Cultural revitalization as a restorative process to combat racial and cultural trauma and promote living well.

OBJECTIVES: This article explores the impact of a decade of cultural education and revitalization with the Miami Tribe of Oklahoma, as they strive to recover from years of historical trauma and cultural oppression. The recovery or resilience is measured through behaviors (defined as living well") seen in tribal youth and community engagement. This study has 4 research questions focused on academic attainment, physical and mental health, community engagement, and national/tribal growth. METHOD: A series of studies using both qualitative (ethnographic-observation and interview) and quantitative measures (survey) examined language use, educational attainment, and tribal event engagement. The samples consisted of 32 Myaamia college students (59% female, 41% male) who matriculated at Miami University between 2013 and 2017 and about 800 community members in attendance at various community events from 2012 to 2017 upon which observational data were collected. RESULTS: Ethnographic content analysis of interviews and descriptive and regression analyses suggest an increase in graduation rates among the college sample who took culture courses, a stronger sense of belonging, an increase in language use and tribal event attendance among tribal members, and increases in scores on Snowshoe's (2015) Cultural Connectedness Scale for the college sample taking culture courses signaling shifts in identity. CONCLUSIONS: This study suggests that reclaiming one's culture and language has an impact on restoring wellness among this tribal nation. Cultural rejuvenation of the Myaamiaki may represent a shift in the way healthy living can be conceptualized within tribal communities. The authors stress the importance of using community knowledge in conjunction with global knowledge to develop community-specific and community-implemented interventions for health promotion. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Determinants of direct cost differences among US employees with major depressive disorders using antidepressants.

OBJECTIVE: To understand factors driving the economic burden of major depressive disorder (MDD) patients with different treatment regimens, by evaluating the relationship between medical profiles and treatment costs. METHODS: Claims data for US privately insured employees (1999-2004) were analysed. Analysis included adult employees with >/=1 diagnosis of MDD and >/=1 prescription for specific antidepressants following a 6-month washout period. Patients were first classified into treatment pattern groups (switchers/discontinuers/maintainers/augmenters), then stratified into mutually exclusive treatment groups - nonstable, stable and intermediate - based on evidence of stability in treatment therapy. Rates of mental and physical co-morbidities, injuries/accidents, substance abuse and urgent care use were analysed across treatment pattern groups. Direct (medical/drug) costs were calculated per patient per year and disaggregated into depression- and non-depression-related components. A two-part multivariate model controlled for baseline characteristics. Costs were also estimated for patients with MDD only, patients with MDD and generalized anxiety disorder (GAD), and patients with MDD and any type of anxiety. RESULTS: Annual per patient adjusted costs (year 2005 values) were significantly lower among stable patients ($US6215) than among intermediate ($US7317) and nonstable patients ($US9948; p < 0.001). Stable patients also had lower depression- and non-depression-related costs. Patients with MDD and comorbid GAD or any type of anxiety had significantly higher costs than MDD-only patients. CONCLUSIONS: Nonstability of treatment is associated with higher comorbidity rates, more urgent care use and higher total, depression- and non-depression-related direct costs. The stable group represents continuity of care and is associated with significant cost savings. Co-morbidities are associated with increased costs.

The United States Department of Energy's Regional Carbon Sequestration Partnerships Program Validation Phase.

This paper reviews the Validation Phase (Phase II) of the Department of Energy's Regional Carbon Sequestration Partnerships initiative. In 2003, the U.S. Department of Energy created a nationwide network of seven Regional Carbon Sequestration Partnerships (RCSP) to help determine and implement the technology, infrastructure, and regulations most appropriate to promote carbon sequestration in different regions of the nation. The objectives of the Characterization Phase (Phase I) were to characterize the geologic and terrestrial opportunities for carbon sequestration; to identify CO(2) point sources within the territories of the individual partnerships; to assess the transportation infrastructure needed for future deployment; to evaluate CO(2) capture technologies for existing and future power plants; and to identify the most promising sequestration opportunities that would need to be validated through a series of field projects. The Characterization Phase was highly successful, with the following achievements: established a national network of companies and professionals working to support sequestration deployment; created regional and national carbon sequestration atlases for the United States and portions of Canada; evaluated available and developing technologies for the capture of CO(2) from point sources; developed an improved understanding of the permitting requirements that future sequestration activities will need to address as well as defined the gap in permitting requirements for large scale deployment of these technologies; created a raised awareness of, and support for, carbon sequestration as a greenhouse gas (GHG) mitigation option, both within industry and among the general public; identified the most promising carbon sequestration opportunities for future field tests; and established protocols for project implementation, accounting, and management. Economic evaluation was started and is continuing and will be a factor in project selection. During the Validation Phase, the seven regional partnerships will put the knowledge learned during the Characterization Phase into practice through field tests that will validate carbon sequestration technologies that are best suited to their respective regions of the country. These tests will verify technologies developed through DOE's core R&D effort and enable implementation of CO(2) sequestration on a large scale, should that become necessary. Pilot projects will have a site-specific focus to test technology; assess formation storage capacity and injectivity; validate and refine existing CO(2) formation models used to determine the transport and fate of CO(2) in the formation; demonstrate the integrity of geologic seals to contain CO(2); validate monitoring, mitigation, and verification (MMV) technologies; define project costs and compare costs of alternatives; assess potential operational and long-term storage risks; address regulatory requirements; and engage and evaluate public acceptance of sequestration technologies. Field validation tests involving both sequestration in geologic formations and terrestrial sequestration are being developed. The results from the Validation Phase will help to confirm the estimates made during the Characterization Phase and will be used to update the regional atlases and NatCarb. Answers to many questions about the effectiveness and safety of carbon sequestration technologies will be instrumental in planning for a Deployment Phase, in which large volume tests will be planned to further sequestration as an option that can mitigate GHG emissions in the United States.

The United States Department of Energy's Regional Carbon Sequestration Partnerships program: a collaborative approach to carbon management.

This paper reviews the Regional Carbon Sequestration Partnerships (RCSP) concept, which is a first attempt to bring the U.S. Department of Energy's (DOE) carbon sequestration program activities into the "real world" by using a geographically-disposed-system type approach for the U.S. Each regional partnership is unique and covers a unique section of the U.S. and is tasked with determining how the research and development activities of DOE's carbon sequestration program can best be implemented in their region of the country. Although there is no universal agreement on the cause, it is generally understood that global warming is occurring, and many climate scientists believe that this is due, in part, to the buildup of carbon dioxide (CO(2)) in the atmosphere. This is evident from the finding presented in the National Academy of Science Report to the President on Climate Change which stated "Greenhouse gases are accumulating in Earth's atmosphere as a result of human activities, causing surface air temperatures and subsurface ocean temperatures to rise. Temperatures are, in fact, rising. The changes observed over the last several decades are likely mostly due to human activities, ...". In the United States, emissions of CO(2) originate mainly from the combustion of fossil fuels for energy production, transportation, and other industrial processes. Roughly one third of U.S. anthropogenic CO(2) emissions come from power plants. Reduction of CO(2) emissions through sequestration of carbon either in geologic formations or in terrestrial ecosystems can be part of the solution to the problem of global warming. However, a number of steps must be accomplished before sequestration can become a reality. Cost effective capture and separation technology must be developed, tested, and demonstrated; a database of potential sequestration sites must be established; and techniques must be developed to measure, monitor, and verify the sequestered CO(2). Geographical differences in fossil fuel use, the industries present, and potential sequestration sinks across the United States dictate the use of a regional approach to address the sequestration of CO(2). To accommodate these differences, the DOE has created a nationwide network of seven Regional Carbon Sequestration Partnerships (RCSP) to help determine and implement the carbon sequestration technologies, infrastructure, and regulations most appropriate to promote CO(2) sequestration in different regions of the nation. These partnerships currently represent 40 states, three Indian Nations, four Canadian Provinces, and over 200 organizations, including academic institutions, research institutions, coal companies, utilities, equipment manufacturers, forestry and agricultural representatives, state and local governments, non-governmental organizations, and national laboratories. These partnerships are dedicated to developing the necessary infrastructure and validating the carbon sequestration technologies that have emerged from DOE's core R&D and other programs to mitigate emissions of CO(2), a potent greenhouse gas. The partnerships provide a critical link to DOE's plans for FutureGen, a highly efficient and technologically sophisticated coal-fired power plant that will produce both hydrogen and electricity with near-zero emissions. Though limited to the situation in the U.S., the paper describes for the international scientific community the approach being taken by the U.S. to prepare for carbon sequestration, should that become necessary.

Beneficial effects of rosuvastatin alone and in combination with extended-release niacin in patients with a combined hyperlipidemia and low high-density lipoprotein cholesterol levels.

Patients with combined hyperlipidemia and low high-density lipoprotein (HDL) cholesterol levels may benefit from combination therapy with a statin and niacin; therefore, we assessed the efficacy and safety of rosuvastatin and extended-release (ER) niacin alone and in combination in 270 patients with this atherogenic dyslipidemia. Men and women > or =18 years with fasting total cholesterol levels > or =200 mg/dl, triglycerides 200 to 800 mg/dl, apolipoprotein B > or cf=110 mg/dl, and HDL cholesterol <45 mg/dl were randomized to 1 of 4 treatments in this 24-week, open-label, multicenter trial: rosuvastatin 10 to 40 mg; ER niacin 0.5 to 2 g; rosuvastatin 40 mg/ER niacin 0.5 to 1 g; or rosuvastatin 10 mg/ER niacin 0.5 to 2 g. Percent changes from baseline in low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and other lipid measurements at week 24 were determined by analysis of variance, with statistical testing performed separately between the rosuvastatin monotherapy group and each remaining treatment group. Daily doses of rosuvastatin 40 mg reduced LDL and non-HDL cholesterol significantly more than either ER niacin 2 g or rosuvastatin 10 mg/ER niacin 2 g (-48% vs -0.1% and -36% for LDL cholesterol and -49% vs -11% and -38% for non-HDL cholesterol, respectively; p <0.01 for all comparisons); no additional reduction in LDL or non-HDL cholesterol was observed with the combination of rosuvastatin 40 mg/ER niacin 1.0 g (-42% and -47%; p = NS). Triglyceride reductions ranged from -21% (ER niacin monotherapy) to -39% (rosuvastatin 40 mg/ER niacin 1 g), but no observed differences were statistically significant. Compared with rosuvastatin alone, rosuvastatin 10 mg/ER niacin 2 g produced significantly greater increases in HDL cholesterol (11% vs 24%, p <0.001) and apolipoprotein A-I (5% vs 11%, p <0.017). Similar increases in HDL cholesterol and apolipoprotein A-I were noted between the monotherapy groups. Over 24 weeks, rosuvastatin alone was better tolerated than either ER niacin alone or the combinations of rosuvastatin and ER niacin.

Safety of rosuvastatin.

The safety and tolerability of rosuvastatin were assessed (as of August 2003) using data from 12,400 patients who received 5 to 40 mg of rosuvastatin in a multinational phase II/III program, which represented 12,212 patient-years of continuous exposure to rosuvastatin. An integrated database was used to examine adverse events and laboratory data. In placebo-controlled trials, adverse events, irrespective of causality assessment, occurred in 57.4% of patients who received 5 to 40 mg of rosuvastatin (n = 744) and 56.8% of patients who received placebo (n = 382). In fixed-dose trials with comparator statins, 5 to 40 mg of rosuvastatin showed an adverse event profile similar to those for 10 to 80 mg of atorvastatin, 10 to 80 mg of simvastatin, and 10 to 40 mg of pravastatin. Clinically significant elevations in alanine aminotransferase (>3 times the upper limit of normal) and creatine kinase (>10 times the upper limit of normal) were uncommon (10 times the upper limit of normal with muscle symptoms) that was possibly related to treatment occurred in

Medial canthoplasty with microplate fixation.

Six patients with malpositioned or surgically excised medial canthal tendons underwent repair with titanium microplate, and two patients underwent repair with titanium miniplate fixation. The T-shaped rigid fixation plates were chosen for medial canthal reconstruction to allow for stabilization of the plate along the anterior lacrimal crest and extension of the plate over the posterior lacrimal crest. The medial canthal tissue was reattached to the titanium plate with 3.0 polypropylene (Prolene) suture. This technique appears to be safer, faster, and, in many cases, more effective than traditional techniques for reconstruction of the medial canthus after tendon avulsion or loss from excision of cutaneous carcinoma.

Adapting human lifestyles for the 21st century.

A number of ecological problems (e.g., global warming, ozone depletion, deforestation, acid rain) have been identified, which threaten to reduce the quality of human life in the 21st century. These problems are human produced, resulting primarily from over-population and over-consumption. Alterations in people's awareness, attitudes, beliefs, and behaviors may stimulate changes in their political and economic systems, which in turn might foster the kind of lifestyle changes that could mitigate these ecological problems. Psychologists can play a role in helping individuals and systems advance toward the goal of becoming a sustainable society: one that satisfies its current needs without jeopardizing the prospects of future generations.

Use of prescription opioids with abuse-deterrent technology to address opioid abuse.

OBJECTIVE: The development of new formulations of extended-release (ER) opioids with abuse-deterrent technology attempts to deter prescription opioid abuse while maintaining appropriate access to care for pain patients. This study examined the degree to which some patients may avoid switching to reformulated ER opioids with abuse-deterrent technology and the extent to which those patients are more likely to be abusers. RESEARCH DESIGN AND METHODS: We analyzed Truven MarketScan pharmacy and medical claims data following the introduction of two reformulated ER opioids with abuse-deterrent technology. Adults aged 18-64 who were continuous users of extended-release oxycodone HCl (ER oxycodone) or extended-release oxymorphone HCl (ER oxymorphone) in a 6 month period prior to the introduction of the respective reformulations of those products were identified and categorized based on whether they switched to the reformulation, switched to other ER/long-acting (LA) opioids (without abuse-deterrent technology), or discontinued ER/LA opioid treatment in a 6 month post-reformulation period. Abusers were identified using ICD-9-CM diagnosis codes for opioid abuse/dependence. Pearson's chi-squared tests and Fisher's exact tests were then used to compare rates of abuse between patients who avoided switching to a reformulated ER opioid. Sensitivity analyses examined several definitions used in this analysis. MAIN OUTCOME MEASURES: ER/LA opioid utilization; rates of diagnosed opioid abuse. RESULTS: A total of 31%-50% of patients avoided switching to reformulated ER opioids. Rates of diagnosed opioid abuse were higher among these patients compared to patients who transitioned to the reformulated ER opioids. LIMITATIONS: Due to the observational research design, caution is warranted in causal interpretation of the findings. The study was conducted among commercially insured continuous ER oxycodone or ER oxymorphone users; future research should consider additional patient populations, such as non-continuous users and those without commercial insurance (i.e., Medicare, Medicaid, uninsured). CONCLUSIONS: Some patients switched to other ER/LA opioids without abuse-deterrent technology or discontinued ER/LA opioid treatment when their existing ER treatment was reformulated. Rates of opioid abuse were higher among patients who switched to other ER/LA opioids or discontinued ER/LA opioid treatment, suggesting that abusers may seek more easily abuseable alternatives such as prescription opioids without abuse-deterrent technology.

Medical cost savings associated with an extended-release opioid with abuse-deterrent technology in the US.

OBJECTIVES: In the US, prescription opioids with technology designed to deter abuse have been introduced to deter drug abuse without hindering appropriate access for pain patients. The objective of this study was to estimate changes in medical costs following the introduction of a new formulation of extended-release (ER) oxycodone HCl (oxycodone) with abuse-deterrent technology in the US. METHODS: Health insurance claims data were used to estimate changes in rates of diagnosed opioid abuse among continuous users of extended-release opioids (EROs) following the introduction of reformulated ER oxycodone in August 2010. This study also calculated the excess medical costs of diagnosed opioid abuse using a propensity score matching approach. These findings were integrated with published government reports and literature to extrapolate the findings to the national level. All costs were inflated to 2011 US dollars. RESULTS: The introduction of reformulated ER oxycodone was associated with relative reductions in rates of diagnosed opioid abuse of 22.7% (p < 0.001) and 18.0% (p = 0.034) among commercially-insured and Medicaid patients, respectively. There was no significant change among Medicare-eligible patients. The excess annual per-patient medical costs associated with diagnosed opioid abuse were $9456 (p < 0.001), $10,046 (p < 0.001), and $11,501 (p < 0.001) for commercially-insured, Medicare-eligible, and Medicaid patients, respectively. Overall, reformulated ER oxycodone was associated with annual medical cost savings of ∼$430 million in the US. LIMITATIONS: Because of the observational research design of this study, caution is warranted in any causal interpretation of the findings. Portions of the study relied on prior literature, government reports, and assumptions to extrapolate the national medical cost savings. CONCLUSIONS: This study provides evidence that reformulated ER oxycodone has been associated with reductions in abuse rates and substantial medical cost savings. Payers and policy-makers should consider these benefits as they devise and implement new guidelines and policies in this therapeutic area.

Disasters; the 2010 Haitian earthquake and the evacuation of burn victims to US burn centers.

Response to the 2010 Haitian earthquake included an array of diverse yet critical actions. This paper will briefly review the evacuation of a small group of patients with burns to burn centers in the southeastern United States (US). This particular evacuation brought together for the first time plans, groups, and organizations that had previously only exercised this process. The response to the Haitian earthquake was a glimpse at what the international community working together can do to help others, and relieve suffering following a catastrophic disaster. The international response was substantial. This paper will trace one evacuation, one day for one unique group of patients with burns to burn centers in the US and review the lessons learned from this process. The patient population with burns being evacuated from Haiti was very small compared to the overall operation. Nevertheless, the outcomes included a better understanding of how a larger event could challenge the limited resources for all involved. This paper includes aspects of the patient movement, the logistics needed, and briefly discusses reimbursement for the care provided.

Volume of prescription opioids used nonmedically in the United States.

ABSTRACT To understand the magnitude of prescription opioid abuse in the United States, it is critical to determine how many dosage units of prescription opioids are ingested nonmedically per year. Using several public and private databases, the authors estimated that in 2002-2003, among the 10.89 million individuals projected to have used prescription opioids nonmedically, a minimum of 430.61 million doses were used nonmedically per year (assuming only one dose consumed per nonmedical use per day per individual). This represented about 1/25 of all prescription opioid doses dispensed. This estimate provides a perspective on the magnitude of prescription opioids abuse and should help policy makers enact policies that reduce prescription opioid abuse and diversion without preventing legitimate access to opioid therapy.