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Abstract: Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co‐occur. However, this dual‐diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge‐eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N = 349). In total, 11.5% of the sample (n = 40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n = 33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling‐related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual‐diagnosed population that may require clinical attention. [ABSTRACT FROM AUTHOR]

Objective: Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity.Method: The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity.Results: Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity.Conclusion: Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours. [ABSTRACT FROM AUTHOR]

The field of gambling studies has extensively focused on isolating risk factors for developing a gambling disorder. Conversely, little attention has been paid to identifying protective factors against gambling disorder among people who choose to not gamble at all. Moreover, the limited number of studies that have focused on non-gamblers have neglected to differentiate current from lifetime non-gamblers. The purpose of the present study was to examine motives for not gambling among a diverse sample of adult lifetime non-gamblers recruited from the community and to compare these motives to an undergraduate student sample of non-gamblers from a previous study. Participants consisted of 219 lifetime non-gamblers (45.2% male) from the United States recruited via Amazon's Mechanical Turk. The previously recruited sample consisted of Canadian undergraduate students (n=196). Eight distinct categories of motivations for not gambling were identified in the sample of adult community non-gamblers, which corresponded closely with previous findings from the student sample. However, comparisons between the two samples revealed that adult lifetime non-gamblers were more likely to provide financial motives as reasons for not gambling. Whereas, the student sample was more likely to mention disinterest and the influence of others as reasons to avoid gambling. Results suggest that the choice not to gamble among lifetime non-gamblers may reflect a more conscious, values-based decision when compared to undergraduate non-gamblers. [ABSTRACT FROM AUTHOR]

Following a southward progression of ice-shelf disintegration along the Antarctic Peninsula (AP), Larsen C Ice Shelf (LCIS) has become the focus of ongoing investigation regarding its future stability. The ice shelf experiences surface melt and commonly features surface meltwater ponds. Here, we use a flow-line model and a firn density model (FDM) to date and interpret observations of meltaffected ice layers found within five 90m boreholes distributed across the ice shelf. We find that units of ice within the boreholes, which have densities exceeding those expected under normal dry compaction metamorphism, correspond to two climatic warm periods within the last 300 years on the Antarctic Peninsula. The more recent warm period, from the 1960s onwards, has generated distinct sections of dense ice measured in two boreholes in Cabinet Inlet, which is close to the Antarctic Peninsula mountains - a region affected by föhn winds. Previous work has classified these layers as refrozen pond ice, requiring large quantities of mobile liquid water to form. Our flow-line model shows that, whilst preconditioning of the snow began in the late 1960s, it was probably not until the early 1990s that the modern period of ponding began. The earlier warm period occurred during the 18th century and resulted in two additional sections of anomalously dense ice deep within the boreholes. The first, at 61m in one of our Cabinet Inlet boreholes, consists of ice characteristic of refrozen ponds and must have formed in an area currently featuring ponding. The second, at 69m in a mid-shelf borehole, formed at the same time on the edge of the pond area. Further south, the boreholes sample ice that is of an equivalent age but which does not exhibit the same degree of melt influence. This west-east and north-south gradient in the past melt distribution resembles current spatial patterns of surface melt intensity. [ABSTRACT FROM AUTHOR]

Background: Co-morbidity with other addictive behaviors is common in disordered gambling (DG). In particular, tobacco dependence has been found to be among the most prevalent disorders co-morbid with DG. While the extant literature has firmly established the co-occurrence of DG and smoking, there is a paucity of research examining factors that differentiate DGs who smoke from those who do not.Objectives: To address this empirical gap, the current study tested whether dimensions of trait impulsivity as measured by the UPPS-P Impulsive Behavior Scale (positive urgency, negative urgency, lack of premeditation, lack of perseverance, and sensation seeking), discriminated between non-DGs and DGs based on their present smoking status: non-smoker, occasional smoker, and daily smoker.Methods: To this end, 564 community gamblers were recruited through a crowdsourcing platform (Amazon's Mechanical Turk) and completed an online survey, assessing problem gambling severity, tobacco use, and trait impulsivity.Results: MANOVA analyses revealed significant main effects for both gambling severity and smoking status groups. Importantly, a significant gambling by smoking interaction was also found. Pairwise comparisons revealed that DGs who were daily smokers scored higher on negative urgency than those who smoked occasionally or not all. Furthermore, among non-DGs, smoking status failed to discriminate between mean scores on negative urgency. No other significant interaction effects were found for the remaining UPPS-P impulsivity facets.Conclusions: Results suggest that individual components of trait impulsivity, and more specifically negative urgency, successfully differentiate DGs who do not smoke, or just smoke occasionally, from DGs who smoke daily. These findings suggest that the degree of trait impulsivity may potentially distinguish between DGs and DGs who are dually addicted to other substances such as tobacco. [ABSTRACT FROM AUTHOR]

• Free-viewing eye-tracking paradigms can reliably measure attentional bias for gambling images. • Both two- and four-image displays can reliably measure gambling-related attentional bias. • Attentional bias indices capturing the full trial (rather than first fixation) are most reliable. • Attentional bias difference scores for gambling images are reliable. Attentional biases for gambling-related stimuli are a robust correlate of problem gambling. Free-viewing eye-tracking paradigms are considered the gold standard for measuring attentional bias in addiction research, but their reliability in measuring biases for gambling-related stimuli remains unclear. Using secondary data from two different free-viewing eye-tracking paradigms (two-image and four-image displays), this study examined the internal consistency of fixation indices in samples with varying degrees of gambling involvement and problem gambling risk. Cronbach's alpha, McDonald's omega, and split-half reliability coefficients were used to assess internal consistency of several fixation indices (total dwell time, total dwell time percent, total fixation count, time of first fixation) for gambling-related images, neutral images, and computed attentional bias difference scores. For both two- and four-image displays, internal consistency estimates for total dwell time, total dwell time percent, and total fixation count were good to excellent for gambling-related images, neutral images, and attentional bias scores. Only time of first fixation exhibited low internal consistency. These findings indicate that both two-image and four-image free-viewing eye-tracking paradigms can reliably measure attentional biases for gambling-related stimuli among participants reporting varying degrees of gambling involvement and problem gambling risk. [ABSTRACT FROM AUTHOR]

Background: Studies show the In-hospital Mortality for Pulmonary embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low-risk of early mortality in a retrospective setting using only claims for the index admission. We sought to externally validate IMPACT, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI) and Hestia for predicting early mortality. Methods: We identified consecutive adults admitted for objectively-confirmed PE between 10/21/2010 and 5/12/ 2015. Patients undergoing thrombolysis/embolectomy within 48 h were excluded. All-cause in-hospital and 30 day mortality (using available Social Security Death Index data through January 2014) were assessed and prognostic accuracies of IMPACT, PESI, sPESI and Hestia were determined. Results: Twenty-one (2.6 %) of the 807 PE patients died before discharge. All rules classified 26.1-38.3 % of patients as low-risk for early mortality. Fatality among low-risk patients was 0 % (sPESI and Hestia), 0.4 % (IMPACT) and 0.6 % (PESI). IMPACT's sensitivity was 95.2 % (95 % confidence interval [CI] = 74.1-99.8 %), and the sensitivities of clinical rules ranged from 91 (PESI)-100 % (sPESI and Hestia). Specificities of all rules ranged between 26.8 and 39.1 %. Of 573 consecutive patients in the 30 day mortality analysis, 33 (5.8 %) died. All rules classified 27.9-38.0 % of patients as low-risk, and fatality occurred in 0 (Hestia)-1.4 % (PESI) of low-risk patients. IMPACT's sensitivity was 97.0 % (95%CI = 82.5-99.8 %), while sensitivities for clinical rules ranged from 91 (PESI)-100 % (Hestia). Specificities of rules ranged between 29.6 and 39.8 %. Conclusion: In this analysis, IMPACT identified low-risk PE patients with similar accuracy as clinical rules. While not intended for prospective clinical decision-making, IMPACT appears useful for identification of low-risk PE patient in retrospective claims-based studies. [ABSTRACT FROM AUTHOR]

Objective: While it has been shown that disordered gamblers with psychosis are at increased risk for comorbid psychopathology, it is unclear whether this dual-diagnosis population is also at greater risk of problematic engagement with comorbid addictive behaviors. Methods: We tested for association between disordered gambling with psychosis and comorbid addictive behaviors in a sample of 349 treatment-seeking disordered gamblers. Results: Twenty-five (7.2%) disordered gamblers met criteria for psychosis. Disordered gamblers with psychosis were no more likely to meet diagnostic criteria for current alcohol/substance use disorder than disordered gamblers without psychosis. However, this dual-disorder population reported greater misuse of shopping, food bingeing, caffeine, and prescription drugs. When controlling for multiple comparisons, binge eating was the only addictive behavior to remain significant. Conclusion: Given these findings, a comprehensive assessment of addictive behaviors - specifically food bingeing - in this population may be warranted. [ABSTRACT FROM AUTHOR]

Casino employees regularly interact with problem and at-risk gamblers and thus have considerable potential to both prevent and reduce gambling-related harm. While harm minimization (HM) and responsible gambling (RG) are routinely espoused by the casino industry, the actual level of employee HM/RG training, knowledge, and behaviour is unknown. The present study investigated this issue in the Canadian context by examining employee surveys collected by the RG Check accreditation program (8,262 surveys from 78 Canadian casinos/racinos collected between 2011 and 2020). These surveys revealed that almost all casino employees receive HM/RG training, but the amount of training tends to be quite limited (one hour) except for supervisors, managers, and security personnel. Basic HM/RG knowledge among all employees appears adequate, although their understanding of probability is incomplete. The most important consideration is whether this training and knowledge translates into meaningful HM/RG behaviour towards patrons. The large majority of employees (83.1%) report engaging in at least one HM/RG interaction with a patron at some point during the course of their employment (median length of 4 to 9 years), with security personnel reporting the highest rates. However, the frequency, nature, and impact of these interactions is unknown. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the information assurance program fro a Future Combat System (FCS) component called the Warfighter Machine Interface (WMI) in the U.S. It mentions that one of the critical missions of the Information Assurance Directorate (IAD) of the National Security Agency is to provide information assurance guidance to national security acquisition programs. It also notes that a prototype model was created to assess the information assurance status of a program.

The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies. low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking. supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating. [ABSTRACT FROM AUTHOR]

Perfectionistic concerns (i.e., negative reactions to failures, concerns over others' criticism and expec- lations, and nagging self-doubts) are a putative risk factor for depressive symptoms. This study proposes and supports the existential model of pcrfcctionism and depressive symptoms (EMPDS), a conceptual model aimed at explaining why perfectionistic concerns confer risk for depressive symptoms. According to the EMPDS, perfectionistic concerns confer risk for depressive symptoms both through catastrophic interpretations that magnify relatively minor setbacks into seemingly major obstacles and through negative views of life experiences as unacceptable, dissatisfying, and meaningless. This investigation tests the EMPDS in a sample of 240 undergraduates studied using a 4-wave, 4-week longitudinal design. Hypotheses derived from the EMPDS were largely supported, with bootstrap tests of mediation sug- gesting that the indirect effect of perfectionistic concerns on depressive symptoms through catastrophic thinking and dtfficulty accepttng the past is significant. Results indicated perfectionistic concerns are more an antecedent of, rather than a complication of, catastrophic thinking, difficulty accepting the past, and depressive symptoms. Consistent (but imperfect) support for the incremental validity of the EMPDS beyond either perfectionistic strivings or neuroticism was also observed. Overall, this investigation suggests persons high in perfectionistic concerns not only tend to catastrophize their life experiences but also struggle to accept their life experiences and to negotiate a sense of purpose, direction, and coherence in their lives. With both a catastrophic view of their present and a dark view of their past, this investigation also suggests persons high in perfectionistie concerns are at risk for depressive symptoms. [ABSTRACT FROM AUTHOR]

This systematic review synthesized the literature examining addiction substitution during recovery from substance use or behavioral addictions. A total of 96 studies were included with sample sizes ranging from 6 to 14,885. The most common recovery addictions were opioids (30.21%), followed by cannabis (20.83%), unspecified use (17.71%), nicotine (12.50%), alcohol (12.50%), cocaine (4.17%), and gambling (2.08%). Statistical results were provided by 70.83% of the studies. Of these, 17.65% found support for addiction substitution, whereas 52.94% found support for concurrent recovery. A total of 19.12% found no statistical changes and 10.29% found both significant increases and decreases. The remaining 29.17% of studies provided descriptive data, without statistical tests. Predictors of addiction substitution were provided by 22.92% of the studies and 11.46% included information on impact of addiction substitution on treatment outcomes. Overall, male gender, younger age, greater substance use severity, and presence of mental health disorders were associated with addiction substitution. Addiction substitution was associated with poorer treatment outcomes. A limitation of the present systematic review is the use of significance counting for the quantitative synthesis. More research examining changes in addiction during recovery would aid in the development of more effective treatments for addictive disorders and prevent addiction substitution. • This is the first comprehensive systematic review of addiction substitution. • 17.65% of identified studies found support for addiction substitution. • 52.94% of studies supported a concurrent model of recovery. • Severity of substance use and mental health predicted addiction substitution. • Addiction substitution was associated with worse treatment outcomes. [ABSTRACT FROM AUTHOR]

Lakes in direct contact with glaciers (ice-marginal lakes) are found across alpine and polar landscapes. Many studies characterize ice-marginal lake behavior over multi-decadal timescales using either episodic ~annual images or multi-year mosaics. However, ice-marginal lakes are dynamic features that experience short-term (i.e., day to year) variations in area and volume superimposed on longer-term trends. Through aliasing, this short-term variability could result in erroneous long-term estimates of lake change. We develop and implement an automated workflow in Google Earth Engine to quantify monthly behavior of ice-marginal lakes between 2013 and 2019 across south-central Alaska using Landsat 8 imagery. We employ a supervised Mahalanobis minimum-distance land cover classifier incorporating three datasets found to maximize classifier performance: shortwave infrared imagery, the normalized difference vegetation index (NDVI), and spatially filtered panchromatic reflectance. We observe physically-meaningful ice-marginal lake area variance on sub-annual timescales, with the median area fluctuation of an ice-marginal lake found to be 10.8% of its average area. The median signal (slow lake growth) to noise (physically-meaningful short-term area variability) ratio is 1.5:1, indicating that short-term variability is responsible for ~33% of observed area change in the median ice-marginal lake. The magnitude of short-term area variability is similar for ice-marginal and nonglacial lakes, suggesting that the cause of observed variations is not of glacial origin. These data provide a new context for interpreting behaviors observed in multi-decadal studies and encourage attention to sub-annual behavior of ice-marginal lakes even in long-term studies. [ABSTRACT FROM AUTHOR]

Many video games incorporate gambling-like elements into their design (and vice versa). Social casino games - a type of video game that mimics gambling activities-are one such example. In the current experimental research, we examined whether offering tangible rewards (i.e., rewards with value outside the game) in a social casino game was associated with increased social casino game play and subsequent gambling. Participants (N = 213, Mage = 36.5, 55.3% female) were recruited from CloudResearch. They were randomly assigned to either a reward condition (n = 109) in which, following a week of social casino game play, participants could trade in their virtual credits for a bonus, or a control condition in which the possibility of reward was not presented (n = 104). Following the week of play, all participants were then provided with an opportunity to gamble in an online roulette game with their study compensation. Participants in the reward condition placed more bets and bet higher credit amounts in the social casino game than participants in the control condition. In contrast, no differences were found between the two groups regarding their decision to gamble with their remuneration. Participants who elected to gamble reported higher problem gambling severity and gambling-related cravings. There were no differences in impulsivity. These results suggest that offering tangible rewards in social casino games may increase social casino game play but not necessarily the decision to gamble with real-world money. [ABSTRACT FROM AUTHOR]

• 45.0% of treatment-seeking gamblers had at least one comorbid behavioral addiction. • The most common comorbid behavioral addiction was food bingeing. • The least common comorbid behavioral addiction was exercise. • Comorbid gambling disorder and behavioral addiction is linked with being younger. • There was also an association with greater rates of PTSD and bulimia nervosa. Gambling disorder (GD) frequently co-occurs with substance use disorders. However, the extent to which GD co-occurs with behavioral addictions (BAs) and the demographic, clinical, and personality correlates of comorbid GD and BA is largely unknown. The aims of the present research were to address this gap among people seeking treatment for GD (N = 458) in São Paulo, Brazil. Structured clinical interviews diagnosed individuals with GD and other psychiatric disorders. The Shorter PROMIS questionnaire was used to identify BAs (work, exercise, food bingeing, sex, and shopping). Questionnaires assessed demographic characteristics, gambling behavior, and personality. Of the total sample, 206 (45.0%) participants met the criteria of having at least one behavioral addiction (GD+BA). The most common comorbid BA was food bingeing (8.1%) with the least common being exercise (3.6%). In a multivariate logistic regression, individuals with GD+BA tended to be younger, and had greater rates of comorbid post-traumatic stress disorder and bulimia nervosa compared to participants who did not present with a comorbid BA. Taken together, individuals with GD+BA present with increased psychopathology. These results may have important implications for the assessment and treatment of individuals with GD and comorbid BAs. [ABSTRACT FROM AUTHOR]

Binge eating is exceedingly common in nonclinical samples of young adults, with epidemiological evidence that 49.1% and 30.0% of university-aged women and men, respectively, engage in episodic binge eating. Thus, there is impetus to identify dispositional factors contributing to the emergence and maintenance of binge eating. Impulsivity is well cited as an important vulnerability factor, as longitudinal studies have indicated impulsivity prospectively predicts future binge eating (i.e., a predisposing model). However, no studies to date have examined whether binge eating reciprocally influences future impulsivity (i.e., a complication model). In addition, no prior longitudinal studies have included men, despite evidence that a significant proportion engage in binge eating. To address these gaps in the literature, we conducted a short-term 3-week, 3-wave cross-lagged longitudinal design with 241 undergraduate students (186 women; 53 men). Consistent with our hypotheses, we found both impulsivity and binge eating exhibited strong stability over time, and impulsivity predicted future binge eating across all three waves of the study. Contrary to the complication model, binge eating did not predict future impulsivity. The findings from the current study suggest that personality-targeted prevention and intervention approaches targeting impulsivity may demonstrate clinical utility in attenuating binge eating symptomatology. • Impulsivity and binge eating showed strong stability over 3 weeks. • Impulsivity prospectively predicted binge eating across the 3 wave study. • Binge eating did not predict future impulsivity over time. [ABSTRACT FROM AUTHOR]

• We compare excoriation disorder (ED), obsessive–compulsive disorder (OCD) and gambling disorder (GD) comorbidity profile with the goal to explore a categorical profile to ED. • Results suggest some ED association with addiction, impulsivity or both. • However, was found that ED share a ground with compulsivity justifying the definitive inclusion of ED within the realm of obsessive–compulsive related disorders spectrum. Excoriation disorder (ED) is currently classified in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders' Obsessive–compulsive and Related Disorders section (OCRD). However, there remain debates regarding whether ED is related to obsessive–compulsive disorder (OCD) or whether it is better conceptualized as a behavioral addiction. The present research compared the diagnostic overlap and psychiatric comorbidities of 121 individuals seeking treatment for ED (n = 40), OCD (n = 41) and gambling disorder (GD) (n = 40). ED was more likely to overlap with OCD (n = 14) than GD (n = 3). Compared to OCD, ED had similar frequencies of other body focused repetitive behaviors (BFRBs), but higher frequency of addictive behaviors (Odds Ratio – OR = 11.82). In comparison to GD, ED had similar frequencies of addictive behaviors, but higher frequency of BFRBs (OR=19.67). The results support the recent classification of ED as an OCRD. However, ED presents an association with behavioral addictions that suggests a mixed impulsive-compulsive nature. A limitation of the present research was the use of a non-validated semi-structured clinical interview to diagnose impulse control disorders. Future research should examine other characteristics (e.g., epidemiology, neurobiology, genetics, treatment response) to further investigate whether ED should remain classified as an OCRD. [ABSTRACT FROM AUTHOR]

Objectives: Transaxillary access is the most popular alternative to transfemoral transcatheter aortic valve replacement. Although left transaxillary access is generally preferred, right transaxillary transcatheter aortic valve replacement could be challenging because of the opposing axillary artery and aortic curvatures, which may warrant procedural modifications to improve alignment. Our aim is to compare our single center's outcomes for left and right transaxillary access groups and to evaluate procedural modifications for facilitating right transaxillary transcatheter aortic valve replacement., Methods: Patient characteristics and outcomes were compared for consecutive left or right axillary TAVRs performed from 6/2016 to 6/2022 with SAPIEN 3. The effects of our previously reported "flip-n-flex" technique on procedural efficiency and new conduction disturbances were subanalyzed in the right axillary group., Results: Right and left transaxillary transcatheter aortic valve replacement were performed in 25 (18 with the "flip-n-flex" technique) and 26 patients, respectively. There were no significant differences between patient characteristics or outcomes. Right axillary subanalysis showed the "flip-n-flex" technique group had significantly shorter fluoroscopy times (21.2 ± 6.2 vs 29.6 ± 12.4 min, p = 0.03) and a trend towards less permanent pacemaker implantation (6.3% vs. 42.9%, p = 0.07) compared to the group without "flip-n-flex"., Conclusions: In our study, despite anatomical challenges, right transaxillary transcatheter aortic valve replacement is comparable to left access. The "flip-n-flex" technique advances right transaxillary as an appealing access for patients with few options., (© 2024. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Objective: Remission from problem gambling (PG) continues to be a priority of clinicians and researchers. Data from cross-sectional studies indicate that some correlates are more predictive of PG, and existing longitudinal studies have exclusively examined risk factors that predict emergence of PG. This study's objective is to fill in the remaining pieces of the puzzle by identifying factors that might facilitate remission from PG., Method: A stratified sample of 10,199 Canadian adult gamblers were recruited from an online panel. Respondents who screened positively for PG at baseline and completed a follow-up assessment 1 year later ( n = 468) were assessed on a series of modifiable gambling, psychosocial, mental health, and substance use variables. A forward stepwise logistic regression was conducted to identify the strongest predictors of remission from PG at follow-up. A Least Absolute Shrinkage and Selection Operator regression was also conducted to confirm the most relevant predictors., Results: Out of 75 candidate variables, 10 were retained by the regression model. Two were related to cessation of specific gambling activities, two were related to gambling motivations, two were psychosocial in nature, two were related to substance use while gambling, and one was related to remission from a mental health disorder. The final and strongest predictor was PG severity at baseline., Conclusions: Although PG remission predictors were mostly gambling-related, psychosocial aspects may also be targeted by stakeholders aiming to reduce PG. Ceasing to use tobacco while gambling and diversifying leisure activities may be promising targets. Other mental health and substance use predictors may still possibly be relevant, but only for a subset of people with PG. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: Patients with hypertrophic cardiomyopathy often have concomitant pulmonary hypertension, which has a negative prognostic effect in patients undergoing myectomy. Our objective was to investigate the effect of myectomy on pulmonary artery pressure obtained via Swan-Ganz catheter and characterize how changes in pulmonary artery systolic pressure may indicate outcomes in these patients., Methods: We performed a single-center retrospective analysis of 271 patients with recordings of intraoperative pulmonary artery pressures during surgical myectomy. We analyzed primary composite outcomes as 30-day or in-hospital major cardiopulmonary adverse events., Results: There was a 5.17% adverse event rate. Patients with adverse events were older, were more likely to be female, had chronic obstructive pulmonary disease, and had longer cardiopulmonary bypass times. Some 35.7% of those with adverse events had moderate to severe pulmonary hypertension (pulmonary artery systolic pressure ≥50 mm Hg) on postbypass stress test, compared with 4.3% of those without adverse events (P < .001). Further, 21.4% of patients with adverse events had pulmonary artery systolic pressure 50 mm Hg or greater at the end of surgery, compared with 1.9% of patients without adverse events (P < .001). The pulmonary artery systolic pressure decrease after surgery in those without adverse events was on average 5 mm Hg more than in those with adverse events., Conclusions: Postoperative pulmonary hypertension was associated with a higher rate of adverse cardiopulmonary events. This may influence the decision to use Swan-Ganz catheters in patients undergoing septal myectomy in monitoring pulmonary artery pressures to better risk stratify and manage these patients postoperatively., (Copyright © 2022. Published by Elsevier Inc.)

Few studies have compared gamblers who play in exclusively online (i.e., Internet-based), exclusively offline (i.e., land-based), and mixed-mode contexts. In studies that have compared these groups, mixed-mode gamblers have consistently exhibited the greatest susceptibility to problematic gambling. In order to expand the scope of previous research that has compared gamblers based on their preferred mode of play, and to improve understanding of mixed-mode gamblers' proneness to problematic gambling, a sample of gamblers who play in exclusively online, exclusively offline, and mixed-mode contexts were compared on indices of gambling involvement, motives, and personality traits. Results indicated that mixed-mode gamblers played a wider range of games, and reported higher problematic gambling severity scores, higher scores on enhancement and social gambling motive scales, and lower and higher honesty-humility and extraversion personality scores, respectively. Associations between gambling motives and personality traits are discussed in relation to the role that these characteristics might play in mixed-mode gamblers' increased risk of gambling-related harm., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Sports betting accounts for the greatest proportion of online gambling behavior globally and has been linked to various harms. Few studies have examined the average sports bettor profile using stratified samples of adults who gamble regularly. The present study builds upon existing research on the demographic variables of sports bettors and provides an in-depth examination of the clinical and gambling-related factors associated with sports betting., Method: Participants (N = 10,039; 53.6% female) consisted of a stratified sample of Canadian adults who endorsed participating in gambling at least once per month in the past year. Participants completed standardized measures assessing demographics, gambling behavior, problem gambling severity, gambling-related harms, gambling motives, and psychological characteristics (e.g., substance use, mental health)., Results: About 1,816 participants (18.1%) reported engaging in sports betting in the past year. Sports bettors tended to be younger, male, and employed full-time compared to nonsports bettors. Sports bettors endorsed different patterns of clinical comorbidities and greater substance use. Sports betting was also associated with unique gambling motives and greater time and money spent on gambling. Among participants who endorsed problem gambling, sports betting was associated with greater impulsivity and likelihood of using illicit substances while gambling., Conclusions: The results highlight the characteristics of individuals who bet on sports, as well as the characteristics of sports bettors with problem gambling which may help to inform the development of targeted prevention and intervention efforts to mitigate the potential harms of sports betting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-regulation strategies, such as limit setting, can be effective in reducing harms associated with gambling. However, limited research has examined their applicability to in-play sports betting. The current study therefore examined the utility of self-regulation strategies in reducing in-play betting intensity and associated harms. Adults engaging in-play betting (N = 77; M age  = 41.23 years, 71.43 % men) completed 14 days of ecological momentary assessment surveys in which they reported their in-play betting behaviours (number of bets placed, money spent), use of self-regulation strategies for in-play betting (setting monetary limits, setting time limits, stopping betting when no longer fun, taking frequent breaks), and in-play-betting-related harms. Multilevel models revealed that participants with a greater propensity to set monetary limits were overall less likely to experience financial, interpersonal, and health harms. In addition, participants were less likely to experience emotional/psychological harms following in-play betting occasions during which they set monetary limits (versus when they did not). In contrast, participants with a greater propensity to set time limits tended to spend more money on in-play bets, experienced more harms on average, and were overall more likely to experience financial and work/study harms. Results provide preliminary support for the utility of monetary limit setting, but not time limit setting, in reducing in-play-betting-related harms. Findings support the applicability of select self-regulation strategies originally proposed for more traditional forms of gambling to in-play sports betting, and highlight a need for further research investigating whether other responsible gambling strategies may be effective in reducing in-play-betting-related harms., Competing Interests: Declaration of Competing Interest Funding for this study was provided by a research grant independently managed from Gambling Research Exchange Ontario (GREO) with funds supported by Ontario Lottery and Gaming Corporation (OLG) to Hyoun S. Kim and Matthew T. Keough. GREO and OLG had no role in the study design; collection, analysis, or interpretation of the data; writing the article; or the decision to submit the article for publication. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: When individuals recover from gambling disorder, their involvement in other potentially addictive substances and behaviors may also subsequently increase (substitution) or decrease (concurrent recovery). The objectives of this study were to identify and compare recovery processes associated with substitution and concurrent recovery in gambling disorder., Methods: A mixed-method study was conducted with 185 people who were recovered from gambling disorder. Semi-structured interviews were used to: (i) establish onset and recovery of gambling disorder as well as other substance and behavioral addictions; and (ii) assess processes (e.g., reasons, emotional state, helpfulness) associated with addiction substitution and concurrent recovery. Participants also completed a survey assessing demographic characteristics, gambling behaviors, and psychological characteristics to compare demographic and clinical differences between participants who engaged in addiction substitution, concurrent recovery, or neither (controls)., Results: The most frequently reported reason for engaging in addiction substitution was as a substitute coping mechanism. The most reported reason for engaging in concurrent recovery was due to the addictions being mutually influenced. Negative emotional states were common when engaging in both addiction substitution and concurrent recovery. Although the three groups did not differ on gambling characteristics, addiction substitution was associated with greater underlying vulnerabilities including childhood adversity, impulsivity, emotion dysregulation, and, maladaptive coping skills., Conclusion: Transdiagnostic treatments that target the underlying mechanisms of addictions may reduce the likelihood of engaging in addiction substitution.

Objective: To conduct a large-scale national cohort study to identify the current etiological risk factors for problem gambling in Canada., Method: A cohort of 10,119 Canadian gamblers completed a comprehensive self-administered online questionnaire in 2018 and were reassessed in 2019. At baseline, the sample contained 1,388 at-risk gamblers, 1,346 problem gamblers, and 2,710 with a major DSM-5 mental health disorder. A total of 108 independent variables (IVs) were available for analysis, as well as the self-report of perceived causes of gambling-related problems for 1,261 individuals., Results: The strongest multivariate predictors of current and future problem gambling were "gambling-related" variables (i.e., current and past problem gambling, intensive gambling involvement, playing electronic gambling machines (EGMs), gambling fallacies, socializing with other people having gambling-related problems, and family history of having gambling-related problems). Beyond gambling-related variables, greater impulsivity and lower household income were robustly predictive. Thirteen additional variables were either concurrently or prospectively predictive, but not both. In contrast to the many different quantitative predictors, self-reported causes tended to be singular and psychologically oriented (i.e., desire to win money, boredom, stress, poor self-control)., Conclusions: The predictors of problematic gambling in the present study are very similar to the predictors identified in prior international longitudinal and cross-sectional research. This implies core cross-cultural risk factors, with gambling-related variables and impulsivity being most important, and comorbidities and demographic variables having more modest contributions. The additional value of the present results is that they comprehensively identify the relative importance of all known etiologically relevant variables within a current Canadian context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Purpose: Hemorrhoidal disease remains a common condition that can have a significant effect on a patient's quality of life. Various methods have been introduced over the years; however, their overall success rates remain low. Although the traditional Milligan Morgan technique is effective, the associated pain level prevents it from being an attractive form of treatment. This study was devised to assess the safety and efficacy associated with a novel minimally invasive approach, radiofrequency ablation (RFA)., Methods: Forty-two patients underwent RFA at a single center, by 1 of 2 surgeons. This was performed under local anesthetic and sedation. Outcomes including postoperative pain levels, recurrence rates, and patient satisfaction scores were recorded and analyzed using medians and interquartile ranges., Results: The median postoperative pain score was 2.5/10 (interquartile range [IQR], 0-4.5) and the overall patient satisfaction score was 9 out of 10 (IQR, 6.5-10). Recurrence rates (6-12 months following the procedure) were low at 12% and all patients reported milder symptoms at recurrence. There were no serious adverse complications., Conclusion: The results from this case series supports other limited data in concluding that RFA is a safe and effective method in the treatment of hemorrhoids and patients report a high level of satisfaction following.

Introduction: Cannabis use frequently co-occurs with gambling, and evidence indicates that both acute and chronic cannabis use may influence gambling behavior. The primary aim of the present study was to further contribute to the literature on this relationship by examining data collected from a Canadian national study of gambling., Methods: Respondents consisted of 10,054 Canadian gamblers recruited from Leger Opinion's (LEO) online panel. In this study, gamblers who used cannabis were compared with non-users across a number of gambling as well as demographic and mental health variables., Results: Of the total sample, 25.4 % reported past 12-month cannabis use. Among the 2,553 cannabis-users, 21.3 % reported daily use, and 69.9 % reported using once a month or more. A total of 56.2 % indicated they had used cannabis while gambling in the past 12 months. Bivariate analysis found significant differences between cannabis use and non-use on numerous demographic, mental health, and gambling-related variables. Individuals with greater problem gambling severity scores, more hours gambling, and a larger range of gambling activities were more likely to endorse using cannabis. Hierarchical logistic regression revealed that tobacco use, and having experienced significant child abuse were predictors of cannabis use. Non-use of cannabis was associated with older age, less engagement in online gambling, and being less likely to consume alcohol., Conclusion: The present findings both corroborate previous studies and expand upon the relationship between cannabis and gambling., Competing Interests: Declaration of Competing Interest DM discloses a speaker’s honorarium from Spectrum Therapeutics. The authors declare no conflict of interest that would impact the current study content, conclusions, or presentation., (Copyright © 2022. Published by Elsevier Ltd.)

Transcarotid transcatheter aortic valve replacement (TAVR) is increasingly accepted as a safe and efficacious alternative when transfemoral access is contraindicated. Technical and anatomic considerations unique to transcarotid access warrant several adaptations to the routine TAVR procedure. This report describes an approach to overcome these challenges and improve efficiency, including adoption of the "flip-n-flex" technique originally developed for right transaxillary TAVR. This technique has been used at Tufts Medical Center (Boston, MA) since 2019 in both left and right transcarotid TAVR approaches with success to ensure coaxial alignment of the transcatheter heart valve to the aortic root., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Wildfire area has been increasing in most ecoregions across the western United States, including snow-dominated regions. These fires modify snow accumulation, ablation, and duration, but the sign and magnitude of these impacts can vary substantially between regions. This study compares spatiotemporal patterns of western United States wildfires between ecoregions and snow zones. Results demonstrate significant increases in wildfire area from 1984 to 2020 throughout the West, including the Sierra Nevada, Cascades, Basin and Range, and Northern to Southern Rockies. In the late snow zone, where mean annual snow-free date is in May or later, 70% of ecoregions experienced significant increases in wildfire area since 1984. The distribution of burned area shifted from earlier melt zones to later-melt snow zones in several ecoregions, including the Southern Rockies, where the area burned in the late snow zone during 2020 exceeded the total burned area over the previous 36 y combined. Snow measurements at a large Southern Rockies fire revealed that burning caused lower magnitude and earlier peak snow-water equivalent as well as an 18-24 d estimated advance in snow-free dates. Latitude, a proxy for solar radiation, is a dominant driver of snow-free date, and fire advances snow-free timing through a more-positive net shortwave radiation balance. This loss of snow can reduce both ecosystem water availability and streamflow generation in a region that relies heavily on mountain snowpack for water supply.

Objective: This study examined past year attempts to reduce or quit gambling among people who gamble generally and those with gambling problems specifically., Methods: Regular gamblers recruited from an online panel ( N = 10,054) completed a survey of gambling, mental health and substance use comorbidity and attempts to reduce or quit gambling. The sample was weighted to match the gambling and demographic profile for the same subsample (i.e., past month gamblers) in a recent Canadian national survey., Results: 5.7% reported that they tried to cutback or stop gambling in the past year. As predicted, individuals making a change attempt had greater levels of problem gambling severity and were more likely to have a gambling problem. Of individuals with problem gambling, 59.8% made a change attempt. Of those, 90.2% indicated that they did this primarily on their own, and 7.7% accessed formal or informal treatment. Most people attempting self- change indicated that this was a personal preference (55%) but about a third reported feeling too ashamed to seek help. Over a third (31%) reported that their attempt was successful. Of the small group of people accessing treatment, 39% described it as helpful., Conclusions: Whereas gambling treatment-seeking rates are low, rates of self-change attempts are high. The public health challenge is to promote self-change efforts among people beginning to experience gambling problems, facilitate success at self-change by providing accessible support for use of successful strategies, and provide seamless bridges to a range of other treatments when desired or required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hodgins, Williams, Belanger, Christensen, El-Guebaly, McGrath, Nicoll, Shaw and Stevens.)

Aims: To examine the effect of alcohol cue exposure on tobacco-related cravings, self-administration and other measures of tobacco-related cue reactivity., Methods: We searched Medline, PsycINFO, Embase, CINAHL and Scopus from inception to May 2020 for articles reporting on a combination of cue reactivity (and/or cross-cue reactivity), alcohol use and tobacco consumption. A semi-quantitative analysis and study quality assessment were performed for the included articles., Results: A total of 37 articles met our inclusion criteria and were included in the systematic review. Most studies (60%) reported that alcohol cue exposure increased tobacco cravings, but only 18% of studies reported that alcohol cue exposure resulted in an increase in ad libitum smoking. There was also substantial heterogeneity between studies due to differences in methodology related to alcohol cue exposure, measures of tobacco cravings, as well as variable participant and study characteristics., Conclusions: Alcohol cue exposure can increase cravings for tobacco. This has important implications for individuals who use both substances but are trying to quit one or both., (© The Author(s) 2021. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Objective: The relationship between the level of gambling fallacy endorsement and type of gambler (nongambler, recreational gambler, at-risk gambler, and problem/pathological gambler) was assessed both concurrently and prospectively in a large national cohort of Canadian adults. Method: This cohort ( n = 10,199 at baseline; 18-24 years, n = 481, 43% female; 25-34 years, n = 1,335, 62% female; 35-44 years, n = 1,543, 55% female, 45-54 years, n = 1,985, 58% female; 55-64 years, n = 2,459, 55% female; 65-74 years, n = 1,865, 44% female, 75+ years, n = 531, 43% female) was recruited from LEO, Leger Opinion's registered online panelists. The follow-up survey was completed by 55.9% of the cohort, 1 year after baseline. The full survey can be viewed at https://www.ucalgary.ca/research/national-gambling-study/. For the current study, scores on the Gambling Fallacies Measure, the Problem and Pathological Gambling Measure, Gambling Participation Instrument, and Impulsivity were analyzed. Results: There were three main findings. The first is that gambling fallacies are common in all categories of gamblers but somewhat more prevalent in problem and pathological gamblers. Second, the multivariate analysis determined that gambling fallacies are significant concurrent and prospective predictors of the problem/pathological gambling category, but not strong predictors relative to other variables. Third, problem gambling and heavier gambling involvement are also predictors of a future higher level of gambling fallacies. Conclusions: Collectively, these results show that gambling fallacies have some etiological relationship to problem gambling but are not the main cause of problem gambling and should not be the exclusive focus of problem gambling treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Attentional biases (ABs) have been shown to develop in the context of substance use disorders. Relatively less focus has been paid toward the development of ABs in behavioral addictions such as gambling disorder (GD). Furthermore, the psychological predictors and moderators of AB in GD remain unknown. The present study addressed these empirical gaps. Methods: Fifty-two non-GD electronic gaming machine (EGM) players, 25 GD-EGM players, and 61 non-gamblers completed measures of gambling-related behaviors and cognitions (problem gambling severity, cravings, expectancies, motives) and substance use and mental health (alcohol use severity, depression symptoms). The relationships between these constructs and AB for EGM images were then assessed using a free-viewing eye-tracking paradigm. Results: Non-GD EGM players and GD-EGM players attended to EGM images significantly more than neutral images (with the largest AB for the EGM players with GD). For all EGM players, gambling expectancies regarding the negative emotional impact of gambling and alcohol use severity were associated with greater AB. For non-GD EGM players only, AB was moderated by the anticipation aspect of gambling craving and the self-enhancement aspect of gambling expectancies. Conclusion: The results provide further evidence that ABs develop in the context of excessive gambling and are associated with gambling and psychological variables. The findings support the incentive-salience theory of ABs in gambling and provide a rationale for the development of AB modification programs in the treatment of gambling disorder. Given the predominantly white sample, our results may not generalize to individuals of other ethnicities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Carotid access has shown promise as an excellent delivery route for transcatheter aortic valve replacement (TAVR). We aimed to compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by conducting a search and analysis of the best evidence in the literature to shed light on its safety and effectiveness., Methods: The PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020 were searched to identify articles reporting comparative data on TC versus TF approaches for TAVR. Patients' baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis., Results: Five studies, including a total of 2470 patients, were included in the study with 1859 patients in the TF group and 611 patients in the TC group. The TC group had higher prevalence of peripheral vascular disease, while the patients in the TF group was older. Meta-analysis revealed that there was no significant differences between the two groups with regard to 30-day mortality (p = 0.09), stroke (p = 0.28), new dialysis (p = 0.58), major bleeding (p = 0.69), or pacemaker implantation (p = 0.44). The TF group had a higher incidence of vascular complications (3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p = 0.02)., Conclusions: Compared with the TF approach, TC-TAVR is associated with comparable procedural and clinical outcomes. Our analysis found a lower rate of vascular complication in TC access compared with TF access. This supports consideration of such an alternative access when there are concerns over the feasibility of TF access., (© 2021 Wiley Periodicals LLC.)

Background: Comparison of conventional (open) surgical versus hybrid aortic arch repair remains debatable. While the majority of previous comparative studies including meta-analyses contained primarily risk-unadjusted cohorts, those focusing on propensity-matched comparisons were limited by their small sample size. We aimed to compare outcomes of these two approaches through an up-to-date search and meta-analysis of the best evidence currently available in the literature., Methods: The PubMed/MEDLINE, EMBASE, and Cochrane library from inception to September 2019 were searched to identify articles reporting propensity-score matching data on open versus hybrid aortic arch repair. Patients' baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Heterogeneity and biases were assessed among the included studies., Results: Five studies, including a total of 378 patients (189 pairs), were included in the study. The two groups were similar in patients' baseline characteristics. Stroke rate favoured the open group [2.1% versus 14.3%, OR 0.18 (0.07, 0.46), P=0.0004, I 2 =0%]. There was no significant difference between the two groups with regard to paraplegia. The hybrid group had numerically higher short-term mortality, but lower rate of acute renal failure requiring dialysis. There was a statistically significant difference between the mid-term survivals of the open and hybrid groups, with lower pooled mortality seen for the open group at 1-year and 2-years (P=0.02)., Conclusions: Open and hybrid repairs do not offer equivalent outcomes. Compared with hybrid aortic arch repair, conventional surgical aortic repair could be associated with favourable outcomes including postoperative stroke. Hybrid repair does not appear to provide better survival. Operative approaches should be carefully selected in treating aortic arch pathology., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-183). The authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.)

Objectives: The purpose of this study is to provide an updated profile of gamblers and problem gamblers in Canada and to identify characteristics most strongly associated with problem gambling., Methods: An assessment of gambling participation and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 23,952 individuals 18 years and older. Descriptive statistics provided a demographic profile for each type of gambling involvement as well as category of gambler (non-gambler, non-problem gambler, at-risk gambler, problem gambler). A logistic regression identified characteristics that best distinguished problem from non-problem gamblers., Results: Gambling participation and problem gambling both varied as a function of gender, income, educational attainment, and race/ethnicity. However, multivariate analysis identified electronic gambling machine (EGM) participation to be the primary predictor of problem gambling status, with race/ethnicity, presence of a mood disorder, male gender, casino table game participation, older age, a greater level of smoking, participation in speculative financial activity, instant lottery participation, lower household income, and lottery or raffle ticket participation providing additional predictive power. Provincial EGM density and EGM participation rates are also very strong predictors of provincial rates of at-risk and problem gambling., Conclusion: Problem gambling has a biopsychosocial etiology, determined by personal vulnerability factors combined with the presence of riskier types of gambling such as EGMs. Effective prevention requires a multifaceted approach, but constraints on the availability and operation of EGMs would likely have the greatest single public health benefit.

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality., Methods: Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort., Results: Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P =0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%)., Conclusions: In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.

Background and Aims: In the present research, we experimentally investigated whether the experience of winning (i.e., inflated payout rates) in a social casino game influenced social casino gamers' subsequent decision to gamble for money. Furthermore, we assessed whether facets of dispositional impulsivity - negative and positive urgency in particular - also influenced participants' subsequent gambling., Methods: Social casino gamers who were also current gamblers ( N  = 318) were asked to play a social casino game to assess their perceptions of the game in exchange for $3. Unbeknownst to them, players were randomly assigned to one of three experimental conditions: winning ( n  = 110), break-even ( n  = 103), or losing ( n  = 105). After playing, participants were offered a chance to gamble their $3 renumeration in an online roulette game., Results: A total of 280 participants (88.1%) elected to gamble, but no between-condition variation in the decision to gamble emerged. Furthermore, there were no differences in gambling on the online roulette between condition. However, higher levels of both negative and positive urgency increased the likelihood of gambling. Finally, impulsivity did not moderate the relationship between experience of winning and decision to gamble., Conclusion: The results suggest that dispositional factors, including impulsive urgency, are implicated in the choice to gamble for social casino gamers following play.

Gamblers Anonymous is the most widely available form of support for disordered gambling. Although chapters exist worldwide, knowledge of how attendees interact with the program is limited. The present study aimed to investigate involvement in Gamblers Anonymous among attendees, motives for attendance, and overall satisfaction with the program. Furthermore, potential gambling-related predictors of attendance versus deciding not to attend Gamblers Anonymous were investigated. A treatment-seeking sample of disordered gamblers (N = 512) from São Paulo, Brazil completed a series of self-report measures including an author-compiled Gamblers Anonymous survey. From the sample, 141 gamblers reported attending Gamblers Anonymous over the previous 30 days. An examination of involvement, satisfaction, and motives for attending Gamblers Anonymous was conducted, followed by regression analyses to assess predictors of attendance and satisfaction with the program. The majority of attendees (80%) reported some satisfaction with the program. The most common motive for attending Gamblers Anonymous was related to relapse prevention. Regression analyses revealed that greater gambling severity and number of days gambled were associated with not attending Gamblers Anonymous while giving testimonials was strongly related (OR = 6.18) to satisfaction with the program. The findings of this study contribute to the literature on Gamblers Anonymous. In particular, that members derive great satisfaction from the program and see it as a way to strengthen their abstinence goals. However, despite high satisfaction, the results also suggest that most members were passively involved in the program. More research that assesses the effectiveness of Gamblers Anonymous as either a stand-alone or adjunct treatment is needed.

Personality dimensions have been found to be important in understanding the aetiology of disordered gambling. While the majority of research has focused on the Five-Factor Model of personality, recent empirical evidence also indicated that the honesty-humility factor of the HEXACO personality model may be a key personality correlate of gambling behaviour. In the present research, we extend the understanding between personality and gambling severity by further assessing whether HEXACO dimensions are associated with both current gambling status and gambling severity in a community-recruited sample of gamblers (N = 427). In addition, we examined whether motivations to engage in gambling (enhancement, coping, social and financial) mediated the relationship between personality and gambling severity on the Problem Gambling Severity Index. Demographic covariates were controlled for in our analyses. The results indicate that honesty-humility was the only personality dimension that significantly predicted gambling status (non-gamblers vs. current gamblers). In addition, lower scores on honesty-humility, conscientiousness and openness were significantly associated with gambling severity. Lastly, coping motives were the only significant mediator in the relationship between honesty-humility and increased gambling severity. The results offer further support to the notion that honesty-humility may be an especially pertinent personality dimension in understanding the aetiology of disordered gambling. © 2018 John Wiley & Sons, Ltd., (© 2018 John Wiley & Sons, Ltd.)