The Social Psychology of Organizations.

Hawaii International Conference on System Sciences

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.

Opioid Epidemic in the United States

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

/pdf/guide-to-advanced-empirical-software-engineering-2f0my2wuh8.pdf

Guide to Advanced Empirical Software Engineering

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.

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Managing the Flow of Technology: Technology Transfer and the Dissemination of Technological Information Within the R&D Organization (Book Review)

We report development of a generalized epidemic model of initiation and nonmedical use of pharmaceutical opioids in the US. The study relies on historical trend data as well as expert panel recommendations that inform model parameters and structure. Derived from current policies, simulated public health interventions are assessed using the model regarding their leverage for reducing initiation and nonmedical use. Preliminary findings indicate that interventions which reduce the perceived attractiveness of opioids for recreational use may significantly reduce initiation and nonmedical use most significantly, while supply restriction effected through drug take back days and prescribing changes may have more modest effects. We argue that system dynamics is an effective approach for evaluating potential interventions to this complex system where the use of pharmaceutical opioids to treat pain is fraught with potentially undesirable distal outcomes in the public sphere.

http://www.pdx.edu/sysc/sites/www.pdx.edu.sysc/files/Simultech2013.pdf

An Epidemic Model of Nonmedical Opioid Use with Simulated Public Health Interventions

https://pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=1087&context=sysc_fac

Creating clinically useful in silico models of intracranial pressure dynamics

The emergence of flexible supply chain systems (FSC) has sparked increased interest in real-time planning, scheduling, and logistics--with particular consideration for strategic implications and overall cost control. Important aspects of an FSC include forecasting, production, materials handling, transportation, and distribution center inventory. There exists a variety of software applications for addressing tactical issues, such as adaptive scheduling, and short term forecasting. However, these programs typically do not permit the user to assess the strategic implications of different policies for flexing capacity and making alternative commitments to manufacturing plants. Recently there has been increased interest in the use of simulation models for strategic policy analysis. Simulation compares favorably to purely analytical methods that often fail to capture the complex interactions of a particular FSC. The challenge is to create an FSC simulation model that is general enough and flexible enough to allow the user to analyze the overall costs and benefits of different policies. This paper presents just such an FSC model, implemented in a system dynamics modeling language. The model is specifically designed to help the user evaluate different policies for scheduling production in the factories and policies that govern factory capacity...in terms of their impact on overall production cost and inventory turns. Preliminary results include new insights regarding the conventional wisdom that minimizing the incremental amount that a factory can fluctuate at any given point in tam will reduce cost. The model suggests the contrary, that requiring larger fluctuations actually reduces the frequency and overall magnitude of the changes without adverse impact on factory utilization.

/pdf/simulation-as-a-tool-for-evaluating-strategic-policies-for-523lyvc1as.pdf

Simulation as a Tool for Evaluating Strategic Policies for Flexible Supply Chain Systems

The objective of the study was to develop a system dynamics model of the medical use of pharmaceutical opioids, and the associated diversion and nonmedical use of these drugs. The model was used to test the impact of the a tamper resistance intervention in this complex system. The study relied on secondary data obtained from the literature and from other public sources for the period 1995 to 2008. In addition, an expert panel provided recommendations regarding model parameters and model structure. The behavior of the resulting systems-level model compared favorably with reference behavior data. After the base model was tested, logic to simulate the replacement of all opioids with tamper resistant formulations was added and the impact on overdose deaths was evaluated over a seven-year period, 2008-2015. Principal findings were that the introduction of tamper resistant formulations unexpectedly increased total overdose deaths. This was due to increased prescribing which counteracted the drop in the death rate. We conclude that it is important to choose metrics carefully, and that the system dynamics modelling approach can help to evaluate interventions intended to ameliorate the adverse outcomes in the complex system associated with treating pain with opioids.

Dynamic Simulation of the Effect of Tamper Resistance on Opioid Misuse Outcomes.

Treatment of opioid addiction has historical employed an opioid drug called Methadone that is dispensed in liquid form at treatment facilities. Drawbacks to this treatment include social stigma and relatively high risk due to the pharmacological properties of methadone and also its side effects. A newer therapy uses another opioid drug called Buprenorphine, which is safer and has less social stigma because it can be prescribed and dispensed in tablet form. Policy makers have been cautious, however, and have place a cap on the number of patients that a physician can treat using Buprenorphine, leading to a concern that even though it is safer, people seeking treatment might not be able to locate a physician and access the treatment because of the cap. An SD model was developed to represent the flows of opioid abusers into and out of treatment with Buprenorphine, as well as the number of physicians certified to treat with Buprenorphine. Treatment is constrained by the cap and also by the amount of budget available for subsidizing treatment. The main finding is the treatment budget is by far the most influential policy variable, and that changing the cap would probably not make much difference. Running Head: Modeling opioid addiction treatment policies 2

/pdf/modeling-opioid-addiction-treatment-policies-using-system-gd1a4m0rlr.pdf

Wayne W. Wakeland

Papers

An Epidemic Model of Nonmedical Opioid Use with Simulated Public Health Interventions

Creating clinically useful in silico models of intracranial pressure dynamics

Simulation as a Tool for Evaluating Strategic Policies for Flexible Supply Chain Systems

Dynamic Simulation of the Effect of Tamper Resistance on Opioid Misuse Outcomes.

Modeling Opioid Addiction Treatment Policies Using System Dynamics