean of 1.8% and a population estimate of 5.5 million. An estimated 500,000 (0.5%) persons reported past-yearNPS. Controlling for country, latent classmodels indicated six classes of past-year illicit drug use, with NPS present in a homogenous class characterized by males (AOR=2.5, p< .001), whites at higher risk relative to black/African descent (AOR=1.6, p< .05), and Asian (AOR=3.3, p< .001). Youth (ages 18–24) were at higher risk for NPS relative to those ages 12–17 (AOR=1.5, p< .001) and 35+ (AOR=1.6, p< .001). Mood/anxiety disorders conferred higher risk of NPS compared to those with no disorder (AOR=2.5, p< .001), or subthreshold symptom levels (AOR=1.6, p< .001). NPS users also reported a greater use of social media. Conclusions: With the increasing erosion of geographic boundaries and increased increased communication, studies are desperately needed to identify the international landscape of drug use.Additionalwavesareplanned to identify trends in transmission patterns between countries and population sub-groups. Financial support: Shire, NIH, RTI International, the European Drug Union. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.448 Effects of withdrawal from chronic nicotine on emotional and cognitive behaviors in adult and adolescent mice Paul A. Nucero2, Erica Holliday1, Munir G. Kutlu1, Thomas Gould1, Ellen Unterwald3 1 Psychology, Temple University, Philadelphia, PA, United States 2 Center for Substance Abuse Research, Temple University School of Medicine, Ambler, PA, United States 3 Center for Substance Abuse Research, Temple University School of Medicine, Philadelphia, PA,