Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma.

OBJECTIVES: To determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers' knowledge of asthma is described. DESIGN: This study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients' homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SETTING: A local Medicaid managed care organization. PARTICIPANTS: Pediatric African American patients (4-17 years old) with uncontrolled asthma. MAIN OUTCOME MEASURES: Outcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. RESULTS: Overall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. CONCLUSION: Rates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.

Performance during competition and competition outcome in relation to testosterone and cortisol among women.

A contribution to a special issue on Hormones and Human Competition. This study investigated the relation between competition, testosterone (T), and cortisol (C) in women. One hundred and twenty female participants competed against a male confederate in a computerized laboratory task. The task was preprogrammed so that half the women won and half of the women lost the competition. T and C concentrations were measured in saliva samples collected at four time points before and after the competition. Accuracy and reaction time during the competition were recorded. T and C increased directly after the competition, though not significantly for C, and then decreased over time regardless of the competition outcome. Regression analyses demonstrated that baseline T was significantly and positively associated with competition accuracy, though only in individuals who were low in C. Individuals who were high in C showed no relation between T and accuracy. This relation was further qualified by competition outcome. Losers of the competition showed a significant positive relation between baseline T levels and competition accuracy, though only if they were low in C. No relation was found between T and accuracy in losers who were high in C. Winners of the competition showed no relation between T and accuracy, regardless of whether C levels were high or low. These results are in line with the dual-hormone hypothesis, whereby the effects of T on status-seeking behaviors are dependent on C levels for individuals whose status is threatened.

Explaining financial and prosocial biases in favor of attractive people: Interdisciplinary perspectives from economics, social psychology, and evolutionary psychology.

Financial and prosocial biases in favor of attractive adults have been documented in the labor market, in social transactions in everyday life, and in studies involving experimental economic games. According to the taste-based discrimination model developed by economists, attractiveness-related financial and prosocial biases are the result of preferences or prejudices similar to those displayed toward members of a particular sex, racial, ethnic, or religious group. Other explanations proposed by economists and social psychologists maintain that attractiveness is a marker of personality, intelligence, trustworthiness, professional competence, or productivity. Evolutionary psychologists have argued that attractive adults are favored because they are preferred sexual partners. Evidence that stereotypes about attractive people are causally related to financial or prosocial biases toward them is weak or nonexistent. Consistent with evolutionary explanations, biases in favor of attractive women appear to be more consistent or stronger than those in favor of attractive men, and biases are more consistently reported in interactions between opposite-sex than same-sex individuals. Evolutionary explanations also account for increased prosocial behavior in situations in which attractive individuals are simply bystanders. Finally, evolutionary explanations are consistent with the psychological, physiological, and behavioral changes that occur when individuals are exposed to potential mates, which facilitate the expression of courtship behavior and increase the probability of occurrence of mating. Therefore, multiple lines of evidence suggest that mating motives play a more important role in driving financial and prosocial biases toward attractive adults than previously recognized.

Moving forward with interdisciplinary research on attractiveness-related biases.

In our response, we review and address the comments on our target article made in the 25 commentaries. First, we review and discuss the commentaries that recognized the value of our approach, accepted the main premises and conclusions of our target article, and suggested further avenues for research on attractiveness-related biases. We then respond to commentators who either misinterpreted some parts of our target article or made statements with which we disagree. These commentaries provided us with an opportunity to clarify some aspects of our target article, for example, the fact that we address both the functional significance of attractiveness-related biases and their underlying mechanisms. We provide a rebuttal to two commentaries, in which we are accused of poor scholarship. We conclude our response by addressing two commentaries that discussed the societal implications of the occurrence of attractiveness-related biases in the labor market by briefly discussing the relationship between scientific research and social policy.

Interest in Babies Negatively Predicts Testosterone Responses to Sexual Visual Stimuli Among Heterosexual Young Men.

Men's testosterone may be an important physiological mechanism mediating motivational and behavioral aspects of the mating/parenting trade-off not only over time but also in terms of stable differences between mating-oriented and parenting-oriented individuals. In this study, we tested the hypothesis that self-reported interest in babies is inversely related to testosterone reactivity to cues of short-term mating among heterosexual young men. Among 100 participants, interest in babies was related to a slow life-history strategy, as assessed by the Mini-K questionnaire, and negatively related to testosterone responses to an erotic video. Interest in babies was not associated with baseline testosterone levels or with testosterone reactivity to nonsexual social stimuli. These results provide the first evidence that differential testosterone reactivity to sexual stimuli may be an important aspect of individual differences in life-history strategies among human males.

The α5 neuronal nicotinic acetylcholine receptor subunit plays an important role in the sedative effects of ethanol but does not modulate consumption in mice.

BACKGROUND: Alcohol use disorders (AUDs) are a major public health problem, and the few treatment options available to those seeking treatment offer only modest success rates. There remains a need to identify novel targets for the treatment of AUDs. The neuronal nicotinic acetylcholine receptors (nAChRs) represent a potential therapeutic target in the brain, as recent human genetic studies have implicated gene variants in the α5 nAChR subunit as high risk factors for developing alcohol dependence. METHODS: Here, we evaluate the role of the α5* nAChR for ethanol (EtOH)-mediated behaviors using male α5+/+ and α5-/- transgenic mice. We characterized the effect of hypnotic doses of EtOH and investigated drinking behavior using an adapted drinking-in-the-dark (DID) paradigm that has been shown to induce high EtOH consumption in mice. RESULTS: We found the α5 subunit to be important in mediating the sedative effects of EtOH. The α5-/- mice showed slower recovery from EtOH-induced sleep, as measured by loss of righting reflex. Additionally, the α5-/- mice showed enhanced impairment to EtOH-induced ataxia. We found the initial sensitivity to EtOH and EtOH metabolism to be similar in both α5+/+ and α5-/- mice. Hence, the enhanced sedation is likely due to a difference in the acute tolerance of EtOH in α5-/- mice. However, the α5 subunit did not play a role in EtOH consumption for EtOH concentrations ranging from 5 to 30% using the DID paradigm. Additionally, varenicline was effective in reducing EtOH intake in α5-/- mice. CONCLUSIONS: Together, our data suggest that the α5 nAChR subunit is important for the sedative effects of EtOH but does not play a role in EtOH consumption in male mice. Varenicline can be a treatment option even when there is loss of function of the α5 nAChR subunit.

Sotrovimab restores neutralization against current Omicron subvariants in patients with blood cancer.

Wu et al. report that patients with hematologic malignancies have reduced immunity against SARS-CoV-2 Omicron subvariants and Sotrovimab retains neutralizing capacity against all tested Omicron subvariants.

Functional immune responses against SARS-CoV-2 variants of concern after fourth COVID-19 vaccine dose or infection in patients with blood cancer.

Patients with blood cancer continue to have a greater risk of inadequate immune responses following three COVID-19 vaccine doses and risk of severe COVID-19 disease. In the context of the CAPTURE study (NCT03226886), we report immune responses in 80 patients with blood cancer who received a fourth dose of BNT162b2. We measured neutralizing antibody titers (NAbTs) using a live virus microneutralization assay against wild-type (WT), Delta, and Omicron BA.1 and BA.2 and T cell responses against WT and Omicron BA.1 using an activation-induced marker (AIM) assay. The proportion of patients with detectable NAb titers and T cell responses after the fourth vaccine dose increased compared with that after the third vaccine dose. Patients who received B cell-depleting therapies within the 12 months before vaccination have the greatest risk of not having detectable NAbT. In addition, we report immune responses in 57 patients with breakthrough infections after vaccination.

Adaptive immunity and neutralizing antibodies against SARS-CoV-2 variants of concern following vaccination in patients with cancer: The CAPTURE study.

CAPTURE (NCT03226886) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively. A lower proportion of patients had detectable neutralizing antibody titers (NAbT) against SARS-CoV-2 variants of concern (VOCs) vs wildtype (WT). Patients with hematological malignancies were more likely to have undetectable NAbT and had lower median NAbT vs solid cancers against both WT and VOCs. In comparison with individuals without cancer, patients with haematological, but not solid, malignancies had reduced NAb responses. Seroconversion showed poor concordance with NAbT against VOCs. Prior SARS-CoV-2 infection boosted NAb response including against VOCs, and anti-CD20 treatment was associated with undetectable NAbT. Vaccine-induced T-cell responses were detected in 80% of patients, and were comparable between vaccines or cancer types. Our results have implications for the management of cancer patients during the ongoing COVID-19 pandemic.

Adaptive immunity and neutralizing antibodies against SARS-CoV-2 variants of concern following vaccination in patients with cancer: the CAPTURE study.

Coronavirus disease 2019 (COVID-19) antiviral response in a pan-tumor immune monitoring (CAPTURE) ( NCT03226886 ) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively. A lower proportion of patients had detectable titers of neutralizing antibodies (NAbT) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOC) versus wild-type (WT) SARS-CoV-2. Patients with hematological malignancies were more likely to have undetectable NAbT and had lower median NAbT than those with solid cancers against both SARS-CoV-2 WT and VOC. By comparison with individuals without cancer, patients with hematological, but not solid, malignancies had reduced neutralizing antibody (NAb) responses. Seroconversion showed poor concordance with NAbT against VOC. Previous SARS-CoV-2 infection boosted the NAb response including against VOC, and anti-CD20 treatment was associated with undetectable NAbT. Vaccine-induced T cell responses were detected in 80% of patients and were comparable between vaccines or cancer types. Our results have implications for the management of patients with cancer during the ongoing COVID-19 pandemic.

Academic Detailing Has a Positive Effect on Prescribing and Decreasing Prescription Drug Costs: A Health Plan's Perspective.

BACKGROUND: When initiated by a health plan, academic detailing can be used to change prescribing practices, which can lead to increased safety and savings. OBJECTIVE: To evaluate the impact of academic detailing on prescribing and prescription drug costs of cefixime to a health plan. METHODS: A prospective intervention study was carried out that evaluated the prescribing practices and prescription drug costs of cefixime. A total of 11 prescribers were detailed by 1 pharmacist between August 2014 and March 2015. Two of the 11 prescribers did not respond to the academic detailing and were not followed up. The physicians' prescribing habits and prescription costs were compared before and after detailing to evaluate the effectiveness of the intervention. Data were collected for approximately 5 months before and after the intervention. Each prescriber served as his or her own control. RESULTS: Overall, an approximate 36% reduction in the number of cefixime prescriptions written and an approximate 20% decrease in prescription costs was seen with academic detailing compared with the year before the intervention. In 9 of 11 (82%) prescribers, intervention with academic detailing was successful and resulted in fewer prescriptions for cefixime during the study period. CONCLUSION: Academic detailing had a positive impact on prescribing, by decreasing the number of cefixime prescriptions and lowering the drug costs to the health plan.

Cometabolism of trihalomethanes by mixed culture nitrifiers.

Three mixed-culture nitrifier sources degraded low concentrations (25-450 microg/L) of four trihalomethanes (THMs) (trichloromethane (TCM) or chloroform, bromodichloromethane (BDCM), dibromochloromethane (DBCM), tribromomethane (TBM) or bromoform) commonly found in treated drinking water. Individual THM rate constants (k1THM) increased with increasing THM bromine-substitution with TBM>DBCM>BDCM>TCM and were comparable to previous studies with the pure culture nitrifier, Nitrosomonas europaea. A decrease in temperature resulted in a decrease in both ammonia and THM degradation rates with ammonia rates affected to a greater extent than THM degradation rates. The significant effect of temperature indicates that seasonal variations in water temperature should be a consideration for technology implementation. Product toxicity, measured by transformation capacity (T(c)), was similar to that observed with N. europaea. Because both rate constants and product toxicities increase with increasing THM bromine-substitution, a water's THM speciation is an important consideration for process implementation during drinking water treatment. Even though a given water is kinetically favored, the resulting THM product toxicity may not allow stable treatment process performance.

Observed Effectiveness of Palivizumab for 29-36-Week Gestation Infants.

BACKGROUND: Respiratory syncytial virus (RSV) is a common reason for hospitalization of infants. In clinical trials, palivizumab reduced RSV hospitalization rates for premature infants. The 2014 American Academy of Pediatrics clinical practice guideline advised against use of palivizumab for otherwise healthy infants ≥29 weeks' gestation. The aim of this study was to determine the effect of palivizumab administration on hospitalization rates for RSV and bronchiolitis without RSV diagnosis among infants 29 to 36 weeks' gestation who do not have chronic illness. METHODS: Claims data were extracted from databases of 9 Texas Medicaid managed care programs. Eligible infants were 29 to 36 weeks' gestation, without claims suggesting chronic illness, and who were born between April 1 and December 31 of 2012, 2013, and 2014. RESULTS: A total of 2031 eligible infants of 29 to 32 weeks' gestation and 12 066 infants of 33 to 36 weeks' gestation were identified; 41.5% of the infants 29 to 32 weeks' gestation and 3.7% of the infants 33 to 36 weeks' gestation had paid claims for dispensing of ≥1 palivizumab doses. Among the infants of 29 to 32 weeks' gestation, palivizumab dispensing was associated with reduced RSV hospitalization rates (3.1% vs 5.0%, P = .04) but increased hospitalizations for bronchiolitis without RSV diagnosis (3.3% vs 1.9%, P = .05). There were no significant differences by palivizumab administration status for the infants of 33 to 36 weeks' gestation. CONCLUSIONS: Among infants 29 to 32 weeks' gestation without chronic illness, palivizumab use was associated with reduced RSV hospitalizations but increased hospitalizations for bronchiolitis without RSV diagnosis.

From a to z: medication cost-management strategies for disproportionate share hospitals.

BACKGROUND: Harris County Hospital District, Houston, TX, is a publicly funded hospital system that provides care to residents of Harris County with a need-based payment system. The Harris County Hospital District pharmacy department, with a drug budget of more than $75 million in fiscal year 2010, utilizes a closed formulary system that is managed by the Formulary Management and Pharmacoeconomics Service, along with the medical staff. This service is comprised of clinical pharmacists whose goal is to provide a comprehensive, safe, and cost-effective formulary. OBJECTIVE: To describe the unique formulary management process at a county hospital system and what makes this process cost-effective, which may benefit pharmacy departments in institutions serving an indigent patient population. SUMMARY: The Harris County Hospital District drug formulary is overseen by the Pharmacy & Therapeutics committee, which is supported by 5 therapeutic subcommittees, including antimicrobials, cardiovascular, general formulary, central nervous system, and oncology. The Pharmacy & Therapeutics Committee consists of a medical staff committee that is supported by clinical pharmacists, who serve as the facilitators of these 5 subcommittees. Their responsibilities include the provision of drug information for formulary decisions, providing parameters to govern the use of certain medications, communicating changes to the formulary, conducting class reviews and medication utilization evaluations, coordinating annual pharmaceutical bids, reviewing and writing medication use policies and procedures, facilitating the use of cost-effective medications, and monitoring the use of medications in the hospital system. CONCLUSION: The processes incorporated by Harris County Hospital District in its formulary management are cost-effective and may be beneficial to other pharmacy departments, especially those institutions that serve an indigent patient population and are interested in cost-effective management strategies.