Joshua Mendelsohn

Opioid analgesic and benzodiazepine prescribing among Medicaid-enrollees with opioid use disorders: The influence of provider communities.

ABSTRACT Opioid analgesic and benzodiazepine use in individuals with opioid use disorders can increase the risk for medical consequences and relapse. Little is known about rates of use of these medications or prescribing patterns among communities of prescribers. The goal of this study was to examine rates of prescribing to Medicaid-enrollees in the calendar year after an opioid use disorder diagnosis, and to examine individual, county, and provider community factors associated with such prescribing. 2008 Medicaid claims data were used from 12 states to identify enrollees diagnosed with opioid use disorders, and 2009 claims data were used to identify rates of prescribing of each drug. Social network analysis was used to identify provider communities, and multivariate regression analyses was used to to identify patient, county, and provider community level factors associated with prescribing these drugs. The authors also examined variation in rates of prescribing across provider communities. Among Medicaid-enrollees identified with an opioid use disorder, 45% filled a prescription for an opioid analgesic, 37% filled a prescription for a benzodiazepine, and 21% filled a prescription for both in the year following their diagnosis. Females, older individuals, individuals with pain syndromes, and individuals residing in counties with higher rates of poverty were more likely to fill prescriptions. Prescribing rates varied substantially across provider communities, with rates in the highest quartile of prescribing communities over 2.5 times the rates in the lowest prescribing communities. Prescribing opioid analgesics and benzodiazepines to individuals diagnosed with opioid use disorders may increase risk of relapse and overdose. Interventions should be considered that target provider communities with the highest rates of prescribing and individuals at the highest risk.

Sexual Mixing in Shanghai: Are Heterosexual Contact Patterns Compatible With an HIV/AIDS Epidemic?

China’s HIV prevalence is low, mainly concentrated among female sex workers (FSWs), their clients, men who have sex with men, and the stable partners of members of these high-risk groups. We evaluate the contribution to the spread of HIV of China’s regime of heterosexual relations, of the structure of heterosexual networks, and of the attributes of key population groups with simulations driven by data from a cross-sectional survey of egocentric sexual networks of the general population of Shanghai and from a concurrent respondent-driven sample of FSWs. We find that the heterosexual network generated by our empirically calibrated simulations has low levels of partner change, strong constraints on partner selection by age and education, and a very small connected core, mainly comprising FSWs and their clients and characterized by a fragile transmission structure. This network has a small HIV epidemic potential but is compatible with the transmission of bacterial sexually transmitted infections (STIs), such as syphilis, which are less susceptible to structural breaks in transmission of infection. Our results suggest that policies that force commercial sex underground could have an adverse effect on the spread of HIV and other STIs.

Methodology of the 2016 RAND Presidential Election Panel Survey (PEPS)

The 2016 RAND Presidential Election Panel Survey uses the American Life Panel (ALP) to study voting intentions, public opinion, and voter behavior. This document provides a detailed description of our methodology.

Integrating Social Media into Information Systems: Requirements, Gaps, and Potential Solutions

This report examines the technical challenges associated with incorporating bulk, automated analysis of social media information into procedures for vetting people seeking entry into the United States. The authors identify functional requirements and a framework for operational metrics for the proposed social media screening capabilities and provide recommendations on how to implement those capabilities.

Assessing, Monitoring, and Evaluating Army Security Cooperation: A Framework for Implementation

The U.S. Army conducts security cooperation activities with partner nations to achieve several objectives; however, evaluating the effectiveness of these activities has been difficult. To help the Army prioritize and increase the effectiveness of its activities, this report addresses two questions: when can Army security cooperation have the greatest impact, and how should the Army assess, monitor, and evaluate security cooperation?

What is the global landpower network and what value might it provide

ABSTRACT US national security guidance, as well as the US Army’s operational experiences since 2001, emphasizes the importance of working closely with partner countries to achieve US strategic objectives. The US Army has introduced the global landpower network (GLN) concept as a means to integrate, sustain and advance the Army’s considerable ongoing efforts to meet US national security guidance. This study develops the GLN concept further, and addresses three questions. What benefits can the GLN provide the Army? What are the essential components of the GLN? What options exist for implementing the GLN concept? By developing the GLN concept, the Army has the opportunity to transition the GLN from an often ad hoc and reactive set of relationships to one that the Army more self-consciously prioritizes and leverages as a resource to meet US strategic objectives.