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Abstract The drug-overdose crisis in the United States continues to intensify. Fatalities have increased 5-fold since 1999 reaching a record high of 108,000 deaths in 2021. The epidemic has unfolded through distinct waves of different drug types, uniquely impacting various age, gender, race, and ethnic groups in specific geographical areas. One major challenge in designing interventions and efficiently delivering treatment is forecasting age-specific overdose patterns at the local level. To address this need, we develop a forecasting method that assimilates observational data obtained from the CDC WONDER database with an age-structured model of addiction and overdose mortality. We apply our method nationwide and to three select areas: Los Angeles County, Cook County, and the five boroughs of New York City, providing forecasts of drug-overdose mortality and estimates of relevant epidemiological quantities, such as mortality and age-specific addiction rates. 

Early-after depolarizations (EADs) are changes in the action potential plateau that can lead to cardiac arrhythmia. At the cellular level, these oscillations are irregular and change from beat to beat due to the sensitivity of voltage repolarization to subcellular stochastic processes. However, the behavior of EADs in tissue, where cells are strongly coupled by gap junctions, is less understood. In this study, we develop a computational model of EADs caused by a reduction in the rate of calcium-induced inactivation of the L-type calcium channel. We find that, as inactivation decreases EADs occur with durations varying randomly from beat to beat. In cardiac tissue, however, gap junction coupling between cells dampens these fluctuations, and it is unclear what dictates the formation of EADs. In this study we show that EADs in cardiac tissue can be modeled by the deterministic limit of a stochastic single-cell model. Analysis of this deterministic model reveals that EADs emerge in tissue after an abrupt transition to alternans, where large populations of cells suddenly synchronize, causing EADs on every other beat. We analyze this transition and show that it is due to a discontinuous bifurcation that leads to a large change in the action potential duration in response to very small changes in pacing rate. We further demonstrate that this transition is highly arrhythmogenic, as the sudden onset of EADs on alternate beats in cardiac tissue promotes conduction block and reentry. Our results highlight the importance of EAD alternans in arrhythmogenesis and suggests that ectopic beats may not be required.