OBJECTIVESDeaths due to prescription opioid overdoses are at record-high levels. Limiting the amount of opioid prescribed has been suggested as a prevention strategy. The purpose of this study was to ...describe the opioid prescribing practices in the emergency departments and urgent care sites of a Midwestern tertiary care children’s hospital system.
METHODSThis retrospective medical record review examined the visits from the 2 pediatric emergency departments and 2 pediatric urgent care sites in the system from June 1, 2012, to May 31, 2013, during which an outpatient opioid prescription was written. The primary outcome was number of days of opioid prescribed. Other data collected included patient demographics, diagnosis, and prescriber information; factors associated with prescriptions written for more than 5 days were identified.
RESULTSA total of 4075 opioid prescriptions were included in the 1-year study period, and 3991 of these had complete data for analysis. The median amount prescribed was 3.3 days with an interquartile range of 2.5 days. Odds of receiving a prescription of more than 5 days’ duration were higher for children younger than 1 year (odds ratio OR, 12.3; 95% confidence interval CI, 7.3–21.0), 1 to 4 years of age (OR, 7.7; 95% CI, 5.5–10.8), and 5 to 9 years of age (OR, 2.4; 95% CI, 1.7–3.4); for children with noninjury diagnoses (OR, 1.4; 95% CI, 1.2–1.7); or if prescribed by a resident physician (OR, 1.4; 95% CI, 1.1–1.8) or from the urgent care (OR, 1.4; 95% CI, 1.1–1.7).
CONCLUSIONSOpioid prescriptions of more than 5 days were more frequently prescribed for younger patients, noninjury diagnoses, or if prescribed by a resident physician or from the urgent care. We need to focus on medical student, resident, and provider education as well as further opioid research in order to decrease unnecessary prescribing.
Database demand resulting from offline analysis and production of data at the STAR experiment at Brookhaven National Laboratory's Relativistic Heavy-Ion Collider has steadily increased over the last ...six years of data taking activities. With each year, STAR more than doubles the number of events recorded with an anticipation of reaching a billion event capabilities as early as next year. The challenges faced from producing and analyzing this magnitude of events in parallel have raised issues with regard to the distribution of calibrations and geometry data, via databases, to STAR's growing global collaboration. Rapid distribution, availability, ensured synchronization and load balancing have become paramount considerations. Both conventional technology and novel approaches are used in parallel to realize these goals. This paper discusses how STAR uses load balancing to optimize database usage. It discusses distribution methods via MySQL master slave replication; the synchronization issues that arise from this type of distribution and solutions, mostly homegrown, put forth to overcome these issues. A novel approach toward load balancing between slave nodes that assists in maintaining a high availability rate for a veracious community is discussed in detail. This load balancing addresses both, pools of nodes internal to a given location, as well as balancing the load for remote users between different available locations. Challenges, trade-offs, rationale for decisions and paths forward will be discussed in all cases, presenting a solid production environment with a vision for scalable growth.
We present results for the measurement of {phi} meson production via its charged kaon decay channel {phi}{yields}K{sup +}K{sup -} in Au+Au collisions at {radical}(s{sub NN})=62.4,130, and 200 GeV, ...and in p+p and d+Au collisions at {radical}(s{sub NN})=200 GeV from the STAR experiment at the BNL Relativistic Heavy Ion Collider (RHIC). The midrapidity (|y|<0.5) {phi} meson transverse momentum (p{sub T}) spectra in central Au+Au collisions are found to be well described by a single exponential distribution. On the other hand, the p{sub T} spectra from p+p, d+Au, and peripheral Au+Au collisions show power-law tails at intermediate and high p{sub T} and are described better by Levy distributions. The constant {phi}/K{sup -} yield ratio vs beam species, collision centrality, and colliding energy is in contradiction with expectations from models having kaon coalescence as the dominant mechanism for {phi} production at RHIC. The {omega}/{phi} yield ratio as a function of p{sub T} is consistent with a model based on the recombination of thermal s quarks up to p{sub T}{approx}4 GeV/c, but disagrees at higher transverse momenta. The measured nuclear modification factor, R{sub dAu}, for the {phi} meson increases above unity at intermediate p{sub T}, similar to that for pions and protons, while R{sub AA} is suppressed due to the energy loss effect in central Au+Au collisions. Number of constituent quark scaling of both R{sub cp} and v{sub 2} for the {phi} meson with respect to other hadrons in Au+Au collisions at {radical}(s{sub NN})=200 GeV at intermediate p{sub T} is observed. These observations support quark coalescence as being the dominant mechanism of hadronization in the intermediate p{sub T} region at RHIC.
Forward-backward multiplicity correlation strengths have been measured for the first time with the STAR detector for Au+Au and $\textit{p+p}$ collisions at $\sqrt{s_{NN}}$ = 200 GeV. Strong short and ...long range correlations are seen in central (0-10%) Au+Au collisions. The magnitude of these correlations decrease with decreasing centrality until only short range correlations are observed in 40-50% Au+Au collisions. The results are in agreement with predictions from the Dual Parton and Color Glass Condensate models.
In ultra-peripheral relativistic heavy-ion collisions, a photon from the electromagnetic field of one nucleus can fluctuate to a quark-antiquark pair and scatter from the other nucleus, emerging as a ...$\rho^0$. The $\rho^0$ production occurs in two well-separated (median impact parameters of 20 and 40 fermi for the cases considered here) nuclei, so the system forms a 2-source interferometer. At low transverse momenta, the two amplitudes interfere destructively, suppressing $\rho^0$ production. Since the $\rho^0$ decay before the production amplitudes from the two sources can overlap, the two-pion system can only be described with an entangled non-local wave function, and is thus an example of the Einstein-Podolsky-Rosen paradox. We observe this suppression in 200 GeV per nucleon-pair gold-gold collisions. The interference is $87% \pm 5% {\rm (stat.)}\pm 8%$ (syst.) of the expected level. This translates into a limit on decoherence due to wave function collapse or other factors, of 23% at the 90% confidence level.
Three-particle azimuthal correlation measurements with a high transverse momentum trigger particle are reported for pp, d+Au, and Au+Au collisions at 200 GeV by the STAR experiment. The ...acoplanarities in pp and d+Au indicate initial state kT broadening. Larger acoplanarity is observed in Au+Au collisions. The central Au+Au data show an additional effect signaling conical emission of correlated charged hadrons.
We measure directed flow ($v_1$) for charged particles in Au+Au and Cu+Cu collisions at $\sqrt{s_{NN}} =$ 200 GeV and 62.4 GeV, as a function of pseudorapidity ($\eta$), transverse momentum ($p_t$) ...and collision centrality, based on data from the STAR experiment. We find that the directed flow depends on the incident energy but, contrary to all existing models, not on the size of the colliding system at a given centrality. We extend the validity of the limiting fragmentation concept to different collision systems, and investigate possible explanations for the observed sign change in $v_1(p_t)$.
We report a new STAR measurement of the longitudinal double-spin asymmetry A_LL for inclusive jet production at mid-rapidity in polarized p+p collisions at a center-of-mass energy of sqrt(s) = 200 ...GeV. The data, which cover jet transverse momenta 5 < p_T < 30 GeV/c, are substantially more precise than previous measurements. They provide significant new constraints on the gluon spin contribution to the nucleon spin through the comparison to predictions derived from one global fit of polarized deep-inelastic scattering measurements.
We report the first measurement of the opening angledistribution between pairs of jets produced in high-energy collisions oftransversely polarized protons. The measurement probes (Sivers)correlations ...between the transverse spin orientation of a proton and thetransverse momentum directions of its partons. With both beams polarized,the wide pseudorapidity (-1 leq eta leq +2) coverage for jets permitsseparation of Sivers functions for the valence and sea regions. Theresulting asymmetries are all consistent with zero and considerablysmaller than Sivers effects observed in semi-inclusive deep inelasticscattering (SIDIS). We discuss theoretical attempts to reconcile the newresults with the sizable transverse spin effects seen in SIDIS andforward hadron production in pp collisions.
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