Predictors of Daily Adherence to Naltrexone for Alcohol Use Disorder Treatment During a Mobile Health Intervention

Background Adherence to medications for treating alcohol use disorder (AUD) is poor. To identify predictors of daily naltrexone adherence over time, a secondary data analysis was conducted of a trial evaluating a mobile health intervention to improve adherence. Methods Participants seeking treatment for AUD (n = 58; M-age = 38 years; 71% male) were prescribed naltrexone for 8 weeks. Adherence was tracked using the Medication Event Monitoring System (MEMS). In response to daily text messages, participants reported the previous day's alcohol use, craving, and naltrexone side effects. Using multilevel structural equation modeling (MSEM), we examined baseline dispositional factors and within-person, time-varying factors as predictors of daily adherence. Results Naltrexone adherence decreased over time. Adherence was higher on days when individuals completed daily mobile assessments relative to days when they did not (odds ratio [OR] = 2.53, 95% confidence interval [CI] 1.61 to 3.98), irrespective of intervention condition. Days when individuals drank more than their typical amount were related to lower next-day adherence (OR = 0.93, 95% CI 0.88 to 0.99). A similar pattern was supported for craving (OR = 0.88, 95% CI 0.79 to 0.98). Weekend days were associated with lower adherence than weekdays (OR = 0.71, 95% CI 0.58 to 0.86); this effect was partly mediated by heavier daily drinking (indirect effect = -0.02, 95% CI -0.04 to -0.003) and stronger-than-usual craving (indirect effect = -0.01, 95% CI -0.02 to 0.00) on weekend days. Conclusions The results further demonstrate the need to improve adherence to AUD pharmacotherapy. The present findings also support developing interventions that target daily-level risk factors for nonadherence. Mobile health interventions may be one means of developing tailored and adaptive adherence interventions

Medulloblastoma therapy generates risk of a poorly-prognostic H3 wild-type subgroup of diffuse intrinsic pontine glioma: a report from the International DIPG Registry

Abstract With improved survivorship in medulloblastoma, there has been an increasing incidence of late complications. To date, no studies have specifically addressed the risk of radiation-associated diffuse intrinsic pontine glioma (DIPG) in medulloblastoma survivors. Query of the International DIPG Registry identified six cases of DIPG with a history of medulloblastoma treated with radiotherapy. All patients underwent central radiologic review that confirmed a diagnosis of DIPG. Six additional cases were identified in reports from recent cooperative group medulloblastoma trials (total n = 12; ages 7 to 21 years). From these cases, molecular subgrouping of primary medulloblastomas with available tissue (n = 5) revealed only non-WNT, non-SHH subgroups (group 3 or 4). The estimated cumulative incidence of DIPG after post-treatment medulloblastoma ranged from 0.3–3.9%. Posterior fossa radiation exposure (including brainstem) was greater than 53.0 Gy in all cases with available details. Tumor/germline exome sequencing of three radiation-associated DIPGs revealed an H3 wild-type status and mutational signature distinct from primary DIPG with evidence of radiation-induced DNA damage. Mutations identified in the radiation-associated DIPGs had significant molecular overlap with recurrent drivers of adult glioblastoma (e.g. NRAS, EGFR, and PTEN), as opposed to epigenetic dysregulation in H3-driven primary DIPGs. Patients with radiation-associated DIPG had a significantly worse median overall survival (median 8 months; range 4–17 months) compared to patients with primary DIPG. Here, it is demonstrated that DIPG occurs as a not infrequent complication of radiation therapy in survivors of pediatric medulloblastoma and that radiation-associated DIPGs may present as a poorly-prognostic distinct molecular subgroup of H3 wild-type DIPG. Given the abysmal survival of these cases, these findings provide a compelling argument for efforts to reduce exposure of the brainstem in the treatment of medulloblastoma. Additionally, patients with radiation-associated DIPG may benefit from future therapies targeted to the molecular features of adult glioblastoma rather than primary DIPG.https://deepblue.lib.umich.edu/bitstream/2027.42/145180/1/40478_2018_Article_570.pd

Demographic analysis of survivorship between Caucasian and Native American females in two temporally separated human populations buried in Emmet County, northern lower Michigan.

A powerful tool for describing life patterns of individuals is the analysis of population demography. This study examined demographics for two temporally separated populations buried in six cemeteries throughout Emmet County, northern lower Michigan. The populations were defined as: (1) females who died between 1900 and 1945 inclusively, and (2) females who died between 1946 and 2000. I examined differences in survivorship between Caucasian and Native American females within the three separate populations, and differences in age-specific mortality rates for females of each ethnic group through time, across the populations. I determined age at death from the dates of birth and death marked on individual tombstones, and then recorded these data for each poulation separately by ethnic group for 1016 people. From the number of deaths observed in certain predetermined age intervals I constructed a life table. Both populations of females showed a statistically significant difference in the distribution of deaths (dx) between Caucasians and Native Americans (X2 df = 2, P 0.05). Biological and evolutionary constraints on the human species may naturally limit increases in survivorship of human populations through time. Further studies involving fecundity and genetic variation in humans may provide stronger evidence for this hypothesis.http://deepblue.lib.umich.edu/bitstream/2027.42/54890/1/3331.pdfDescription of 3331.pdf : Access restricted to on-site users at the U-M Biological Station

Selection and survivorship in the freshwater snail Campleoma decisum.

In this study, we investigated selection for survivorship in the freshwater snail Campeloma decisum. Two primary evolutionary trends were observed for C. decisum: selection for smaller shell size, and smaller aperture area. Differences in living and dead population means revealed a selection for decreased weight, overall length, overall width, aperture length, number of whorls, shell volume, and aperture area. Selection for an increase in distance from last growth bar to aperture and aperture area to shell volume was also observed. Our results from an analysis of variance difference (F-test) suggested the occurrence of either directional or stabilizing selection in the living and dead populations for weight, overall length, overall width, aperture length, aperture width, shell shape, shell volume, aperture area, and growth rate. Overall selection is toward a smaller overall shell length for self-defense and protection, however, increasing shell size is important reproductively.http://deepblue.lib.umich.edu/bitstream/2027.42/54891/1/3332.pdfDescription of 3332.pdf : Access restricted to on-site users at the U-M Biological Station

Study of two caucasian and native American populations of females from 1900-1945 to 1946-2000: comparison of death distributions, survivorship, and age-specific mortality rates.

Throughout the US, there are many distinct ethnic groups coexisting in the same geographic area that share access to resources. One would expect to find ethnic populations living in the same local area, to have similar demography. However, many factors outside of geography influence demography. These include differential access to resources and different lifestyle practices. We examined death distribution, survivorship, and age-specific mortality rates of Caucasian and Native American female populations in Emmet County, northern Michigan between 1900-1945 and 1946-2000. Both Caucasian and Native American female populations showed a significant difference in death distributions for 1900-1945 (X2 = 39.71, df 2, P <= 0.05) and 1946-2000 (X2 = 17.21, df 2, P <= 0.05). We also found that there was no statistical difference in mean age-specific mortality rates for Caucasian females (t = 1.363, df 42, P = 0.180) and for Native American females (t = 0.933, df 42, P = 0.356) for both periods. Based on past studies, we concluded that differential access and distinct lifestyle practices were more influential on demographic differences between Caucasian and Native American female populations from 1900-2000.http://deepblue.lib.umich.edu/bitstream/2027.42/54902/1/3343.pdfDescription of 3343.pdf : Access restricted to on-site users at the U-M Biological Station

Single-centre parental survey of paediatric rehabilitation services for children with cerebral palsy

Cerebral palsy (CP) is the most common childhood motor disability. The dose of usual care for rehabilitation therapies is unknown. The purpose of this study was to describe current dosage of rehabilitation services for children with CP recruited from a paediatric hospital system in the USA. 96 children with CP were included in this cross-sectional survey. Parents reported frequency, intensity, time and type of therapy services. Weekly frequency was the most common. Children with CP received 0.9–1.2 hours/month of each discipline in the educational setting and 1.5–2.0 hours/month in the clinical setting, lower than the recommendations for improvements in motor skills

Presidential Address: The Cost of Active Investing

I compare the fees, expenses, and trading costs society pays to invest in the U.S. stock market with an estimate of what would be paid if everyone invested passively. Averaging over 1980-2006, I find investors spend 0.67% of the aggregate value of the market each year searching for superior returns. Society's capitalized cost of price discovery is at least 10% of the current market cap. Under reasonable assumptions, the typical investor would increase his average annual return by 67 basis points over the 1980-2006 period if he switched to a passive market portfolio. Copyright (c) 2008 The American Finance Association.