Preferences in medications for patients seeking treatment for opioid use disorder: A conjoint analysis.

INTRODUCTION: The opioid epidemic continues to be a public health crisis that has worsened during the COVID-19 pandemic. Medications for opioid use disorder (MOUD) are the most effective way to reduce complications from opioid use disorder (OUD), but uptake is limited by both structural and individual factors. To inform strategies addressing individual factors, we evaluated patients' preferences and trade-offs in treatment decisions using conjoint analysis. METHOD: We developed a conjoint analysis survey evaluating patients' preferences for FDA-approved MOUDs. We recruited patients with OUD presenting to initiate treatment. This survey included five attributes: induction, location and route of administration, impact on mortality, side effects, and withdrawal symptoms with cessation. Participants performed 12 choice sets, each with two hypothetical profiles and a "none" option. We used Hierarchical Bayes to identify relative importance of each attribute and part-worth utility scores of levels, which we compared using chi-squared analysis. We used the STROBE checklist to guide our reporting of this cross-sectional observational study. RESULTS: Five-hundred and thirty participants completed the study. Location with route of administration was the most important attribute. Symptom relief during induction and withdrawal was a second priority. Mortality followed by side effects had lowest relative importance. Attribute levels with highest part-worth utilities showed patients preferred monthly pick-up from a pharmacy rather than daily supervised dosing; and oral medications more than injection/implants, despite the latter's infrequency. CONCLUSION: We measured treatment preferences among patients seeking to initiate OUD treatment to inform strategies to scale MOUD treatment uptake. Patients prioritize the route of administration in treatment preference-less frequent pick up, but also injections and implants were less preferred despite their convenience. Second, patients prioritize symptom relief during the induction and withdrawal procedures of medication. These transition periods influence the sustainability of treatment. Although health professionals prioritize mortality, it did not drive decision-making for patients. To our knowledge, this is the largest study on patients' preferences for MOUD among treatment-seeking people with OUD to date. Future analysis will evaluate patient preference heterogeneity to further target program planning, counseling, and decision aid development.

Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US.

Importance: Studies have suggested that greater primary care physician (PCP) availability is associated with better population health and that a diverse health workforce can improve care experience measures. However, it is unclear whether greater Black representation within the PCP workforce is associated with improved health outcomes among Black individuals. Objective: To assess county-level Black PCP workforce representation and its association with mortality-related outcomes in the US. Design, Setting, and Participants: This cohort study evaluated the association of Black PCP workforce representation with survival outcomes at 3 time points (from January 1 to December 31 each in 2009, 2014, and 2019) for US counties. County-level representation was defined as the ratio of the proportion of PCPs who identifed as Black divided by the proportion of the population who identified as Black. Analyses focused on between- and within-county influences of Black PCP representation and treated Black PCP representation as a time-varying covariate. Analysis of between-county influences examined whether, on average, counties with increased Black representation exhibited improved survival outcomes. Analysis of within-county influences assessed whether counties with higher-than-usual Black PCP representation exhibited enhanced survival outcomes during a given year of heightened workforce diversity. Data analyses were performed on June 23, 2022. Main Outcomes and Measures: Using mixed-effects growth models, the impact of Black PCP representation on life expectancy and all-cause mortality for Black individuals and on mortality rate disparities between Black and White individuals was assessed. Results: A combined sample of 1618 US counties was identified based on whether at least 1 Black PCP operated within a county during 1 or more time points (2009, 2014, and 2019). Black PCPs operated in 1198 counties in 2009, 1260 counties in 2014, and 1308 counties in 2019-less than half of all 3142 Census-defined US counties as of 2014. Between-county influence results indicated that greater Black workforce representation was associated with higher life expectancy and was inversely associated with all-cause Black mortality and mortality rate disparities between Black and White individuals. In adjusted mixed-effects growth models, a 10% increase in Black PCP representation was associated with a higher life expectancy of 30.61 days (95% CI, 19.13-42.44 days). Conclusions and Relevance: The findings of this cohort study suggest that greater Black PCP workforce representation is associated with better population health measures for Black individuals, although there was a dearth of US counties with at least 1 Black PCP during each study time point. Investments to build a more representative PCP workforce nationally may be important for improving population health.

Rhesus monkeys manipulate mental images.

Humans form mental images and manipulate them in ways that mirror physical transformations of objects. Studies of nonhuman animals will inform our understanding of the evolution and distribution among species of mental imagery. Across three experiments, we found mostly converging evidence that rhesus monkeys formed and rotated mental images. In Experiment 1, monkeys discriminated rotations of sample images from mirror images, and showed longer response latencies with greater rotation as is characteristic of human mental rotation. In Experiment 2 monkeys used a rotation cue that indicated how far to mentally rotate sample images before tests, indicating a precision of better than 30° in discriminating rotations. Experiment 3 yielded mixed evidence on whether the rotation cue shortened decision times as has been found in humans. These results show that rhesus monkeys manipulate mental images.

Control of Attention in Rhesus Monkeys Measured Using a Flanker Task.

At least three processes determine whether information we encounter is attended to or ignored. First, attentional capture occurs when attention is drawn automatically by "bottom up" processes, to distinctive, salient, rewarding, or unexpected stimuli when they enter our sensory field. Second, "top down" attentional control can direct cognitive processing towards goal-relevant targets. Third, selection history, operates through repeated exposure to a stimulus, particularly when associated with reward. Attentional control is measured using tasks that require subjects to selectively attend to goal-relevant stimuli in the face of distractions. In the Eriksen flanker task, human participants report which direction a centrally placed arrow is facing, while ignoring "flanking" arrows that may point in the opposite direction. Attentional control is evident to the extent that performance reflects only the direction of the central arrow. We describe four experiments in which we systematically assessed attentional control in rhesus monkeys using a flanker task. In Experiment 1, monkeys responded according to the identity of a central target, and accuracy and latency varied systematically with manipulations of flanking stimuli, validating our adaptation of the Eriksen flanker task. We then tested for converging evidence of attentional control across three experiments in which flanker performance was modulated by the distance separating targets from flankers (Experiment 2), luminance differences (Experiment 3), and differences in associative value (Experiment 4). The approach described is a new and reliable measure of attentional control in rhesus monkeys that can be applied to a wide range of situations with freely behaving animals.

Influences of demographic, seasonal, and social factors on automated touchscreen computer use by rhesus monkeys (Macaca mulatta) in a large naturalistic group.

Animals housed in naturalistic social groups with access to automated cognitive testing vary in whether and how much they participate in cognitive testing. Understanding how demographic, seasonal, and social factors relate to participation is essential to evaluating the usefulness of these systems for studying cognition and in assessing the data produced. We evaluated how sex, age, reproductive experience, seasonality, and rank related to patterns of participation in a naturalistic group of rhesus monkeys over a 4-year period. Females interacted with the touchscreen systems more than males and were more likely to complete initial training. Age was positively correlated with touchscreen activity through adolescence in females, at which point seasonality and reproductive experience were stronger associates of participation. While monkeys in different rank categories did not differ in how much they interacted with the touchscreen systems, monkeys of different ranks tended not to work at the same times, perhaps reflecting avoidance of high ranking animals by those of lower rank. Automated cognitive testing systems for naturalistic social groups of rhesus monkeys can yield quality cognitive data from individuals of all ages and ranks, but participation biases may make it difficult to study sex differences or seasonal variation in cognition.

Change in the relative contributions of habit and working memory facilitates serial reversal learning expertise in rhesus monkeys.

Functionally distinct memory systems likely evolved in response to incompatible demands placed on learning by distinct environmental conditions. Working memory appears adapted, in part, for conditions that change frequently, making rapid acquisition and brief retention of information appropriate. In contrast, habits form gradually over many experiences, adapting organisms to contingencies of reinforcement that are stable over relatively long intervals. Serial reversal learning provides an opportunity to simultaneously examine the processes involved in adapting to rapidly changing and relatively stable contingencies. In serial reversal learning, selecting one of the two simultaneously presented stimuli is positively reinforced, while selection of the other is not. After a preference for the positive stimulus develops, the contingencies of reinforcement reverse. Naïve subjects adapt to such reversals gradually, perseverating in selection of the previously rewarded stimulus. Experts reverse rapidly according to a win-stay, lose-shift response pattern. We assessed whether a change in the relative control of choice by habit and working memory accounts for the development of serial reversal learning expertise. Across three experiments, we applied manipulations intended to attenuate the contribution of working memory but leave the contribution of habit intact. We contrasted performance following long and short intervals in Experiments 1 and 2, and we interposed a competing cognitive load between trials in Experiment 3. These manipulations slowed the acquisition of reversals in expert subjects, but not naïve subjects, indicating that serial reversal learning expertise is facilitated by a shift in the control of choice from passively acquired habit to actively maintained working memory.