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2327: Prescription opioid dependence in Western New York: Using data analytics to find an answer to the opioid epidemic
- Shyamashree Sinha, Gale Burstein, Kenneth E. Leonard, Timothy Murphy, Peter Elkin
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 15
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OBJECTIVES/SPECIFIC AIMS: Dependence and abuse of prescription opioid pain medication has substantially increased over the last decade. The consistent rise in opioid dependence contributes to the rising prescription drug overdose deaths over the last decade. The study of the distribution and determinants of opioid dependence among patients who are treated with chronic pain medications prescribed by their healthcare providers would aid in answering some key questions about potential abuse and overdose on opioids. The descriptive epidemiology of opioid dependence would help in identifying the vulnerable age group, race, ethnicity, and type of opioid pain medications that more commonly result in dependence. METHODS/STUDY POPULATION: We implemented an Observational Medical Outcomes Partnership/Observational Health Data Sciences and Informatics (OMOP/OHDSI) database, to hold structured EHR data from our Allscripts patient records. We also created a high-throughput phenotyping, natural language processing system that can parse 7,000,000 clinical notes in 1.5 hours. This runs as a web service and provides a modular component based NLP system. After the full semantic parse, we match the content against any number of ontologies. For each match we tag it as either a positive, negative, or uncertain assertion. We then perform automated compositional expressions. The codes are stored in a Berkley database (BDB) NOSQL database and the compositional expressions are stored in Neo4J (a graph database) and Graph DB (a triple store). This flexibility allows rapid retrieval of complex questions in real time. The High-Throughput Phenotyping (HTP) Natural Language Processing (NLP) Subsystem (HTP-NLP) is software that produces, given biomedical text, semantic annotations of the text. The semantic annotations identify conceptual entities—their attributes, the relations they have with other entities and the events they participate in, as expressed in the input text. The conceptual entities, relations, attributes, and events identified are specified by various knowledge representations (KRs) as documented in Coding Sources. Examples of coding sources are medical terminologies [eg, SNOMED CT, RxNorm, LOINC and open biomedical ontologies (OBO) foundry ontologies, eg, gene ontology (GO), functional model of anatomy, OBI, and others]. The annotation results may be displayed or output in formats suitable for further processing. Entity identified is assigned a truth value from 0 to 1. Values from the text are assigned to entities from ontologies such as SNOMED CT. The retrospective analysis of EHR data from local clinic patients was performed using queries on the problem list, demographic data, and medication list of all the patients in the database. The OMOP/OHDSI database was collected from Allscripts EHRs from 2010 to 2015. This common data model helps in the systematic analysis of disparate observational databases of clinic records from the primary care and family medicine clinics in Western New York region. The database contained 212,343 patient records that were parsed and deidentified. Specific research IDs were assigned to each of the patient records and stored in a secure firewall device for data analytics. The entire 212,343 records were queried for opioid dependence from the ICD-9 and 10 diagnostic codes and SNOMED CT codes mapped to both the clinical notes and the problem list for each patient based on the mapped ICD and SNOMED CT codes. In total, 1356 patients were identified as to having opioid dependence. The records were stratified into 7 age groups from age 18 to 28 and ending with age 79–89 years. RESULTS/ANTICIPATED RESULTS: Of the 212,343 patients in the database 1356 patients revealed opioid dependence on the problem list, ICD9-10 codes and prescription opioid pain medication with or without Buprenorphine and Naloxone (Suboxone) in the medication list. The prevalence of opioid dependence in the clinic population was 0.64% (95% CI: 0.61%–0.67%) over a 5-year period. The 7,000,000 patient records generated 750,000,000 SNOMED CT codes (on average 107 codes per record). The highest numbers of opioid dependence were seen in the 29 to 38 years’ age group. That comprised 39.38% (95% CI: 36.78%–41.98%) of the total opioid dependent population but accounted for only 2.03% of whole clinic population in this age group (95% CI: 1.86% to 2.2%). The subjects were then stratified by race and ethnicity. There were 1005 patients with opioid dependence, in the non-Hispanic population (total number 108,402). Among the White non-Hispanic or Latino population with opioid dependence, 41.33% (95% CI: 38.27%–44.39%) were 29–38 years old. The next common age group among the White Non-Hispanic opioid dependent subjects was 19–28 years, comprising of 22.48% (95% CI: 19.88%–25.08%) of the total number of White non-Hispanic or Latino opioid dependent population. Among the total clinic population Hispanics comprise 51.24%, but they comprise only 2.58% (95% CI: 1.74%–3.42%) of the total opioid dependent population. The non-Hispanic population comprise 51.05% of total clinic population while the percent of people who are opioid dependent is 83.26% (95% CI: 83.04%–83.48%) of the total 1356 opioid dependent population. DISCUSSION/SIGNIFICANCE OF IMPACT: The trends of opioid dependence among the clinic population in the study indicate that the prevalence is more in a certain section of the population. The predominance is among the non-Hispanic White population in the 19–38 years of age. The prevalence in younger age implies that the complications related to opioid dependence would be there for a longer duration of time. The prevalence of dependence in this clinic population would be rising if this trend continues. Interventions at curbing prescription opioid dependence is necessary for the vulnerable population. The findings suggest that a broad based approach is necessary to address this problem. The distribution of opioid dependence in this patient population indicate the need for special attention to these specific age group and race ethnicities. The young age of many of the addicted patients demonstrate the risks of legitimate opioid prescriptions in leading this age group towards addiction and implies the need for routine screening for substance abuse. The evidence of complications of opioid overdose among long-term opioid users and risk of abuse with other agents including illicit agents makes the need for an approach that uses real-time interventions in addition to effect long-term improvement in addiction rates. A potentially cost-effective approach to implement monitoring programs and clinical decision support tools would be to develop inter operable linkage from the EHRs to the state Department of Healths’ prescription monitoring programs.
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Paternal alcohol use and the mother-infant relationship
- Rina Das Eiden, Kenneth E. Leonard
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- Journal:
- Development and Psychopathology / Volume 8 / Issue 2 / Spring 1996
- Published online by Cambridge University Press:
- 04 March 2009, pp. 307-323
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The purpose of this study was to examine the association between paternal alcohol use and the mother-infant relationship. A related goal was to investigate the role of maternal depression and marital satisfaction in moderating this relationship. Subjects were 55 mother-infant dyads (12–24-month-old infants) who were observed in the Strange Situation paradigm to assess infant attachment and in structured play interactions. There were 23 families with heavy drinking fathers and 32 with light drinking fathers. As predicted, infants of heavy drinking fathers were more likely to be insecurely attached compared to infants of light drinking fathers. Contrary to expectations, neither maternal depression nor marital interaction mediated the relationship between paternal alcohol use and mother-infant interactions. However, maternal depression did interact with paternal alcohol use to predict infant attachment security and maternal sensitivity. There was also an interactive effect of marital satisfaction and paternal alcohol use on maternal sensitivity. The results suggest that paternal alcohol use may influence family functioning and the mother-child relationship as early as infancy and suggest one possible pathway toward maladjustment among infants of heavy drinking fathers. However, in addition to investigating the impact of paternal alcohol use on the father-infant relationship, the influence of various familial factors associated with paternal alcohol use need to be more closely examined from a longitudinal perspective.
Behavior problems in 18- to 36-month-old children of alcoholic fathers: Secure mother–infant attachment as a protective factor
- ELLEN P. EDWARDS, RINA DAS EIDEN, KENNETH E. LEONARD
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- Journal:
- Development and Psychopathology / Volume 18 / Issue 2 / June 2006
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- 04 May 2006, pp. 395-407
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This study examined the relationship between paternal alcoholism and toddler behavior problems from 18 to 36 months of age, as well as the potential moderating effects of 12-month infant–mother attachment security on this relationship. Children with alcoholic fathers had higher levels of internalizing and externalizing behavior than children of nonalcoholic fathers. Simple effects testing of an interaction effect of child age, group, and attachment security with mothers on externalizing behavior suggested that at 24 and 36 months of age mother–infant attachment security moderated the relationship between alcohol group status and externalizing behavior. Namely, within the alcohol group, those children with secure relationships with their mothers had significantly lower externalizing than insecure children of alcoholics. A similar pattern was noted for internalizing behavior at 36 months of age. Implications for intervention are discussed.
The authors thank the parents and infants who participated in this study and the research staff who were responsible for conducting numerous assessments with these families. This study was made possible by grants from NIAAA (1RO1 AA-10042-01A1) and NIDA (1K21DA00231-01A1).
4 - Cognition and Communication during Marital Conflict: How Alcohol Affects Subjective Coding of Interaction in Aggressive and Nonaggressive Couples
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- By Alan Sillars, University of Montana, Kenneth E. Leonard, Research Institute on Addictions and State University of New York at Buffalo Medical School, Linda J. Roberts, University of Wisconsin-Madison, Tim Dun, University of Iowa
- Edited by Patricia Noller, University of Queensland, Judith A. Feeney, University of Queensland
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- Understanding Marriage
- Published online:
- 25 July 2009
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- 26 September 2002, pp 85-112
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Summary
At the base of every marital conflict there is a rupture of consensus. All conflicts involve differences in perception that increase in depth and magnitude as a dispute escalates. While couples may resolve or put aside differences by talking together, communication can also inflame matters and drive perspectives further apart. The variable effects of communication partly stem from the way communication itself is subjectively construed. In a bitter quarrel, disagreements are not confined to the surface issues and background events associated with conflict. Individuals may also perceive the stream of interaction differently (Watzlawick, Beavin, & Jackson, 1967), and this fact accounts for the explosive nature of some conflicts. To follow this reasoning a step further, communication patterns are also implicated in marital conflicts that culminate in violence (for example, Lloyd & Emery, 2000a). Further, there are strong indications that distorted perceptions of interaction, particularly by maritally violent men, contribute to the dysfunctional communication patterns of aggressive couples (Eckhardt, Barbour, & Davison, 1998). Thus, to better understand the role of communication in marital conflict and aggression, it is useful to consider not only how couples talk with each other, but also the subjective interpretations that accompany these acts.
In this chapter we look at the interpretive process connected with marital interaction, drawing upon a study of couple conflict, aggression, and alcohol. In this research the conscious thoughts and feelings that individuals experienced during couple interactions were reconstructed using video-assisted recall methods.
Mother–infant and father–infant attachment among alcoholic families
- RINA DAS EIDEN, ELLEN PETERSON EDWARDS, KENNETH E. LEONARD
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- Journal:
- Development and Psychopathology / Volume 14 / Issue 2 / June 2002
- Published online by Cambridge University Press:
- 15 May 2002, pp. 253-278
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This study examined the association between fathers' alcoholism and other risk factors such as parental depression, family conflict, infant temperament, and parent–infant attachment. The quality of parent–infant interactions was hypothesized to be a proximal mediator of the associations among alcoholism and other risk factors and attachment. The participants were 223 families (104 nonalcoholic families and 119 alcoholic families) with 12-month-old infants recruited through birth records. Infants in families with two parents with alcohol problem had significantly higher rates of insecure attachment with both parents. Structural Equations Modeling indicated that the fathers' alcohol problem was associated with lower paternal sensitivity (higher negative affect, lower positive engagement, and lower sensitive responding) during father–infant play interactions, and this in turn was associated with higher risk for infant attachment insecurity with fathers. The association between the fathers' alcohol problem and infant attachment security with the mother was mediated by maternal depression, and maternal alcohol problems and family conflict were associated with maternal sensitivity during play interactions. These results indicate that the fathers' alcoholism is associated with higher family risk including the quality of the parent–infant relationship; infant attachment develops in a family context; and this context has a significant association with attachment security.
Parent–infant interactions among families with alcoholic fathers
- RINA DAS EIDEN, FELIPA CHAVEZ, KENNETH E. LEONARD
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- Journal:
- Development and Psychopathology / Volume 11 / Issue 4 / December 1999
- Published online by Cambridge University Press:
- 01 December 1999, pp. 745-762
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The purpose of this study was to examine the relationship between fathers' alcoholism and the quality of parent–infant interactions during free play. A related goal was to study the potential mediating or moderating role of comorbid parental psychopathology, such as depression and antisocial behavior, difficult infant temperament, and parental aggression. The sample consisted of 204 families with 12-month-old infants (104 alcoholic and 100 control families), recruited from New York State birth records. Results indicated that fathers' alcoholism was associated with a number of other risk factors (depression, antisocial behavior, and family aggression). Fathers' alcoholism was also associated with more negative father–infant interactions as indicated by lower paternal sensitivity, positive affect, verbalizations, higher negative affect, and lower infant responsiveness among alcoholic fathers. As expected, fathers' depression mediated the relationship between fathers' alcoholism and sensitivity, while maternal depression mediated the association between maternal alcohol problems and maternal sensitivity. Parents' psychopathology did not moderate the association between alcoholism and parent-infant interactions. The results from the present study suggest that the origins of risk for later maladjustment among children of alcoholic fathers are apparent as early as infancy and highlight the role of comorbid parental risk factors.
2 - Marital Aggression, Quality, and Stability in the First Year of Marriage: Findings from the Buffalo Newlywed Study
- Edited by Thomas N. Bradbury, University of California, Los Angeles
- Foreword by Robert L. Weiss
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- Book:
- The Developmental Course of Marital Dysfunction
- Published online:
- 13 October 2009
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- 13 August 1998, pp 44-73
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Summary
Marriage represents one of the most important transition events in the course of individual development. When two individuals marry, it is likely to fundamentally alter their views of themselves and the social world, the nature of their interactions with friends and family, and their transactions with the broader social network (Boss, 1983; McGoldrick & Carter, 1982). Newly weds are thus faced with a set of important and challenging tasks: they must negotiate a satisfactory division of roles and responsibilities; reestablish or redefine ties, both as individuals and as a couple, with each member's extended family and peer network; and learn ways to maintain and nurture their developing relationship. Although these tasks are often begun prior to marriage and continue throughout marriage, the early years of marriage are usually the time in which major conflicts are first revealed and confronted. For example, Suitor, Pillemer, and Straus (1990) report that marital conflict and verbal aggression within the marriage are negatively correlated with age (though this may represent either developmental declines or a winnowing effect of divorce). Consequently, the early years of marriage may represent the period in which marital conflict is the most frequent and most intense. Because a couple's ability to manage marital conflict and reconcile differences may be an important determinant of marital satisfaction and stability (e.g., Gottman, 1979; Markman, Floyd, Stanley, & Storaasli, 1988), the early years of marriage may represent a critical phase for the developmental course of the marriage.
Complex Permittivity Studies of Polyaniline
- Leonard J. Buckley, Kenneth E. Dudeck
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- Journal:
- MRS Online Proceedings Library Archive / Volume 269 / 1992
- Published online by Cambridge University Press:
- 25 February 2011, 579
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- 1992
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A study of the complex dielectric properties at microwave and millimeterwave frequencies on several polyanilines was performed. The polymers investigated were based on emeraldine salts. The chemically synthesized emeraldine base was protonated with acids of various pH levels. Aqueous HCI (pH range 0.12 to 1.07) and Tosylic (pH range 0.22 to 1.13) were used. Complex permittivities of the emeraldine base and salts were determined at X-band and R-band using waveguide measurements. Characterization techniques were developed to reduce the measurement error. This included the electrical determination of the sample holder length and sample position. The real component of the dielectric constant was found to vary from 4 to 107 at Xband and from 3.8 to 926 at R-band. The dielectric loss spanned 3 orders of magnitude at X-band and 4 orders of magnitude at Rband. The frequency dependence was relatively level within each band with a slight decrease in each permittivity component with increasing frequency. The DC conductivity ranged from 10−4 S/cm to 10−1 S/cm for the emeraldine salts. The time dependence of the complex permittivity and DC conductivity was examined.