Racial/ethnic representation in opioid use disorder-related clinical trials

BACKGROUND

Little is known about representation in trials aimed at addressing Opioid Use Disorder. This is a crucial issue given high mortality rates overall and substantial differences in death rates across racial/ethnic groups.

METHODS

We analyzed data from clinical trials, data on Census population, data on new admissions to treatment facilities with a diagnosis of Opioid Use Disorder, and mortality data.

RESULTS

We found that Native American people (who face the highest opioid-related mortality burden in the United States) were under-represented in clinical trials. Black people (who face the second highest mortality rate) were enrolled at levels that exceeded those expected. Our results suggest the need for increased efforts to include Native Americans in OUD clinical trials and also that researchers should consider the possibility that high levels of enrollment among black Americans may represent an undue burden. We found ambiguous results for Asian American and Hispanic people. Our analysis also suggests that White people were represented at levels below those expected, although they were a majority of clinical trials participants.

CONCLUSION

Overall, these findings highlight the importance of equity in clinical trials and major gaps in terms of representation.

Unclaimed Bodies and Medical Education in Texas

This study examines the trends in use of unclaimed bodies in medical education in Texas.

"We do it ourselves": strengths and opportunities for improving the practice of harm reduction

BACKGROUND

Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas.

METHODS

Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data.

RESULTS

Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices.

CONCLUSIONS

Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.

Impact of Medicaid, Race/Ethnicity, and Criminal Justice Referral on Opioid Use Disorder Treatment

We examined the impact of Medicaid expansion and of race/ethnicity on medication-assisted treatment (MAT) for opioid use disorder among those referred for treatment through the criminal justice system. Using a cross-sectional design, we combined data from the Substance Use and Mental Health Services Administration's Treatment Episode Data Set with data on Medicaid expansion and age-adjusted mortality for drug poisoning deaths. Logistic regression was performed within state panels from 2012 to 2016, with 2014 excluded due to this being the transitional Medicaid expansion year. We found that Medicaid expansion led to an increase in the use of MAT to treat those referred to substance treatment facilities through the criminal justice system. We also identified key racial disparities in the use of MAT for those referred from the criminal justice system, with Blacks and Hispanics less likely to receive MAT than non-Hispanic Whites.

The association between medication for opioid use disorder and employment outcomes in the U.S.: The relevance of race and ethnicity

•White admissions given MOUD were less likely to become unemployed at discharge.•Blacks and Hispanics given MOUD were more likely to remain unemployed at discharge.•Racial disparities associated with MOUD have notable implications for policy.

Public perceptions of the role of government and nonstate actors in responding to COVID-19

In this article, we examine public perceptions of the importance of different levels of government and of nongovernmental entities in responding to the COVID‐19 pandemic. By analyzing the case of COVID‐19, we illuminate patterns that may be helpful for understanding public perceptions of the response to a broader range of crises, including the impacts of hurricanes, tornadoes, earthquakes, wildfires, and other hazards. We contribute to the public policy literature on public perceptions of government response to crises and expand it to include consideration of the role of nonstate actors. Drawing on a representative survey of 1200 registered voters in Texas, we find that individuals are more likely to view government as extremely important to respond to the pandemic than nonstate actors. We find that perceptions of the role of state and nonstate actors are shaped by risk perception, political ideology and religion, gender, and race/ethnicity. We do not find evidence that direct impacts from the COVID‐19 pandemic consistently shape perceptions of the role of state and nonstate actors.

Considering the Role of Transparency in Health and Health Care

This book review essay discusses Transparency in Health and Health Care in the United States (2019), edited by Holly Fernandez Lynch, I. Glenn Cohen, Carmel Shachar, and Barbara Evans.

The challenges of modeling and forecasting the spread of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has placed epidemic modeling at the forefront of worldwide public policy making. Nonetheless, modeling and forecasting the spread of COVID-19 remains a challenge. Here, we detail three regional-scale models for forecasting and assessing the course of the pandemic. This work demonstrates the utility of parsimonious models for early-time data and provides an accessible framework for generating policy-relevant insights into its course. We show how these models can be connected to each other and to time series data for a particular region. Capable of measuring and forecasting the impacts of social distancing, these models highlight the dangers of relaxing nonpharmaceutical public health interventions in the absence of a vaccine or antiviral therapies.

Impact of social distancing during COVID-19 pandemic on crime in Los Angeles and Indianapolis

Governments have implemented social distancing measures to address the ongoing COVID-19 pandemic. The measures include instructions that individuals maintain social distance when in public, school closures, limitations on gatherings and business operations, and instructions to remain at home. Social distancing may have an impact on the volume and distribution of crime. Crimes such as residential burglary may decrease as a byproduct of increased guardianship over personal space and property. Crimes such as domestic violence may increase because of extended periods of contact between potential offenders and victims. Understanding the impact of social distancing on crime is critical for ensuring the safety of police and government capacity to deal with the evolving crisis. Understanding how social distancing policies impact crime may also provide insights into whether people are complying with public health measures. Examination of the most recently available data from both Los Angeles, CA, and Indianapolis, IN, shows that social distancing has had a statistically significant impact on a few specific crime types. However, the overall effect is notably less than might be expected given the scale of the disruption to social and economic life.

From Disaster Response to Community Recovery: Nongovernmental Entities, Government, and Public Health

In this article, we examine the role of nongovernmental entities (NGEs; nonprofits, religious groups, and businesses) in disaster response and recovery. Although media reports and the existing scholarly literature focus heavily on the role of governments, NGEs provide critical services related to public safety and public health after disasters. NGEs are crucial because of their ability to quickly provide services, their flexibility, and their unique capacity to reach marginalized populations. To examine the role of NGEs, we surveyed 115 NGEs engaged in disaster response. We also conducted extensive field work, completing 44 hours of semistructured interviews with staff from NGEs and government agencies in postdisaster areas in Texas, Florida, Puerto Rico, Northern California, and Southern California. Finally, we compiled quantitative data on the distribution of nonprofit organizations. We found that, in addition to high levels of variation in NGE resources across counties, NGEs face serious coordination and service delivery problems. Federal funding for expanding the capacity of local Voluntary Organizations Active in Disaster groups, we suggest, would help NGEs and government to coordinate response efforts and ensure that recoveries better address underlying social and economic vulnerabilities.

Linking Public Health and Individual Medicine: The Health Policy Approach of Surgeon General Thomas Parran

Surgeon General Thomas Parran Jr was once viewed as a path-breaking leader, but his legacy is now highly contested. Scholars of national health insurance have viewed Parran as an impediment to government-backed insurance, and revelations about his role in the Tuskegee Study and in the Public Health Service's experiments in Guatemala have cast a shadow over his career. Surgeon General from 1936 to 1948, Parran led the Public Health Service during the development of key features of the modern American health system and was involved in critical debates over the role of the national government in health. I argue that Parran is best understood not as an opponent of insurance but as the proponent of an approach to health policy that sought to link public health and individual medicine. A pragmatic bureaucrat, Parran believed that effective policymaking required compromise with the American Medical Association.

Eliminating malaria in the American South: an analysis of the decline of malaria in 1930s Alabama

Until the 1930s, malaria was endemic throughout large swaths of the American South. We used a Poisson mixture model to analyze the decline of malaria at the county level in Alabama (an archetypical Deep South cotton state) during the 1930s. Employing a novel data set, we argue that, contrary to a leading theory, the decline of malaria in the American South was not caused by population movement away from malarial areas or the decline of Southern tenant farming. We elaborate and provide evidence for an alternate explanation that emphasizes the role of targeted New Deal-era public health interventions and the development of local-level public health infrastructure. We show that, rather than disappearing as a consequence of social change or economic improvements, malaria was eliminated in the Southern United States in the face of economic dislocation and widespread and deep-seated poverty.

Characterization of Ceriporiopsis subvermispora bicupin oxalate oxidase expressed in Pichia pastoris

Oxalate oxidase (E.C. 1.2.3.4) catalyzes the oxygen-dependent oxidation of oxalate to carbon dioxide in a reaction that is coupled with the formation of hydrogen peroxide. Although there is currently no structural information available for oxalate oxidase from Ceriporiopsis subvermispora (CsOxOx), sequence data and homology modeling indicate that it is the first manganese-containing bicupin enzyme identified that catalyzes this reaction. Interestingly, CsOxOx shares greatest sequence homology with bicupin microbial oxalate decarboxylases (OxDC). We show that CsOxOx activity directly correlates with Mn content and other metals do not appear to be able to support catalysis. EPR spectra indicate that the Mn is present as Mn(II), and are consistent with the coordination environment expected from homology modeling with known X-ray crystal structures of OxDC from Bacillus subtilis. EPR spin-trapping experiments support the existence of an oxalate-derived radical species formed during turnover. Acetate and a number of other small molecule carboxylic acids are competitive inhibitors for oxalate in the CsOxOx catalyzed reaction. The pH dependence of this reaction suggests that the dominant contribution to catalysis comes from the monoprotonated form of oxalate binding to a form of the enzyme in which an active site carboxylic acid residue must be unprotonated.

Proposal of a 2-tier histologic grading system for canine cutaneous mast cell tumors to more accurately predict biological behavior

Currently, prognostic and therapeutic determinations for canine cutaneous mast cell tumors (MCTs) are primarily based on histologic grade. However, the use of different grading systems by veterinary pathologists and institutional modifications make the prognostic value of histologic grading highly questionable. To evaluate the consistency of microscopic grading among veterinary pathologists and the prognostic significance of the Patnaik grading system, 95 cutaneous MCTs from 95 dogs were graded in a blinded study by 28 veterinary pathologists from 16 institutions. Concordance among veterinary pathologists was 75% for the diagnosis of grade 3 MCTs and less than 64% for the diagnosis of grade 1 and 2 MCTs. To improve concordance among pathologists and to provide better prognostic significance, a 2-tier histologic grading system was devised. The diagnosis of high-grade MCTs is based on the presence of any one of the following criteria: at least 7 mitotic figures in 10 high-power fields (hpf); at least 3 multinucleated (3 or more nuclei) cells in 10 hpf; at least 3 bizarre nuclei in 10 hpf; karyomegaly (ie, nuclear diameters of at least 10% of neoplastic cells vary by at least two-fold). Fields with the highest mitotic activity or with the highest degree of anisokaryosis were selected to assess the different parameters. According to the novel grading system, high-grade MCTs were significantly associated with shorter time to metastasis or new tumor development, and with shorter survival time. The median survival time was less than 4 months for high-grade MCTs but more than 2 years for low-grade MCTs.

Group B streptococcal endocarditis involving the tricuspid valve in a 7-month-old infant

To our knowledge, we report the first case of group B streptococcal endocarditis that occurred in an infant after the neonatal period. A large, friable vegetation had destroyed the tricuspid valve and resulted in pulmonary emboli. Surgical resection of the valve was needed to achieve clinical cure of the patient. A review of the English-language literature on older patients with group B streptococcal endocarditis revealed a mortality rate of 60% among patients treated with antimicrobial drugs alone and a mortality rate of 29% among those whose treatment included both surgery and therapy with antimicrobial drugs. Surgical debridement of the valve may be necessary for children with large vegetations, which tend to embolize and thus contribute to the morbidity and mortality associated with group B streptococcal endocarditis.

Data communications within a health authority

This paper describes the data communication network installed in four hospitals in the Hammersmith and Queeen Charlotte's Special Health Authority to support several hundred microcomputers, terminals and printers and several host systems, including the integrated computerized hospital information system which is currently under development. Broadband local area network and wide area network technologies have been employed to provide a flexible system, which is capable of being expanded to meet the increasing demand for data communications within the authority. The broadband networks are the first such installations in a health authority in Britain.