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Aktuell ist jeder zehnte alterstraumatologische Patient dauerhaft antikoaguliert. Zur oralen Antikoagulation stehen Vitamin-K-Antagonisten (VKA) und direkte orale Antikoagulanzien (DOAK) zur Verfügung. Inzwischen beträgt der Verordnungsanteil der DOAK mehr als 60 %. Dabei handelt es sich um eine eher neue Wirkstoffklasse, deren antikoagulatorischer Effekt auf der Hemmung spezifischer Gerinnungsfaktoren (Faktor (F)-IIa, FXa) beruht. Aufgrund geringerer Blutungsrisiken, kürzerer Halbwertszeiten, einer fehlenden Notwendigkeit für ein regelmäßiges Monitoring sowie selteneren Arznei- und Lebensmittel-Interaktionen ist absehbar, dass die DOAK weiter an Bedeutung gewinnen und die etablierten VKA nach und nach ablösen werden. In etwa 15 % der Fälle müssen Patienten ihre antikoagulatorische Medikation für eine Operation (OP) unterbrechen. Trotz zunehmender Erfahrungen und existierender Empfehlungen stellt das perioperative DOAKManagement eine Herausforderung im klinischen Alltag dar. Die vorliegende Studie untersuchte den Einsatz von DOAK im perioperativen Setting der Alterstraumatologie des Zentrums für Orthopädie und Unfallchirurgie (ZfOU) des Uniklinikum Gießen und Marburg – Standort Marburg. Neben einer Darstellung des bisherigen perioperativen Vorgehens sollte diese Arbeit evaluieren, ob die DOAK-Einnahme den OP-Zeitpunkt bei Patienten mit proximaler Femurfraktur verzögert. Weiter sollte die Adhärenz zu bestehenden Empfehlungen analysiert und auf Basis der gewonnenen Ergebnisse eine präoperative Checkliste entwickelt werden. In der retrospektiven Studie wurden die Krankenakten aller >60-jährigen Patienten mit DOAKMedikation, die von 2015–2016 am ZfOU aufgrund eines operativen Eingriffs stationär behandelt wurden, ausgewertet. Untersucht wurden Patientencharakteristika, OP-spezifische Parameter (z. B. Blutungsrisiko des Eingriffs) sowie Aspekte des perioperativen Verlaufs (z. B Auftreten von Komplikationen). Bei der Entwicklung der Checkliste für den klinischen Alltag wurde neben den eigenen Daten auch der über eine Literaturrecherche ermittelte aktuelle Wissensstand berücksichtigt. Eingeschlossen wurden 112 Patienten (FIIa- Inhibitor: n=19, 17 %; FXa-Inhibitor: n=93, 83 %) mit einem mittleren Alter von 78±8 Jahre. Das Kollektiv bestand aus (multi-) morbiden Patienten unter Polypharmazie (Anzahl an Medikamenten bei Entlassung 10±3) mit einer hohen Prävalenz für Nierenfunktionseinschränkungen (anamnestisch n=20, 17,9 %, laborchemisch n=66, 74,1 %). Die häufigste Indiktion für die DOAK-Einnahme war Vorhofflimmern (n=68, 73,9 %). 70 % der primären OPs gingen mit einem niedrigen Blutungsrisiko einher. Die häufigste Diagnose waren Frakturen der unteren Extremität (n=28, 30,1 %). Die mittlere Dauer zwischen stationärer Aufnahme und operativer Versorgung betrug 34±38 h, die mittlere OP-Dauer 79±53 min. Bei 98 % der Patienten wurde die antikoagulatorische Medikation perioperativ pausiert (präoperativ 48±44 h, postoperativ 238±240 h). Es bestand kein signifikanter Unterschied bei der präoperativen Pausierungsdauer in Abhängigkeit vom intraoperativen Blutungsrisiko (p=0,466). 90 % der Patienten erhielten Enoxaparin (ClexaneÒ); 60 % davon in therapeutischer Dosierung und wurden somit einer Bridging-Maßnahme unterzogen. Signifikante Unterschiede beim perioperativen Vorgehen zwischen der FIIa- und FXa-Inhibitor-Gruppe fehlten. Bei 43 % der Patienten trat postoperativ mindestens eine Komplikation auf. Dabei dominierten systemische oder mechanische Komplikationen. Fünf Patienten (3,8 %) erlitten eine Blutungskomplikation, bei 16 Patienten (12,1 %) kam es zu einem Hämoglobin-Abfall und bei einem Patienten (0,8 %) zu einem thrombembolischen Ereignis. Ein Vergleich des perioperativen Managements mit den bestehenden Empfehlungen ergab eine mangelnde Adhärenz insbesondere beim postoperativen Vorgehen im Sinne einer Verlängerung der Pausierung. Ausgenommen davon waren Patienten mit Hochrisiko-Konstellationen (z. B. schwer eingeschränkte Nierenfunktion, hohes intraoperatives Blutungsrisiko), die entsprechend den Empfehlungen behandelt wurden. Die Datenanalyse ergab eine Reihe von Faktoren, die im perioperativen Management berücksichtigt und präoperativ exploriert werden sollten. Auf der Basis der Studienergebnisse und der Literaturauswertung wurde für das ZfOU eine Checkliste entwickelt. Die proximale Femurfraktur ist eine häufige Verletzung in der Alterstraumatologie, bei der der OPZeitpunkt die Morbidität und Mortalität stark beeinflusst. Daher existieren klare Richtlinien für die operative Versorgung. Die DOAK-Einnahme gilt als Risikofaktor für eine verspätete operative Versorgung. Im vorliegenden Kollektiv wurden Patienten mit proximaler Femurfraktur (16 % des Gesamtkollektivs) signifikant (p=0,043) früher operiert als Patienten mit anderen Verletzungen. Die mittlere Zeit zwischen Aufnahme und OP (17±9 h) war am ZfOU kürzer als in vergleichbaren Studien. Zusammengefasst deuten die Ergebnisse auf ein heterogenes Vorgehen im perioperativen Setting trotz klarer Empfehlungen hin. Zur Verbesserung dieser Situation bedarf es weiterer prospektiver Studien, insbesondere für nicht elektive Eingriffe sowie für Hochrisikokonstellationen. Der fehlende Vergleich mit nicht-antikoagulierten Patienten und Patienten unter VKA sowie die fehlende Differenzierung von elektiven und Notfall-OPs limitiert Aussagekraft der Studie. Die erarbeitete Checkliste kann helfen, das perioperative Vorgehen zu optimieren und die Patientensicherheit zu erhöhen. Auch für die Konzeption sowie Datenerhebung zukünftiger Studien könnte die Checkliste nützlich sein. Letztlich bleibt aber das Vorgehen bei jedem Patienten aufgrund seiner individuellen Charakteristika und Risikofaktoren eine Einzelfallentscheidung.

Effectively communicating hazardous weather conditions to the general aviation (GA) community is acontinuously evolving effort of US National Weather Service (NWS) Aviation Weather Center (AWC)operations. AWC has started to transition text heavy products in favor of easily interpreted dynamicgraphics that provide additional information that was never fully realized through text alone.AWC provides domestic and international aviation weather forecasts and warnings, disseminatedthrough traditional product dissemination as well as directly to end users through AviationWeather.gov.The web site is currently undergoing a complete rewrite, in order to both modernize and improveconsistency. Customer feedback has been gathered over multiple years and the rewrite is intended toaddress a number of issues in a comprehensive manner.Many products that were previously available in multiple formats are now presented through a moreintegrated framework, allowing for the user to combine different datasets as desired. The GraphicalForecasts for Aviation (GFA), first developed as a replacement for the traditional text Area Forecast,now spans a wide variety of weather information in a one stop Geographic Information Systems (GIS)interactive web framework. The site is designed to adjust to available screen real estate, making thesame data and interface available on a variety of platforms from desktop computers to tablets andphones.The new site has been in an experimental status since spring of 2022, while AWC collects feedback onthe new design and performed a social science user assessment in partnership with the US FederalAviation Administration’s (FAA) Aviation Weather Demonstration and Evaluation service group. Thispresentation will discuss the design and features of the new site, as well as lessons learned from theaviation weather user community during the development and evaluation.

This study aims to investigate people’s responses to criticism of their meat-eating behaviour. Specifically, the study focuses on the content of the criticism—whether the criticism targets the recipient’s morality or competence. Past research has shown that when faced with criticism, people’s responses are influenced by how the criticism was framed. When the criticism is framed as a moral failure rather than a lack of competence, people demonstrate more defensive responses (Täuber & van Zomeren, 2013). For example, Rösler et al. (2021) found that when people were asked to recall moral criticism (criticism accusing them of being insincere or dishonest), they tended to think that the critic was not trustworthy and the criticism was not credible, compared to recalling competence criticism (criticism accusing them of being incompetent or unintelligent). As the behaviour of eating meat can be conceived as a choice due to lack of morality (not caring about the environment) or competence (not knowing how to prepare plant-based meals), it begs the question that which type of criticism might be more effective in eliciting behavioural change and which one might lead to self-defensiveness. The study was therefore designed to test the hypothesis that moral criticism will trigger more defensive responses.

Self-transcendent emotions such as awe have been shown to reduce narcissism-like states and behaviours. However, whether trait narcissism affects the capacity to feel such emotions has to our knowledge yet to be investigated. This study will therefore cross-sectionally and experimentally investigate the relationship between narcissistic rivalry and the capacity to feel self-transcendent emotions awe and moral elevation, as well as any differences between awe and moral elevation in regard to this association.

Three studies tested a novel model of the narcissism-paranoia link, whereby narcissism (primarily its socially maladaptive facets) is associated with paranoia via over-use of defensive self-protection and/or under-use of self-affirmation.In Study 1, 245 online volunteers (87% female; MIn Study 1, narcissism was associated with higher paranoia via defensiveness. In Study 2, this was replicated in difficult but not pleasant events, and was driven by the Entitlement/Exploitativeness facet of narcissism. In Study 3, narcissistic rivalry and vulnerable narcissism, but not admiration, were associated with Cyberball-related paranoia via general defensiveness and denigration of others.Individuals high in narcissism-especially its socially maladaptive facets-who over-rely on defensive self-protection strategies in response to threat, are particularly vulnerable to paranoia. Findings help to understand individual differences in paranoia.

Preliminary survey study examining self-related predictors of resilience to weight stigma among adults of different weights

The following study addresses the research question of whether intellectual modesty correlates with self-efficacy expectancy. The sub-dimensions of intellectual modesty are examined individually with self-efficacy expectancy. Through an extensive literature review, interest in this topic area was sparked and is now intended to complement and extend the existing body of research. This is because there is still much need for high quality research findings specifically on intellectual modesty.

Data files created by Sapphira Thorne in the course of completed a PhD at the University of Surrey under the supervision of Peter Hegarty and Erica Hepper.

Pre-registration of data analysis for survey study on nonclinical paranoia and its self-reported behavioural consequences

Prior research on moral disengagement has indicated that individuals may engage in morally questionable or immoral behaviour by applying a range of cognitive mechanisms that allow them to perform such behaviour without experiencing much guilt or self-censure (Bandura et al., 1996). In other words, moral disengagement mechanisms serve to maintain agents’ moral self-image when they perform unethical deeds. However, it is less clear why a preserved or protected moral self-image would drive people to engage in less-than-virtuous behaviour that can potentially damage their moral social image. This study will investigate whether a positive moral self-regard allows people to combat potential moral criticism by considering and calling the criticism unjust. This investigation is important as it may help us better understand when moral criticism could change the recipient’s behaviour (and thus serves its social function of regulating behaviours) and when the criticism might lead the recipient to retaliate (and thus cause the opposite effect and spark conflicts). This study focuses on the context of climate change and seeks to manipulate the notion of moral disengagement by exploring a mechanism of “responsibility shifting”. This mechanism is related to the original mechanism “diffusion of responsibility” developed by Bandura. Yet unlike “diffusion of responsibility”, “responsibility shifting” does not describe how people attribute responsibility to other individuals, but to specific entities, namely governments and fossil fuel companies, for responding to climate change. We will explain our hypotheses in the next section

Nostalgia is an emotion that confers psychological benefits. The literature has neglected romantic nostalgia—that is, nostalgia specifically for past experiences shared with one’s partner—and its potential advantages for relationships. We examined romantic nostalgia in one correlational study, two experiments, and one daily diary study ( N = 638). Romantic nostalgia was positively associated with greater relationship commitment, satisfaction, and closeness (Study 1). Additionally, inducing romantic nostalgia via a writing task (Study 2) or music (Study 3) strengthened relational benefits. Finally, participants reported more positive relationship-specific experiences on days when they felt greater romantic nostalgia (Study 4). We discuss contributions to the nostalgia and relationships literatures.

We propose criteria for assessing the cross-cultural universality of cognitive representations that underlie complex psychological constructs. According to prototype theory, complex constructs are cognitively represented in terms of central and peripheral features. The cross-cultural universality of a complex construct, then, pertains to the level of agreement among cultures with regard to these central and peripheral features. We specify four criteria for cross-cultural universality: (1) similar ordinality in features, (2) consistency in rating central (compared to peripheral) features, (3) distinctiveness of feature sets, and (4) similar elevations in prototypicality for feature sets. We suggest simple statistical techniques to evaluate these criteria and demonstrate them in a case study assessing the cross-cultural universality of nostalgia conceptions. The proposed methodology is generative and provides a viable alternative to the restrictive multiple-group confirmatory factor analysis procedures that have impeded progress in this research area.

Taser was introduced into UK policing in 2003 to bridge the operational gap between use of incapacitant sprays and firearms. Use of force reporting in the UK indicates that Taser is relatively safe provided that it is used lawfully. Taser use can result in injuries and has been implicated in a small number of deaths. The latest version of the weapon, the TASER 7, has entered UK policing. The TASER 7 uses a novel probe that has implications for the medical community. A review of Taser medical effects and probe removal for TASER 7 are presented.

This thesis was scanned from the print manuscript for digital preservation and is copyright the author. Researchers can access this thesis by asking their local university, institution or public library to make a request on their behalf. Monash staff and postgraduate students can use the link in the References field.

Supplemental Material, sj-pdf-1-spr-10.1177_02654075221075773 for Romantic nostalgia as a resource for healthy relationships by Nicholas D. Evans, Jacob Juhl, Erica G. Hepper, Tim Wildschut, Constantine Sedikides and Adam K. Fetterman in Journal of Social and Personal Relationships

Improving the quality of life for individuals with severe dysphagia is a priority when considering new areas of dysphagia management, especially if this increases opportunities to participate in social activities associated with eating and drinking. Edible foam is widely researched and available in the food industry; however, the use of edible foam within the field of dysphagia remains unexplored. Despite no research published on effectiveness and safety, a commercial product currently on the market is widely distributed across both Europe and the UK, including 28 NHS Trusts, suggesting that it is increasingly being used in clinical practice.To explore the perceptions and experiences of healthcare professionals on the use of stabilized edible foam (SEF) with adults with severe dysphagia in order to inform areas for future research in this novel dysphagia intervention.Healthcare professionals were recruited using purposeful sampling and snowballing technique. A total of 56 healthcare professionals were initially approached, of which 10 completed the semi-structured interviews. Interview questions were developed from a topic guide and a pilot questionnaire.Thematic analysis was used to identify three themes: potential impact, consideration of risk and perceived experiences. Overarching each of these themes was the element of the unknown.Use of SEF with adults with dysphagia is in its infancy. Whilst results indicate that some clinicians are embracing this novel approach, others express concerns. Therefore, further research is needed, particularly in relation of direct experience of individuals and contra-indications.What is already known on the subject The use of SEF with individuals with swallowing problems is a relatively novel area of dysphagia intervention in the UK. There are currently no published studies on its effectiveness and safety profile. What this paper adds to existing knowledge This study provides valuable preliminary work into the area of SEF and adults with severe dysphagia, capturing the experience and perceptions of healthcare professions who have an awareness of SEF. What are the potential or actual clinical implications of this work? Increasing clinicians and researcher's awareness of this novel area of dysphagia management.

Summary Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.

Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. This review’s aim was to classify and describe the issues with current systems when used in blast, identify deficiencies in the literature, and propose scope for improvements of scoring systems. Strengths of current scoring systems include the ability to highlight survival trends for populations, thus allowing for assessment of medical advances. The review identified the major limitations of current scoring systems as: the inability to accurately and reliably predict mortality outcomes for an individual patient; the saturation effect, where scoring systems are unable to discriminate between high injury score individuals; and underrepresentation of blast injuries by omitting: systemic effects, the effect of the overall injury burden, lack of precision in discriminating between injury mechanism, and lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare, and the delay between injury and presentation. It is an open question whether these should be incorporated in scoring systems. We recommend that a new score adapt the severity of injuries to the blast mechanism. This may include refined and additional codes, and severity scores, being added to the AIS system for high frequency blast-specific injuries; a weighting for body regions of higher risk of fatality; and blast specific trauma coefficients. Finally, the saturation effect (maximum value) be removed enabling classification of more severe injury constellations

Conducted energy devices (CEDs) are designed to immobilise aggressive individuals through the application of an electrical discharge administered via probes fired at the subject. Although the discharge is intended to disrupt voluntary movement, CEDs have their limitations and several factors are qualitatively understood to adversely influence CED effectiveness. The introduction of the twin-cartridge TASER X2™ into UK policing in 2017 provided a unique opportunity to undertake a quantitative assessment of the factors modulating probe discharge effectiveness based on data reported by police officers firing the device operationally. The overall operational subdual effectiveness of the TASER X2™ was 68.5%. However, several factors were identified that could alter the likelihood of achieving subdual of the subject. The officer-reported data show that probe discharge was highly effective at subduing subjects when both probes had penetrated the skin, least effective when both probes were in clothing and confirmed the reduced effectiveness of narrow probe spreads. The most commonly cited reasons why probe discharge failed to subdue the subject were thick or loose clothing, probe misses and narrow probe spread. These findings, which are likely to generalise to other types of CED, may be used to inform tactics and training to optimise the likelihood of achieving incapacitation when probes are deployed, with benefits for the safety of both the police and the public. The findings may also assist investigations requiring the reconstruction of incidents in which probe discharge has been deployed.