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Combined Use of Donepezil and Memantine Increases the Probability of Five-Year Survival of Alzheimer’s Disease Patients
Get PDFBackground
Alzheimer’s disease (AD) is the most common neurodegenerative disease. Studying the effects of drug treatments on multiple health outcomes related to AD could be beneficial in demonstrating which drugs reduce the disease burden and increase survival. Methods
We conducted a comprehensive causal inference study implementing doubly robust estimators and using one of the largest high-quality medical databases, the Oracle Electronic Health Records (EHR) Real-World Data. Our work was focused on the estimation of the effects of the two common Alzheimer’s disease drugs, Donepezil and Memantine, and their combined use on the five-year survival since initial diagnosis of AD patients. Also, we formally tested for the presence of interaction between these drugs. Results
Here, we show that the combined use of Donepezil and Memantine significantly elevates the probability of five-year survival. In particular, their combined use increases the probability of five-year survival by 0.050 (0.021, 0.078) (6.4%), 0.049 (0.012, 0.085), (6.3%), 0.065 (0.035, 0.095) (8.3%) compared to no drug treatment, the Memantine monotherapy, and the Donepezil monotherapy respectively. We also identify a significant beneficial additive drug-drug interaction effect between Donepezil and Memantine of 0.064 (0.030, 0.098). Conclusions
Based on our findings, adopting combined treatment of Memantine and Donepezil could extend the lives of approximately 303,000 people with AD living in the USA to be beyond five-years from diagnosis. If these patients instead have no drug treatment, Memantine monotherapy or Donepezil monotherapy they would be expected to die within five years
Moral Content Diminishes Preference Falsification
Get PDFWe examine how the moral (or neutral) content of an issue influences the tendency to falsify attitudes, given varying social and monetary incentives to engage in such ‘preference falsification’. We conduct an incentivized two stage online experimental study where, in a prior first stage, attitude strength over moral and neutral issues is elicited. Then, in the second stage participants in groups of ten were asked to express their preferences regarding the moral or neutral issues for each possible combination of supporters and opposers in their group, each associated with varying monetary payoffs. More than half of the participants falsify their preferences between the two phases for both moral and neutral frames. The rate is significantly lower for the moral (vs neutral) issues. Participants’ average monetary cost to avoid falsifying preferences is higher in moral treatments, and increases with the level of attitude strength
Mean Affect Moderates the Association Between Affect Variability and Mental Health
Get PDFIncreasing evidence suggests that within-person variation in affect is a dimension distinct from mean levels along which individuals can be characterized. This study investigated affect variability’s association with concurrent and longitudinal mental health and how mean affect levels moderate these associations. The mental health outcomes of depression, panic disorder, self-rated mental health, and mental health professional visits from the second and third waves of the Midlife in the United States Study were used for cross-sectional (n = 1,676) and longitudinal outcomes (n = 1,271), respectively. These participants took part in the National Study of Daily Experiences (NSDE II), where they self-reported their affect once a day for 8 days, and this was used to compute affect mean and variability. Greater positive affect variability cross-sectionally predicted a higher likelihood of depression, panic disorder, mental health professional use, and poorer self-rated mental health. Greater negative affect variability predicted higher panic disorder probability. Longitudinally, elevated positive and negative affect variability predicted higher depression likelihood and worse self-rated mental health over time, while greater positive affect variability also predicted increased panic disorder probability. Additionally, mean affect moderated associations between variability and health such that variability-mental health associations primarily took place when mean positive affect was high (for concurrent mental health professional use and longitudinal depression) and when mean negative affect was low (for concurrent depression, panic disorder, self-rated mental health, and longitudinal self-rated mental health). Taken together, affect variability may have implications for both short- and long-term health and mean levels should be considered
Romantic Resilience: Fractal Conflict Dynamics and Network Flexibility Predict Dating Satisfaction and Commitment
Get PDFPrevious research has demonstrated that interpersonal dynamics are fractal, and that conflict is a key control parameter that drives fractal complexity. The present study aimed to extend this line of research to examine the putative fractal structure of conflict dynamics over time, and the role that this self-organizing fractal structure may play in the resilience of romantic relationships. An experience sampling methodology was used to assess levels of conflict, satisfaction, and commitment in the dating relationships of undergraduate students, three times per day for 30 days. Hypothesis 1 was supported, with conflict ratings over time generally conforming to an inverse power-law distribution (IPL) distribution. Hypothesis 2 was supported as well, with better IPL fits measured as variance accounted for (R2), predicting higher levels of satisfaction and commitment over the 30 days. Hypothesis 3 showed mixed support, with moderate network linkages (i.e., soft assembly) between conflict and satisfaction and commitment predicting higher IPL fits (the linkage of satisfaction and commitment did not predict IPL fit as predicted). Hypothesis 4 predicted that IPL fit would interact with mean conflict, buffering the impacts of conflict on mean satisfaction and commitment across the 30 days. This hypothesis was not supported; however, several statistical factors may have obscured the buffering effects of higher IPL fit and so results may be inconclusive. These methodological factors, and others, are discussed along with the potential theoretical and practical implications of the current results
Mexican, Mexican American, and Chicano: The Integration of Mexican Immigrants During the Chicano Movement
Get PDFThe Role of Pharmacy in Supporting Safe and Effective Transitions of Care
Get PDFGoal To inform pharmacists and pharmacy technicians of the importance of and processes for conducting transitions of care when patients are moving among healthcare settings. Summary A narrative review of recent events and research into transitions of care (TOCs) — the movement of patients from one healthcare setting to another. To be conducted safely and effectively, the entire patient care team must optimize patient care and communicate up-to-date information among its members. As the medication experts on the healthcare team, pharmacists are well poised to receive and share information that impacts medication use and patient safety. Pharmacy technicians can play an important role by assisting with tasks such as taking medication histories. In this program, the importance of effective TOC practices is examined, including effects on morbidity and mortality, readmissions, emergency department visits, need for follow up, hospital length of stay, quality of care, medication errors, adverse events, and patient satisfaction.
Pharmacist interventions support patients by effectively managing medications, providing patient-centered education, assessing, and addressing access barriers, and supporting continuity of care. The impact of these interventions includes reducing readmission rates, medication error reduction, improved patient satisfaction, and cost savings. Successful TOC practice models should be multimodal and multidisciplinary; interventions should provide continuity of care beyond the inpatient setting and include services at home and in the outpatient setting
Jewish Nationalism in Israel: A Measurement
Get PDFSince Israel’s founding, being a “Jewish state” has been central to its self-representation. However, Israel has struggled to identify what that means. This article examines the strength of Jewish nationalism in Jewish Israeli public opinion. It draws on a recent survey of 200 Jewish Israelis for a qualitative and quantitative investigation of public responses to religious nationalist statements. These findings offer a utilizable survey short scale for measuring Jewish nationalism and to understand how Jewish Israelis are interpreting these statements. This study is a necessary step to empirically evaluating religious nationalism in the “Jewish state”
The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain
Get PDFObjective The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP). Methods A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The VA Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression. Results Nearly all veterans (98%) received active interventions but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30–130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions. Conclusion The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. Impact Statement The use of active interventions, which is supported by most Clinical Practice Guidelines (CPGs), was the cornerstone of physical therapist care for veterans with LBP. However, the use of CPG-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes