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Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often impossible. Inaccurate estimations may lead to inaccurate drug doses, which may cause patient harm. Little is known about the relative accuracy of different methods of weight estimation that could be used during resuscitative care. The aim of this study was to evaluate the performance and suitability of existing weight estimation methods for use in adult emergency care. A systematic literature search was performed for suitable articles that studied the accuracy of weight estimation systems in adults. The study characteristics, the quality of the studies, the weight estimation methods evaluated, the accuracy data, and any information on the ease-of-use of the method were extracted and evaluated. A total of 95 studies were included, in which 27 different methods of total body weight estimation were described, with 42 studies included in the meta-analysis. The most accurate methods, determined from the pooled estimates of accuracy (the percentage of estimates within 10% of true weight, with 95% confidence intervals) were 3-D camera estimates (88.8% (85.8 to 91.8%)), patient self-estimates (88.7% (87.7 to 89.7%)), the Lorenz method (77.5% (76.4 to 78.6%)) and family estimates (75.0% (71.5 to 78.6%)). However, no method was without significant potential limitations to use during emergency care. Patient self-estimations of weight were generally very accurate and should be the method of choice during emergency care, when possible. However, since alternative estimation methods must be available when confused, or otherwise incapacitated, patients are unable to provide an estimate, alternative strategies of weight estimation should also be available. [ABSTRACT FROM AUTHOR]

Cannabis is increasingly consumed and increasingly perceived as harmless. Among those whose use develops into a cannabis use disorder (CUD), <5% initiate and engage in treatment. Thus, novel options for low-barrier, appealing treatments are needed to foster engagement in care. We conducted an open trial of a telehealth-delivered multicomponent behavioral economic intervention for non-treatment-engaged adults with CUD. Participants with CUD were recruited from a health system and screened for eligibility. Participants completed behavioral economic indices (cannabis demand, proportionate cannabis-free reinforcement), measures of cannabis use and mental health symptoms, and provided open-ended feedback on the intervention experience. Of the 20 participants who enrolled and engaged in the initial intervention session, 70% (14 out of 20) completed all intervention components. All participants were satisfied/very satisfied with the intervention and 85.7% reported the telehealth delivery made it at least slightly easier/more likely for them to receive substance use care. Baseline to immediate post-treatment, behavioral economic cannabis demand decreased (intensity: Hedges' g = 0.14, maximum total expenditure: Hedges' g = 0.53, maximum expenditure for a single hit: Hedges' g = 0.10) and proportionate cannabis-free reinforcement (Hedges' g = 0.12) increased. Past-month total cannabis use decreased by 8.9% from baseline to post-treatment (Hedges' g = 0.39), along with decreases in recent depression (Hedges' g = 0.50) and anxiety symptoms (Hedges' g = 0.29). These preliminary findings suggest that this behavioral economic intervention was highly acceptable and feasible for adults with untreated CUD. Changes in potential mechanisms of behavior change (cannabis demand, proportionate cannabis-free reinforcement) were consistent with reduced frequency of cannabis use and improved mental health outcomes. • The vast majority of people with a cannabis use disorder receive no treatment. • Novel approaches are critically needed for people with cannabis use disorder. • Behavioral economic mechanisms may be a novel target to reduce use and harms. • A telehealth-delivered behavioral economic intervention was feasible and acceptable. • Preliminary outcomes support additional evaluation. [ABSTRACT FROM AUTHOR]

Emerging adult (EA) cannabis use is associated with increased risk for health consequences. Just-in-time adaptive interventions (JITAIs) provide potential for preventing the escalation and consequences of cannabis use. Powered by mobile devices, JITAIs use decision rules that take the person's state and context as input, and output a recommended intervention (e.g., alternative activities, coping strategies). The mHealth literature on JITAIs is nascent, with additional research needed to identify what intervention content to deliver when and to whom. Herein we describe the protocol for a pilot study testing the feasibility and acceptability of a micro-randomized trial for optimizing MiWaves mobile intervention app for EAs (ages 18–25; target N = 120) with regular cannabis use (≥3 times per week). Micro-randomizations will be determined by a reinforcement learning algorithm that continually learns and improves the decision rules as participants experience the intervention. MiWaves will prompt participants to complete an in-app twice-daily survey over 30 days and participants will be micro-randomized twice daily to either: no message or a message [1 of 6 types varying in length (short, long) and interaction type (acknowledge message, acknowledge message + click additional resources, acknowledge message + fill in the blank/select an option)]. Participants recruited via social media will download the MiWaves app, and complete screening, baseline, weekly, post-intervention, and 2-month follow-up assessments. Primary outcomes include feasibility and acceptability, with additional exploratory behavioral outcomes. This study represents a critical first step in developing an effective mHealth intervention for reducing cannabis use and associated harms in EAs. [ABSTRACT FROM AUTHOR]

• 3 dimensions of CEQ in individuals who use medical cannabis for chronic pain. • Four expectancy subgroups: low, negative, amotivation and positive. • Expectancy subgroups dynamic over two years. • Expectancy subgroup able to predict cannabis frequency and mental health functioning. Cannabis is increasingly available to individuals in the United States, with the majority of states legalizing medical or recreational cannabis use. Cannabis expectancies (e.g., positive expectations from cannabis use) are related to more frequent cannabis use and associated with greater odds of lapse following a cessation attempt. To evaluate the relationship between expectancies and cannabis- and health-related outcomes, we surveyed adults who used medical cannabis for chronic pain (n = 633; 52.2 % female; 82.1 % white) over a two-year period. Then, we performed a principal components analysis (PCA) on the Cannabis Expectancies Questionnaire to derive components of cannabis expectancies. We performed k-means clustering to identify subgroups with similar expectancies. The relationship between subgroup assignment and cannabis use outcomes (frequency, quantity), and physical and mental health functioning were evaluated. The PCA identified a three-component solution and k-means clustering identified four subgroups: low expectancies, negative expectancies, amotivation expectancies, and positive expectancies. Participants' cannabis expectancies were dynamic over time. After adjusting for demographics, expectancy subgroup was able to predict six-month cannabis use frequency (χ2(3) = 11.244; p = 0.010) and mental health functioning (χ2(3) = 24.926; p < 0.001), but not quantity (χ2(3) = 2.741, p = 0.433) or physical health functioning (χ2(3) = 5.110, p = 0.164). In a large cohort of individuals who use medical cannabis, four subgroups with differing cannabis expectancies emerged: low expectancies, negative expectancies, amotivation expectancies, and positive expectancies. These subgroups predicted subsequent outcomes and may be important for targeted intervention approaches to reduce cannabis use and improve functioning. [ABSTRACT FROM AUTHOR]

Introduction: Contingency management (CM) is one of the most effective interventions for substance use disorders (SUDs), including stimulant use disorder. In the United States, the Veterans Health Administration (VHA) led the largest-scale rollout of CM in the US to date, but little is known about characteristics of patients treated and CM clinical practices. Methods: In this retrospective cohort study, we used VHA electronic health records data to descriptively examine CM treatment course (e.g., number of visits, time between visits, duration of treatment episode) and characteristics of patients receiving CM for SUDs from 2018 to 2022. Results: From January 2018 to September 2022, 2844 patients received CM at 90 VA Health Systems (including 98 VA Medical Center, 7 community-based outpatient clinics, and 15 other sites). The median number of CM visits was 8 (mean = 10.17, SD = 8.12) visits over the course of 1.5 months (median = 45 days, mean = 57.46 days, SD = 62.65). The target substance was stimulants in 86.42 % of visits. Average age of patients was 52.29 years (SD = 12.10), with 55.06 % of patients experiencing homelessness or housing instability, and 97.50 % of patients diagnosed with more than one SUD. Compared to the year prior to the COVID-19 pandemic (03/2019–02/2020; mean = 957.33, SD = 157.71 visits/month), CM visits declined by 83.20 % in the year following the pandemic (03/2020–02/2021; mean = 160.83, SD = 164.14), and have yet to return to pre-pandemic levels. Conclusions: The CM rollout has been markedly successful in the VHA, with adoption across multiple VHA sites within a complex patient population, indicating the potential for effective, more widespread CM implementation. At the same time, there was a considerable reduction in CM care during the COVID-19 pandemic and CM has not yet returned to pre-pandemic levels. Moreover, only a small minority of VA patients with stimulant use disorder have received CM. Given increasing rates of overdose, including stimulant-involved overdose, it is important to increase CM provision in VHA and non-VHA settings. • 2844 patients received CM across 90 VA Health Systems from 2018 to 2022. • The Veterans Health Administration (VHA) leads the largest CM rollout in the U.S. • The target substance was stimulants in over 85 % of CM visits. • The VHA CM rollout is improving addiction care across the country. [ABSTRACT FROM AUTHOR]

The aim of this study was to detail the incidence of venous thromboembolism (VTE) in patients hospitalised with COVID-19 in England. This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1st March 2020 and 31st March 2021 were included. A recorded diagnosis of VTE during the index stay or during a subsequent admission in the six weeks following discharge was the primary outcome in the main analysis. In secondary analysis, VTE diagnosis was the primary exposure and in-hospital mortality the primary outcome. Over the 13 months, 374,244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 17,346 (4.6%) had a recorded diagnosis of VTE. VTE was more commonly recorded in patients aged 40–79 years, males and in patients of Black ethnicity, even after adjusting for covariates. Recorded VTE diagnosis was associated with longer hospital stay and higher adjusted in-hospital mortality (odds ratio 1.35 (95% confidence interval 1.29 to 1.41)). VTE was a common complication of hospitalisation with COVID-19 in England. VTE was associated with both increased length of stay and mortality rate. [ABSTRACT FROM AUTHOR]

Smartphone use has become an "always-on" activity. Caring for children and being sensitive to their needs seems to conflict with this immersive and time-consuming activity. Building on John Bowlby's Attachment Theory, we focused on how mothers' smartphone use is related to maternal sensitivity. Using the Mini-Maternal Behavior Q-Sort method and a post-observation questionnaire, we collected data from 89 mother-child dyads on playgrounds. Our results showed that mothers who used their smartphones longer had lower sensitivity ratings (β = −0.51, p <.001), whereas there was no association between low sensitivity ratings and the frequency of use. Our results suggest that it might be valuable to further study the influences of the content of use on sensitivity. The study's results demonstrate that smartphone use is related to the extent to which mothers are sensitive to their children's needs. However, smartphone use in itself is not necessarily in conflict with the ability to be sensitive. We discuss the boundary conditions of how using a smartphone for certain reasons and time-periods might be compatible with the ability to be a sensitive caregiver. • 43 of 89 observed mothers used their smartphone on playgrounds. • Phones were used mostly to take photos, organize everyday life and chat. • The duration and not the frequency of phone use was associated with lower maternal sensitivity. • Studying the content of phone use is a valuable venue for future research. [ABSTRACT FROM AUTHOR]

Aims: Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders.Method: Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005 to 2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively.Results: Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions.Conclusions: Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas. [ABSTRACT FROM AUTHOR]

Introduction: For many people with alcohol use disorders, alcohol drinking is a highly ingrained and automatized behavior with negative long-term health consequences. Implementation intentions, a behavioral intervention that links high-risk drinking situations with alternative, healthier responses, provide a means to intervene on habitual drinking behaviors. Here, a pilot treatment using implementation intentions was assessed with remote assessments and treatment prompts.Methods: Treatment-seeking individuals with alcohol use disorder between the ages of 18 and 65 were recruited from the community from October 2014 to November 2016. Participants (N=35) were quasi-randomly assigned to complete either active (n=18) or control (n=17) two-week implementation intention interventions. Active implementation intentions linked high-risk situations with alternative responses whereas the control condition selected situations and responses but did not link these together. Daily ecological momentary interventions of participant-tailored implementation intentions were delivered via text message. Alcohol consumption was assessed once daily with self-reported ecological momentary assessments (EMAs) of drinks consumed the previous day and thrice daily remotely submitted breathalyzer samples to assess reliability of self-reports.Results: On drinking days (80% of days), the active implementation intentions group reduced alcohol consumption during the intervention period compared to the control condition; however the difference between consumption was not observed at one-month follow-up.Discussion: The implementation intention intervention was associated with a 1.09 drink per day decrease in alcohol consumption on drinking days compared to a decrease of 0.29 drinks per day in the control condition. Future studies may combine implementation intentions with other treatments to help individuals to reduce alcohol consumption. [ABSTRACT FROM AUTHOR]

Background A minimum-volume policy restricting hospitals not meeting the threshold from performing complex operation may increase travel burden and decrease spatial access to operation. We aim to identify vulnerable populations that would be sensitive to an added travel burden. Methods We performed a retrospective analysis of the database of the California Office of Statewide Health Planning and Development for patients undergoing pancreatectomy from 2005 to 2014. Number of hospitals bypassed was used as a metric for travel. Patients bypassing fewer hospitals were deemed to be more sensitive to an added travel burden. Results There were 13,374 patients who underwent a pancreatectomy, of whom 2,368 (17.7%) were nonbypassers. On unadjusted analysis, patients >80 year old travelled less than their younger counterparts, bypassing a mean of 10.9 ± 9.5 hospitals compared with 14.2 ± 21.3 hospitals bypassed by the 35–49 year old age group ( P < .001). Racial minorities travelled less when compared with non-Hispanic whites ( P < .001). Patients identifying their payer status as self-pay (8.9 ± 15.6 hospitals bypassed) and Medicaid (10.1 ± 17.2 hospitals bypassed) also travelled less when compared with patients with private insurance (13.8 ± 20.4 hospitals bypassed, P < .001). On multivariate analysis, advanced age, racial minority, and patients with self-pay or Medicaid payer status were associated independently with increased sensitivity to an added travel burden. Conclusion In patients undergoing pancreatectomy, the elderly, racial minorities, and patients with self-pay or Medicaid payer status were associated with an increased sensitivity to an added travel burden. This vulnerable cohort may be affected disproportionately by a minimum-volume policy. [ABSTRACT FROM AUTHOR]

Substance use and related consequences (e.g., impaired driving, injuries, disease transmission) continue to be major public health concerns. Contingency management (CM) is a highly effective treatment for substance use disorders. Yet CM remains vastly underutilized, in large part due to implementation barriers to in-person delivery. If feasible and effective, remote delivery of CM may reduce barriers at both the clinic- and patient-level, thus increasing reach and access to effective care. Here, we summarize data from a systematic review of studies reporting remote delivery of CM for substance use treatment. We conducted a systematic review, reported according to PRISMA guidelines. The study team identified a total of 4358 articles after deduplication. Following title and abstract screening, full-text screening, and reference tracking, 39 studies met the eligibility criteria. We evaluated the methodological quality of the included studies using the Effective Public Health Practice Project Quality tool. Of 39 articles included in the review, most (n = 26) targeted cigarette smoking, with others focusing on alcohol (n = 9) or other substance use or targeting multiple substances (n = 4). Most remotely delivered CM studies focused on abstinence (n = 29), with others targeting substance use reduction (n = 2), intervention engagement (n = 5), and both abstinence and intervention engagement (n = 3). CM was associated with better outcomes (either abstinence, use reduction, or engagement), with increasingly more remotely delivered CM studies published in more recent years. Studies ranged from moderate to strong quality, with the majority (57.5 %) of studies being strong quality. Consistent with in-person CM, remotely delivered CM focusing on abstinence or use reduction from substances or engagement in substance use treatment services improves outcomes at the end of treatment compared to control conditions. Moreover, remotely delivered CM is feasible across a variety of digital delivery platforms (e.g., web, mobile, and wearable), with acceptability and reduced clinic and patient burden as technological advancements streamline monitoring and reinforcer delivery. • Remotely delivered contingency management is feasible and acceptable for substance use treatment. • Remotely delivered contingency management improves substance use outcomes. • Remotely delivered contingency management increases engagement in health care services (e.g., Quiline, medication adherence). [ABSTRACT FROM AUTHOR]

Background Deep vein thrombosis (DVT) is a common complication of acute stroke, but the new incidence in the era of improved specialist input in stroke care is yet unknown. The models for VTE diagnosis is well established, but prediction models to target at-risk patients for pharmacological prophylaxis is lacking and requires further research, particularly in the aftermath of acute stroke. Objectives To predict DVT after acute stroke using markers of haemostatic activation and stroke severity scores. Methods We examined the clinical utility of laboratory factors such as thrombin generation, D-dimer, fibrinogen alongside clinical factors (National Institute of Health Stroke Scale and Barthel Index) in the prediction of asymptomatic DVT, among 92 consecutively admitted patients. Results One in five patients (19.6%) had objectively confirmed DVT (6 proximal, 12 distal). Thrombolytic therapy did not protect against DVT, with 21% (6/29) of patients treated with r-tPA went on to develop DVT. Thrombin generation and fibrinogen had no clinical utility, but D-dimer at baseline and week 2 had high clinical potential in the prediction of asymptomatic DVT (2425 ng/mL versus 1010 ng/mL; p = 0.001) and (2240 Vs 970 ng/mL; p < 0.001) respectively. Patients with DVT had worse stroke severity, and are functionally less able, with lower Barthel index (p = 0.05), and high National Institute of Health Stroke Score (p = 0.07). Conclusion Thrombolytic therapy and specialist stroke intervention does not protect against DVT risk. D-dimer concentration within 48 h of acute stroke is independently associated with development of DVT. This observation would require confirmation in a large study. [ABSTRACT FROM AUTHOR]

Objective: The six-dimensional health state short form (SF-6D) was designed to be derived from the short-form 36 health survey (SF-36). The purpose of this research was to compare the SF-6D index values generated from the SF-36 (SF-6DSF-36) with those obtained from the SF-6D administered as an independent instrument (SF-6DInd). The goal was to assess the consistency of respondents' answers to these two methods of deriving the SF-6D.Methods: Data were obtained from a sample of the Portuguese population (n = 414). Agreement between the instruments was assessed on the basis of a descriptive system and their indexes. The analysis of the descriptive system was performed by using a global consistency index and an identically classified index. Agreement was also explored by using correlation coefficients. Parametric tests were used to identify differences between the indexes. Regression models were estimated to understand the relationship between them.Results: The SF-6DInd generates higher values than does the SF-6DSF-36. There were significant differences between the indexes across sociodemographic groups. There was a significant ceiling effect in the SF-6DInd but not in the SF-6DSF-36. The correlation between the indexes was high but less than what was anticipated. The global consistency index identified the dimensions with larger differences. Considerable differences were found in two dimensions, possibly as a result of different item contexts. Further research is needed to fully understand the role of the different layouts and the length of the questionnaires in the respondents' answers.Conclusions: The results show that as the SF-6D was designed to derive utilities from the SF-36 it should be used in this way and not as an independent instrument. [ABSTRACT FROM AUTHOR]

Abstract: Differences in the presentation of clinical features of body dysmorphic disorder (BDD) across ethnic groups have received little investigation. The current study assessed BDD symptoms in an ethnically diverse sample of adults (n =401) using an online survey. Participants completed self-report measures assessing BDD symptoms, body parts of concern and BDD behaviors. Compared to Caucasian participants, no significant differences were found in body parts or behaviors reported by Latino or African American participants. Significant group differences did emerge between Asian and Caucasian participants. Specifically, Asians reported more concern with straight hair and dark skin and fewer body shape concerns than Caucasians. Asians also endorsed lower rates of grooming, touching body parts, and camouflaging and higher rates of exercise compared to Caucasians. Although most clinical features of BDD appear similar across ethnic groups, results showed some differences in body parts and behaviors between Caucasians and Asian Americans with BDD symptoms. [Copyright &y& Elsevier]

Objectives: The SF-6D is a preference-based measure of health derived from the SF-36 that can be used for cost-effectiveness analysis using cost-per-quality adjusted life-year analysis. This study seeks to estimate a system weight for the SF-6D for Portugal and to compare the results with the UK system weights. Methods: A sample of 55 health states defined by the SF-6D has been valued by a representative random sample of the Portuguese population, stratified by sex and age ( n = 140), using the Standard Gamble (SG). Several models are estimated at both the individual and aggregate levels for predicting health-state valuations. Models with main effects, with interaction effects and with the constant forced to unity are presented. Random effects (RE) models are estimated using generalized least squares (GLS) regressions. Generalized estimation equations (GEE) are used to estimate RE models with the constant forced to unity. Estimations at the individual level were performed using 630 health-state valuations. Alternative functional forms are considered to account for the skewed distribution of health-state valuations. Results: The models are analyzed in terms of their coefficients, overall fit, and the ability for predicting the SG-values. The RE models estimated using GLS and through GEE produce significant coefficients, which are robust across model specification. However, there are concerns regarding some inconsistent estimates, and so parsimonious consistent models were estimated. There is evidence of under prediction in some states assigned to poor health. The results are consistent with the UK results. Conclusion: The models estimated provide preference-based quality of life weights for the Portuguese population when health status data have been collected using the SF-36. Although the sample was randomly drowned findings should be treated with caution, given the small sample size, even knowing that they have been estimated at the individual level. [ABSTRACT FROM AUTHOR]

Abstract: Neonatal screening for haematological disorders has advanced over the last decade in England, with the phased implementation of a universal screening programme for the detection of sickle cell disease. Glucose-6-phosphate dehydrogenase deficiency and haemoglobin H disease are included in the universal newborn screening programmes in some parts of the world. Selective screening for haematological diseases should be considered in neonates with unexplained or prolonged hyperbilirubinaemia. Additionally, selective screening for haemostatic disorders is recommended in neonates at risk of hereditary bleeding disorders, although the majority of haemostatic abnormalities detected in the newborn are acquired. This review will give an introduction to the above disorders and discuss the role and procedures in place for newborn screening. [Copyright &y& Elsevier]

Claspin is required for the phosphorylation and activation of the Chk1 protein kinase by ATR during DNA replication and in response to DNA damage. This checkpoint pathway plays a critical role in the resistance of cells to genotoxic stress. Here, we show that human Claspin is cleaved by caspase-7 during the initiation of apoptosis. In cells, induction of DNA damage by etoposide at first produced rapid phosphorylation of Chk1 at a site targeted by ATR. Subsequently, etoposide caused activation of caspase-7, cleavage of Claspin, and dephosphorylation of Chk1. In apoptotic cell extracts, Claspin was cleaved by caspase-7 at a single aspartate residue into a large N-terminal fragment and a smaller C-terminal fragment that contain different functional domains. The large N-terminal fragment was heavily phosphorylated in a human cell-free system in response to double-stranded DNA oligonucleotides, and this fragment retained Chk1 binding activity. In contrast, the smaller C-terminal fragment did not bind Chk1, but did associate with DNA and inhibited the DNA-dependent phosphorylation of Chk1 associated with its activation. These results indicate that cleavage of Claspin by caspase-7 inactivates the Chk1 signaling pathway. This mechanism may regulate the balance between cell cycle arrest and induction of apoptosis during the response to genotoxic stress. [ABSTRACT FROM AUTHOR]

The Veterans Crisis Line (VCL) is a core component of VA's suicide prevention strategy. Despite the availability and utility of the VCL, many Veterans do not utilize this resource during times of crisis. A brief, psychoeducational behavioral intervention (termed Crisis Line Facilitation [CLF]) was developed to increase utilization of the VCL and reduce suicidal behaviors in high-risk Veterans. The therapist-led session includes educational information regarding the VCL, as well as a chance to discuss the participant's perceptions of contacting the VCL during periods of crisis. The final component of the session is a practice call placed to the VCL by both the therapist and the participant. The CLF intervention was compared to Enhanced Usual Care (EUC) during a multi-site randomized clinical trial for 307 Veteran participants recently hospitalized for a suicidal crisis who reported no contact with the VCL in the prior 12 months. Initial analyses indicated that participants randomized to the CLF intervention were less likely to report suicidal behaviors, including suicide attempts compared to participants randomized to receive EUC over 12-months of follow-up (χ2 = 18.48/p < 0.0001), however this effect was not sustained when analyses were conducted on an individual level. No significant differences were found between conditions on VCL utilization. Initial evidence suggests a brief CLF intervention has an impact on preventing suicidal behaviors in Veterans treated in inpatient mental health programs; however, it may not change use of the VCL. This brief intervention could be easily adapted into clinical settings to be delivered by standard clinical staff. • Veterans have fewer suicide attempts after intervention encouraging Crisis Line use. • Use of the Veterans Crisis Line was common in both conditions. • Crisis Line Facilitation has the potential to reduce suicide risk. [ABSTRACT FROM AUTHOR]

The response to the COVID-19 crisis has created direct pressure on health care providers to deliver virtual care, and has created the opportunity to develop innovations in remote treatment for people with substance use disorders. Remote treatments provide an intervention delivery framework that capitalizes on technological innovations in remote monitoring of behaviors and can efficiently use information collected from people and their environment to provide personalized treatments as needed. Interventions informed by behavioral economic theories can help to harness the largely untapped potential of virtual care in substance use treatment. Behavioral economic treatments, such as contingency management, the substance-free activity session, and episodic future thinking, are positioned to leverage remote monitoring of substance use and to use personalized medicine frameworks to deliver remote interventions in the COVID-19 era and beyond. [ABSTRACT FROM AUTHOR]

We report two patients with peripheral vascular disease requiring multiple bilateral radiologic and surgical interventions, and whose disease was unresponsive to conventional anticoagulation and antiplatelet therapy. Although thrombocytosis was only intermittent, analysis of the Janus kinase 2 (JAK2) gene revealed a V617F mutation, thus confirming the presence of an underlying occult myeloproliferative disorder. We propose that JAK2 mutation analysis be considered in patients with recurrent, unexplained arterial events to identify those with occult myeloproliferative disorders. [Copyright &y& Elsevier]

Previous research on stress and media use mainly concentrated on between-person effects. We add to this research field by additionally assessing within-person associations, assuming that experiencing more stress than usual goes along with more nomophobia ("no-mobile-phone phobia") and more passive and active Facebook use than usual, cross-sectionally and over time, and by exploring potential age differences. We conducted a secondary analysis of three waves of a representative multi-wave survey of adult Dutch internet users (N = 861). Specifically, we used two subsamples: (1) smartphones users for the analyses on nomophobia (n = 600) and (2) Facebook users for the analyses on social media (n = 469). Employing random-intercept cross-lagged panel models, we found within-person correlations between nomophobia and stress at one time-point, but not over time. For the younger age group (18–39 years), more passive Facebook use than usual was associated with more stress than usual six months later, and more stress than usual was followed by less passive Facebook use six month later. There were no longitudinal relationships for active Facebook use across the different age groups. Methodological and theoretical implications are discussed. • We study the relationships of nomophobia, Facebook use and stress over time. • Nomophobia and stress correlate on the within-person level at one time-point. • Passive Facebook use is associated with more stress over time for younger adults. • Stress relates to less passive Facebook use six months later for younger adults. • There are no longitudinal effects for nomophobia, active Facebook use, and stress. [ABSTRACT FROM AUTHOR]

Vaquejada is an important Brazilian equine discipline. Understanding physiological adaptations of these athletes is crucial to improve properly performance, guaranteeing welfare. The objective of this study was to evaluate the influence of three vaquejada simulation tests (VST) on physiological parameters of horses and standardize a possible rest interval between races. Ten clinically healthy Quarter horses, 8.9 ± 4.3 year-old and 441.3 ± 25.0 kg, executed three VST, 5 days apart from each other. Vaquejada simulation tests consisted of two horses, a puller, and a helper, running with a bull on a soft sand track in which they must put the bull down. On M1, they ran three times with a 5-min rest between races; on M2, with a 10-min rest; and M3, with a 15-min rest. Clinical evaluation and blood sampling were made in all VST, before (T0), immediately after first run (T1), second run (T2), third run (T3) and at 30 minutes (T4), and 4 hours (T5) of recovery. Variables were statistically analyzed with a bifactorial comparison (P <.05). Exercise increased heart rate (HR), respiratory rate, body temperature (BT), lactate, triglycerides, packed cell volume, RBC, and hemoglobin concentration, with higher values in pull horses due to a more intense exercise. With 15-min of rest interval, helper horses showed lower values of glucose, aspartate aminotransferase, creatine kinase, BT, and higher values of triglycerides, also working at the same speed and distance with a lower HRmax and HRmed. Pull and helper horses had shown modifications of biomarkers. Furthermore, 15-min rest interval between races improved performance of helper horses as they used properly energy sources and cardiovascular function, respecting precepts of welfare. [ABSTRACT FROM AUTHOR]

In an unmodified state, positively charged histone N-terminal tails engage nucleosomal DNA in a manner which restricts access to not only the underlying DNA but also key tail residues subject to binding and/or modification. Charge-neutralizing modifications, such as histone acetylation, serve to disrupt this DNA–tail interaction, facilitating access to such residues. We previously showed that a polyacetylation-mediated chromatin “switch” governs the read-write capability of H3K4me3 by the MLL1 methyltransferase complex. Here, we discern the relative contributions of site-specific acetylation states along the H3 tail and extend our interrogation to other chromatin modifiers. We show that the contributions of H3 tail acetylation to H3K4 methylation by MLL1 are highly variable, with H3K18 and H3K23 acetylation exhibiting robust stimulatory effects and that this extends to the related H3K4 methyltransferase complex, MLL4. We show that H3K4me1 and H3K4me3 are found preferentially co-enriched with H3 Nterminal tail proteoforms bearing dual H3K18 and H3K23 acetylation (H3{K18acK23ac}). We further show that this effect is specific to H3K4 methylation, while methyltransferases targeting other H3 tail residues (H3K9, H3K27, & H3K36), a methyltransferase targeting the nucleosome core (H3K79), and a kinase targeting a residue directly adjacent to H3K4 (H3T3) are insensitive to tail acetylation. Together, these findings indicate a unique and robust stimulation of H3K4 methylation by H3K18 and H3K23 acetylation and provide key insight into why H3K4 methylation is often associated with histone acetylation in the context of active gene expression. [ABSTRACT FROM AUTHOR]

• Diagnostic algorithms are used to risk-stratify patients requiring imaging for DVT. • Age-adjusted & fixed D-dimer threshold >1000 had high sensitivity for proximal DVT. • Imaging was reduced for age-adjusted (4.4 %) & fixed D-dimer threshold >1000 (12.2 %). [ABSTRACT FROM AUTHOR]

Abstract Introduction Based on current guidelines, many women qualify for postnatal thromboprophylaxis following childbirth, however, little information exists on how adherent women are and their experiences to both pharmacological and mechanical forms of thromboprophylaxis. Materials and methods Women requiring postnatal thromboprophylaxis were given questionnaire packs exploring their beliefs about enoxaparin, anti-embolic stockings (AES) and intermittent pneumatic compression devices (IPCD). Women were also asked to complete a diary recording when doses of enoxaparin were injected, along with an estimation of the number of hours the AES were worn each day, if at all. Results were entered onto SPSS and analysed. Results Sixty-seven women completed the questionnaire packs. Adherence to enoxaparin therapy was relatively high (82.4%). Women self-reported sub-optimal adherence levels to the AES, with 24% stating they never wore them once home. Reasons for this included being mobile, feeling hot and feeling as if they were cutting circulation off in the legs. Women reported a high level of acceptance of IPCD post caesarean section and would be happy for IPCD to be applied again in future deliveries, if required. Conclusions Although many women are adherent to postnatal TP, our findings suggest that adherence to AES is sub-optimal following discharge from hospital and therefore their usefulness is questionable. Front-line clinical staff should discuss the importance of adherence to postnatal TP, in order to avert preventable venous thromboembolic events. Highlights • Adherence to postnatal thromboprophylaxis has been reported to be variable. • Women's adherence to mechanical and pharmacological thromboprophylaxis was explored. • Adherence to enoxaparin therapy was relatively high (82.4%). • Adherence to stockings was low, with 24% of women stating they never wore them once home. • Counsel women on the important role of thromboprophylaxis in preventing VTE [ABSTRACT FROM AUTHOR]