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Historical cultural practices that no longer exist can have modern day effects. Because communism has been linked with distrust of government, it was hypothesized that (a) historical communism would be negatively associated with COVID-19 vaccination rates, and (b) trust in government would mediate the association. Two studies assessed these hypotheses. Study 1 tested the hypotheses among European, Asian, and African countries, while Study 2 focused on East and West Germany within Europe. All samples except Africa found support for an association between historical communism and lower COVID-19 vaccination rates. However, trust in government did not mediate the association in Study 1, though a significant indirect effect did emerge within Germany in Study 2. Associations held controlling for GDP and age of population. Together, the studies suggest that historical communism in Europe and Asia is associated with real-world behavior today, and that trust in government might be partly responsible for the effect within Germany but less likely within Europe as a whole.

OBJECTIVE Innovative strategies are needed to reduce young adult drinking. Real-time feedback via mobile health (mHealth) technology (e.g., smartphone devices/apps) may facilitate moderate drinking, yet requires evidence of feasibility, acceptability, and usability. METHOD Young adults reporting frequent heavy drinking (N = 99, Mage = 23, 51% male) participated in a manualized, brief, motivational interview on recent typical and peak blood alcohol concentration (BAC), then were randomized to use 1 of the 3 forms of technology: (a) smartphone breathalyzer device/app; (b) app that estimates BAC based on factors including sex, weight, number/types of drinks over time; or (c) self-text messaging after each drink. Technologies were tested initially in small-group laboratory alcohol self-administration sessions. Participants then completed a 2-week field test wherein they had free access to all three technologies. Participants reported on usability and acceptability. RESULTS Laboratory alcohol self-administration did not differ significantly by technology condition. The smartphone breathalyzer and BAC estimator app had favorable acceptability and usability. Participants used at least one form of technology on 67% of drinking days in the field period. In exploratory analyses, alcohol use during the field period was significantly lower than the baseline including a decrease of nearly one drink per drinking day. CONCLUSIONS These findings support the feasibility of research combining lab and field methods to test moderate drinking technologies in young adults. Findings further support the acceptability and usability of these technologies, along with young adults' openness to using them. Exploratory results suggest potential efficacy of combined mobile technology intervention to be tested in subsequent controlled studies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The outbreak of coronavirus disease (COVID-19) represents a major public health challenge and a serious threat to sustainable social development. A consideration of animal welfare is clearly justified, given the potential contribution of animals to the spread of the disease. The present study, therefore, sought to investigate the concern the Chinese people have for animal welfare (PCAW) and how their ‘ethical ideology’ (idealism and relativism) determines PCAW after COVID-19, through comparison with the same study, carried out in China in 2015. Our results demonstrated a significant improvement in Chinese PCAW after COVID-19. The adverse impact of COVID-19 may have resulted in a lowered idealism score and this decreased score served to neutralise significant correlations between idealism and PCAW, compared to the 2015 results. The global pandemic did not increase people's relativism score and a significant correlation was found between relativism and PCAW. Gender, age, educational level, public perception of animals after COVID-19, zoo and aquarium visiting were all shown to be predictor variables for PCAW. This study is one of the first to investigate Chinese PCAW after COVID-19 and can therefore provide knowledge that will potentially increase Chinese PCAW.

The association between behavioral economic demand and various alcohol use outcomes is well established. However, few studies have examined whether changes in demand occur following a brief alcohol intervention (BAI), and whether this change predicts alcohol outcomes over the long term.Parallel process piecewise latent growth curve models were examined in a sample of 393 heavy drinking emerging adults (60.8% women; 85.2% white; MA two-session BAI predicted significant reductions in all five outcomes from baseline to 1-month follow-up. Although no further reduction was observed from the 1-month to the 16-month follow-up, there was no regression to baseline levels. Slope 1 demand intensity, but not OReducing high valuation of alcohol among heavy drinking emerging adults within the first month following BAI is critical for the long-term efficacy of the intervention. A two-session BAI was associated with enduring reductions in alcohol demand, and the change in demand intensity, but not O

Background: Infective endocarditis (IE) is characterized by an infected thrombus at the heart valves. How bacteria bypass the immune system and cause these thrombi remains unclear. Neutrophils releasing NETs (neutrophil extracellular traps) lie at this interface between host defense and coagulation. We aimed to determine the role of NETs in IE immunothrombosis. Methods: We used a murine model of Staphylococcus aureus endocarditis in which IE is provoked on inflamed heart valves and characterized IE thrombus content by immunostaining identifying NETs. Antibody-mediated neutrophil depletion and neutrophil-selective PAD4 (peptidylarginine deiminase 4)-knockout mice were used to clarify the role of neutrophils and NETs, respectively. S. aureus mutants deficient in key virulence factors related to immunothrombosis (nucleases or staphylocoagulases) were investigated. Results: Neutrophils releasing NETs were present in infected thrombi and within cellular infiltrates in the surrounding vasculature. Neutrophil depletion increased occurrence of IE, whereas neutrophil-selective impairment of NET formation did not alter IE occurrence. Absence of S. aureus nuclease, which degrades NETs, did not affect endocarditis outcome. In contrast, absence of staphylocoagulases (coagulase and von Willebrand factor binding protein) led to improved survival, decreased bacteremia, smaller infiltrates, and decreased tissue destruction. Significantly more NETs were present in these vegetations, which correlated with decreased bacteria and cell death in the adjacent vascular wall. Conclusions: Neutrophils protect against IE independent of NET release. Absence of S. aureus coagulases, but not nucleases, reduced IE severity and increased NET levels. Staphylocoagulase-induced fibrin likely hampers NETs from constraining infection and the resultant tissue damage, a hallmark of valve destruction in IE.

Graphical abstract, Highlights • We report repaired URCS defect concomitant with coronary bypass surgery. • Systematic TEE was used to determine the etiology of isolated dilatation of right heart. • A diagram including the complete spectrum of URCS is provided.

Several bumble bee species (Bombus Latreille) are declining and efforts to conserve populations will be strengthened by an improved knowledge of their geographic distribution. Knowledge gaps exist, however, especially in central portions of North America. Here we report 29 species of bumble bees from South Dakota in the north-central USA, based on 130 years of records from 1891 to 2021. Specimens or observations were available for >90% of the 66 counties, though they were not distributed evenly as most records came from Pennington, Lawrence, Custer, Brookings, and Day Counties. The five most commonly collected or reported bumble bee species were B. griseocollis (54 counties), B. pensylvanicus (41 counties), B. fervidus (39 counties), B. huntii (27 counties), and B. bimaculatus (25 counties). Twenty species were recorded from 10 or fewer counties. Despite differences in occurrence, 66% of the Bombus species in South Dakota were collected or observed since 2020, including six of the nine species of conservation concern (B. fraternus, B. pensylvanicus, B. fervidus, B. occidentalis, B. terricola, and B. morrisoni). However, the critically endangered B. affinis, B. variabilis, and B. suckleyi have not been collected or observed for over 50 years. While this checklist is the first for South Dakota bumble bees in nearly 100 years, data are still lacking as ~55% of counties had fewer than five species reported. We suggest future efforts should focus on these under-sampled areas to fill in baseline knowledge of the wild bee fauna towards completing a more holistic view of bumble bee distributions across the Great Plains.

Vaccine hesitancy has taken global prominence with the rapid spread of COVID-19, but what factors are related to this considerable variation in vaccination rates globally? Three studies that encompass 195 unique regions from around the world found that the relative spirituality and religiosity of a region predict ongoing COVID-19 vaccination rates, such that those regions higher in spirituality and/or religiosity are regions with lower COVID-19 vaccination rates. In Study 1, data from 23 regions globally were obtained, and both spirituality and religiosity were negatively associated with vaccination rates. These effects held when applying two methods to account for vaccine supply issues. In Study 2, data from 144 regions globally were obtained, and once again religiosity negatively predicted COVID-19 vaccination rates. It remained a significant predictor of vaccination rates when controlling for GDP, population age, collectivism, general skepticism towards vaccinations, and previous inoculation history. In Study 3, data from all USA states and the District of Columbia were obtained, and religiosity and spirituality once again were negatively associated with COVID-19 vaccination rates. Effects held controlling for other factors. Across studies, spirituality and religiosity account for a large amount of the variance in vaccination rates. These results suggest that real-world behavior can be predicted by the relative spirituality and religiosity of a region.

Infective endocarditis (IE) is characterized by an infected thrombus at the heart valves. How bacteria bypass the immune system and cause these thrombi remains unclear. Neutrophils releasing NETs (neutrophil extracellular traps) lie at this interface between host defense and coagulation. We aimed to determine the role of NETs in IE immunothrombosis.We used a murine model ofNeutrophils releasing NETs were present in infected thrombi and within cellular infiltrates in the surrounding vasculature. Neutrophil depletion increased occurrence of IE, whereas neutrophil-selective impairment of NET formation did not alter IE occurrence. Absence ofNeutrophils protect against IE independent of NET release. Absence of

Item does not contain fulltext BACKGROUND: Pregnancy-related venous thromboembolism is a leading cause of maternal morbidity and mortality, and thromboprophylaxis is indicated in pregnant and post-partum women with a history of venous thromboembolism. The optimal dose of low-molecular-weight heparin to prevent recurrent venous thromboembolism in pregnancy and the post-partum period is uncertain. METHODS: In this open-label, randomised, controlled trial (Highlow), pregnant women with a history of venous thromboembolism were recruited from 70 hospitals in nine countries (the Netherlands, France, Ireland, Belgium, Norway, Denmark, Canada, the USA, and Russia). Women were eligible if they were aged 18 years or older with a history of objectively confirmed venous thromboembolism, and with a gestational age of 14 weeks or less. Eligible women were randomly assigned (1:1), before 14 weeks of gestational age, using a web-based system and permuted block randomisation (block size of six), stratified by centre, to either weight-adjusted intermediate-dose or fixed low-dose low-molecular-weight heparin subcutaneously once daily until 6 weeks post partum. The primary efficacy outcome was objectively confirmed venous thromboembolism (ie, deep-vein thrombosis, pulmonary embolism, or unusual site venous thrombosis), as determined by an independent central adjudication committee, in the intention-to-treat (ITT) population (ie, all women randomly assigned to treatment). The primary safety outcome was major bleeding which included antepartum, early post-partum (within 24 h after delivery), and late post-partum major bleeding (24 h or longer after delivery until 6 weeks post partum), assessed in all women who received at least one dose of assigned treatment and had a known end of treatment date. This study is registered with ClinicalTrials.gov, NCT01828697, and is now complete. FINDINGS: Between April 24, 2013, and Oct 31, 2020, 1339 pregnant women were screened for eligibility, of whom 1110 were randomly assigned to weight-adjusted intermediate-dose (n=555) or fixed low-dose (n=555) low-molecular-weight heparin (ITT population). Venous thromboembolism occurred in 11 (2%) of 555 women in the weight-adjusted intermediate-dose group and in 16 (3%) of 555 in the fixed low-dose group (relative risk [RR] 0·69 [95% CI 0·32-1·47]; p=0·33). Venous thromboembolism occurred antepartum in five (1%) women in the intermediate-dose group and in five (1%) women in the low-dose group, and post partum in six (1%) women and 11 (2%) women. On-treatment major bleeding in the safety population (N=1045) occurred in 23 (4%) of 520 women in the intermediate-dose group and in 20 (4%) of 525 in the low-dose group (RR 1·16 [95% CI 0·65-2·09]). INTERPRETATION: In women with a history of venous thromboembolism, weight-adjusted intermediate-dose low-molecular-weight heparin during the combined antepartum and post-partum periods was not associated with a lower risk of recurrence than fixed low-dose low-molecular-weight heparin. These results indicate that low-dose low-molecular-weight heparin for thromboprophylaxis during pregnancy is the appropriate dose for the prevention of pregnancy-related recurrent venous thromboembolism. FUNDING: French Ministry of Health, Health Research Board Ireland, GSK/Aspen, and Pfizer.

Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 (ACE2) receptor, a critical component of the kallikrein-kinin system. Its dysregulation may lead to increased vascular permeability and release of inflammatory chemokines. Interactions between the kallikrein-kinin and the coagulation system might further contribute to thromboembolic complications in COVID-19. Methods In this observational study, we measured plasma and tissue kallikrein hydrolytic activity, levels of kinin peptides, and myeloperoxidase (MPO)-DNA complexes as a biomarker for neutrophil extracellular traps (NETs), in bronchoalveolar lavage (BAL) fluid from patients with and without COVID-19. Findings In BAL fluid from patients with severe COVID-19 (n = 21, of which 19 were mechanically ventilated), we observed higher tissue kallikrein activity (18·2 pM [1·2-1535·0], median [range], n = 9 vs 3·8 [0·0-22·0], n = 11; p = 0·030), higher levels of the kinin peptide bradykinin-(1-5) (89·6 [0·0-2425·0], n = 21 vs 0·0 [0·0-374·0], n = 19, p = 0·001), and higher levels of MPO-DNA complexes (699·0 ng/mL [66·0-142621·0], n = 21 vs 70·5 [9·9-960·0], n = 19, p < 0·001) compared to patients without COVID-19. Interpretation Our observations support the hypothesis that dysregulation of the kallikrein-kinin system might occur in mechanically ventilated patients with severe pulmonary disease, which might help to explain the clinical presentation of patients with severe COVID-19 developing pulmonary oedema and thromboembolic complications. Therefore, targeting the kallikrein-kinin system should be further explored as a potential treatment option for patients with severe COVID-19. Funding Research Foundation-Flanders (G0G4720N, 1843418N), KU Leuven COVID research fund. Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 (ACE2) receptor, a critical component of the kallikrein-kinin system. Its dysregulation may lead to increased vascular permeability and release of inflammatory chemokines. Interactions between the kallikrein-kinin and the coagulation system might further contribute to thromboembolic complications in COVID-19. Methods In this observational study, we measured plasma and tissue kallikrein hydrolytic activity, levels of kinin peptides, and myeloperoxidase (MPO)-DNA complexes as a biomarker for neutrophil extracellular traps (NETs), in bronchoalveolar lavage (BAL) fluid from patients with and without COVID-19. Findings In BAL fluid from patients with severe COVID-19 (n = 21, of which 19 were mechanically ventilated), we observed higher tissue kallikrein activity (18·2 pM [1·2-1535·0], median [range], n = 9 vs 3·8 [0·0-22·0], n = 11; p = 0·030), higher levels of the kinin peptide bradykinin-(1-5) (89·6 [0·0-2425·0], n = 21 vs 0·0 [0·0-374·0], n = 19, p = 0·001), and higher levels of MPO-DNA complexes (699·0 ng/mL [66·0-142621·0], n = 21 vs 70·5 [9·9-960·0], n = 19, p < 0·001) compared to patients without COVID-19. Interpretation Our observations support the hypothesis that dysregulation of the kallikrein-kinin system might occur in mechanically ventilated patients with severe pulmonary disease, which might help to explain the clinical presentation of patients with severe COVID-19 developing pulmonary oedema and thromboembolic complications. Therefore, targeting the kallikrein-kinin system should be further explored as a potential treatment option for patients with severe COVID-19. Funding Research Foundation-Flanders (G0G4720N, 1843418N), KU Leuven COVID research fund. ispartof: Ebiomedicine vol:83 pages:104195- ispartof: location:Netherlands status: published

Objective Recent studies have examined the extent to which alcohol dependence (AD) criteria prospectively predict the course of AD. Critically, these studies have lacked a developmental perspective. However, the differential performance of criteria by age might indicate overendorsement in younger individuals. The current study examined AD criteria in terms of persistence and prediction of AD course and alcohol use by age in order to identify criteria that are likely to be overly endorsed by younger individuals. Method The current study used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions to depict age differences in rates of new onset, recurrence, and persistence for each AD criterion, thereby showing how these three factors contribute to the overall age-prevalence curve of each criterion. Additionally, we tested age moderation of the predictive association between each criterion at baseline and new onset, recurrence, and persistence of syndromal AD. Results Some criteria (particularly, persistent desire or unsuccessful efforts to cut down or control drinking, and drinking despite physical/psychological problems) are both less persistent and less predictive of AD course among younger adults compared to older adults. Conclusions These findings raise the possibility of elevated rates of false-positive AD among younger adults and suggest ways to improve the assessment of AD criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

High levels of 3 behavioral economic indices (delay discounting, alcohol demand, and proportionate substance-related reinforcement) are consistently associated with greater alcohol misuse and alcohol-related problems. However, it is unclear whether and how these variables jointly increase the risk for alcohol-related outcomes among college students who engage in heavy episodic drinking (HED; 4/5+ drinks for women/men, respectively). The current study used a person-centered approach to identify similar patterns of behavioral economic domains among heavy-drinking college students and investigate the relationship between these empirically derived classes and alcohol-related outcomes. A sample of 393 college students (60.8% female, 78.9% White/Caucasian) reporting at least 2 heavy drinking episodes in the previous month completed measures of alcohol use and problems, demographics, delay discounting, and alcohol reward value (alcohol demand and proportionate substance-related reinforcement). Latent profile analyses revealed that a 3-class solution provided the best fit to the data: a low reward value, high discounting (LRHD) class (n = 53), a moderate reward value, low discounting (MRLD) class (n = 214), and a high reward value, high discounting (HRHD) class (n = 126). Members of the HRHD class reported significantly greater alcohol consumption, past-month HED episodes, alcohol-related problems, and symptoms of alcohol use disorder than those in the MRLD and LRHD classes. The results suggest that there are 3 constellations of behavioral economic processes and that, consistent with the reinforcer pathology model, students who overvalue alcohol-related reward and discount the future more steeply are at the greatest risk for alcohol misuse and alcohol-related problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

BACKGROUND Previous studies have demonstrated that carefully selected donor hearts (DHs) with poor left ventricular ejection fraction (EF) may be transplanted with long-term survival equivalent to hearts with normal function. The purpose of this study is to facilitate their selection. METHODS Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Regression models were developed to estimate hazard ratios with 95% confidence intervals of post-transplant 1-year mortality and failure of EF to recover at 1 year for DHs with EF ≥50%, EF 40%-49.9%, and EF 30%-30.9%. RESULTS During the study period, 31,979 DHs were transplanted. Compared with DHs with left ventricular ejection fraction ≥50%, DHs with reduced EF were younger and had slightly lower body mass index. There were no differences in the mechanism of death between groups and no differences in recipient characteristics, except for a higher incidence of African American recipients of hearts with an EF of 40%-49.9%. Of the variables analyzed, only a 1-hour increase in ischemia time had different hazard ratios for 1-year mortality between groups, with increasing hazard as EF diminished. It was also the only variable that predicted failure of recovery of normal EF and that was in the lowest EF group. CONCLUSIONS The impact of DH traits associated with adverse outcomes after heart transplantation that we studied are similar between DHs with EF

Abstract. The present study examined whether personality traits and drinking motives interact to predict binge drinking and alcohol-related problems in a cross-cultural sample of college students. Participants were undergraduate drinkers ( N = 904; 66% female) from universities in Portugal ( N = 391) and the US ( N = 513). Participants completed measures assessing neuroticism, extraversion, conscientiousness, drinking motives, frequency of binge drinking, and the number of alcohol-related problems. A significant Country × Neuroticism × Conformity interaction was explained by differences between US and Portuguese samples. The effect of this interaction on alcohol- related problems was mediated by binge drinking. Findings suggest similarities and differences across cultures in the manner in which personality and drinking motives are associated with alcohol outcomes. Across cultures, neuroticism, extraversion, conscientiousness, and drinking motives are key factors to consider in the assessment, prevention, and treatment of alcohol use among college students.

BACKGROUND: Venous thromboembolism (VTE) frequently occurs in hospitalized patients with coronavirus disease 2019 (COVID-19). The optimal dose of anticoagulation for thromboprophylaxis in COVID-19 is unknown. AIMS: To report VTE incidence and bleeding before and after implementing a hospital-wide intensified thromboprophylactic protocol in patients with COVID-19. METHODS: On March 31, 2020, we implemented an intensified thromboprophylactic protocol consisting of 50 IU anti-Xa low molecular weight heparin (LMWH)/kg once daily at the ward, twice daily at the intensive care unit (ICU). We included all patients hospitalized in a tertiary care hospital with symptomatic COVID-19 between March 7 and July 1, 2020. The primary outcome was the incidence of symptomatic or subclinical VTE and major bleeding during admission. Routine ultrasound screening for VTE was performed whenever logistically possible. RESULTS: We included 412 patients, of which 116 were admitted to the ICU. Of 219 patients with standard a prophylactic dose of LMWH, 16 (7.3%) had VTE, 10 of which were symptomatic (4.6%). Of 193 patients with intensified thromboprophylaxis, there were no symptomatic VTE cases, three incidental deep venous thrombosis cases (1.6%), and one incidental pulmonary embolism (0.5%). The major bleeding rate was 1.2% in patients with intensified thromboprophylaxis and 7.7% when therapeutic anticoagulation was needed. CONCLUSION: In hospitalized patients with COVID-19, there were no additional symptomatic VTEs and a reduction in incidental deep vein thrombosis after implementing systematic thromboprophylaxis with weight-adjusted prophylactic (ward) to intermediate (ICU), but not therapeutic dosed anticoagulation. This intensified thromboprophylaxis was associated with a lower risk of major bleeding compared with therapeutic dosed anticoagulation. ispartof: RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS vol:6 issue:3 ispartof: location:United States status: published

Efforts to understand and remedy the rejection of science are impeded by lack of insight into how it varies in degree and in kind around the world. The current work investigates science skepticism in 24 countries (N = 5,973). Results show that while some countries stand out as generally high or low in skepticism, predictors of science skepticism are relatively similar across countries. One notable effect was consistent across countries though stronger in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) nations: General faith in science was predicted by spirituality, suggesting that it, more than religiosity, may be the ‘enemy’ of science acceptance. Climate change skepticism was mainly associated with political conservatism especially in North America. Other findings were observed across WEIRD and non-WEIRD nations: Vaccine skepticism was associated with spirituality and scientific literacy, genetic modification skepticism with scientific literacy, and evolution skepticism with religious orthodoxy. Levels of science skepticism are heterogeneous across countries, but predictors of science skepticism are heterogeneous across domains.

Background Thromboinflammation plays a central role in severe COVID-19. The kallikrein pathway activates both inflammatory pathways and contact-mediated coagulation. We investigated if modulation of the thromboinflammatory response improves outcomes in hospitalized COVID-19 patients. Methods In this multicenter open-label randomized clinical trial (EudraCT 2020-001739-28), patients hospitalized with COVID-19 were 1:2 randomized to receive standard of care (SOC) or SOC plus study intervention. The intervention consisted of aprotinin (2,000,000 IE IV four times daily) combined with low molecular weight heparin (LMWH; SC 50 IU/kg twice daily on the ward, 75 IU/kg twice daily in intensive care). Additionally, patients with predefined hyperinflammation received the interleukin-1 receptor antagonist anakinra (100 mg IV four times daily). The primary outcome was time to a sustained 2-point improvement on the 7-point World Health Organization ordinal scale for clinical status, or discharge. Findings Between 24 June 2020 and 1 February 2021, 105 patients were randomized, and 102 patients were included in the full analysis set (intervention N = 67 vs. SOC N = 35). Twenty-five patients from the intervention group (37%) received anakinra. The intervention did not affect the primary outcome (HR 0.77 [CI 0.50-1.19], p = 0.24) or mortality (intervention n = 3 [4.6%] vs. SOC n = 2 [5.7%], HR 0.82 [CI 0.14-4.94], p = 0.83). There was one treatment-related adverse event in the intervention group (hematuria, 1.49%). There was one thrombotic event in the intervention group (1.49%) and one in the SOC group (2.86%), but no major bleeding. Conclusions In hospitalized COVID-19 patients, modulation of thromboinflammation with high-dose aprotinin and LMWH with or without anakinra did not improve outcome in patients with moderate to severe COVID-19. This studywas funded by Life SciencesResearchPartners (LSRP),Research Foundation Flanders (FWO) project G0G4720N and the COVID-19 fund of the KU Leuven. We are grateful to all patients, their family members, and all health care workers who help to perform clinical studies in extraordinary and challenging times during this COVID-19 pandemic, and by doing so contribute to fighting SARS-CoV-2. We would like to express our gratitude to all collaborators, the clinical trial center of UZ Leuven and all participating centers with their study teams for their collaboration and efforts. A list with all collaborators of the DAWn consortium is provided as in Appendix S2. We want to thank the following DAWn collaborators personally: Eric Van Wijngaerden, Wim Janssens, Geert Meyfroidt, Robin Vos, Timothy Devos, Paul De Munter, Johan Neyts, Lieven Dupont, Isabel Spriet, Geert Verbeke, Kathleen Claes, Wim Robberecht, Chris Van Geet, Barbara Debaveye, Helga Ceunen, Veerle Servaes, Katrien Cludts, Kristine Vanheule, Cato Jacobs, Daimy Roebroek, Paulien Dreesen, Nele Smet, Jan Dolhain, Mieke Hoppenbrouwers, Kathleen Wens, Kristel Daems, Monique D'hondt.

BackgroundBehavioral economic theory predicts that low access to environmental reward is a risk factor for alcohol use disorder (AUD). The Substance-Free Activity Session (SFAS) is a behavioral economic supplement to standard brief alcohol interventions that attempts to increase environmental reward and may therefore have beneficial effects, particularly for individuals with low levels of environmental reward.MethodsParticipants were 393 college students who reported at least 2heavy-drinking episodes in the past month. Participants were randomly assigned to 1 of 3 conditions following a baseline assessment: a standard alcohol-focused brief motivational intervention plus relaxation training session (BMI+RT), BMI plus Substance-Free Activity Session (BMI+SFAS), or an assessment-only control condition (AO). In a secondary analysis of the data from this study, we used person-centered statistical techniques to describe trajectories of alcohol severity and environmental reward over a 16-month follow-up and examined whether environmental reward levels moderated the effectiveness of the interventions.ResultsPiecewise growth mixture modeling identified 2 trajectories of reward availability: low increasing (LR; n=120) and high stable (HR; n=273). Depressive symptoms, cannabis use, sensation seeking, and low life satisfaction were associated with a greater probability of classification in the LR trajectory. Alcohol severity was greater in the LR trajectory than the HR trajectory. For students in the LR trajectory, at 1, 6, and 12 months, BMI+SFAS led to greater increases in reward availability and reduced levels of alcohol severity compared with the BMI+RT and AO conditions and at 16months compared with AO.ConclusionsYoung adults with low levels of environmental reward are at heightened risk for greater alcohol severity and may show greater benefit from brief alcohol interventions that focus on increasing substance-free reward than individuals who are not deficient in reward availability.

Background We examined the effect of cold ischemic interval on modern outcomes to determine whether advances in patient management have made an impact. Methods Using the United Network of Organ Sharing database, we reviewed adult heart transplants between January 2000 and March 2016. We divided donor age into terciles: younger than 18 years, 18 to 33 years, and 34 years and older. Within each tercile, transplants were divided by cold ischemic interval of less than 4 hours, 4 to 6 hours, and more than 6 hours. Survival curves were compared between cold ischemic interval categories within each tercile. Covariate-adjusted and donor age-stratified Cox proportional hazards regression models were used to estimate overall mortality and graft failure hazards ratios. Results Of 29,192 transplants, no significant differences between cold ischemic interval groups in survival or graft failure were apparent in the group aged younger than 18. For donors older than 18, significant differences were found for survival and graft failure with cold ischemic interval exceeding 4 hours in both univariate and multivariate analysis, and survival functions at different ischemic intervals continued to diverge beyond 1 year. The interaction effect between donor age and cold ischemic interval on overall mortality was not significant when analyzed as continuous variables, however younger donor age appeared to attenuate increase in overall mortality with longer cold ischemic intervals. Conclusions Despite advances in perioperative management during the past 30 years, for donors older than 18 years, cold ischemic interval exceeding 4 hours is associated with gradual but significantly diminished survival that persists well beyond the perioperative period. Comparison to historical data suggests that advances in management have somewhat attenuated the hazard associated with longer ischemic times.

Objective Despite small single-center reports demonstrating acceptable outcomes using donor hearts with left ventricular dysfunction, 19% of potential donor hearts are currently unused exclusively because of left ventricular dysfunction. We investigated modern long-term survival of transplanted donor hearts with left ventricular dysfunction using a large, diverse cohort. Methods Using the United Network for Organ Sharing database, we reviewed all adult heart transplants between January 2000 and March 2016. Baseline and postoperative characteristics and Kaplan–Meier survival curves were compared. A covariates-adjusted Cox regression model was developed to estimate post-transplant mortality. To address observed variation in patient profile across donor ejection fraction, a propensity score was built using Cox predictors as covariates in a generalized multiple linear regression model. All the variables in the original Cox model were included. For each recipient, a predicted donor ejection fraction was generated and exported as a new balancing score that was used in a subsequent Cox model. Cubic spline analysis suggested that at most 3 and perhaps no ejection fraction categories were appropriate. Therefore, in 1 Cox model we added donor ejection fraction as a grouped variable (using the spline-directed categories) and in the other as a continuous variable. Results A total of 31,712 donor hearts were transplanted during the study period. A total of 742 donor hearts were excluded for no recorded left ventricular ejection fraction, and 20 donor hearts were excluded for left ventricular ejection fraction less than 20%. Donor hearts with reduced left ventricular ejection fraction were from younger donors, more commonly male donors, and donors with lower body mass index than normal donor hearts. Recipients of donor hearts with reduced left ventricular ejection fraction were more likely to be on mechanical ventilation. Kaplan–Meier curves revealed no significant differences in recipient survival up to 15 years of follow-up (P = .694 log-rank test). Cox regression analysis showed that after adjustment for propensity variation, transplant year, and region, ejection fraction had no statistically significant impact on mortality when analyzed as a categoric or continuous variable. Left ventricular ejection fraction at approximately 1 year after transplantation was normal for all groups. Conclusions Carefully selected donor hearts with even markedly diminished left ventricular ejection fraction can be transplanted with long-term survival equivalent to normal donor hearts and therefore should not be excluded from consideration on the basis of depressed left ventricular ejection fraction alone. Functional recovery of even the most impaired donor hearts in this study suggests that studies of left ventricular function in the setting of brain death should be interpreted cautiously.

At-risk gambling is a public health problem that college students engage in at a disproportionate level compared to the general adult population. Brief interventions that incorporate personalized feedback have been efficacious at reducing gambling and related problems. The purpose of the present study was to examine the efficacy of personalized feedback-based interventions delivered via smartphone and text message. Participants were 255 students who met our screening criteria for “problem” or “pathological” gambling, and were randomized to one of three conditions: personalized feedback and follow-up targeted text messages (PFB-TXT); personalized feedback and follow-up educational information about gambling (PFB-EDU); and a control condition that received no personalized feedback or follow-up text messages. Dependent variables included percent days abstinent (PDA) from gambling, average amount wagered on a gambling day, and gambling-related problems. Results indicated that the PFB conditions did not have a direct effect relative to the control condition on the dependent variables at the six-month follow-up, but a statistically significant mediated effect on gambling-related problems via gambling norms did emerge at one-month. No differences between the two PFB conditions in terms of direct or indirect effects on the six-month outcome variables were determined. Findings from this study suggest that the personalized text condition did not provide greater efficacy in changing gambling-related outcomes over general educational messages with personalized feedback. To help explain the lack of direct intervention effects, we explored two hypotheses related to our study design and sample of gamblers.Résumé La pratique des jeux de hasard chez les étudiants universitaires constitue un problème de santé publique, car ils s’y adonnent en nombre disproportionné par rapport à la population adulte générale. Les interventions brèves qui incorporent une rétroaction personnalisée (RP) se sont avérées efficaces pour réduire la fréquence de jeu et les problèmes qui s’y rattachent. Ce projet visait à analyser l’efficacité des interventions axées sur la RP, relayées par téléphone intelligent et messagerie texte. 255 étudiants répondant à nos critères de sélection en matière de « problème de jeu » ou de jeu « pathologique » été répartis aléatoirement en trois groupes. Le premier groupe a reçu une RP et des messages textes de suivi; le deuxième groupe, une RP et du matériel d’information sur le jeu; et le troisième, soit le groupe contrôle, n’a reçu ni rétroaction ni message texte. Les variables dépendantes (VD) incluaient : le pourcentage de jours d’abstinence; la somme moyenne misée les jours de pari; ainsi que les problèmes de jeu. Selon nos résultats, la RP n’a aucun effet direct sur les VD au 6e mois de suivi par rapport au groupe contrôle; toutefois, on a constaté au 1er mois un effet de médiation statistiquement significatif d’une variable relative aux habitudes de jeu sur les problèmes de jeu. Par ailleurs, aucune différence n’a été observée entre les deux interventions quant à leur effet direct ou indirect sur les VD au 6e mois. Selon nos conclusions, la RP ne serait pas plus efficace que les messages d’information générale en ce qui touche l’incidence sur les problèmes de jeu. Pour tenter d’expliquer cette absence d’effet de l’intervention directe, nous proposons deux hypothèses, l’une relative à la méthodologie de notre étude et l’autre, à l’échantillon des joueurs.

Little research exists on how partners of sex offenders are perceived. Using attachment theory, we hypothesised that one's attachment would generalise to perceptions of sexual offenders and their partners. One hundred and six British adults’ attachment styles were assessed, as well as perceptions of sex offenders and their partners. Generally, perceivers’ attachment avoidance was associated with positive perceptions of both partners and offenders, while attachment anxiety was associated with negative perceptions of partners but positive perceptions of sex offenders. Perceptions of sex offenders and their partners were highly correlated and negative in nature, and sex offenders were more negatively perceived.

Conditional Direction Dependence Analysis (CDDA) has recently been proposed as a statistical framework to test reverse causation ( x → y vs. y → x) and potential of confounding ( x ← c → y) of variable relations in linear models when moderation is present. Similar to standard DDA, CDDA assumes that the “true” predictor is a continuous, non-normal, exogenous variable. Under non-normality, a conditional causal effect of one variable does not only change means, variances, and covariances, but also the distributional shape (i.e., skewness, kurtosis, co-skewness, and co-kurtosis) of another variable given the moderator. Such distributional changes can be used to study underlying mechanisms of heterogenous causal effects. The present study introduces conditional direction of dependence modeling and presents SPSS macros to make CDDA easily accessible to applied researchers. A real-world data example from the field of gambling addiction research is used to introduce the functionality of CDDA SPSS macros. Limitations of CDDA due to violated assumptions and poor data quality are discussed. The CDDA installation package is available at no charge from www.ddaproject.com .

Tailgating drinking prior to a football game is a type of event-specific drinking associated with increased alcohol use and related problems. Personalized drinking feedback interventions (PFI) are efficacious in reducing alcohol use and problems. The current study aimed to advance understanding of event-specific interventions by examining: (1) the efficacy of an event-specific, text message PFI on tailgating alcohol outcomes, and (2) the extent to which intervention effects generalize to "typical" alcohol outcomes at 1-month follow-up. College students (N = 130; 71% female; 92% white) who reported tailgating within the past 30 days and binge drinking when tailgating in the past year completed assessments on tailgating and typical alcohol use. They were randomly assigned to one of two text message conditions delivered on the morning of a home football game: event-specific PFI (TXT PFI) or a control condition. Multilevel modeling examined the association of treatment condition on tailgating and 1-month alcohol outcomes. When tailgating, participants in TXT PFI reported lower estimated peak blood alcohol concentration (eBAC) and consumed less drinks than the control condition. At the 1-month "typical" drinking follow-up, participants in TXT PFI reported lower peak eBAC and fewer alcohol-related problems than the control condition. Perceived tailgating drinking norms were found to statistically mediate the relationship between condition and alcohol outcome at tailgating and 1-month follow-ups. Findings provide preliminary support for the efficacy of an event-specific, text message PFI in reducing both tailgating and typical drinking alcohol outcomes. Event-specific TXT PFI can be used for prevention/intervention of alcohol misuse.

Alcohol use is highly comorbid with depression, especially among college students, whose rates of both phenomena are higher than in the general population. The self-medication hypothesis (i.e., alcohol use is negatively reinforced via the alleviation of negative affect) has dominated explanatory models of comorbidity. However, self-regulation has also demonstrated cross-sectional relationships with both depression and alcohol problems and may contribute to the development of alternative comorbidity models. Self-regulation introduces three alternative models that can be tested empirically: (a) a depressed regulation model, (b) a central nervous system depressant model, and (c) a self-regulatory failure model. The purpose of this study was to test the utility of these models (in addition to the self-medication hypothesis) by examining the temporal precedence in the relations between self-regulation, depressive symptoms, and alcohol problems among heavy-drinking college students (N = 393) over 5 assessment points (baseline, 1 month, 6 months, 12 months, and 16 months) using an autoregressive cross-lagged model. Lower self-regulation, and higher alcohol problems and depressive symptoms, prospectively predicted higher depressive symptoms. Higher alcohol problems and lower self-regulation prospectively predicted higher alcohol problems. Only self-regulation prospectively predicted self-regulation. These results were consistent across multiple time points. Findings are consistent with a self-regulatory failure model of depressive symptoms and alcohol problems. Therefore, self-regulation may be an important etiological variable and potential intervention target to reduce both alcohol problems and depressive symptoms among college students. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective Behavioral economic theory suggests that a reduction in alcohol use is most likely when there is an increase in rewarding substance-free activities. Anxiety has also been linked to heavy drinking, and strategies to reduce anxiety may enhance alcohol interventions. The goal of this 2-site randomized controlled clinical trial was to evaluate the efficacy of a brief alcohol intervention that was supplemented with either a behavioral economic substance-free activity session (SFAS) or a relaxation training (Relaxation training [RT]) session. Method Participants were 393 college students (61% female, mean age = 18.77 years) who reported 2 or more past-month heavy drinking episodes. Participants were randomized to 1 of 3 conditions: (a) assessment; (b) alcohol brief motivational intervention (BMI) plus SFAS; or (c) BMI plus RT. Both treatment conditions included 2 in-person sessions plus a phone booster session. Outcomes were evaluated 1-, 6-, 12-, and 16-months postintervention. Results Generalized linear mixed models indicated that the combination of a BMI plus either the SFAS or RT was associated with significant reductions in alcohol use and problems across the 16-month follow-up compared with assessment only. There were no significant differences between the two active treatment conditions. Changes in proportional reinforcement from substance-related activities, and protective behavioral strategies mediated treatment effects. Conclusion Two-session (plus booster) interventions that combine BMI and either substance-free activity enhancement or RT can result in enduring reductions in alcohol misuse among college drinkers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

INTRODUCTION Behavioral economic theory views addiction as a reinforcer pathology characterized by excessive demand for drugs relative to alternatives. Complementary to this theory, Lamb and Ginsburg (Pharmacology Biochemistry and Behavior, 164, 2018, 62) describe addiction as a behavioral allocation disorder and predict that decisions to drink under increasingly stringent constraints are a central indicator of addiction. This study used a modified demand-curve paradigm to examine alcohol demand in the context of a next-day contingency (high opportunity cost demand) as a specific indicator of a severe pattern of alcohol problems. METHODS Participants were 370 undergraduates (61.1% female, 86.5% white, Mage = 18.8) reporting multiple past-month heavy drinking episodes (5/4 drinks per occasion for men/women) who completed 2 versions of an alcohol purchase task (APT), along with measures of past-month alcohol use and problems. In 1 APT (low opportunity cost), students imagined they had no next-day responsibilities, and in the other APT (high opportunity cost), they imagined having a 10:00 am test the next day. Item-response theory analyses were used to determine mild and severe alcohol problems from the Young Adult Alcohol Consequences Questionnaire (Journal of Studies on Alcohol, 67, 2006, 169), and the most and least severe binge drinking days throughout the week. RESULTS Low opportunity cost demand (β = 0.15, p = 0.02) significantly predicted beyond high opportunity cost demand for the least severe problems, and high opportunity cost demand (β = 0.17, p = 0.009) significantly predicted beyond low opportunity cost demand for the most severe problems. Similarly, low opportunity cost demand (β = 0.26, p

Author(s): Acuff, Samuel F; Voss, Andrew T; Dennhardt, Ashley A; Borsari, Brian; Martens, Matthew P; Murphy, James G | Abstract: BackgroundAlcohol-induced blackouts, a form of anterograde amnesia that restricts the encoding of short-term memories into long-term ones, are among the most severe alcohol-related consequences. College students are at high risk of experiencing alcohol-induced blackouts, and there is a need to determine whether alcohol interventions can effectively reduce blackouts in this population. The current study uses data from 3 randomized clinical trials to examine the effect of various intervention approaches on alcohol-induced blackouts.MethodsFour interventions were compared over 3 studies: (i) a computerized feedback intervention (electronic Check-Up To Go [e-Chug]; Study 1); (ii) a single-session brief motivational intervention (BMI; Study 1); (iii) a BMI plus behavioral economic session focused on increasing substance-free activities (BMI + Substance-Free Activity Session [SFAS]; Studies 2 and 3); and (iv) a BMI plus supplemental Relaxation Training session (BMI + Relaxation Training; Studies 2 and 3). Studies 1 and 3 also included an assessment-only control condition. For each study, participants reported whether they had experienced an alcohol-induced blackout at each time point; binary logistic regressions examined differential likelihood of experiencing an alcohol-induced blackout over time.ResultsNeither the single-session BMI nor e-Chug reduced alcohol-induced blackouts over assessment only; however, participants in the BMI + SFAS or BMI + Relaxation Training condition were significantly less likely to experience an alcohol-induced blackout compared to assessment only at 1-month (Wald = 4.77, odds ratio [OR] = 0.53, p = 0.03) and 6-month follow-ups (Wald = 5.72, OR = 0.52, p = 0.02). Study 2 also revealed a larger effect for the BMI + SFAS over the BMI + Relaxation Training condition at 6 months (Wald = 4.11 OR = 0.22, p = 0.043), although this was not replicated in Study 3. The effects for the 2-session BMIs lasted 6 months, at which point maturation effects diminished differences between assessment-only and intervention conditions.ConclusionsTwo sessions of BMI are a substantial enough dose to result in reductions in alcohol-induced blackouts among college student heavy drinkers.

The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology

Non-verbal expressions of pride convey status. But pride displays can be interpreted as either authentic or hubristic. Given negative stereotypes about Blacks, we hypothesized that when displaying pride, Blacks would be rated higher in hubristic and lower in authentic pride compared to Whites. Contrary to predictions, three experiments found consistent evidence that Whites are judged to be more hubristic than Blacks when displaying pride. This effect occurred when pride was displayed in an unspecified (Study 1), academic (Study 2), or work-related context (Study 3). Effects were largely specific to pride displays and not a function of a general race-based response bias. We speculate that these counterintuitive findings might reflect a negative reaction to those with high status flaunting their success.

Background Reward deprivation has been implicated in major depressive disorder and severe substance abuse, but its potential relation to alcohol use disorder (AUD) symptoms in non-treatment-seeking young adult drinkers is less clear. Depression is often comorbid with alcohol misuse, so relations of AUD with reward deprivation might be due in part to the presence of depressive symptoms in young adults. Behavioral economic theory views addiction as a state that is related in part to deficits in drug-free rewards, and therefore requires an investigation into whether reward deprivation has a direct relation to alcohol misuse that is, at least partially, independent of mood. Methods This study evaluates the contribution of 2 facets of reward deprivation (reward availability and experience) to alcohol use, AUD symptoms, and depression in a sample of young adult heavy episodic drinkers. Data were collected from 392 undergraduates (60.4% female, 85.1% Caucasian) who reported recent heavy drinking (83.7% with at least 1 AUD symptom). Results Low reward availability (environmental suppression) was significantly associated with both DSM-5 AUD symptoms and alcohol-related problems after controlling for age, gender, depressive symptomatology, and drinking level. Conclusions This study provides support for behavioral economic models that emphasize reward deprivation as a unique risk factor for AUD that is independent of mood and drinking level. Limited access to natural rewards may be a risk and/or maintaining factor for AUD symptoms in college student drinkers.

Prior research has indicated that relative to other specialty areas in psychology, counseling psychology researchers are less likely to engage in research activities sponsored by external funding agencies. The primary purposes of this article were to address external funding in the counseling psychology profession and to compare the rates of articles published in the premier counseling psychology research journal ( Journal of Counseling Psychology [ JCP]) that reported external funding to other specialty areas’ premier research journals. Between 2007 and 2011, articles in JCP were less likely than those in other journals to report external funding and less likely to report research designs associated with external sponsorship. Post hoc analyses indicated that articles in a leading vocational research journal also had relatively low rates of external funding, and counseling psychology faculty members were less likely than peers in other programs to report external funding. The implications of these findings for the field are discussed.

The Meaning Maintenance Model posits that individuals seek to resolve uncertainty by searching for patterns in the environment, yet little is known about how this is accomplished. Four studies investigated whether uncertainty has an effect on people's cognitive functioning. In particular, we investigated whether meaning threats lead to increased working memory capacity. In each study, we exposed participants to either an uncertain stimulus used to threaten meaning in past studies, or a control stimulus. Participants then completed a working memory measure, where they either had to recall lists of words (Studies 1, 2), or strings of digits (Studies 3, 4). We used both a frequentist approach and Bayesian analysis to evaluate our findings. Across the four studies, we find a small but consistent effect, where participants in the meaning threat condition show improved performance on the working memory tasks. Overall, our findings were consistent with the hypothesis that working memory capacity increases when people experience a meaning threat, which may help to explain improved pattern recognition. Additionally, our results highlight the value of using a Bayesian analytic approach, particularly when studying phenomena with high variance.

Behavioral economic theory suggests that increased engagement in constructive, substance-free activities that are in the service of long-term goals (e.g., college graduation, career development, health) can decrease alcohol use and related problems. However, engaging in activities such as these in the high-risk college environment requires the ability to self-regulate by avoiding rewarding but risky behaviors (e.g., drinking) while also effectively organizing behavior in the pursuit of delayed academic and career-related rewards. The current secondary data analyses evaluated self-regulation as a potential mechanism of behavior change in an alcohol intervention trial that compared a standard alcohol-focused brief motivational intervention (BMI) plus a behavioral economic substance-free activity session (SFAS) with an alcohol BMI plus relaxation training (reaction time [RT]) session (Murphy et al., 2012). Participants were 82 first-year undergraduate students (50% women; Mage = 18.5, SD = .71) who reported 2 or more past-month heavy drinking episodes. After completing a baseline assessment and an individual alcohol-focused BMI, participants were randomized to either the SFAS or the RT session. The BMI + SFAS condition reported greater mean self-regulation at 1 month compared with BMI + RT. Furthermore, self-regulation at 1 month significantly mediated the relation between condition and alcohol-related outcomes at 6-month follow-up. Although preliminary, these results suggest that brief behavioral economic intervention elements that an attempt to increase future goal pursuit and substance-free activities can enhance the short-term efficacy of standard alcohol BMIs and that this effect may be due in part to increases in self-regulation. (PsycINFO Database Record

Behavioral economic measures of alcohol reward value and future orientation have received support as predictors of alcohol consumption, alcohol-related problems, and response to intervention. Protective behavioral strategies (PBS) have been shown to be a significant mediator between a variety of risk factors and alcohol-related problems. The current article examines direct and mediating associations between measures of alcohol reward value (proportionate substance-related activity participation and enjoyment) and future orientation, use of PBS, and alcohol-related problems. Participants were 393 undergraduates (39.2% male, 78.9% Caucasian) who reported at least 2 past-month binge drinking episodes (5 and 4 drinks for men and women, respectively). This study is a secondary analysis of data collected previously as part of a brief intervention study. Alcohol reward value and future orientation were significantly associated with both protective behavioral strategies and alcohol problems. PBS was a significant partial mediator between these variables and alcohol-related problems after controlling for gender, level of alcohol consumption, and sensation seeking. This study provides support for the hypothesis that high levels of reinforcement from alcohol relative to alternatives and low consideration of the future may lead to patterns of dysregulated drinking with few harm-reduction strategies that increase risk for alcohol problems. In addition to directly targeting PBS, brief alcohol interventions for college students should attempt to increase future orientation and substance-free activities. (PsycINFO Database Record

Aims: Decisive evidence on the optimal diuretic agent, dosing schedule, and administration route is lacking in acute heart failure (AHF) with congestion. The Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) trial is designed to test the hypothesis that the carbonic anhydrase inhibitor acetazolamide, a potent inhibitor of proximal tubular sodium reabsorption, improves decongestion when combined with loop diuretic therapy in AHF, potentially leading to better clinical outcomes. Methods: The ADVOR trial is set up as a multicentre, randomized, double-blind, placebo-controlled study, aiming to recruit 519 patients with AHF and clinically evident volume overload. All study participants receive high-dose intravenous loop diuretics as background therapy and are randomized towards intravenous acetazolamide at a dose of 500 mg once daily vs. placebo, stratified according to including study centre and ejection fraction (< 40% vs. ≥ 40%). The primary endpoint is successful decongestion with no more than trace oedema assessed on the third morning after hospital admission, with good diuretic efficacy defined as a urine output > 3.5 L during the first 30–48 h of decongestive treatment. Secondary endpoints include all-cause mortality or heart failure readmission after 3 months, length of hospital stay for the index admission, and longitudinal changes in the EuroQol-5 dimensions questionnaire. Conclusion: ADVOR will investigate if acetazolamide combined with loop diuretic therapy improves decongestion in AHF with volume overload. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology