Background Gabapentinoids (gabapentin and pregabalin), a class of FDA-approved antiepileptic medications with expanded indications for certain neuropathic pain conditions, have been prescribed off-label for almost all types of pain in the US opioid epidemic. Methods We used IBM® MarketScan® Research Databases (2015-2018) and collected primary data. In Aim 1, we described the geographic variation in gabapentinoids and opioids for pain by US state and metropolitan statistical area (MSA). In Aim 2, we implemented a controlled multiple baseline interrupted time series analysis and assessed the impact of including gabapentin in states’ prescription drug monitoring programs (PDMP) and listing gabapentin as a Schedule V controlled substance. In Aim 3, we developed an algorithm to identify potential gabapentin misuse and/or abuse in administrative claims data. Results The pattern of the geographic variation in gabapentinoids was similar to that of opioids across states and MSAs. Including gabapentin in PDMPs and Schedule V controlled ABSTRACT viii substance classification were effective in curbing the growth of gabapentin use and reducing opioid-related adverse events. Our algorithm identified approximately one in six patients with gabapentin use as having potentially misused and/or abused gabapentin. Multiple comorbidities and drug use were associated with gabapentin misuse and/or abuse. Conclusions Gabapentinoids may have been widely used as alternative or adjuvant analgesics to opioids for pain across the US. Policy makers should consider including gabapentin in proactive PDMPs and scheduling of gabapentin. Monitoring requirements and individualized safety measures should be put in place for patients who potentially misuse and/or abuse gabapentin.

Contexte et objectifs. En 1995, le gouvernement canadien a promulgué la Loi C-68, rendant ainsi obligatoire l’enregistrement de toutes les armes à feu et affermissant les vérifications auprès des futurs propriétaires. Faute de preuves scientifiques crédibles, le potentiel de cette loi à prévenir les homicides est présentement remis en question. Tout en surmontant les biais potentiels retrouvés dans les évaluations antérieures, l’objectif de ce mémoire est d’évaluer l’effet de la Loi C-68 sur les homicides au Québec entre 1974 et 2006. Méthodologie. L’effet de la Loi C-68 est évalué à l’aide d’une analyse des bornes extrêmes. Les effets immédiats et graduels de la Loi sont évalués à l’aide de 372 équations. Brièvement, il s’agit d’analyses de séries chronologiques interrompues où toutes les combinaisons de variables indépendantes sont envisagées afin d’éviter les biais relatifs à une spécification arbitraire des modèles. Résultats. L’introduction de la Loi C-68 est associée à une baisse graduelle des homicides commis à l’aide d’armes longues (carabines et fusils de chasse), sans qu’aucun déplacement tactique ne soit observé. Les homicides commis par des armes à feu à autorisation restreinte ou prohibées semblent influencés par des facteurs différents. Conclusion. Les résultats suggèrent que le contrôle des armes à feu est une mesure efficace pour prévenir les homicides. L’absence de déplacement tactique suggère également que l’arme à feu constitue un important facilitateur et que les homicides ne sont pas tous prémédités. D’autres études sont toutefois nécessaires pour clairement identifier les mécanismes de la Loi responsables de la baisse des homicides. / Context and objectives. Laws with extensive background checks and making mandatory the registration of all guns have been adopted by some governments to prevent firearms-related homicides. On the other hand, methodological flaws found in previous evaluations question the potential of such laws to prevent gun homicides. By taking into account previous limitations, the main objective of this study is to estimate the effect of Bill C-68 on homicides committed in the Province of Quebec, Canada, between 1974 and 2006. Methodology. Using extreme bounds analysis, we assess the effect of Bill C-68 on homicides. Estimates of the immediate and gradual effects of the law are based on a total of 372 equations. More precisely, interrupted time series analyses were conducted, using all possible variable combinations, in order to overcome biases related to model specification. Results. We found that Bill C-68 is associated with a significant and gradual decline in homicides committed with a long gun (either a riffle or a shotgun). The substitution effects are not robust with respect to different model specifications. Patterns observed in homicides involving restricted or prohibited firearms suggest that they are influenced by different factors, not considered in our analyses. Conclusion. Results suggest that enhanced firearm control laws are an effective tool to prevent homicides. The lack of tactical displacement supports the concept of firearm as a crime facilitator and suggests that all homicides are not carefully planned. Other studies are however needed to pinpoint law provisions accountable for the decrease in homicides.

Contexte et objectifs. Depuis plusieurs années, la criminalité économique génère des coûts économiques et sociaux importants. Plusieurs acteurs, dont les entreprises privées, se sont mobilisés pour lutter contre ce phénomène. La fraude par carte de débit est un crime économique en expansion contre lequel plusieurs organisations ont entrepris des actions. L’objectif de ce mémoire est d’améliorer les connaissances sur les effets des mesures de prévention situationnelle appliquées dans les succursales d’un commerce de détail et leur impact sur le processus décisionnel des délinquants impliquées dans le clonage de cartes de débit. Méthodologie. Les effets des mesures de prévention mises en place sont évalués à l’aide d’analyses de séries chronologiques interrompues. En complément des analyses statistiques, des entrevues et une analyse documentaire sont effectuées. Les entrevues sont réalisées avec des enquêteurs du service de sécurité de l’entreprise de commerce de détail. L’analyse documentaire est basée sur les rapports d’événement ouverts lors des fraudes par carte de débit. Résultats. Les mesures de prévention ont produit différents effets. Selon la mesure, il fut possible de constater soit une hausse ou une baisse dans le nombre de délits commis. Certaines mesures ont, en outre, provoqué un déplacement spatial, un déplacement dans le choix de la cible, un déplacement dans le type de crime commis et, finalement, un déplacement tactique. Conclusion. Les résultats suggèrent que les mesures de prévention adoptées ont empêché la réalisation des délits associés à la fraude par carte de débit. Par contre, la présence de plusieurs formes de déplacement indique que les fraudeurs se sont adaptés aux mesures de prévention. Afin de documenter adéquatement cette forme de crime et les déplacements générés, d’autres études s’avèrent nécessaires. / Context and objectives. Each year, economic crimes generate important economic and social losses. Many enterprises, including private enterprises, collaborated and introduced initiatives in order to combat this criminality. Fraud using automated payment cards is a crime in full expansion against which many organizations have taken actions. The objective of this dissertation is, on one hand, to improve the knowledge on the impact of preventive measures implemented in the branches of a retailer and, on the other hand, to estimate their impact on the criminal decision-making process. Methodology. The effect of preventive measures is assessed through interrupted time series analysis. In addition, members the retailer security staff were interviewed and a review of event reports associated with debit card fraud was performed. Results. The preventive measures were associated to various results. Depending on the preventive measure, one can observe either an increase or a decrease in the number of crimes performed. It is also observed that some measures have resulted in tactical and spatial displacements. Some offenders have also started to commit other types of crimes. Conclusion. The results suggest that the preventive measures implemented had a significant preventive effect on debit card crimes. However, the presence of many types of displacement shows that the offenders have adjusted to those preventive measures. In order to properly document this type of crime and associated displacements, additional studies are necessary.

No description available.

Estudos realizados em vários países têm demonstrado a importância da atenção pré-hospitalar móvel, principalmente por atuar na redução do tempo resposta. No Brasil, essa modalidade de assistência é realizada por meio do Serviço de Atendimento Móvel de Urgência (SAMU), implantado em 2003, cujos objetivos são redução do número de óbitos, do tempo de internação e das sequelas incapacitantes provenientes de um agravo clínico ou acidente. Em que pesem os avanços alcançados ao longo de quinze anos de implementação do SAMU no país, ainda permanecem desafios importantes a serem superados. O propósito desse estudo foi avaliar o desempenho do SAMU, na Região do Grande ABC Paulista, utilizando como condição traçadora o infarto agudo do miocárdio. Trata-se de pesquisa avaliativa, exploratório-analítica, realizada por meio do método misto sequencial explanatório. Na abordagem quantitativa foi utilizado o desenho de séries temporais interrompidas, para testar efeitos imediatos e graduais da intervenção sobre a taxa de mortalidade hospitalar por infarto agudo do miocárdio. Para aumentar a validade interna do estudo foram incluídas análises com desfecho e região controles. A abordagem qualitativa foi baseada em análise documental e entrevistas semiestruturadas. O roteiro de entrevista foi desenvolvido visando aprofundar os resultados da análise de series temporais interrompidas ao explorar atitudes e valores dos entrevistados sobre o desempenho do SAMU na região. Para interpretação dos achados da pesquisa qualitativa foi empregada técnica de análise do tipo temática. A elaboração do modelo lógico do programa foi fundamental para compreender o funcionamento do SAMU na região do Grande ABC. Após a modelagem da intervenção, observou-se viabilidade metodológica e operacional para o desenvolvimento da pesquisa avaliativa. A análise de series temporais interrompidas mostrou redução de -0.04% na taxa de mortalidade, em relação a tendência subjacente, desde a implantação do SAMU (IC 95%:-0.0816; -0.0162; P-valor: 0.0040) e uma redução no nível de -2.89 (IC 95%:-4.3293;-1.4623 P-valor: 0.0001), ambos com significância estatística. Não é possível excluir confundimentos devido a outros eventos ocorridos na época da política, no entanto, para melhorar a robustez dos achados foi incluida séries de controle relevantes. Análises com desfecho controle não mostrou mudanças significativas na tendência e nível. Em relação a região controle, Baixada Santista, a diferença da tendência do desfecho, pós-intervenção, de -0.0639 mostrou-se estatisticamente significativa (IC 95%: -0.1060; -0.0219; P-valor: 0.0031). As entrevistas revelaram que o SAMU tem potencial para intervir no melhor prognóstico dos casos de infarto agudo do miocárdio que são transportados, contudo, é preciso superar desafios relacionados a garantia de leitos de referência, expansão da telemedicina e qualificação contínua das equipes da regulação e assistência. A heterogeneidade das condições sociais e econômicas dos municípios da região pode estar contribuindo para que a atenção móvel de urgência não seja equânime, apontando para a importância do processo de regionalização, visando aprimorar o fluxo assistencial e o acesso oportuno ao sistema de saúde. Os resultados sinalizam que a intervenção estudada pode ser uma condição que por si só não implica em efetividade, mas sem a qual essa mesma efetividade não teria ocorrido, sendo parte de um conjunto de condições que, agregadas, geram um resultado positivo / Studies conducted in several countries have demonstrated the importance of prehospital mobile care, mainly by acting in reducing the response time. In Brazil, this type of care is performed through the Mobile Emergency Care Service (SAMU), implemented in 2003, whose objectives are to reduce the number of deaths, length of hospital stay and disabling sequelae resulting from a clinical or accident. Regardless of the progress achieved over the fifteen years of implementation of SAMU in the country, important challenges remain to be overcome. The purpose of this study was to evaluate the performance of SAMU, in the Region of Grande ABC Paulista, using acute myocardial infarction as the tracer condition. This is an evaluative, exploratory-analytic research, carried out using the mixed sequential explanatory method. In the quantitative approach, the design of interrupted time series was used to test the immediate and gradual effects of the intervention on the hospital mortality rate due to acute myocardial infarction. In order to increase the internal validity of the study, analyzes with outcome and control regions were included. The qualitative approach was based on documentary analysis and semi-structured interviews. The interview script was developed in order to deepen the results of the analysis of interrupted time series by exploring the attitudes and values of interviewees about SAMU performance in the region. For the interpretation of the qualitative research findings, a thematic type analysis technique was used. The elaboration of the program\'s logical model was fundamental to understanding the operation of SAMU in the Grande ABC region. After the intervention modeling, methodological and operational feasibility was observed for the development of the evaluative research. The analysis of interrupted time series showed a -0.04% reduction in the mortality rate, in relation to the underlying trend, since the implantation of SAMU (95% CI: 0.0816 to -0.0162, p-value 0.0040) and a reduction in the level of -2.89 (95% CI: 4.3293, -1.4623 p-value: 0.0001), both with statistical significance. It is not possible to exclude confounding due to other events occurring at the time of the policy, however, in order to improve the robustness of the findings, relevant control series were included. Analyzes with outcome control did not show significant changes in trend and level. In relation to the control region, Baixada Santista, the difference in trend of the post-intervention outcome of -0.0639 was statistically significant (95% CI -0.1060; -0.0219; p-value: 0.0001). The interviews revealed that the SAMU has the potential to intervene in the best prognosis of the cases of acute myocardial infarction that are transported, however, it is necessary to overcome challenges related to reference bed assurance, telemedicine expansion and continuous qualification of the regulation and care teams. The heterogeneity of the social and economic conditions of the municipalities in the region may be contributing to the fact that mobile emergency care is not equitable, pointing to the importance of the regionalization process, aiming at improving the flow of care and timely access to the health system. The results indicate that the intervention studied may be a condition that in itself does not imply effectiveness, but without which this same effectiveness would not have occurred, being part of a set of conditions that, together, generate a positive result

Contexte et objectifs. En 1995, le gouvernement canadien a promulgué la Loi C-68, rendant ainsi obligatoire l’enregistrement de toutes les armes à feu et affermissant les vérifications auprès des futurs propriétaires. Faute de preuves scientifiques crédibles, le potentiel de cette loi à prévenir les homicides est présentement remis en question. Tout en surmontant les biais potentiels retrouvés dans les évaluations antérieures, l’objectif de ce mémoire est d’évaluer l’effet de la Loi C-68 sur les homicides au Québec entre 1974 et 2006. Méthodologie. L’effet de la Loi C-68 est évalué à l’aide d’une analyse des bornes extrêmes. Les effets immédiats et graduels de la Loi sont évalués à l’aide de 372 équations. Brièvement, il s’agit d’analyses de séries chronologiques interrompues où toutes les combinaisons de variables indépendantes sont envisagées afin d’éviter les biais relatifs à une spécification arbitraire des modèles. Résultats. L’introduction de la Loi C-68 est associée à une baisse graduelle des homicides commis à l’aide d’armes longues (carabines et fusils de chasse), sans qu’aucun déplacement tactique ne soit observé. Les homicides commis par des armes à feu à autorisation restreinte ou prohibées semblent influencés par des facteurs différents. Conclusion. Les résultats suggèrent que le contrôle des armes à feu est une mesure efficace pour prévenir les homicides. L’absence de déplacement tactique suggère également que l’arme à feu constitue un important facilitateur et que les homicides ne sont pas tous prémédités. D’autres études sont toutefois nécessaires pour clairement identifier les mécanismes de la Loi responsables de la baisse des homicides. / Context and objectives. Laws with extensive background checks and making mandatory the registration of all guns have been adopted by some governments to prevent firearms-related homicides. On the other hand, methodological flaws found in previous evaluations question the potential of such laws to prevent gun homicides. By taking into account previous limitations, the main objective of this study is to estimate the effect of Bill C-68 on homicides committed in the Province of Quebec, Canada, between 1974 and 2006. Methodology. Using extreme bounds analysis, we assess the effect of Bill C-68 on homicides. Estimates of the immediate and gradual effects of the law are based on a total of 372 equations. More precisely, interrupted time series analyses were conducted, using all possible variable combinations, in order to overcome biases related to model specification. Results. We found that Bill C-68 is associated with a significant and gradual decline in homicides committed with a long gun (either a riffle or a shotgun). The substitution effects are not robust with respect to different model specifications. Patterns observed in homicides involving restricted or prohibited firearms suggest that they are influenced by different factors, not considered in our analyses. Conclusion. Results suggest that enhanced firearm control laws are an effective tool to prevent homicides. The lack of tactical displacement supports the concept of firearm as a crime facilitator and suggests that all homicides are not carefully planned. Other studies are however needed to pinpoint law provisions accountable for the decrease in homicides.

Contexte et objectifs. Depuis plusieurs années, la criminalité économique génère des coûts économiques et sociaux importants. Plusieurs acteurs, dont les entreprises privées, se sont mobilisés pour lutter contre ce phénomène. La fraude par carte de débit est un crime économique en expansion contre lequel plusieurs organisations ont entrepris des actions. L’objectif de ce mémoire est d’améliorer les connaissances sur les effets des mesures de prévention situationnelle appliquées dans les succursales d’un commerce de détail et leur impact sur le processus décisionnel des délinquants impliquées dans le clonage de cartes de débit. Méthodologie. Les effets des mesures de prévention mises en place sont évalués à l’aide d’analyses de séries chronologiques interrompues. En complément des analyses statistiques, des entrevues et une analyse documentaire sont effectuées. Les entrevues sont réalisées avec des enquêteurs du service de sécurité de l’entreprise de commerce de détail. L’analyse documentaire est basée sur les rapports d’événement ouverts lors des fraudes par carte de débit. Résultats. Les mesures de prévention ont produit différents effets. Selon la mesure, il fut possible de constater soit une hausse ou une baisse dans le nombre de délits commis. Certaines mesures ont, en outre, provoqué un déplacement spatial, un déplacement dans le choix de la cible, un déplacement dans le type de crime commis et, finalement, un déplacement tactique. Conclusion. Les résultats suggèrent que les mesures de prévention adoptées ont empêché la réalisation des délits associés à la fraude par carte de débit. Par contre, la présence de plusieurs formes de déplacement indique que les fraudeurs se sont adaptés aux mesures de prévention. Afin de documenter adéquatement cette forme de crime et les déplacements générés, d’autres études s’avèrent nécessaires. / Context and objectives. Each year, economic crimes generate important economic and social losses. Many enterprises, including private enterprises, collaborated and introduced initiatives in order to combat this criminality. Fraud using automated payment cards is a crime in full expansion against which many organizations have taken actions. The objective of this dissertation is, on one hand, to improve the knowledge on the impact of preventive measures implemented in the branches of a retailer and, on the other hand, to estimate their impact on the criminal decision-making process. Methodology. The effect of preventive measures is assessed through interrupted time series analysis. In addition, members the retailer security staff were interviewed and a review of event reports associated with debit card fraud was performed. Results. The preventive measures were associated to various results. Depending on the preventive measure, one can observe either an increase or a decrease in the number of crimes performed. It is also observed that some measures have resulted in tactical and spatial displacements. Some offenders have also started to commit other types of crimes. Conclusion. The results suggest that the preventive measures implemented had a significant preventive effect on debit card crimes. However, the presence of many types of displacement shows that the offenders have adjusted to those preventive measures. In order to properly document this type of crime and associated displacements, additional studies are necessary.

The purpose of this study was to gain an understanding of the potential effect of sudden loss on the personality structures of bereaved individuals. For this purpose, I focused on the individual personality structures of five nuclear family members during the first year following the sudden loss of their daughter/sister. I followed a concurrent nested mixed model research approach and relied upon both the post-positivist and interpretivist paradigms, allowing me to integrate the complementary strengths of quantitative and qualitative data collection by means of triangulation. I utilised a within group interrupted time series design, comparing the family’s MBTI® profiles prior to and following the sudden loss they had experienced. In addition, I incorporated the results of 16PF profiles of the participants administered post-sudden loss. I further substantiated my findings in terms of recurring themes on individual metaphors concerning the sudden loss experience, constructed by the participants. The findings of the study indicated that distinct changes in personality structures occurred in terms of the personality structures of the participants. Pertaining to the four polarities of the MBTI®, I found that the participants displayed a greater preference for the Introversion attitude, as well as both the Sensing and Feeling functions, after they had experienced sudden loss. All participants displayed an inclination towards personal growth by moving closer to the Judging/Perceiving axis post-sudden loss. In addition, two general tendencies were evident amongst the participants, namely a greater dependence on the inferior functions; and secondly the tendency to rely on type exaggeration when dealing with sudden loss. / Dissertation (MEd)--University of Pretoria, 2008. / Educational Psychology / unrestricted

Background Bikesharing is a versatile intervention, that enables cheap and convenient cycling for urban populations, and according to recent literature, has a positive impact on health, safety and the economy. Many of these impacts are based on the assumption of a modal shift induced by bikesharing, i.e. implementing a Bicycle Sharing System (BSS) will increase population cycling. However, the evidence is inconclusive. The aim of this study was to evaluate if the intervention of implementing a BSS increases cycling. The study was conducted using bicycle count data from Helsinki between 2014 to 2018. Methods A controlled interrupted time series design was used in combination with segmented regression as the method. An intervention series and a control series were analysed separately. The slopes (trend) and intercepts (level) of pre-intervention (2014&2015) segments were compared with post-intervention segments (2016-2018). The same analysis was performed in both intervention series and control series.  ResultsThe results from the intervention series showed an increase of 105% in the level of the outcome after the implementation of the intervention. Simultaneously, the control series showed that the underlying trend of cycling remained largely unchanged during the whole study period (level increased by 3%). Stratified analysis supported these results in both intervention and control series.   Conclusion The analysis of the intervention series revealed, that the level of the outcome increased sharply after the intervention, implying that the intervention had an immediate effect. However, the lack of statistical significance in the analysis of the slopes made it impossible to determine if the effect was sustained.

This research paper addresses the compelling intersection of economic behavior and neo-colonial structures, specifically within the context of the CFA Franc currency union. The central issue under examination is the impact of the CFA Franc agreement on the behavior of capital owners in Guinea-Bissau. The purpose of this study is to understand the complex interplay between economic actions and neo-colonial mechanisms, tested via two hypotheses derived from Public Choice theory and the CFA agreement, and further relate the findings to the discourse on neo-colonialism. The study employs an Interrupted Time Series (ITS) design and Time Series Analysis (TSA) to systematically explore changes over time and assess the cause-effect relationships in a realistic manner. Findings partially confirm the hypothesis regarding foreign reserves, indicating that the CFA agreement indeed impacts capital owners' behavior. However, contrary to expectations, capital flight was found to decrease post-intervention, suggesting additional factors at play. The results illuminate the complex dynamics of the CFA union and broaden the understanding of potential neo-colonial structures, contributing to the ongoing debate on economic inequality and neo-colonialism.