Brian W. Weir

EMS Runs for Suspected Opioid Overdose: Implications for Surveillance and Prevention

Abstract Background. Opioid (including prescription opiate) abuse and overdose rates in the United States have surged in the past decade. The dearth and limitations of opioid abuse and overdose surveillance systems impede the development of interventions to address this epidemic. Objective. We explored evidence to support the validity of emergency medical services (EMS) data on naloxone administration as a possible proxy for estimating incidence of opioid overdose. Methods. We reviewed data from Baltimore City Fire Department EMS patient records matched with dispatch records over a 13-month time period (2008–2009) based on 2008 Census data. We calculated incidence rates and patient demographic and temporal patterns of naloxone administration, and examined patient evaluation data associated with naloxone administration. Results were compared with the demographic distributions of the EMS patient and city populations and with prior study findings. Results. Of 116,910 EMS incidents during the study period for patients aged 15 years and older, EMS providers administered naloxone 1,297 times (1.1% of incidents), an average of 100 administrations per month. The overall incidence was 1.87 administrations per 1,000 residents per year. Findings indicated that naloxone administration peaked in the summer months (31% of administrations), on weekends (32%), and in the late afternoon (4:00–5:00 pm [8%]); and there was a trend toward peaking in the first week of the month. The incidence of suspected opioid overdose was highest among male patients, white patients, and those in the 45–54-year age group. Findings on temporal patterns were comparable with findings from prior studies. Demographic patterns of suspected opioid overdose were similar to medical examiner reports of demographic patterns of fatal drug- or alcohol-related overdoses in Baltimore in 2008–2009 (88% of which involved opioids). The findings on patient evaluation data suggest some inconsistencies with previously recommended clinical indications of opioid overdose. Conclusions. While our findings suggest limitations of EMS naloxone administration data as a proxy indicator of opioid overdose, the results provide partial support for using these data for estimating opioid overdose incidence and suggest ways to improve such data. The study findings have implications for an EMS role in conducting real-time surveillance and treatment and prevention of opioid abuse and overdose.

Violence Against Women With HIV Risk and Recent Criminal Justice System Involvement Prevalence, Correlates, and Recommendations for Intervention

This research note examines the prevalence and correlates of intimate partner violence (IPV) and other violence (OV) among women (N = 529) at risk for HIV and with histories of criminal justice system involvement. The 3-month prevalences of IPV and OV were 31.2% and 18.7%, respectively. IPV was associated with having a current main partner, substance use, sexual risk behavior, trading sex, anxiety, depression, and lower self-esteem. OV was associated with no current employment or schooling, unstable housing, drug use, trading sex, anxiety, depression, and lower self-esteem. The high prevalence of violence demonstrates the need for intervention in this population; the correlates show that effective interventions must address the complex issues in these womens lives.

A call to action for concentrated HIV epidemics.

As the HIV community attempts to define what is meant by terms like “The End of the AIDS Epidemic,” or the goal of “An AIDS Free Generation,” as articulated by the U.S. Government [1], the relevance of accurate, granular, and precise epidemiologic characterization of HIV prevalence, incidence trends, and other key indicators has only increased. The level or declining resource base for global HIV surveillance, prevention, treatment, and care mandates strategic and much more nuanced use of resources where they will matter most. The current conceptualization of geographic, geospatial, ‘hot spot,’ or high transmission and burden zones of HIV is one approach aimed at focusing resources to where HIV is currently spreading, where high proportions of people living with HIV infection remain untested and untreated, or where sub-epidemics, often among those at risk for both HIV infection and lack of access to services, persist [2]. A sea change in thinking is underway, and is long overdue, in responding to what have long been characterized as concentrated epidemics [3]. As the papers in this issue demonstrate, this understanding is also changing the way we think about the role of concentrated epidemics within generalized ones. We can no longer afford broad and low efficacy or inefficacious campaigns aimed at “youth” or “reproductive aged adults” when relatively small numbers of people, largely excluded from such programs, are those most in need of services, and of services tailored to their actual risks, HIV treatment needs, and lived experiences. The last several years have seen heartening decreases in HIV incidence in many of the world’s (relatively few) generalized epidemic contexts [4]. With a handful of exceptions, these epidemics have been limited to Southern and Eastern Sub-Saharan Africa, and they have been devastating. Few epidemiologists predicted that we would see the impressive gains in HIV control now being reported from many of these hardest hit regions. Fewer still would have predicted that in 2013 we would be seeing so much success in control of these primarily sexually and perinatally driven epidemics, and so little in the concentrated epidemics. The latter involve many fewer people, are much more likely to be focused in urban areas, and have been primary foci of HIV research, programs, and community efforts since the initial identification of HIV/AIDS in the 1980s. Yet this is what the papers in this issue clearly demonstrate. That over 60% of new HIV infections in the U.S. in 2011 (the year for which we have the most current data from the U.S. CDC) [5] should be occurring among the relatively small percentage of the population who are men who have sex with men [6] is just one example among all too many of the persistence of these concentrated epidemics [7], persistence which has continued despite the development and rollout of effective antiretroviral therapy (ART) in much of the world.

Syringe Exchange in the United States: A National Level Economic Evaluation of Hypothetical Increases in Investment

Abstract To examine whether increasing investment in needle/syringe exchange programs (NSPs) in the US would be cost-effective for HIV prevention, we modeled HIV incidence in hypothetical cases with higher NSP syringe supply than current levels, and estimated number of infections averted, cost per infection averted, treatment costs saved, and financial return on investment. We modified Pinkerton’s model, which was an adaptation of Kaplan’s simplified needle circulation theory model, to compare different syringe supply levels, account for syringes from non-NSP sources, and reflect reduction in syringe sharing and contamination. With an annual

Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission

10 to

Economic evaluation of a hospital- based palliative care program

50 million funding increase, 194–816 HIV infections would be averted (cost per infection averted

Alcohol, Intercourse, and Condom Use Among Women Recently Involved in the Criminal Justice System: Findings from Integrated Global-Frequency and Event-Level Methods.

51,601–

A Direct Observation Checklist to Measure Respect and Dignity in the Icu

61,302). Contrasted with HIV treatment cost savings alone, the rate of financial return on investment would be 7.58–6.38. Main and sensitivity analyses strongly suggest that it would be cost-saving for the US to invest in syringe exchange expansion.

CPAP IMPACT: a protocol for a randomised trial of bubble continuous positive airway pressure versus standard care for high-risk children with severe pneumonia using adaptive design methods

Author(s): Bekker, Linda-Gail; Alleyne, George; Baral, Stefan; Cepeda, Javier; Daskalakis, Demetre; Dowdy, David; Dybul, Mark; Eholie, Serge; Esom, Kene; Garnett, Geoff; Grimsrud, Anna; Hakim, James; Havlir, Diane; Isbell, Michael T; Johnson, Leigh; Kamarulzaman, Adeeba; Kasaie, Parastu; Kazatchkine, Michel; Kilonzo, Nduku; Klag, Michael; Klein, Marina; Lewin, Sharon R; Luo, Chewe; Makofane, Keletso; Martin, Natasha K; Mayer, Kenneth; Millett, Gregorio; Ntusi, Ntobeko; Pace, Loyce; Pike, Carey; Piot, Peter; Pozniak, Anton; Quinn, Thomas C; Rockstroh, Jurgen; Ratevosian, Jirair; Ryan, Owen; Sippel, Serra; Spire, Bruno; Soucat, Agnes; Starrs, Ann; Strathdee, Steffanie A; Thomson, Nicholas; Vella, Stefano; Schechter, Mauro; Vickerman, Peter; Weir, Brian; Beyrer, Chris

Mucous fistula refeeding decreases parenteral nutrition exposure in postsurgical premature neonates

PURPOSE Establish costs of an inpatient palliative care unit (PCU) and conduct a threshold analysis to estimate the maximum possible costs for the PCU to be considered cost effective. METHODS We used a hospital perspective to determine costs on the basis of claims from administrative data from Johns Hopkins PCU between March 2013 and March 2014. Using existing literature, we estimated the number of quality-adjusted life years (QALYs) that the PCU could generate. We conducted a threshold analysis to assess the maximum costs for the PCU to be considered cost effective, incorporating willingness to pay (