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Wayne W. Wakeland

Bio: Wayne W. Wakeland is an academic researcher from Portland State University. The author has contributed to research in topics: Intracranial pressure & Software development process. The author has an hindex of 24, co-authored 100 publications receiving 1783 citations.


Papers
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Journal ArticleDOI
TL;DR: Clinical strategies to reduce opioid-related mortality should be empirically tested, should not reduce access to needed therapies, should address risk from methadone as well as other opioids, and should be incorporated into any risk evaluation and mitigation strategies enacted by regulators.
Abstract: Objective. A panel of experts in pain medicine and public policy convened to examine root causes and risk factors for opioid-related poisoning deaths and to propose recommendations to reduce death rates. Methods. Panelists reviewed results from a search of PubMed and state and federal government sources to assess frequency, demographics, and risk factors for opioid-related overdose deaths over the past decade. They also reviewed results from a Utah Department of Health study and a summary of malpractice lawsuits involving opioid-related deaths. Results. National data demonstrate a pattern of increasing opioid-related overdose deaths beginning in the early 2000s. A high proportion of methadone-related deaths was noted. Although methadone represented less than 5% of opioid prescriptions dispensed, one third of opioid-related deaths nationwide implicated methadone. Root causes identified by the panel were physician error due to knowledge deficits, patient non-adherence to the prescribed medication regimen, unanticipated medical and mental health comorbidities, including substance use disorders, and payer policies that mandate methadone as first-line therapy. Other likely contributors to all opioid-related deaths were the presence of additional central nervous system-depressant drugs (e.g., alcohol, benzodiazepines, and antidepressants) and sleep-disordered breathing. Conclusions. Causes of opioid-related deaths are multifactorial, so solutions must address prescriber behaviors, patient contributory factors, nonmedical use patterns, and systemic failures. Clinical strategies to reduce opioid-related mortality should be empirically tested, should not reduce access to needed therapies, should address risk from methadone as well as other opioids, and should be incorporated into any risk evaluation and mitigation strategies enacted by regulators.

282 citations

Journal ArticleDOI
TL;DR: This review paper is a qualitative systematic review that covers areas most relevant for moving the stress and resilience field forward from a more quantitative and neuroscientific perspective.

196 citations

23 Jun 2006
TL;DR: In this article, the authors investigated the environmental performance of lean supply chains using carbon dioxide emissions as the key performance indicator and found that a lean supply chain is not necessarily green, although they could turn out to be green in certain cases.
Abstract: This paper investigates the environmental performance of lean supply chains using carbon dioxide emissions as the key performance indicator. Lean is based on the premise that compressing time reveals hidden quality problems and that their resolution leads to more efficient, cost-effective business processes. If time compression always implies lower emissions, then a leaner system is always greener as measured by emissions. If time compression does not always lead to lower emissions, then further changes to the lean system may be required in order to make it greener. We use a simulation model of a generic supply chain as well as two representative examples of supply chains to examine this. Our analysis shows that supply chain emissions are highly sensitive to the frequency and mode of delivery of goods as well as the type and amount of inventory stored at each company. Our results suggest that lean supply chains are not necessarily green, although they could turn out to be green in certain cases. The main impediment appears to be distance. While lean supply chains typically have lower emissions due to reduced inventory levels, the frequent replenishment at every point in the provision stream generally tends to increase the emissions. If a lean supply chain is located entirely within a small region, then it would almost certainly be green from an emissions perspective due to the low levels of inventory and short shipping distances. As distances increase along the supply chain, it is quite possible for lean and green to be in conflict, leading to tradeoffs as well as additional opportunities for optimization.

93 citations

Book ChapterDOI
01 Jan 2012
TL;DR: In this article, the authors provide an overview of supply chain basics and the special issues related to transport and storage of food from the point of production to the retail shelf, and evaluate several options for packaging and distributing food and beverage products.
Abstract: Transportation is the largest overall contributor to greenhouse gas emissions in many developed countries. Because food products often travel long distances to reach consumers, one might expect transportation to be the major food-related contributor to greenhouse gas emissions. As we show in this chapter, this is rarely the case. Supply chains tend to be long and complex, especially in the food industry. We provide an overview of supply chain basics and the special issues related to transport and storage of food from the point of production to the retail shelf. We include a variety of carbon audits and discuss the lessons learned from several industry case studies. We evaluate several options for packaging and distributing food and beverage products. We also consider interactions and trade-offs associated with these options. In carrying out these analyses, we are often able to identify opportunities for significant energy savings and overall greenhouse gas emissions reductions.

88 citations

Journal ArticleDOI
TL;DR: Concepts and ways of thinking about concussion that currently impede research design and block advancements in care of TBI are examined to provide a broader, multi-scale model for understanding concussion pathophysiology, classification, and treatment.
Abstract: Traumatic brain injury (TBI) has been called "the most complicated disease of the most complex organ of the body" and is an increasingly high-profile public health issue. Many patients report long-term impairments following even "mild" injuries, but reliable criteria for diagnosis and prognosis are lacking. Every clinical trial for TBI treatment to date has failed to demonstrate reliable and safe improvement in outcomes, and the existing body of literature is insufficient to support the creation of a new classification system. Concussion, or mild TBI, is a highly heterogeneous phenomenon, and numerous factors interact dynamically to influence an individual's recovery trajectory. Many of the obstacles faced in research and clinical practice related to TBI and concussion, including observed heterogeneity, arguably stem from the complexity of the condition itself. To improve understanding of this complexity, we review the current state of research through the lens provided by the interdisciplinary field of systems science, which has been increasingly applied to biomedical issues. The review was conducted iteratively, through multiple phases of literature review, expert interviews, and systems diagramming and represents the first phase in an effort to develop systems models of concussion. The primary focus of this work was to examine concepts and ways of thinking about concussion that currently impede research design and block advancements in care of TBI. Results are presented in the form of a multi-scale conceptual framework intended to synthesize knowledge across disciplines, improve research design, and provide a broader, multi-scale model for understanding concussion pathophysiology, classification, and treatment.

84 citations


Cited by
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Book
01 Jan 1996

1,170 citations

Journal ArticleDOI
TL;DR: The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain.
Abstract: Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations. Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use. This has evolved into the present stage, with the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion. The purpose of this comprehensive review is to describe various aspects of crisis of opioid use in the United States. The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain.

1,103 citations

BookDOI
01 Oct 2007
TL;DR: This book gathers chapters from some of the top international empirical software engineering researchers focusing on the practical knowledge necessary for conducting, reporting and using empirical methods in software engineering.
Abstract: This book gathers chapters from some of the top international empirical software engineering researchers focusing on the practical knowledge necessary for conducting, reporting and using empirical methods in software engineering. Topics and features include guidance on how to design, conduct and report empirical studies. The volume also provides information across a range of techniques, methods and qualitative and quantitative issues to help build a toolkit applicable to the diverse software development contexts

741 citations

Journal ArticleDOI
TL;DR: Managing the Flow of Technology: Technology Transfer and the Dissemination of Technological Information Within the R&D Organization is summarized, showing how human and organizational systems could be restructured to bring about improved productivity and better person-to-person contact.
Abstract: The original edition of this book summarized more than a decade of work on communications flow in science and engineering organizations, showing how human and organizational systems could be restructured to bring about improved productivity and better person-to-person contact. While many studies have been done since then, few of them invalidate the general conclusions and recommendations Allen offers. In a new preface he points out new developments, noting areas that need some modification, elaboration, or extension, and directing readers to the appropriate journal articles where the findings, are reported. The first three chapters provide an overview of the communication system in technology, present the author's research methods, and describe differences in the career paths and goals of engineers and scientists that cause special problems for organizations. The book then discusses how technological information is acquired by the R & D organization, shows how critical technical communication within the laboratory is for R & D performance, and originates the idea of the \"gatekeeper,\" the person who links his or her organization to the world at large. Concluding chapters take up the influence of formal and informal organization and of architecture and office layouts on communication. Many of these ideas have been successfully incorporated by architects and managers in the design of new R & D facilities and complexes. Suggested Citation Handle: RePEc:mtp:titles:0262510278 Download reference as HTML Thomas J. Allen, 1984. \"Managing the Flow of Technology: Technology Transfer and the Dissemination of Technological Information Within the R&D Organization,\" MIT Press Books, The MIT Press, edition 1, volume 1, number 0262510278, November. More services and features MyIDEAS Follow serials, authors, keywords & more New papers by email Subscribe to new additions to RePEc Author registration Public profiles for Economics researchers MPRA Upload your paper to be listed on RePEc and IDEAS EconAcademics Blog aggregator for economics research Plagiarism Cases of plagiarism in Economics Rankings Various rankings of research in Economics & related fields RePEc Genealogy Who was a student of whom, using RePEc RePEc Biblio Curated articles & papers on various economics topics Job market papers RePEc working paper series dedicated to the job market Fantasy league Pretend you are at the helm of an economics department Services from the StL Fed Data, research, apps & more from the St. Louis Fed IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.

597 citations