Robert Prather

THE EXECUTION OF LEGAL DOCUMENTS BY SEXUAL MINORITY INDIVIDUALS

Sexual minority individuals (specifically bisexual, gay, lesbian and transgendered [BGLT]) have identities and relationships that are socially stigmatized and legally unrecognized. An online survey of 398 BGLT individuals was conducted concerning their execution of 5 legal planning documents: a will, powers of attorney for finances and health care, a living will, and hospital visitation authorization. We found support for the hypothesis that BGLT individuals who are in committed relationships, have disclosed their sexual orientation to immediate family, and have more income are more likely to have executed some or all of these documents. The authors discuss implications for BGLT individuals and same-sex couples, the need for policy changes and therapeutic intervention, and future directions for research in this area. Sexual minority individuals have important chosen relationships, including long-term partners and close friends who function as “family.” Yet, the identities of sexual minority individuals (herein referring specifically to bisexual, gay, lesbian and transgendered identified individuals [BGLT]), and the relationships they form, are socially stigmatized and most often legally unrecognized. Persons who are biologically or legally related to BGLT individuals, their families of origin or “relatives,” may refuse to honor or even acknowledge the individual’s identity or chosen relationships. Under these circumstances, these important relationships may be particularly vulnerable from a legal standpoint in the event of a physical or emotional crisis if relatives challenge the legitimacy of the BGLT individual’s chosen family. Sexual minority individuals can attempt to protect certain aspects of their chosen relationships through the execution of legal documents available to every individual. These documents include a will or living trust, powers of attorney for finances and health care, a living will, and hospital visitation authorization. Individuals can use combinations of these documents to specify their wishes and convey rights to chosen others outside of their legally assumed family. In the absence of marriage (or equivalent) rights, these documents take on particular importance for individuals with same-sex partners. Without these documents, an individual’s family of origin is presumptively given rights as a matter of law or legal determination. Despite the immediate importance of this situation to millions of self-identi

Advance Planning by Same-Sex Couples:

The lack of legal recognition of same-sex couples can leave partners vulnerable in a crisis or emergency. Advance planning is one strategy couples can use to establish legal rights. Analyses of data collected from both partners in 131 same-sex couples suggested that executing advance-planning documents (wills, powers of attorney for finance and health care, and living wills) was associated with age and couple-level relational variables. Older couples and couples that reported higher commitment levels were more likely to have executed the four documents. Couples who had disclosed their relationship to a higher percentage of their relatives were more likely to have executed wills and living wills. Implications of these findings for public policy and social services affecting same-sex couples are discussed.

Dose-dependent cocaine place conditioning and D1 dopamine antagonist effects in male Japanese quail

The dopamine D1 receptor subtype has been implicated in drug reward processes in mammals. Two experiments investigated whether dose-dependent differences in cocaine conditioned place preference (CPP) would be obtained in an avian species and whether these cocaine effects were mediated by the dopamine D1 antagonist R(+/-)-SCH23390. In Experiment 1, male birds were given intraperitoneal injections of 1, 3, 10, or 30 mg/kg of cocaine hydrochloride, paired with a chamber that contained distinct visual cues. On alternate days, they received saline paired with a chamber containing different visual cues. A CPP test was given after four pairings of cocaine with the distinct chamber. In Experiment 2, 0.0025, 0.025, or 0.25 mg/kg of SCH 23390 or saline was administered 15 min prior to cocaine (3 mg/kg) and placement into the least preferred chamber. CPP was observed at 1, 3, and 10 mg/kg doses of cocaine but not at 30 mg/kg or saline. All doses of SCH 23390 attenuated cocaine-induced CPP. The findings suggest that cocaine administration results in a dose-dependent CPP, and that similar with mammals, it may be mediated by D1 receptors in an avian species. Thus, the avian species may be a beneficial comparative model for drug studies, especially those involving visual cue mechanisms of drug reward.

Neurophysiological correlates of moderate alcohol consumption in older and younger social drinkers.

BACKGROUND Nearly 40% of adults aged 65 and older in the United States consume alcohol. Research in older adults has largely examined potential health effects of a moderate drinking lifestyle. Examination of acute effects in this population is generally lacking. To investigate alcohol-induced alteration of electrophysiological correlates of attention in this population, we employed a covert attentional task. We hypothesized that moderate alcohol administration as well as older age would reduce P3 amplitude and increase latency. We anticipated an interaction such that, relative to their age-matched controls, older adults receiving alcohol would be more affected than their younger counterparts. METHODS Participants included healthy older (aged 50 to 67; n = 20; 9 men) and younger (aged 25 to 35; n = 12; 5 men) moderate drinkers. Participants received either a moderate dose of alcohol (breath alcohol concentration ~50 mg/dl) or a placebo beverage. Following absorption, the task was administered and neurophysiological measures were obtained. P3 amplitude and latency were separately subjected to ANOVA across cue conditions using age and dose as independent variables. RESULTS As predicted, P3 amplitude in older adults was significantly lower than in younger adults across cue conditions. An age by alcohol interaction was detected, revealing that older adults receiving alcohol showed lower P3 amplitudes than any other group. An age effect for P3 latency was found, with older adults having longer latencies than their younger counterparts. A significant age by alcohol interaction for P3 latency was detected, revealing that older adults receiving alcohol displayed delayed P3 latencies relative to older adults receiving placebo. In contrast, younger adults receiving alcohol had reduced latency compared to those receiving placebo, although this effect did not reach significance. CONCLUSIONS Results suggest that older adults demonstrated alcohol-related shifts in P3 characteristics during an intentional attention task, whereas younger adults failed to demonstrate this pattern.

Sex differences in alcohol-related neurobehavioral consequences

In this chapter, we review existing research regarding sex differences in alcohols effects on neurobehavioral functions/processes. Drawn largely from laboratory studies, literature regarding acute alcohol administration and chronic alcohol misuse is explored focusing on commonly employed neuropsychologic domains (e.g., executive function, visuospatial skills, learning and memory, gait and balance), neurophysiologic measures (e.g., electroencephalography and event-related potentials), and structural and functional neuroimaging (e.g., magnetic resonance imaging (MRI), functional MRI, diffusion tensor imaging, positron emission tomography, and magnetic resonance spectroscopy). To provide a historical perspective on the development of these questions, we have included reference to early and more recent research. Additionally, specific biases, knowledge gaps, and continuing controversies are noted.

Contrasting behavioral effects of acute nicotine and chronic smoking in detoxified alcoholics

BACKGROUND Current literature suggests that acute nicotine administration provides a compensatory mechanism by which alcoholics might alleviate attentional deficits. In contrast, chronic smoking is increasingly recognized as negatively affecting neurobehavioral integrity. These opposing effects have not been simultaneously examined. Thus, we sought to a) extend previous work by exploring the effects of acute nicotine effects on vigilance components of attention and replicate previous findings suggesting that treatment-seeking alcoholics experience benefit to a greater extent than do other groups; and b) to examine the impact of chronic smoking on these tasks and across subgroups. METHODS Substance abusing participants (N=86) were recruited and subgrouped on the basis of dependency criteria as either alcoholics, alcoholics with co-morbid stimulant dependence, or stimulant dependent individuals. Groups of cigarette-smoking (N=17) and non-smoking (N=22) community controls were recruited as comparison groups. Smoking subjects were assigned a placebo, low, or high dose nicotine patch in a double-blind placebo controlled fashion. Non-smoking controls were administered either a placebo or low dose. Testing occurred after dose stabilization. RESULTS General linear models indicated greater sensitivity to acute nicotine administration among alcoholics than other groups when controlling for the effect of intensity of smoking history, as reflected by pack-years. Pack-years correlated negatively with performance measures in alcoholics but not stimulant abusing subgroups or smoking controls. Finally, regression analyses demonstrated that pack-years predicted poorer performance only for the alcoholic subgroup. CONCLUSIONS These results support previous work finding a compensatory effect of acute nicotine administration on attentional performance in alcoholics and reinforce the consideration of recent nicotine use as a confound in neurocognitive studies of alcoholics. Of particular interest is the finding that smoking history as reflected in pack-years predicted poorer performance, but only among alcoholics. Further systematic study of these opposing effects among alcoholics and other groups using a broader array of tasks is needed.

Nicotine effects on immediate and delayed verbal memory after substance use detoxification

Decrements in verbal memory are commonly reported by detoxified treatment-seeking individuals. Although acute nicotine has been shown to improve attentional performance, its effects on verbal memory in substance abusers have not been addressed. Treatment-seeking alcohol-dependent (ALCs, n = 29; 14 male), illicit-stimulant-dependent (predominantly cocaine; STIMs, n = 25; 15 male), and alcohol- and illicit-stimulant-dependent (ALC/STIMs, n = 50; 35 male) participants with comorbid nicotine dependence were studied. Subjects had been abstinent from their drugs of choice for 41 (±18) days and were in short-term abstinence from tobacco (∼8–10 hours). Subjects received double-blind administration of either transdermal nicotine (high dose: 21/14 mg for men and women, respectively, or low dose: 7 mg) or placebo. The Logical Memory (LM) subtest from the Wechsler Memory Scale–Revised (WMS–R) was used to assess immediate and delayed verbal memory recall. Results indicated that STIMs receiving the high dose of nicotine recalled more words at immediate recall than STIMs who received placebo. Trend level differences were also noted at delayed recall between STIM nicotine and placebo doses. Nicotine failed to impact either recall in alcoholic subgroups. Although not the primary focus, results also revealed differences in the forgetting rates between the groups with the ALC/STIMs demonstrating the steepest forgetting slope. In summary, this study suggests that nicotine effects may be differentially experienced by substance-using subgroups; that nicotine may have a direct effect on memory; and that in considering neurocognitive processes (e.g., encoding vs. retrieval), underlying endpoint indicators (e.g., correct recall) may be critical in predicting outcomes.

Development of a novel observer reported outcome tool as the primary efficacy outcome measure for a rare disease randomized controlled trial

We developed an Observer-Reported Outcome (ObsRO) survey instrument to be applied in a multicenter, placebo-controlled, crossover randomized controlled trial of dichloroacetate in children with pyruvate dehydrogenase complex deficiency. The instrument quantifies a subjects at-home level of functionality, as reported by a parent/caregiver, who were instrumental in providing the clinical descriptors and domains that formed the instruments content. Feasibility testing of the ObsRO tool showed it to be easy to use and comprehensive in capturing the major clinical functional limitations of affected children and requires less than 5min for a parent/caregiver to complete daily.

Transdermal nicotine administration and the electroencephalographic activity of substance abusers in treatment.

Objectives:It is widely recognized that individuals with alcohol or illicit substance abuse disorders often smoke cigarettes. However, few studies have examined the direct effects of nicotine among substance abuse subgroups. The current study examined patterns of electroencephalographic (EEG) activity in alcohol-dependent, stimulant-dependent, alcohol- and stimulant-dependent participants, and community controls. All participants were regular smokers. Methods:After overnight nicotine abstinence, subjects were administered either a high (14 or 21 mg) or low (7 mg) dose transdermal nicotine patch. EEG data were collected during a 2-minute eyes open and 5-minute eyes closed baseline recording session, which occurred as part of a larger study of brain electrophysiology. Results:The most interesting finding was a differential pattern of nicotine dose effects by group. EEGs of controls and alcohol- and stimulant-dependent participants did not distinguish between high and low nicotine doses; whereas, nicotine administration in the alcohol-dependent and stimulant-dependent groups resulted in opposite findings across a range of spectral bands. Conclusions:Although further research is warranted, these results may have implications for the study of smoking cessation and attentional functioning among substance abusers in treatment. These data suggest that nicotine-related changes in neurophysiology may be associated with specific brain areas and/or specific drug histories and reinforce the need for caution in generalizing among such groups.

Exploring the Role of Executive Functioning Capacity in Patient Activation and Health Outcomes Among Medicaid Members With Multiple Comorbidities

Patient activation, the perceived capacity to manage one’s health, is positively associated with better health outcomes and lower costs. Underlying characteristics influencing patient activation are not completely understood leading to gaps in intervention strategies designed to improve patient activation. We suggest that variability in executive functioning influences patient activation and ultimately has an impact on health outcomes. To examine this hypothesis, 440 chronically ill Medicaid enrollees completed measures of executive functioning, patient activation, and health-related quality of life. Mediation analyses revealed that executive functioning: (a) directly affected patient activation and mental health-related quality of life, (b) indirectly affected mental health-related quality of life through patient activation, and (c) was unrelated to physical health-related quality of life. These data indicate that further study of the relationships among neurocognitive processes, patient activation, and health-related quality of life is needed and reinforces previous work demonstrating the association between patient activation and self-reported outcomes.