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Schwandt ML, Ramchandani VA, Upadhyay J, Ramsden C, Diazgranados N, Goldman D. Pain in alcohol use disorder: Evaluating effects of childhood trauma, perceived stress, and psychological comorbidity. Alcohol 2024; 117:43-54. [PMID: 38537764 DOI: 10.1016/j.alcohol.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/18/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
The relationship between pain and alcohol use disorder (AUD) is complex and bidirectional. The current study examines risk factors for pain in a large comprehensively phenotyped sample including individuals from across the spectrum of alcohol use and misuse. Participants (n = 1101) were drawn from the National Institute on Alcohol Abuse and Alcoholism Natural History Protocol and included treatment-seeking AUD inpatients (AUD+Tx, n = 369), individuals with AUD not seeking treatment (AUD+, n = 161), and individuals without AUD (AUD-, n = 571). General linear models were utilized to test the effects of AUD status, history of childhood trauma exposure, perceived stress, and psychological comorbidity on daily percent time in pain, as well as change in daily percent time in pain across the inpatient stay in AUD+Tx individuals. Overall, 60.2% individuals reported any pain, with a significantly higher prevalence in the AUD+Tx group (82.1%) compared to the AUD+ (56.5%) and AUD- (47.1%) groups. Daily percent time in pain was also highest in the AUD+Tx group (30.2%) and was further increased in those with a history of childhood abuse and comorbid posttraumatic stress disorder (PTSD). Years of heavy drinking and craving were also associated with increased percent time in pain in the AUD+Tx group. Percent time in pain decreased following acute withdrawal in the AUD+Tx group but plateaued around 25% just prior to discharge. Individuals seeking inpatient treatment for AUD, especially those with a history of childhood trauma and/or comorbid PTSD, report greater percent time in pain compared to those not seeking treatment and those without AUD. The prolonged experience of pain in abstinent AUD inpatients after the resolution of acute withdrawal may signal the early stages of protracted withdrawal. Integrative treatments targeting pain and other symptoms of protracted withdrawal may be effective in improving overall function in people with severe AUD.
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Affiliation(s)
- M L Schwandt
- Office of the Clinical Director, National Institute on Alcoholism and Alcohol Abuse (NIAAA), Bethesda, MD, USA.
| | - V A Ramchandani
- Human Psychopharmacology Laboratory, NIAAA, Bethesda, MD, USA
| | - J Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - C Ramsden
- Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, USA
| | - N Diazgranados
- Office of the Clinical Director, National Institute on Alcoholism and Alcohol Abuse (NIAAA), Bethesda, MD, USA
| | - D Goldman
- Office of the Clinical Director, National Institute on Alcoholism and Alcohol Abuse (NIAAA), Bethesda, MD, USA; Laboratory of Neurogenetics, NIAAA, Rockville, MD, USA
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2
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McClatchy J, Strogantsev R, Wolfe E, Lin HY, Mohammadhosseini M, Davis BA, Eden C, Goldman D, Fleming WH, Conley P, Wu G, Cimmino L, Mohammed H, Agarwal A. Clonal hematopoiesis related TET2 loss-of-function impedes IL1β-mediated epigenetic reprogramming in hematopoietic stem and progenitor cells. Nat Commun 2023; 14:8102. [PMID: 38062031 PMCID: PMC10703894 DOI: 10.1038/s41467-023-43697-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Clonal hematopoiesis (CH) is defined as a single hematopoietic stem/progenitor cell (HSPC) gaining selective advantage over a broader range of HSPCs. When linked to somatic mutations in myeloid malignancy-associated genes, such as TET2-mediated clonal hematopoiesis of indeterminate potential or CHIP, it represents increased risk for hematological malignancies and cardiovascular disease. IL1β is elevated in patients with CHIP, however, its effect is not well understood. Here we show that IL1β promotes expansion of pro-inflammatory monocytes/macrophages, coinciding with a failure in the demethylation of lymphoid and erythroid lineage associated enhancers and transcription factor binding sites, in a mouse model of CHIP with hematopoietic-cell-specific deletion of Tet2. DNA-methylation is significantly lost in wild type HSPCs upon IL1β administration, which is resisted by Tet2-deficient HSPCs, and thus IL1β enhances the self-renewing ability of Tet2-deficient HSPCs by upregulating genes associated with self-renewal and by resisting demethylation of transcription factor binding sites related to terminal differentiation. Using aged mouse models and human progenitors, we demonstrate that targeting IL1 signaling could represent an early intervention strategy in preleukemic disorders. In summary, our results show that Tet2 is an important mediator of an IL1β-promoted epigenetic program to maintain the fine balance between self-renewal and lineage differentiation during hematopoiesis.
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Affiliation(s)
- J McClatchy
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - R Strogantsev
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - E Wolfe
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - H Y Lin
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - M Mohammadhosseini
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - B A Davis
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - C Eden
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA
| | - D Goldman
- Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
- Division of Pediatric Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| | - W H Fleming
- Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA
- Division of Pediatric Hematology and Oncology, Oregon Health & Science University, Portland, OR, USA
| | - P Conley
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - G Wu
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - L Cimmino
- University of Miami, Department of Biochemistry and Molecular Biology, Sylvester Comprehensive Cancer Center, Miami, USA
| | - H Mohammed
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - A Agarwal
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA.
- Department of Cell, Developmental, and Cancer Biology, Oregon Health & Science University, Portland, OR, USA.
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
- Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, OR, USA.
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA.
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Chaturvedi R, Gracner T, Tysinger B, Narain K, Goldman D, Sturm R. The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus. Ann Surg 2023; 277:789-797. [PMID: 35801703 PMCID: PMC9825684 DOI: 10.1097/sla.0000000000005517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bariatric surgery can cause type 2 diabetes (diabetes) remission for individuals with comorbid obesity, yet utilization is <1%. Surgery eligibility is currently limited to body mass index (BMI) ≥35 kg/m 2 , though the American Diabetes Association recommends expansion to BMI ≥30 kg/m 2 . OBJECTIVE We estimate the individual-level net social value benefits of diabetes remission through bariatric surgery and compare the population-level effects of expanding eligibility alone versus improving utilization for currently eligible individuals. METHODS Using microsimulation, we quantified the net social value (difference in lifetime health/economic benefits and costs) of bariatric surgery-related diabetes remission for Americans with obesity and diabetes. We compared projected lifetime surgical outcomes to conventional management at individual and population levels for current utilization (1%) and eligibility (BMI ≥35 kg/m 2 ) and expansions of both (>1%, and BMI ≥30 kg/m 2 ). RESULTS The per capita net social value of bariatric surgery-related diabetes remission was $264,670 (95% confidence interval: $234,527-294,814) under current and $227,114 (95% confidence interval: $205,300-248,928) under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); followed by earnings ($51,395 and $46,466), and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). Doubling surgical utilization for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilization ($29.0B). CONCLUSIONS Diabetes remission following bariatric surgery improves healthy life expectancy and provides net social benefit despite high procedural costs. Per capita benefits appear greater among currently eligible individuals. Therefore, policies that increase utilization may produce larger societal value than expanding eligibility criteria alone.
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Affiliation(s)
- Ritika Chaturvedi
- RAND Corporation, 1776 Main St, Santa Monica, CA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles; 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA University of Southern California, 635 Downey Way, Los Angeles, CA
| | | | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles; 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA University of Southern California, 635 Downey Way, Los Angeles, CA
| | - Kimberly Narain
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles; 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA University of Southern California, 635 Downey Way, Los Angeles, CA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles; 1100 Glendon Ave. Suite 850, Los Angeles, CA
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles; 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA University of Southern California, 635 Downey Way, Los Angeles, CA
| | - Roland Sturm
- RAND Corporation, 1776 Main St, Santa Monica, CA
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Nadeem H, Zhou B, Goldman D, Romley J. Association between use of ß2-adrenergic receptor agonists and incidence of Parkinson's disease: Retrospective cohort analysis. PLoS One 2022; 17:e0276368. [PMID: 36441791 PMCID: PMC9704661 DOI: 10.1371/journal.pone.0276368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Previous observational studies assessing β2-agonist/-antagonist use on PD risk have yielded conflicting results. We evaluated the relationship between β2-agonist use and the incidence of Parkinson's disease in patients with chronic lung disease. METHODS We performed a retrospective cohort analysis on a 20% random sample abstracted from a traditional (fee-for-service) Medicare program in the United States. Inclusion criteria were individuals over 65 years old diagnosed with asthma, COPD, and/or bronchiectasis who were enrolled in a prescription drug (standalone Part D) plan over 2007-2010 and alive through 2014. The main outcome measure was a diagnosis of Parkinson's disease over the period 2011-2014, in relation to the number of 30-day-equivalent drug claims over 2007-2010. Logistic regression analysis was performed on a sample including 236,201 Medicare beneficiaries. RESULTS The sample was 68% female, 80% white, and on average 77 years old as of 2010. Compared to non-users, β2-agonist users were more likely to be younger (76.3y versus 78.0y), smokers (40.4% versus 31.1%) and asthmatic (62.4% versus 28.3%). The odds ratio for a β2-agonist claim on PD development was 0.986 (95% CI 0.977-0.995) after adjusting for demographics, smoking history, respiratory exacerbations, comorbidities, and other drug use. Risk reductions were larger for males than females (0.974 versus 0.994, P = 0.032), and for individuals with COPD compared to those with asthma (0.968 versus 0.998, P = 0.049). Reverse causality was addressed with a Cox analysis that allowed β2-agonist use to vary from medication initiation to disease onset. By the end of the follow-up period, β2-agonist use was shown to be associated with a true protective effect against PD onset. DISCUSSION β2-agonist use is associated with decreased risk of PD incidence. Further investigation, possibly including clinical trials, is warranted to strengthen the evidence base supporting clinical decision-makers looking to repurpose pharmaceuticals to prevent neurodegenerative disease onset.
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Affiliation(s)
- Hasan Nadeem
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Bo Zhou
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
| | - Dana Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
| | - John Romley
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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Abstract
OBJECTIVES To determine the use of formulary restrictions (prior authorization and step therapy) on the use of non-vitamin K antagonist oral anticoagulants (NOACs) and their effect on health outcomes. STUDY DESIGN Longitudinal cohort study. We identified a sample of Medicare beneficiaries with an incident diagnosis of atrial fibrillation (AF) in 2011 to 2015 and followed them until the end of 2016 or death. We compared anticoagulant use and health outcomes associated with Medicare Part D plan coverage of NOACs. METHODS The primary outcomes were composite rates of death, stroke, transient ischemic attack, and systemic embolism. We used Cox proportional hazards models to estimate the association between formulary restrictions and adverse health outcomes. RESULTS Beneficiaries enrolled in Part D plans that restricted access to NOACs had a lower probability of NOAC use (30.2% vs 32.2%), worse adherence conditional on NOAC use (32.1% vs 34.3% adherent), and longer delays in filling an initial prescription (46% vs 55% filled within 30 days of AF diagnosis). Beneficiaries in restricted plans had higher aggregate risk of mortality/stroke/transient ischemic attack (adjusted HR, 1.098; 95% CI, 1.079-1.118). CONCLUSIONS Limiting access to NOACs may exacerbate current underuse of anticoagulants and increase the risk of stroke among patients with newly diagnosed AF. Pharmacy benefit managers and Part D plans need to continuously review the appropriateness of formulary policies to ensure patient access to effective medications.
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Affiliation(s)
| | | | | | - Geoffrey Joyce
- USC Schaeffer Center for Health Policy and Economics, 635 Downey Way, VPD 412D, Los Angeles, CA 90089-3333.
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Goldman D, Marion J, Lookstein R, Misra S. Abstract No. 79 Drug Eluting Stents for Percutaneous Endovascular Renal Artery DilatatiOn (DESPERADO): initial report from a multicenter registry. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tafreshi S, Le R, Ramasamy S, Choudhury P, Goldman D, Hamilton B. Abstract No. 285 Women in academic radiology: comparative analysis of leadership in interventional and diagnostic radiology. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Watchmaker J, Carlon T, Goldman D, Marinelli B, Korff R, Bishay V, Patel R, Nowakowski S, Shilo D, Garcia-Reyes K, Patel R, Fischman A, Lookstein R. Abstract No. 272 Initial single-center experience percutaneous thromboaspiration for patients with acute pulmonary embolism. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Marinelli B, Goldman D, Sharma H, Leong T, Bishay V, Garcia-Reyes K, Shilo D, Kim E, Nowakowski S, Fischman A, Lookstein R, Patel R. Abstract No. 187 Safety and feasibility of “gun-sight technique” for complex transjugular intrahepatic portosystemic shunt (TIPS) creation: single-center retrospective study of 98 interventions. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Barb JJ, Maki KA, Kazmi N, Meeks BK, Krumlauf M, Tuason RT, Brooks AT, Ames NJ, Goldman D, Wallen GR. The oral microbiome in alcohol use disorder: a longitudinal analysis during inpatient treatment. J Oral Microbiol 2021; 14:2004790. [PMID: 34880965 PMCID: PMC8648028 DOI: 10.1080/20002297.2021.2004790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Alcohol use disorder (AUD)-induced disruption of oral microbiota can lead to poor oral health; there have been no studies published examining the longitudinal effects of alcohol use cessation on the oral microbiome. Aim To investigate the oral microbiome during alcohol cessation during inpatient treatment for AUD. Methods Up to 10 oral tongue brushings were collected from 22 AUD patients during inpatient treatment at the National Institutes of Health. Alcohol use history, smoking, and periodontal disease status were measured. Oral microbiome samples were sequenced using 16S rRNA gene sequencing. Results Alpha diversity decreased linearly during treatment across the entire cohort (P = 0.002). Alcohol preference was associated with changes in both alpha and beta diversity measures. Characteristic tongue dorsum genera from the Human Microbiome Project such as Streptococcus, Prevotella, Veillonella and Haemophilus were highly correlated in AUD. Oral health-associated genera that changed longitudinally during abstinence included Actinomyces, Capnocytophaga, Fusobacterium, Neisseria and Prevotella. Conclusion The oral microbiome in AUD is affected by alcohol preference. Patients with AUD often have poor oral health but abstinence and attention to oral care improve dysbiosis, decreasing microbiome diversity and periodontal disease-associated genera while improving acute oral health.
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Affiliation(s)
- J J Barb
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - K A Maki
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - N Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - B K Meeks
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - M Krumlauf
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - R T Tuason
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - A T Brooks
- Center for Scientific Review, National Institutes of Health, Bethesda, Md, USA
| | - N J Ames
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - D Goldman
- Office of the Clinical Director, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Md, USA
| | - G R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
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Kelley MA, Lucas J, Stewart E, Goldman D, Doctor JN. Opioid-related deaths before and after COVID-19 stay-at-home orders in Los Angeles County. Drug Alcohol Depend 2021; 228:109028. [PMID: 34500239 PMCID: PMC8411574 DOI: 10.1016/j.drugalcdep.2021.109028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Opioid-related morbidity and mortality has increased during the COVID-19 pandemic, yet specific information about the communities most affected remains unknown. Our objective is to evaluate decedent-level associations with an opioid-related death following the implementation of stay-at-home orders in Los Angeles County. METHODS This retrospective cohort study used data from the L.A. County Medical Examiner-Coroner to identify opioid-related deaths in 2019 and 2020. We used logistic regression to analyze the change in opioid-related deaths following a 30-day washout period after the start of stay-at-home orders. Independent variables included decedent age, gender, race and ethnicity, heroin or fentanyl present at the time of death, census tract-level education, and a scheduled drug prescription in the year before death. RESULTS Opioid-related deaths in L.A. County are most common in census tracts where a small percentage of the population has a Bachelor's degree. Following stay-at-home orders, Non-Hispanic Caucasian individuals had significantly more opioid-related deaths than Hispanic individuals (risk ratio (RR): 1.82 [95 % CI, 1.10-3.02]; P < 0.05) after adjusting for age, gender, and heroin or fentanyl use. Racial and ethnic differences in mortality were not explained by census tract-level education or recent scheduled drug prescriptions. DISCUSSION There has been an alarming rise in opioid-related deaths in L.A. County during 2020. The increase in opioid-related overdose deaths following the onset of COVID-19 and related policies occurred most often among Non-Hispanic Caucasian individuals. Further research on this trend's underlying cause is needed to inform policy recommendations during these simultaneous public health crises.
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Affiliation(s)
- Marcella A. Kelley
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Lucas
- Department of Medical Examiner-Coroner, County of Los Angeles, CA, USA
| | - Emily Stewart
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Jason N. Doctor
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA,Corresponding author at: The Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
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Atella V, Goldman D, McFadden D. Disparate ageing: The role of education and socioeconomic gradients in future health and disability in an international context. Health Econ 2021; 30 Suppl 1:3-10. [PMID: 34128290 DOI: 10.1002/hec.4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, University of Rome Tor vergata and CEIS Tor Vergata, Roma, Italy
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Daniel McFadden
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
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13
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Atella V, Belotti F, Kim D, Goldman D, Gracner T, Piano Mortari A, Tysinger B. The future of the elderly population health status: Filling a knowledge gap. Health Econ 2021; 30 Suppl 1:11-29. [PMID: 33772966 DOI: 10.1002/hec.4258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 06/12/2023]
Abstract
The aging process in OECD countries calls for a better understanding of the future disease prevalence, life expectancy (LE) and patterns of inequalities in health outcomes. In this paper we present the results obtained from several dynamic microsimulation models of the Future Elderly Model family for 12 OECD countries, with the aim of reproducing for the first time comparable long-term projections in individual health status across OECD countries. We provide projections of LE and prevalence of major chronic conditions and disabilities, overall, by gender and by education. We find that the prevalence of main chronic conditions in Europe is catching-up with the United States and significant heterogeneity in the evolution of gender and educational gradients. Our findings represent a contribution to support policymakers in designing and implementing effective interventions in the healthcare sector.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Federico Belotti
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Daejung Kim
- Korea Institute for Health and Social Affairs (KIHASA), Sejong City, South Korea
| | - Dana Goldman
- University of Southern California, Los Angeles, California, USA
| | | | - Andrea Piano Mortari
- Centre for Economic and International Studies. University of Rome "Tor Vergata", Rome, Italy
| | - Bryan Tysinger
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Minniti M, Foquet L, Gierer E, Pedrelli M, Goldman D, Copenhaver R, Grompe M, Parini P. Liver-humanized mice fed a NASH-diet are an advanced model to study cardiometabolic diseases. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McCrea MA, Giacino JT, Barber J, Temkin NR, Nelson LD, Levin HS, Dikmen S, Stein M, Bodien YG, Boase K, Taylor SR, Vassar M, Mukherjee P, Robertson C, Diaz-Arrastia R, Okonkwo DO, Markowitz AJ, Manley GT, Adeoye O, Badjatia N, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson AR, Foreman B, Gardner R, Gaudette E, Goldman D, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Keene CD, Korley FK, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Ngwenya LB, Noel F, Nolan A, Palacios E, Perl D, Puccio A, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Toga A, Valadka A, Wang K, Yue JK, Yuh E, Zafonte R. Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study. JAMA Neurol 2021; 78:982-992. [PMID: 34228047 DOI: 10.1001/jamaneurol.2021.2043] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US and worldwide. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after msTBI. Objective To prospectively assess outcomes in major areas of life function at 2 weeks and 3, 6, and 12 months after msTBI. Design, Setting, and Participants This cohort study, as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, was conducted at 18 level 1 trauma centers in the US from February 2014 to August 2018 and prospectively assessed longitudinal outcomes, with follow-up to 12 months postinjury. Participants were patients with msTBI (Glasgow Coma Scale scores 3-12) extracted from a larger group of patients with mild, moderate, or severe TBI who were enrolled in TRACK-TBI. Data analysis took place from October 2019 to April 2021. Exposures Moderate or severe TBI. Main Outcomes and Measures The Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale (DRS) were used to assess global functional status 2 weeks and 3, 6, and 12 months postinjury. Scores on the GOSE were dichotomized to determine favorable (scores 4-8) vs unfavorable (scores 1-3) outcomes. Neurocognitive testing and patient reported outcomes at 12 months postinjury were analyzed. Results A total of 484 eligible patients were included from the 2679 individuals in the TRACK-TBI study. Participants with severe TBI (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) and moderate TBI (n = 122; 98 men [80.3%]; median [interquartile range] age, 38 [25-53] years) were comparable on demographic and premorbid variables. At 2 weeks postinjury, 36 of 290 participants with severe TBI (12.4%) and 38 of 93 participants with moderate TBI (41%) had favorable outcomes (GOSE scores 4-8); 301 of 322 in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%) had moderate disability or worse on the DRS (total score ≥4). By 12 months postinjury, 142 of 271 with severe TBI (52.4%) and 54 of 72 with moderate TBI (75%) achieved favorable outcomes. Nearly 1 in 5 participants with severe TBI (52 of 270 [19.3%]) and 1 in 3 with moderate TBI (23 of 71 [32%]) reported no disability (DRS score 0) at 12 months. Among participants in a vegetative state at 2 weeks, 62 of 79 (78%) regained consciousness and 14 of 56 with available data (25%) regained orientation by 12 months. Conclusions and Relevance In this study, patients with msTBI frequently demonstrated major functional gains, including recovery of independence, between 2 weeks and 12 months postinjury. Severe impairment in the short term did not portend poor outcomes in a substantial minority of patients with msTBI. When discussing prognosis during the first 2 weeks after injury, clinicians should be particularly cautious about making early, definitive prognostic statements suggesting poor outcomes and withdrawal of life-sustaining treatment in patients with msTBI.
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Affiliation(s)
- Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Harvey S Levin
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Neurological Surgery, University of Washington, Seattle
| | - Murray Stein
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle
| | - Sabrina R Taylor
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Mary Vassar
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Pratik Mukherjee
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Claudia Robertson
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - David O Okonkwo
- Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amy J Markowitz
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Geoffrey T Manley
- Neurological Surgery, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Jain
- University of California, San Diego, La Jolla
| | | | | | - Joel Kramer
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | - Amber Nolan
- University of California, San Francisco, San Francisco
| | - Eva Palacios
- University of California, San Francisco, San Francisco
| | - Daniel Perl
- Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | - Arthur Toga
- University of Southern California, Los Angeles
| | | | | | - John K Yue
- University of California, San Francisco, San Francisco
| | - Esther Yuh
- University of California, San Francisco, San Francisco
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Abstract
Moral hazard and adverse selection create inefficiencies in private health insurance markets and understanding the relative importance of each factor is critical for addressing these inefficiencies. We use claims data from a large firm which changed health insurance plan options to isolate moral hazard from plan selection, estimating a discrete choice model to predict household plan preferences and attrition. Variation in plan preferences identifies the differential causal impact of each health insurance plan on the entire distribution of medical expenditures. Our estimates imply that 53% of the additional medical spending observed in the most generous plan in our data relative to the least generous is due to adverse selection. We find that quantifying adverse selection by using prior medical expenditures overstates the true magnitude of selection due to mean reversion. We also statistically reject that individual health care consumption responds solely to the end-of-the-year marginal price.
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Affiliation(s)
| | - Dana Goldman
- University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics
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Goldman D, Sharma H, Finkelstein M, Carlon T, Fischman A, Bishay V, Patel R, Titano J, Nowakowski F, Kim E, Lookstein R. Abstract No. 442 The role of telemedicine in the maintenance of interventional radiology outpatient evaluation and management volume during the COVID-19 global pandemic. J Vasc Interv Radiol 2021. [PMCID: PMC8079615 DOI: 10.1016/j.jvir.2021.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Papadopoulos V, Goldman D, Wang C, Keller M, Chen S. Looking Ahead to 2030: Survey of Evolving Needs in Pharmacy Education. Pharmacy (Basel) 2021; 9:pharmacy9010059. [PMID: 33802653 PMCID: PMC8005936 DOI: 10.3390/pharmacy9010059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
In order to keep pharmacy education relevant to a rapidly-evolving future, this study sought to identify key insights from leaders from a broad array of pharmacy and non-pharmacy industries on the future of the pharmacy profession, pharmaceutical sciences, and pharmacy education. Thought leaders representing a variety of industries were surveyed regarding their perspectives on the future of pharmacy practice, pharmaceutical science disciplines, and pharmacy education in seven domains. From 46 completed surveys, top challenges/threats were barriers that limit clinical practice opportunities, excessive supply of pharmacists, and high drug costs. Major changes in the drug distribution system, automation/robotics, and new therapeutic approaches were identified as the top technological disrupters. Key drivers of pharmacy education included the primary care provider shortage, growing use of technology and data, and rising drug costs. The most significant sources of job growth outside of retail and hospital settings were managed care organizations, technology/biotech/pharmaceutical companies, and ambulatory care practices. Needs in the industry included clinical management of complex patients, leadership and management, pharmaceutical scientists, and implementation science. Knowledge gaps were pharmacists not recognizing their value on the health care team, preparation to embrace and lead change, and expertise in data science and analytics. Pharmacy schools will need to address several disruptive trends to future-proof their curricula, including expanding patient management skills, leadership and management training, technology, and data analytics.
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Affiliation(s)
- Vassilios Papadopoulos
- School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA; (D.G.); (C.W.); (M.K.)
- Correspondence: (V.P.); (S.C.); Tel.: +1-323-442-1369 (V.P.); +1-323-206-0427 (S.C.)
| | - Dana Goldman
- School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA; (D.G.); (C.W.); (M.K.)
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA 90089, USA
| | - Clay Wang
- School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA; (D.G.); (C.W.); (M.K.)
| | - Michele Keller
- School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA; (D.G.); (C.W.); (M.K.)
| | - Steven Chen
- School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA; (D.G.); (C.W.); (M.K.)
- Correspondence: (V.P.); (S.C.); Tel.: +1-323-442-1369 (V.P.); +1-323-206-0427 (S.C.)
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Zhou B, Zissimopoulos J, Nadeem H, Crane MA, Goldman D, Romley JA. Association between exenatide use and incidence of Alzheimer's disease. Alzheimers Dement (N Y) 2021; 7:e12139. [PMID: 33614900 PMCID: PMC7882542 DOI: 10.1002/trc2.12139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Recent developments suggest that insulin-sensitizing agents used to treat type II diabetes (T2DM) may also prove useful in reducing the risk of Alzheimer's disease (AD). The objective of this study is to analyze the association between exenatide use among Medicare beneficiaries with T2DM and the incidence of AD. METHODS We performed a retrospective cohort analysis on claims data from a 20% random sample of Medicare beneficiaries with T2DM from 2007 to 2013 (n = 342,608). We compared rates of incident AD between 2009 and 2013 according to exenatide use in 2007-2008, measured by the number of 30-day-equivalent fills. We adjusted for demographics, comorbidities, and use of other drugs. Unmeasured confounding was assessed with an instrumental variables approach. RESULTS The sample was mostly female (65%), White (76%), and 74 years old on average. Exenatide users were more likely to be male (38% vs. 35%), White (87% vs. 76%), and younger (by 4.2 years) than non-users. Each additional 30-day-equivalent claim was associated with a 2.4% relative reduction in incidence (odds ratio 0.976; 95% confidence interval 0.963-0.989; P < .001). There was no evidence of unmeasured confounding. DISCUSSION Exenatide use is associated with a reduced incidence of AD among Medicare beneficiaries aged 65 years or older with T2DM. The association shown in this study warrants consideration by clinicians prescribing insulin sensitizing agents to patients.
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Affiliation(s)
- Bo Zhou
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
| | - Julie Zissimopoulos
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
| | - Hasan Nadeem
- University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | | | - Dana Goldman
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
| | - John A. Romley
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
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Abstract
Alzheimer's disease (AD) is the predominant cause of dementia and a leading cause of death globally. With no cure or treatment to slow disease progression, AD-related healthcare costs are substantial and increase as the severity of the disease progresses. Given the complexity of this disease, including initial pathophysiological damage occurring decades before clinical manifestation, finding new impactful treatments for AD relies on highly innovative research and development. However, such sizable and sustained investments bring into question whether conventional value assessment models are fit for this purpose. In this article, we examine the importance and challenges of assimilating the perspectives of varied stakeholders, including patients, caregivers, health systems, payers, and society at large, into a comprehensive value assessment model that may be well suited for a breakthrough treatment for AD.
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Affiliation(s)
- Charles Makin
- Medical Health Outcomes Research, Biogen, Cambridge, MA, USA
| | - Peter Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Sue Peschin
- Alliance for Aging Research, Washington, DC, USA
| | - Dana Goldman
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
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21
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Serajelahi B, Kharche S, Goldman D. Steady-State Tissue Oxygen Distributions Calculated by a Green's Function Method and a Finite Difference Method: A Comparison .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:2279-2282. [PMID: 33018462 DOI: 10.1109/embc44109.2020.9175901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Simulations that are meant to determine the steady-state distribution of a diffusible solute such as oxygen in tissues have typically used finite difference methods to solve the diffusion equation. Finite difference methods require a tissue mesh with enough points to resolve oxygen gradients near and between discrete blood vessels. The large number of points that are typically required can make these calculations very slow. In this paper, we investigate a numerical method known as the Green's function method which is not bound by the same constraint. The Green's function method is expected to yield an accurate oxygen distribution more quickly by requiring fewer mesh points. Both methods were applied to calculate the steady state oxygen distribution in a model simulation region. When the Green's function calculation used meshes with 1/2, 1/4 and, 1/8 of the resolution required for the finite-difference mesh, there was good agreement with the finite difference calculation in all cases. When the volume of the domain was increased 8-fold the Green's function method was able to calculate the O2 field in 22 minutes, whereas the finite difference calculation is expected to take approximately 1 week. The number of steps required for the Green's function calculation increases quadratically with the number of points in the tissue mesh. As a result, small meshes are calculated very quickly using Green's functions, while for larger mesh sizes this method experiences a significant decrease in efficiency.
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22
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Sharp S, Gascue L, Goldman D, Lawrence PF, Romley J, Woo K. Higher Surgeon Procedure Volume is Associated with Improved Hemodialysis Vascular Access Outcomes. Am Surg 2020. [DOI: 10.1177/000313481908501001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to examine the association between surgeon characteristics, procedural volume, and short-term outcomes of hemodialysis vascular access. A retrospective cohort study was performed using Medicare Part A and B data from 2007 through 2014 merged with American Medical Association Physician Masterfile surgeon data. A total of 29,034 procedures met the inclusion criteria: 22,541 (78%) arteriovenous fistula (AVF) and 6,493 (22%) arteriovenous graft (AVG). Of these, 13,110 (45.2%) were performed by vascular surgeons, 9,398 (32.3%) by general surgeons, 2,313 (8%) by thoracic surgeons, 1,517 (5.2%) by other specialties, and 2,696 (9.3%) were unknown. Every 10-year increase in years in practice was associated with a 6.9 per cent decrease in the odds of creating AVF versus AV G ( P = 0.02). Surgeon characteristics were not associated with the likelihood of vascular access failure. Every 10-procedure increase in cumulative procedure volume was associated with a 5 per cent decrease in the odds of vascular access failure ( P = 0.007). There was no association of provider characteristics or procedure volume with survival free of repeat AVF/AVG or TC placement at 12 months. A significant portion of the variability in likelihood of creating AVF versus AVG is attributable to the provider-level variation. Increase in procedure volume is associated with decreased odds of vascular access failure.
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Affiliation(s)
- Sydney Sharp
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Laura Gascue
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
| | - Dana Goldman
- School of Pharmacy, University of Southern California, Los Angeles, California; and
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| | - Peter F. Lawrence
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - John Romley
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
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Petri MA, Konig M, LI J, Goldman D. OP0160 HYDROXYCHLOROQUINE BLOOD LEVELS AND RISK OF THROMBOTIC EVENTS IN SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Hydroxychloroquine (HCQ) has a primary role in the treatment of systemic lupus erythematous (SLE). Beyond its pleiotropic immunomodulatory effects on Toll-like receptor and type I interferon signaling, HCQ use has been found to be protective for thrombosis in SLE (1). Optimal dosing of HCQ in SLE is unknown. The longitudinal measurement of HCQ blood levels may provide an opportunity to individualize weight-based dosing strategies and reduce risk of toxicity.Objectives:Examine the association of HCQ blood levels with thrombotic events in a longitudinal SLE cohort.Methods:812 SLE patients with HCQ blood level measured prior to the thrombosis were included: 93% female, 43% African-American, 46% Caucasian. HCQ blood levels were quantified by liquid chromatography-tandem mass spectrometry. Mean HCQ blood levels (± standard deviation) over all cohort visits prior to occurrence of thrombosis were calculated for each patient. Thromboses were defined as venous (DVT/PE or other venous) or arterial thrombosis (stroke, myocardial infarction, digital gangrene or other arterial).Results:Thrombosis had occurred during prospective follow up in 43 patients (5.5%), venous in 3.0% and arterial in 2.9%. Lupus anticoagulant was strongly associated with a history of any thrombosis (OR 3.25, p<0.0001), venous thrombosis (OR 3.53, p<0.0001), and arterial thrombosis (OR 3.08, p<0.0001). A prospective analysis shows that for any thrombosis and for venous thrombosis, the HCQ blood level was significantly lower (Table 1). Higher prescribed doses of HCQ (as opposed to HCQ blood levels) were also associated with decreased odds of any thrombosis and venous thrombosis in a separate cross-sectional analysis (OR 0.88, p=0.04 and OR 0.83, p=0.009, respectively for each 1 mg/kg increase in prescribed HCQ).Table 1.Thrombotic Events are Associated with Lower Mean HCQ Blood LevelMean HCQ Blood Level (± Std. Dev.)Thrombotic EventNo EventP-valueAny thrombosis695 ±464887 ± 5620.029Any venous thrombosis682 ± 374881 ± 5600.10DVT/PE only615 ± 384881 ± 5590.055Any arterial thrombosis708 ± 539882 ± 5580.13Stroke720 ± 643880 ± 5570.27Conclusion:HCQ blood levels are inversely associated with risk of any thrombosis and of venous thrombosis in patients with SLE in a prospective analysis. Reduction of HCQ dosing, as suggested by the American Academy of Ophthalmologists (2), could reduce or eliminate the benefit of hydroxychloroquine to prevent thrombosis.References:[1]Petri M. Use of hydroxychloroquine to prevent thrombosis in systemic lupus erythematosus and in antiphospholipid antibody–positive patients. Curr Rheumatol Rep 2011;13:77–80.[2]Marmor MF, Kellner U, Lai TYY, Melles RB, Mieler WF. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology 2016;123:1386–1394.Acknowledgments:The Hopkins Lupus Cohort is supported by NIH Grant RO1 AR069572Disclosure of Interests:Michelle A Petri Grant/research support from: GSK, Eli Lilly and Company, Consultant of: Eli Lilly and Company, Maximilian Konig: None declared, Jessica Li: None declared, Daniel Goldman: None declared
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Goldman D, Martin J, Carlon T, Liu L, Sag A, Ronald J, Patel R, Ranade M, Bishay V, Kim E, Nowakowski F, Lookstein R, Fischman A. Abstract No. 454 Crowd-sourced assessment of interventional radiology technical skill: a method to guide future training of interventional radiologists. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Watchmaker J, Goldman D, Marinelli B, Bishay V, Lookstein R, Fischman A. 3:00 PM Abstract No. 364 Clinical outcomes of patients with acute gastrointestinal tract bleeding treated with N-butyl-2-cyanoacrylate glue embolization. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Goldman D, Bageac D, Kellner C, Fischman A, Faries P, De Leacy R. Abstract No. 717 Transradial approach for neuroendovascular procedures: a single-center review of safety and feasibility. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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27
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Goldman D, Posham R, Lee J, Carlon T, Bishay V, Ranade M, Patel R, Nowakowski F, Kim E, Titano J, Lookstein R, Fischman A. Abstract No. 467 Tweet characteristics associated with higher engagement rate for a large academic interventional radiology department. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- John A Romley
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
- USC School of Pharmacy, Los Angeles, CA, USA.
| | - Zhiwen Xie
- USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| | - Tommy Chiou
- USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| | - Dana Goldman
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
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Mattke S, Schneider S, Orr P, Lakdawalla D, Goldman D. Temporal Trends in Mortality after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Regression Analysis. Structural Heart 2019. [DOI: 10.1080/24748706.2019.1689321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Soeren Mattke
- Center for Improving Chronic Illness Care, University of Southern California, Los Angeles, California, USA
| | - Stefan Schneider
- Center for Self-Report Science, University of Southern California, Los Angeles, California, USA
| | - Patrick Orr
- Center for Improving Chronic Illness Care, University of Southern California, Los Angeles, California, USA
| | - Darius Lakdawalla
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
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Abstract
AIM The Lupus Low Disease Activity State (LLDAS) is a potential treat to target goal in systemic lupus erythematosus (SLE). SLE patients in LLDAS for more than half of the observation time have about a 50% lower risk of new organ damage and have reduced mortality. We identified predictors of being in LLDAS ≥50% of the observation time. METHODS A total of 2228 SLE patients who had at least three clinical visits were included. Percentage of time in LLDAS was calculated based on the proportion of days under observation. LLDAS-50 was defined as being in LLDAS for ≥50% of the observation time. We used the stepwise selection procedure in logistic regression to identify predictors of LLDAS-50. RESULTS A total of 1169 (52.5%) SLE patients, but only 37.6% of African Americans, achieved LLDAS-50. In the multivariable model, African American ethnicity, hypocomplementemia, serositis, renal activity, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use were negative predictors of LLDAS-50. Older age at diagnosis, longer disease duration, higher education level, and greater percentage of time taking hydroxychloroquine remained positive predictors of LLDAS-50. CONCLUSION In this large cohort, only 52.5% achieved LLDAS-50. This proportion was even less in African Americans. A higher percentage of time taking hydroxychloroquine was a modifiable positive predictor of LLDAS-50. Anti-RNP, anti-dsDNA, and low complement were negatively associated with LLDAS-50. Our findings further emphasize the importance of inclusion of African Americans in clinical trials and hydroxychloroquine adherence in both clinical practice and clinical trials.
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Affiliation(s)
- H Babaoglu
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - J Li
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D Goldman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - L S Magder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA
| | - M Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Myerson R, Romley J, Chiou T, Peters AL, Goldman D. The Affordable Care Act and Health Insurance Coverage Among People With Diagnosed and Undiagnosed Diabetes: Data From the National Health and Nutrition Examination Survey. Diabetes Care 2019; 42:e179-e180. [PMID: 31548249 DOI: 10.2337/dc19-0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 08/15/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Rebecca Myerson
- USC School of Pharmacy, University of Southern California, Los Angeles, CA .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - John Romley
- USC School of Pharmacy, University of Southern California, Los Angeles, CA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Tommy Chiou
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Dana Goldman
- USC School of Pharmacy, University of Southern California, Los Angeles, CA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
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Sharp S, Gascue L, Goldman D, Lawrence PF, Romley J, Woo K. Higher Surgeon Procedure Volume Is Associated with Improved Hemodialysis Vascular Access Outcomes. Am Surg 2019; 85:1079-1082. [PMID: 31657298 PMCID: PMC7073255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to examine the association between surgeon characteristics, procedural volume, and short-term outcomes of hemodialysis vascular access. A retrospective cohort study was performed using Medicare Part A and B data from 2007 through 2014 merged with American Medical Association Physician Masterfile surgeon data. A total of 29,034 procedures met the inclusion criteria: 22,541 (78%) arteriovenous fistula (AVF) and 6,493 (22%) arteriovenous graft (AVG). Of these, 13,110 (45.2%) were performed by vascular surgeons, 9,398 (32.3%) by general surgeons, 2,313 (8%) by thoracic surgeons, 1,517 (5.2%) by other specialties, and 2,696 (9.3%) were unknown. Every 10-year increase in years in practice was associated with a 6.9 per cent decrease in the odds of creating AVF versus AVG (P = 0.02). Surgeon characteristics were not associated with the likelihood of vascular access failure. Every 10-procedure increase in cumulative procedure volume was associated with a 5 per cent decrease in the odds of vascular access failure (P = 0.007). There was no association of provider characteristics or procedure volume with survival free of repeat AVF/AVG or TC placement at 12 months. A significant portion of the variability in likelihood of creating AVF versus AVG is attributable to the provider-level variation. Increase in procedure volume is associated with decreased odds of vascular access failure.
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Affiliation(s)
- Sydney Sharp
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Laura Gascue
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Dana Goldman
- School of Pharmacy, University of Southern California, Los Angeles, CA
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Peter F. Lawrence
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
| | - John Romley
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
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Sexton Ward A, Kabiri M, Yucel A, Silverstein AR, van Eijndhoven E, Bowers C, Bensink M, Goldman D. The long-term social value of granulocyte colony-stimulating factors. Am J Manag Care 2019; 25:486-493. [PMID: 31622064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Febrile neutropenia (FN) is a life-threatening complication of chemotherapy that can lead to hospitalizations, chemotherapy dose reductions or delays, and mortality. Granulocyte colony-stimulating factor (G-CSF) prophylaxis reduces the incidence of FN, enabling patients to undergo and remain on myelosuppressive chemotherapy. We estimate the benefits of continuing current G-CSF use patterns and an alternative that aligns prophylactic G-CSF use with guideline recommendations. STUDY DESIGN Using The Health Economics Medical Innovation Simulation microsimulation, we estimated lifetime social value (SV) of prophylactic G-CSF for a nationally representative US population with breast, lung, and gynecological cancers and non-Hodgkin lymphoma. METHODS SV estimates included the cost of G-CSF, FN, chemotherapy relative dose intensity (RDI) less than 85% (RDI<85%), medical spending, and deaths for 3 scenarios: current use (current G-CSF use), targeted use (100% G-CSF use among patients with high FN risk), and reduced use (current G-CSF use reduced by 20% across all FN risk categories). RESULTS Over 10 years, current use, compared with no G-CSF use, would decrease cases of FN by 3.3 million, prevent 354,000 cases of RDI<85%, and generate $96 billion in SV. Compared with current use, targeted use would decrease cases of FN by an additional 3.3 million, prevent 355,000 more cases of RDI<85%, and generate another $119 billion in SV. Reduced use would increase FN and RDI<85%, lowering SV by $18 billion compared with current use. CONCLUSIONS Current use of G-CSF prophylaxis would provide $96 billion in SV over the next 10 years. Targeting G-CSF prophylaxis to align with guidelines would more than double SV, highlighting the substantial value of appropriate FN risk assessment and targeted G-CSF prophylaxis.
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Affiliation(s)
- Alison Sexton Ward
- Precision Health Economics, 11100 Santa Monica Blvd, Ste 500, Los Angeles, CA 90025.
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MacEwan JP, Doctor J, Mulligan K, May SG, Batt K, Zacker C, Lakdawalla D, Goldman D. The Value of Progression-Free Survival in Metastatic Breast Cancer: Results From a Survey of Patients and Providers. MDM Policy Pract 2019; 4:2381468319855386. [PMID: 31259249 PMCID: PMC6589981 DOI: 10.1177/2381468319855386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/05/2019] [Indexed: 01/27/2023] Open
Abstract
Background. Value assessments and treatment decision making typically focus on clinical endpoints, especially overall survival (OS). However, OS data are not always available, and surrogate markers may also have some value to patients. This study sought to estimate preferences for progression-free survival (PFS) relative to OS in metastatic breast cancer (mBC) among a diverse set of stakeholders—patients, oncologists, and oncology nurses—and estimate the value patients and providers place on other attributes of treatment. Methods. Utilizing a combined conjoint analysis and discrete choice experiment approach, we conducted an online prospective survey of mBC patients and oncology care providers who treat mBC patients across the United States. Results. A total of 299 mBC patients, 100 oncologists, and 99 oncology nurses completed the survey. Virtually all patients preferred health state sequences with contiguous periods of PFS, compared with approximately 85% and 75% of nurses and oncologists, respectively. On average, longer OS was significantly (P < 0.01) preferred by the majority (75%) patients, but only 15% of nurses preferred longer OS, and OS did not significantly affect oncologists’ preferred health state. However, in the context of a treatment decision, whether a treatment offered continuous periods of stable disease holding OS constant significantly affected nurses’ treatment choices. Patients and providers alike valued reductions in adverse event risk and evidence from high-quality randomized controlled clinical trials. Conclusions. The strong preference for observed PFS suggests more research is warranted to better understand the reasons for PFS having positive value to patients. The results also suggest a range of endpoints in clinical trials may have importance to patients.
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Affiliation(s)
| | - Jason Doctor
- Precision Health Economics, Los Angeles, California
| | | | | | | | | | | | - Dana Goldman
- Precision Health Economics, Los Angeles, California
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Shasha D, Valinsky L, Hershkowitz Sikron F, Glatman-Freedman A, Mandelboim M, Toledano A, Paran Y, Ben-Ami R, Goldman D. Quadrivalent versus trivalent influenza vaccine: clinical outcomes in two influenza seasons, historical cohort study. Clin Microbiol Infect 2019; 26:101-106. [PMID: 31108229 DOI: 10.1016/j.cmi.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The quadrivalent influenza vaccine (QIV) contains two influenza B antigens (one of each B lineage), while the trivalent vaccine (TIV) contains solely one. As a result, a mismatch between the circulating B lineage and the lineage in the TIV occurs frequently. We aimed to compare the frequency of clinically significant outcomes in a large cohort of vaccinees receiving either TIV or QIV. METHODS Historical cohort study of all inactivated influenza vaccinees (aged 3 years and older) in a Health Maintenance Organization insuring 1.2 million individuals, over two influenza seasons in which both vaccines were provided non-selectively. Primary outcome was hospital admissions during the influenza season. Multivariate analysis was performed using logistic regression to adjust for relevant covariates. RESULTS Our cohort included 150 518 and 168 296 vaccinees in the first (S1) and second season (S2), respectively. The two influenza seasons were characterized by high Influenza B activity. Of those vaccinated with QIV, 2074 of 49 726 (4.2%) and 6563 of 121 741 (5.4%) were hospitalized compared with 7378 of 100 792 (7.3%) and 3372 of 46 555 (7.2%) of those vaccinated with TIV (S1 and S2, respectively). After multivariate analysis adjusting for several covariates (gender, age, socioeconomic status, chronic morbidity, timing of vaccination), compared with TIV recipients, QIV vaccinees had lower odds for hospitalization (OR = 0.92, 95% CI 0.87-0.98 and OR = 0.89, 95% CI 0.85-0.93) or emergency department visit (OR = 0.91, 95% CI 0.87-0.95 and OR = 0.84, 95% CI 0.81-0.87) in S1 and S2, respectively (p < 0.001). Lower odds of mortality and influenza-like illness were also observed in S2 (OR = 0.61, 95% CI 0.50-0.75 and OR = 0.92, 95% CI 0.90-0.95, respectively). CONCLUSIONS In seasons with relatively high influenza B activity, QIV appeared more protective than TIV in Israel.
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Affiliation(s)
- D Shasha
- Meuhedet Health Services, Tel-Aviv, Israel; Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - L Valinsky
- Meuhedet Health Services, Tel-Aviv, Israel
| | | | - A Glatman-Freedman
- Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Mandelboim
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Chaim Sheba Medical Centre, Israel Ministry of Health, Tel-Hashomer, Israel
| | - A Toledano
- Meuhedet Health Services, Tel-Aviv, Israel
| | - Y Paran
- Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Ben-Ami
- Infectious Diseases Unit, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Goldman
- Meuhedet Health Services, Tel-Aviv, Israel
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Romley J, Trish E, Goldman D, Beeuwkes Buntin M, He Y, Ginsburg P. Geographic variation in the delivery of high-value inpatient care. PLoS One 2019; 14:e0213647. [PMID: 30908492 PMCID: PMC6433342 DOI: 10.1371/journal.pone.0213647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/26/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To measure value in the delivery of inpatient care and to quantify its variation across U.S. regions. DATA SOURCES / STUDY SETTING A random (20%) sample of 33,713 elderly fee-for-service Medicare beneficiaries treated in 2,232 hospitals for a heart attack in 2013. STUDY DESIGN We estimate a production function for inpatient care, defining output as stays with favorable patient outcomes in terms of survival and readmission. The regression model includes hospital inputs measured by treatment costs, as well as patient characteristics. Region-level effects in the production function are used to estimate the productivity and value of the care delivered by hospitals within regions. DATA COLLECTION / EXTRACTION METHODS Medicare claims and enrollment files, linked to the Dartmouth Atlas of Health Care and Inpatient Prospective Payment System Impact Files. PRINCIPAL FINDINGS Hospitals in the hospital referral region at the 90th percentile of the value distribution delivered 54% more high-quality stays than hospitals at the 10th percentile could have delivered, after adjusting for treatment costs and patient severity. CONCLUSIONS Variation in the delivery of high-value inpatient care points to opportunities for better quality and lower costs.
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Affiliation(s)
- John Romley
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
| | - Erin Trish
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
| | - Dana Goldman
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
- School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
| | | | - Yulei He
- University of Maryland University College, Adelphi, Maryland, United States of America
| | - Paul Ginsburg
- Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America
- Brookings Institution, Washington D.C., United States of America
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Goldman D, Marzban S, Conway A, Short H, Giangola G, Carroccio A, Rosen R. 03:27 PM Abstract No. 46 Transarterial embolization of arteriovenous malformations in pediatric patients with Parkes-Weber syndrome. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mattke S, Schneider S, Orr P, Lakdawalla D, Goldman D. TEMPORAL TRENDS IN 30-DAY AND 1-YEAR MORTALITY RATES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-REGRESSION ANALYSIS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31698-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Goldman D, Koury J. Laparoscopic Hartmann's reversal after laparoscopic Hartmann's procedure for Hinchey III diverticulitis: a surprisingly difficult rectal stump dissection - a video vignette. Colorectal Dis 2018; 20:938. [PMID: 30098130 DOI: 10.1111/codi.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Affiliation(s)
- D Goldman
- Department of Colon and Rectal Surgery, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - J Koury
- Department of Colon and Rectal Surgery, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
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Chen A, Goldman D. Productivity Benefits of Medical Care: Evidence from US-Based Randomized Clinical Trials. Value Health 2018; 21:905-910. [PMID: 30098667 PMCID: PMC6092019 DOI: 10.1016/j.jval.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/02/2018] [Accepted: 01/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One of the key recommendations of the Second Panel on Cost-Effectiveness in Health and Medicine is to take a societal perspective when evaluating new technologies-including measuring the productivity benefits of new treatments. Yet relatively little is known about the impact that new treatments have on labor productivity. OBJECTIVES To examine the relationship between new drug treatments and gains in labor productivity across conditions in the United States and to evaluate which randomized clinical trials (RCTs) collected labor productivity data. METHODS We collected data on US-based RCTs with work-ability surveys from searches of Google Scholar, PubMed, Scopus, the Cochrane Central Registry of Clinical Trials, and ClinicalTrails.gov. Combining RCT data with survey data from the Medical Expenditure Panel Survey, we assessed productivity changes from new drug treatments. RESULTS During the last decade, some disease conditions have seen treatments that improve ability to work by as much as 60%. The annual increase in productivity gains attributable to new drug treatments was modest 1.1% (P = 0.53). Of the 5092 RCTs reviewed, ability-to-work measures were collected in 2% of trials. Work productivity surveys were more likely among prevalent medical conditions that affected individuals who worked, earned higher wages, and experienced larger reductions in hours worked as a consequence of disease diagnosis. CONCLUSIONS From our data, we estimated that drug innovation increased productivity by 4.8 million work days per year and $221 billion in wages per year. These labor-sector benefits should be taken into account when assessing the socially optimal cost for new drug innovation.
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Affiliation(s)
- Alice Chen
- Sol Price School of Public Policy, University of Southern
California, 635 Downy Way, VPD 414J, Los Angeles, California 90089-3333.
. Telephone: 213-821-1763; Fax:
213-740-3460
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics,
University of Southern California, 635 Downey Way, VPD 414, Los Angeles, CA
90089-3333.
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41
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Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, Powers AC, Taylor SI, Yatvin AL. Erratum. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care 2018;41;1299-1311. Diabetes Care 2018; 41:1831. [PMID: 29954841 PMCID: PMC6054492 DOI: 10.2337/dc18-er08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Cefalu WT, Dawes DE, Gavlak G, Goldman D, Herman WH, Van Nuys K, Powers AC, Taylor SI, Yatvin AL. Insulin Access and Affordability Working Group: Conclusions and Recommendations. Diabetes Care 2018; 41:1299-1311. [PMID: 29739814 DOI: 10.2337/dci18-0019] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | | | | | - Dana Goldman
- USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA
| | | | - Karen Van Nuys
- USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA
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Arndt S, Gilbert P, Sandow T, Kay D, DeVun D, Goldman D, Gimenez J, Ramalingam V. Abstract No. 488 Overall survival and survival after second primary in thermal ablation, resection, and transplantation in patients with cured primary and subsequent second primary hepatocellular carcinoma, a SEER study. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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44
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Goldman D, Sandow T, Gimenez J, Arndt S, Thevenot P, Nunez K, DeVun D, Gulotta P, Ramalingam V, Gilbert P, Kirsch D, Bohorquez H, Galliano G, Cohen A, Kay D. 3:00 PM Abstract No. 33 Pre-TACE immune status correlates with treatment response and necrosis rates in HCC as a bridge to liver transplant. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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45
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Arndt S, Sandow T, Milburn J, Nguyen T, Goldman D, Gimenez J, Ramalingam V. 3:00 PM Abstract No. 181 Machine learning and machine vision image analysis can predict treatment response from preprocedural imaging alone for Y90 radioembolization and DEB-TACE in hepatocellular carcinoma. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Much progress in our understanding of RNA metabolism has been made since the first RNA nucleoside modification was identified in 1957. Many of these modifications are found in noncoding RNAs but recent interest has focused on coding RNAs. Here, we summarize current knowledge of cellular consequences of RNA modifications, with a special emphasis on neuropsychiatric disorders. We present evidence for the existence of an "RNA code," similar to the histone code, that fine-tunes gene expression in the nervous system by using combinations of different RNA modifications. Unlike the relatively stable genetic code, this combinatorial RNA epigenetic code, or epitranscriptome, may be dynamically reprogrammed as a cause or consequence of psychiatric disorders. We discuss potential mechanisms linking disregulation of the epitranscriptome with brain disorders and identify potential new avenues of research.
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Affiliation(s)
- Y. Jung
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - D. Goldman
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
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Affiliation(s)
- Daniel M Blumenthal
- Cardiology Division, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.,RAND Corporation, Santa Monica, California
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston.,National Bureau of Economic Research, Cambridge, Massachusetts
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Rowe J, Goldman D. PRESIDENTIAL SYMPOSIUM: THE HARTFORD AGING SOCIETY INDEX. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J.W. Rowe
- Columbia University, New York, New York
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49
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Goldman D, Rowe J. POLICY AND PROGRAM RECOMMENDATIONS FOR AN AGING SOCIETY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D. Goldman
- University of Southern California, Los Angeles, California,
| | - J.W. Rowe
- Columbia University, New York, New York
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Auerbach AJ, Charles KK, Coile CC, Gale W, Goldman D, Lee R, Lucas CM, Orszag PR, Sheiner LM, Tysinger B, Weil DN, Wolfers J, Wong R. HOW THE GROWING GAP IN LIFE EXPECTANCY MAY AFFECT RETIREMENT BENEFITS AND REFORMS. Geneva Pap Risk Insur Issues Pract 2017; 42:475-499. [PMID: 31768091 PMCID: PMC6876930 DOI: 10.1057/s41288-017-0057-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Older Americans have experienced dramatic gains in life expectancy in recent decades, but an emerging literature reveals that these gains are accumulating mostly to those at the top of the income distribution. We explore how growing inequality in life expectancy affects lifetime benefits from Social Security, Medicare, and other programs and how this phenomenon interacts with possible program reforms. We first project that life expectancy at age 50 for males in the two highest income quintiles will rise by 7 to 8 years between the 1930 and 1960 birth cohorts, but that the two lowest income quintiles will experience little to no increase over that time period. This divergence in life expectancy will cause the gap between average lifetime program benefits received by men in the highest and lowest quintiles to widen by $130,000 (in $2009) over this period. Finally we simulate the effect of Social Security reforms such as raising the normal retirement age and changing the benefit formula to see whether they mitigate or enhance the reduced progressivity resulting from the widening gap in life expectancy.
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Affiliation(s)
- Alan J Auerbach
- Department of Economics, 530 Evans Hall, #3880 University of California, Berkeley Berkeley, CA 94720-3880 and NBER,
| | - Kerwin K Charles
- Harris School of Public Policy, University of Chicago, 1155 East 60th Street, Chicago, IL 60637 and NBER,
| | - Courtney C Coile
- Department of Economics, Wellesley College, 106 Central Street, Wellesley, MA 02481 and NBER,
| | - William Gale
- Brookings Institution, 1775 Massachusetts Avenue, NW, Washington, DC 20036,
| | - Dana Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3333,
| | - Ronald Lee
- Departments of Demography and Economics, University of California, Berkeley, 2232 Piedmont Avenue, Berkeley, CA 94720,
| | | | | | - Louise M Sheiner
- Brookings Institution, 1775 Massachusetts Avenue N.W. Washington, DC 20036,
| | - Bryan Tysinger
- Schaeffer Center for Health Policy, and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3333,
| | - David N Weil
- Department of Economics, Box B, Brown University Providence, RI 02912, and NBER,
| | - Justin Wolfers
- Department of Economics, University of Michigan, 611 Tappan St, Lorch Hall #319, Ann Arbor, MI 48104,
| | - Rebeca Wong
- University of Texas Medical, Branch Sealy Center on Aging, 301 University Blvd., Galveston, TX 77555-0177,
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