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Background: At-risk alcohol use is associated with increased adverse health consequences, yet is undertreated in healthcare settings. People residing in rural areas need improved access to services; however, few interventions are designed to meet the needs of rural populations. Mobile interventions can provide feasible, low-cost, and scalable means for reaching this population and improving health, and behavioral economic approaches are promising. Methods: We conducted a pilot randomized controlled trial focused on acceptability and feasibility of a mobile behavioral economic intervention for 75 rural-residing adults with at-risk alcohol use. We recruited participants from a large healthcare system and randomized them to one of four virtually-delivered conditions reflecting behavioral economic approaches: episodic future thinking (EFT), volitional choice (VC), both EFT and VC, or enhanced usual care control (EUC). The intervention included a telephone-delivered induction session followed by two weeks of condition-consistent ecological momentary interventions (EMIs; 2x/day) and ecological momentary assessments (EMAs; 1x/day). Participants completed assessments at baseline, post-intervention, and two-month follow-up, and provided intervention feedback. Results: All participants completed the telephone-delivered session and elected to receive EMI messages. Average completion rate of EMAs across conditions was 92.9%. Among participants in active intervention conditions, 89.3% reported the induction session was helpful and 80.0% reported it influenced their future drinking. We also report initial alcohol use outcomes. Discussion: The behavioral economic intervention components and trial procedures evaluated here appear to be feasible and acceptable. Next steps include determination of their efficacy to reduce alcohol use and public health harms.

The purpose of this study was to assess the stress responses associated with vaquejada simulating tests (VSTs). Ten clinically healthy 8.9 ± 4.3-year-old Quarter horses, weighing 441.3 ± 25.0 kg, performed two VSTs five days apart. In the first VST (M1), animals ran three times with a 5-min rest between races; and in the second (M2), they ran with a 15-min rest between races. Horses were examined before (T0) and immediately after the third run (T1) and at 4 h (T2) of recovery. Stress biomarkers included heart rate (HR), heart rate variability (HRV), cortisol, and white blood cell count. All variables were analyzed by ANOVA and Tukey tests, considering p < 0.05. A significant reduction in cortisol was observed for pull (p = 0.0463) and helper (p = 0.0349) horses when they had a 15-min rest between races. The rMSSD and mean R-R values for helper horses were also significantly lower in M2. In conclusion, the 15-min rest interval proved to be better than the 5-min period for both categories of equine athletes used in vaquejada mainly for helper horses. A longer rest time between races allowed the organic recovery necessary for these animals to impose a greater applied physical effort load, which is a fact that guarantees good performance and well-being.

Abstract Background COVID-19 pandemic placed unprecedented pressure on societies and healthcare systems around the world. Over the last years, measures imposed in almost all countries dealing with the pandemic sent the entire world into an extensive crisis and thus into a deep global recession. Since the outbreak began, many European countries have faced three/four waves of pandemic. Portugal has mainly dealt with three waves (March/April’2020; October/November’2020; January/February’2021), the third being the deadliest one. The purpose of this article is to provide evidence on the impact of the COVID-19 on health-related quality of life (HRQol) and well-being (W-B) of Portuguese citizens. It aims to (i) characterize these outcomes during the COVID-19 pandemic; (ii) compare them to pre-COVID-19 Portuguese population; and (iii) identify the social determinants that may affect these outcomes during the COVID-19 pandemic. Methods This study used data from a survey that collected data on HRQoL, W-B, satisfaction with life, economic and labour impacts, access to healthcare, mental and physical health, amongst others. The survey was implemented by telephone to a representative random sample of 1,255 respondents from the general adult Portuguese population, stratified by sex, age group and region. Data was collected during the end of the second national lockdown. For comparison purposes, we have also used two other representative databases from the general Portuguese population: (i) data from before the pandemic (n = 1,006); and (ii) data from a survey conducted during the first lockdown, (n = 904). Results Looking at health and access to healthcare, 4% of citizens had their surgeries postponed or cancelled because of COVID-19, more than a quarter had medical appointments or complementary exams postponed or cancelled, with 7% over 65 years old with surgeries cancelled or postponed and 32% medical appointments. COVID-19 pandemic also impacted negatively on the HRQoL of citizens, especially in the first lockdown. Half of the respondents reported feeling nervous, anxious, or on edge, about 45% of citizens felt sad or depressed. Sleeping problems were reported for almost 39% of citizens, and loneliness is reported by 29% of citizens. For about 70–85% of citizens, these feelings were more so than before the pandemic. Citizens with fair/strong economic stability were the most economically affected by the pandemic. Conclusions We provided evidence on the impact of COVID-19 on health and W-B of Portuguese citizens. Their health was worse than before the pandemic and the access to healthcare was highly affected.

The article is based on a report given in course of the round table meeting 'Language as an art', dedicated to the 90th anniversary since the birth of the outstanding linguist L.A. Novikov, whose reknown works on the issues of linguistic meaning and the aesthetic aspects of language have attracted wide critical acclaim and become a valuable part of philology as a science. The choice of the topic is methodologically adjusted to L.A. Novikov’s conception of verbal arts, which is succinctly represented in the term 'poetheme'. Emotives (vocabulary that names, expresses and describes emotions) can be categorised as poethemes, since the verbalisation process of emotions in poetry is related to their aesthetic transformation. The description of emotions in the article is conducted in multiple directions, each of which is significant in order to understand the specifics of the verbalisation of emotions in poems. The author relates the new aspect of viewing the poetic semantics of emotives to the influence of the grammatical meaning of the verb mood on the illocutionary function of verbalised emotions that take part in the declaration of intent. Besides, the imperative mood and the infinitive accentuate the extravert semantics (emotions for others and for oneself), the subjunctive mood being introvert (emotions for oneself). Additional information regarding the contextual features of emotions could be acquired through the emphasis on the indefinite, demonstrative, negative and possessive pronouns, which accompany emotives. The article demonstrates that metaphorical rows of emotions organise the personal mental image of the poet’s world. Basic poetic emotions, established due to the fact of attractiveness (mutual attraction, approach), are related to Russian mentality as a whole. The range of problems dealt with in the article is significant to filling the forming term 'emotional picture of the world’ with content.

Abstract Background The use of patient‐reported outcomes (PRO) in clinical practice is gaining increasing attention. This study aimed to provide a critical assessment of the current state‐of‐the‐art and beliefs about the use of PRO in the management of people with epilepsy across some European countries. Methods Structured interviews were conducted with European experts to collect insights about (I) the personal experience with PRO; (II) the value and impact of PRO in the decision‐making process at the national level; and (III) the interest for and use of PRO by national health authorities. Results Nine neurologists (Austria, Belgium, Czechia, Denmark, France, Greece, Italy, Poland, and United Kingdom), three health economists (Portugal, Romania, and Sweden), and one epidemiologist (Slovakia) participated. They all stated that PRO are collected at their own countries in the context of clinical trials and/or specific projects. During everyday clinical practice, PRO are collected routinely/almost routinely in Austria and Sweden and only at the discretion of the treating physicians in Czechia, Denmark, France, Greece, and Portugal. There was complete consensus about the favorable impact that the PRO can have in terms of clinical outcomes, healthcare resources utilization, and general patient satisfaction. Only participants from Portugal and Sweden answered that the PRO are perceived as very important by the National Health Authorities of their respective countries. Conclusions Differences exist in attitudes and perspectives about PRO in epilepsy across Europe. An active plan is warranted to harmonize the measurement of PRO and ensure they can be relevant to people with epilepsy and health services.

Hospitalisation with an acute medical illness represents a significant risk factor for venous thromboembolism. Identification of patients at high risk of VTE at hospital admission and provision of appropriate thromboprophylaxis is a key intervention to improve patient safety during hospitalisation. The successful implementation of a systematic approach to VTE prevention in England highlights the effectiveness of this approach. However, the optimal strategy for identification of at-risk patients enabling targeted thromboprophylaxis provisions remains uncertain and many VTE events occur despite provision of appropriate thromboprophylaxis. In this narrative review, we discuss the pros and cons of commonly utilised VTE risk assessment tools for acutely ill medical patients, the current controversies in optimal dosing and duration of thromboprophylaxis and highlight special patient populations where further research is required.

Emotional intelligence (EI) is comprised of a set of critical life skills that develop, in part, through practice in social interaction. As such, some have expressed concern that the heavy screen media diet of today’s youth threatens the development of those crucial abilities. This research assesses how the media diet of children and the media use of their parents relates to child EI levels to assess what, if any, specific patterns exist. Four hundred parents of children aged 5–12 reported on, among other variables, their child’s EI, empathy, and emotional regulation skills along with their child’s various digital and non-digital media use, and non-media activities. Parental EI, screen use, media emotional mediation, and media co-use with their children were also assessed. Analyses revealed no significant relationships between child EI and screen use of any kind, though reading positively associated with child EI. Especially interesting, children whose parents used their mobile device more frequently in the presence of their child had lower EI, and parents who engaged in emotional mediation around their child’s media use reported higher EI levels in their children. These findings suggest that concerns about children’s digital media usage are perhaps overblown in terms of impeding emotional skill development. Further, and especially critical, parents’ own media-related behaviors around their children could have significant impact on child EI development.

Primary human papillomavirus (HPV) testing, in which a high-risk HPV test is administered without cytology, was first included in 2018 US cervical cancer screening guidelines. Subsequent guidelines endorsed primary HPV testing as the preferred method for cervical cancer screening following evidence of its clinical and economic benefits, although many sources still indicate it as an option along with cytology and HPV/Pap co-testing. Primary HPV testing could be key to improving the declining cervical cancer screening rates in the US; however its adoption has been slow as clinicians are hesitant to make the change. Indiana ranks in the top ten states for cervical cancer mortality, with marked race-ethnic disparities in cervical cancer screening and low HPV vaccination rates. To examine clinician practices, knowledge, and attitudes regarding primary HPV testing, in 2021 we conducted an online cross-sectional survey (n = 224) and in-depth interviews (n = 20) with Indiana clinicians practicing cervical cancer screening. Only 3 % reported using primary HPV testing for eligible patients, and only 50 % were willing to adopt it as the preferred cervical cancer screening method for the recommended patient group. In a multivariable logistic regression model, knowledge of the effectiveness (aOR 2.58 [1.41–4.72]) and perceived benefit (aOR 7.35 [3.65–14.81]) of primary HPV testing predicted willingness to adopt. In-depth interviews revealed knowledge gaps, uncertainty, and perceived limitations of this method as the reasons for limited uptake of primary HPV testing. Targeted messages about the benefits and effectiveness may enhance clinician knowledge, acceptance, and adoption.

Cervical cancer screening rates are declining in the US, with persistent disparities among vulnerable populations. Strategies to better reach under-screened communities are needed. The COVID pandemic sparked major shifts in healthcare delivery, including the accelerated development and adoption of rapid diagnostic testing, broadened access to remote care, and growing consumer demand for self-testing, which could be leveraged for cervical cancer. Rapid tests for the detection of Human Papillomavirus (HPV) have the potential to improve cervical cancer screening coverage, and if coupled with patient-collected cervicovaginal samples, create an opportunity for self-testing. The objectives of this study were: 1) to examine whether COVID influenced clinician perspectives of rapid testing as a screening modality; and 2) to assess clinician awareness, perceived benefits and limitations, and willingness to adopt point-of-care HPV testing, patient self-sampling, and rapid HPV self-testing with self-collected samples. The methodology adopted consisted of an online cross-sectional survey (n = 224) and in-depth interviews (n = 20) were conducted with clinicians who perform cervical cancer screening in Indiana, ranked in the top ten states for cervical cancer mortality and with marked disparities across socio-demographic groups. The main findings show that about half the clinicians reported that the COVID pandemic had influenced their views on rapid testing as a screening modality both positively (greater public acceptability of rapid testing and impact on patient care) and negatively (concerns regarding accuracy of rapid tests). The majority of clinicians (82%) were willing to adopt rapid HPV testing at the point-of-care, while only 48% were willing to adopt rapid HPV self-testing with self-collected samples. In-depth interviews revealed provider concerns around patients’ ability to collect their own sample, report results correctly, and return to the clinic for follow-up and other preventive care. Addressing clinician concerns about self-sampling and rapid HPV testing, such as ensuring that rapid tests include sample adequacy controls, is necessary to mitigate barriers to adoption for cervical cancer screening.

In times of the COVID-19 pandemic, difficult decisions such as the distribution of ventilators must be made. For many of these decisions, humans could team up with algorithms; however, people often prefer human decision-makers. We examined the role of situational (morality of the scenario; perspective) and individual factors (need for leadership; conventionalism) for algorithm preference in a preregistered online experiment with German adults (n = 1,127). As expected, algorithm preference was lowest in the most moral-laden scenario. The effect of perspective (i.e., decision-makers vs. decision targets) was only significant in the most moral scenario. Need for leadership predicted a stronger algorithm preference, whereas conventionalism was related to weaker algorithm preference. Exploratory analyses revealed that attitudes and knowledge also mattered, stressing the importance of individual factors.

The article presents material supporting the thesis about the discourse register of emo­tions in their movement from poetic communications to non-poetic ones. The subjects of the description are emotives — linguistic signs of emotions. The part of the article that deals with poetry interprets emotives in multiple aspects: in the aspect of the grammar of poetic language and in their figurative representation. Within the frames of such grammatical categories as the imperative and subjunctive moods, emotives acquire typologically significant cognitive and semantic characteristics: a drive to display emotions, desire and the unattainability of the desired. The semantic features of emotives are revealed in the structures of the 'inner speech': in interrogative structures and pseudo-dialogical reflexions. The figurative representation of emotions is realised through conceptual metaphors, which bestow upon emotions new charac­teristics correlating to personal mental images of the emotional world. The linguistic means of representing emotions are closely linked to the features of the social period, to existential de­mands and to the state of public consciousness. The part of the article that is related to non-poetic communication interprets such links based on the examples of PR and advertising dis­courses. The particular "poetic" use of language is, of course, most obvious in poetry, but a broad understanding of the poetic function allows us to speak of the "poetic in the non-poetic". In the segment of the article related to non-poetical communication, linguistic repre­sentations of emotions and techniques for creating "referential illusions" are considered on the example of PR-discourse and advertising discourse. Attention is focused on discursive transformations associated with the formation of a mythological world in which its own spe­cial laws operate. In both discourse types, orientation towards results correlates with orienta­tion towards the message itself.

Abstract Background Schizophrenia and bipolar disorder are serious psychiatric disorders with a high disease burden, a high number of years of life lived with disability and a high risk for relapses and re-hospitalizations. Besides, both diseases are often accompanied with a reduced quality of life (QoL). A low level of quality of life is one predictor for relapses. This study examines whether a telemedical care program can improve QoL. Methods Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) is a prospective controlled randomized intervention trial to implement and evaluate a telemedical care concept for patients with schizophrenia and bipolar disorder. Participants were randomized to an intervention or a control group. The intervention group received telemedical care including regular, individualized telephone calls and SMS-messages. QoL was measured with the German version of the WHOQOL-BREF. Effects of telemedicine on QoL after 6 months and treatment*time interactions were calculated using linear regressions (GLM and linear mixed models). Results One hundred eighteen participants were recruited, thereof 57.6% men (n = 68). Participants were on average 43 years old (SD 13). The treatment*time interaction was not significant. Hence, treatment had no significant effect either. Instead, gender is an influencing factor. Further analysis showed that social support, the GAF-level and QoL-values at baselines were significant determinants for the improvement of QoL. Conclusion The telemedicine care concept Tecla was not significant for QoL in patients with severe psychiatric disorders. More important for the QoL is the general social support and the level of global functioning of the patients. Trial registration German Clinical Trials Register, DRKS00008548, registered 21 May 2015 – retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do

Abstract The ISTH London 2022 Congress is the first held (mostly) face‐to‐face again since the COVID‐19 pandemic took the world by surprise in 2020. For 2 years we met virtually, but this year’s in‐person format will allow the ever‐so‐important and quintessential creativity and networking to flow again. What a pleasure and joy to be able to see everyone! Importantly, all conference proceedings are also streamed (and available recorded) online for those unable to travel on this occasion. This ensures no one misses out. The 2022 scientific program highlights new developments in hemophilia and its treatment, acquired and other inherited bleeding disorders, thromboinflammation, platelets and coagulation, clot structure and composition, fibrinolysis, vascular biology, venous thromboembolism, women’s health, arterial thrombosis, pediatrics, COVID‐related thrombosis, vaccine‐induced thrombocytopenia with thrombosis, and omics and diagnostics. These areas are elegantly reviewed in this Illustrated Review article. The Illustrated Review is a highlight of the ISTH Congress. The format lends itself very well to explaining the science, and the collection of beautiful graphical summaries of recent developments in the field are stunning and self‐explanatory. This clever and effective way to communicate research is revolutionary and different from traditional formats. We hope you enjoy this article and will be inspired by its content to generate new research ideas.

The concept of frontier has been formed for a long time and in different directions. The main characteristics of a frontier - its flexible borders, a zone of space development characterised by uncertainty and instability - have proved their importance for understanding and describing the current state of the environment with regard to its social, cultural, communicative and linguistic indicators. The interdisciplinary (transcendental) potential of a frontier is realised in a complementary combination of natural-scientific and humanitarian scholarship. The aim of the present paper is to justify the scholarly integrity of the term frontier discourse the conceptual milieu of which is created through two overlapping multi-layered phenomena: frontier and discourse. The paper names the vectors of expanding the interdisciplinary possibilities of a frontier under the conditions of a discourse approach. Frontier as a flexible border is presented in the Internet communication, the socio-cultural space of the modern city, in the daily behavioural norms of the elite, in the family relations and in many other conceptual spheres the list of which remains open based on the ontological features of a frontier. Based on the examples from Russian and foreign literature, the author demonstrates the role of the frontier modus in the interpretation of literary texts whose plot, style and images are projected onto national history, culture, mentality in the by-border characteristics. Such frontier features as instability, its ability to create an interaction zone, which, under certain conditions, can lead to integration, are important for understanding the problems of modern language, speech and genre norms. The byborder territory is a place accumulating violations of traditional norms and providing the material which is necessary in order to anticipate the arising norm changes. The transformation of traditional genres and the formation of new ones also take place on frontier territories. It is concluded that frontier discourse ensures the understanding of norm movements in genre-stylistic characteristics.

BackgroundMotivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal intervention engagement, individual burden, and up-front costs.PurposeTechnological advancements can mitigate some of these barriers. For example, mobile abstinence monitoring and digital, automated incentive delivery have the potential to lower the clinic burden associated with monitoring abstinence and administering incentives while also reducing the frequency of clinic visits. However, to fully realize the potential of digital technologies to deliver motivational incentives it is critical to develop strategies to mitigate longstanding concerns that reliance on extrinsic monetary reinforcement may hamper internal motivation for cessation, improve individual engagement with the intervention, and address scalability limitations due to the up-front cost of monetary incentives. Herein, we describe the state of digitally-delivered motivational incentives. We then build on existing principles for creating just-in-time adaptive interventions to highlight new directions in leveraging digital technology to improve the effectiveness and scalability of motivational incentive interventions.ConclusionsTechnological advancement in abstinence monitoring coupled with digital delivery of reinforcers has made the use of motivational incentives for smoking cessation increasingly feasible. We propose future directions for a new era of motivational incentive interventions that leverage technology to integrate monetary and non-monetary incentives in a way that addresses the changing needs of individuals as they unfold in real-time.

Abstract Background Medication nonadherence can result in poor clinical outcomes and significant costs to health care providers. When treating venous thromboembolism (VTE), subtherapeutic anticoagulation may contribute to complications such as recurrent VTE or postthrombotic syndrome. Objectives To describe the extent, reasons for, and predictors of nonadherence to rivaroxaban for the treatment of VTE in clinical practice in the United Kingdom reported by participants of the FIRST registry. Patients/Methods The FIRST registry was an observational, multicenter registry reporting on the use of rivaroxaban in routine clinical practice. FIRST registry participants completed an adherence screening questionnaire during their treatment and follow‐up. Results In total, 1028 participants completed 1660 questionnaires over 2 years. One hundred thirteen of 1028 (11%) reported nonadherence at 28 days (interquartile range, 21‐45). Reasons given for nonadherence at 1 month were forgetfulness (8.6% vs 74.7%; P

BackgroundAlcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. ObjectiveThis study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. MethodsFollowing a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). ResultsBooster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. ConclusionsThe use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. Trial RegistrationClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283

Abstract Background Rivaroxaban was reported as effective as traditional therapies for the acute treatment of venous thromboembolism (VTE) with fewer major bleeding complications in the seminal Einstein program and is now a recommended option for the treatment of VTE around the world. Objective To report the safety and efficacy of rivaroxaban in daily care for the management of acute VTE in the United Kingdom. Patients/Method The FIRST registry is a UK‐only, multicenter, noninterventional, observational VTE study (NCT 02248610). Consecutive patients diagnosed with acute VTE, managed with rivaroxaban, were recruited and followed for up to 5 years. The primary outcomes were treatment‐emergent symptomatic objectively diagnosed recurrent VTE, major and clinically relevant nonmajor bleeding (CRNMB), and all‐cause mortality. Results A total of 1262 participants were recruited between 2014 and 2018. Participants were heterogeneous, with age range 18 to 95 years, weight 35 to 234 kg, and maximum body mass index 64.4 kg/m2. The median duration of treatment exposure was 135 days (interquartile range [IQR], 84‐307) and overall follow‐up 497 days (IQR, 175‐991). There were seven episodes of symptomatic VTE recurrence, 0.6%, (0.74/100 patient‐years; 95% confidence interval [CI], 0.19‐1.28). There were 79 of 1239 (6.4%), 8.66 of 100 patient‐years (95% CI, 6.90‐10.73) first episodes of major or CRNMB, which were most frequently reported by women aged

Objectives: To systematically review the literature to analyze the effect of lumbar elastic tape application on trunk mobility, surpassing the minimal detectable change of the used outcome measurement tool, and to analyze the additional effect of applied tension and direction of elastic tape application in low back pain and participants without low back pain. Data Sources: Four databases were used: PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and Google Scholar. Study Selection: The inclusion criteria were randomized and clinical controlled trials evaluating the effectiveness of lumbar elastic tape application on trunk mobility. Data Extraction: Two researchers executed the search and a third author was consulted to resolve disagreements. The methodological quality was scored using the PEDro scale, with studies scoring ≤5 being excluded. Data Synthesis: Eight out of 6799 studies were included; 5 studied individuals with low back pain, and 3 studied participants without low back pain. Two studies scored low on the PEDro scale and were excluded. None of the reported significant changes in trunk mobility due to elastic tape application exceeded the indicated minimal detectable change. No conclusions can be drawn from the direction and applied tension of elastic tape application. Conclusions: Based on the results of this systematic review, there is no evidence supporting the effect of lumbar elastic tape application. We recommend consensus in the use of more reliable and valid instruments in future studies.

Introduction Venous thromboembolism (VTE) is a significant cause of maternal mortality with the greatest risk postpartum. Mode of delivery influences VTE risk, with emergency caesarean section (CS) associated with the highest risk (CS). Thromboprophylaxis is recommended for selected women to reduce the risk of VTE. We aimed to investigate the impact of mode of delivery and thromboprophylaxis on hypercoagulability as measured by thromboelastometry (TEM) and thrombin generation (TG) in women at high VTE risk. Materials and Methods Blood was collected from 99 pregnant women with VTE risk factors at up to five time points from pre- (T1) and post (T2)-delivery to 6 weeks postpartum (T5). Multiple linear regression was utilised to compare TG and TEM between those with vaginal delivery (VD) and CS at each time point. Paired sample t-test with post hoc Bonferroni correction was utilised to compare laboratory markers over time. Results Women in both groups had a median of three postpartum VTE risk factors, with higher body mass index and parity post-VD. In both the groups, TG and TEM parameters suggested hypercoagulability at T2 compared with T1, with resolution at T5. There were minimal differences between groups, apart from T2 with shorter clot formation time and higher maximum clot firmness in the VD group. Conclusion TG and TEM illustrate hypercoagulability associated with pregnancy and delivery. The pattern of postpartum hypercoagulability seen in women with VTE risk factors was similar irrespective of mode of delivery. Further research is required to establish the effect of labour on TG/TEM in the absence of low molecular weight heparin use.

Artigo publicado com erros: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/10241 Na página 405, Tabela 3 onde se lê: A negrito o valor 34,4 na dimensão "limitação do Desempenho" referente à coluna "Seguimento a 6 meses" Deverá ler-se: A negrito o valor 37,9. Na página 406, Figura 4, onde se lê: O eixo do índice SF-6D com valores entre 0 a 50. Deverá ler-se: O eixo do índice SF-6D com valores entre 0 a 1.

Abstract Background Schizophrenia and bipolar disorder are characterized by a high disease burden. Antipsychotic medication is an essential part of the treatment. However, non-adherence is a major problem. Our aim was to examine potential determinants of non-adherence for patients with severe mental disorders. Methods Baseline data of the study “Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) were used. Medication adherence was assessed with the Medication Adherence Report Scale German version (MARS-D). A logistic regression was calculated with age, sex, education, employment status, level of global functioning, social support and intake of typical and atypical antipsychotics as predictors. Results N = 127 participants were included in the analysis (n = 73 men, mean age 42 years). The mean MARS-D Score was 23.4 (SD 2.5). The most common reason for non-adherence was forgetting to take the medicine. Significant positive determinants for adherence were older age (OR 1.02, 95% CI 1.011–1.024, p

Vaquejada is a high-intensity and short-duration exercise in which helper horses (HH) are responsible to keep a bull running in a line while pull horses (PH) work to put the bull down after 100 m of running. The purpose of this study was to quantify and compare energy expenditures (EE), transport costs (COT) and metabolic energy requirements (Pmet) of horses used in Vaquejada. Thus, eight Quarter Horses, in randomly formed pairs, performed a vaquejada simulation test (VST), which consisted of three races on a sand track (130–150 m), with a 5-min interval between them. All horses used an integrated heart rate (HR) and GPS monitoring system (V800, Polar Electro) and, from these data, EE, COT and Pmet were calculated using the formulas: EE (J/kg/min) = 0.0566 × HR1.9955, COT = (HR-35)/kg/m × 103 and Pmet = (HR-35)/min/kg. Blood samples were collected for lactate analysis at rest, immediately after the first, second and third race and after 30 min of recovery. Data obtained were submitted to one-way ANOVA and Tukey tests (p ≤ 0.05). In VST, HH had higher EE and higher HR at trot; while PH presented higher EE and HR at canter. Finally, considering total VST, PH had higher EE and COT, while HH had higher Pmet. Lactate was higher in PH. Despite practicing the same sport, PH and HH should be considered distinct athletes, and these must be considered to set up appropriate physical and nutritional programs, which will lead to better performance and guarantees of well-being.

The article is an analytical review of three volumes of the Bulletin of the Russian University of Friendship of Peoples on the problem of discourse. The author has formed a number of headings, the complex of which allows to judge the priority areas of modern scientific knowledge, an essential part of which is discourse. The heading «Pragmatics and metapragmatics of discourse» was formed mainly on the basis of the articles of famous foreign researchers. In each article there are curious ideas, and the generalization of the thesis can be as follows: the evaluation category has a direct relation to the pragmatics, and the estimated semantics of the word is manifested in communication. In the section «Synchronization of paradigmatic relations: text, discourse, style, utterance, speech act, genre» the articles are presented, the material of which is important for revealing the paradigmatic relations between the phenomena named in the heading, including the culturally conditioned features. In the heading “Institutional discourses and problems of hybridization of discourses”, the material of articles of both Russian and foreign researchers is summarized, which makes it possible to identify both the general (even universal) orientation of discourse studies and specific approaches and characteristics due to the peculiarities of social processes and national cultural codes . The heading «Identity in its relation to the language / discursive personality» focuses on understanding the close relationship of the category of identity with the problems of discourse and various types of communication. Many authors of the articles present a retrospective of the development of the concepts under consideration, describe the path of their development from the moment they enter the scientific space to the present. At the same time, ways of coordination and integration of methods and approaches are outlined, which is necessary for understanding the prospects of discourse studies.

Background: Stroke presents commonly to the emergency department (ED), and is a common cause of morbidity and mortality in South Africa. Early ED presentation and early neuroimaging are required in order for thrombolysis to be a potential therapeutic modality. Objectives: To determine the time to ED presentation, time to computed tomography (CT) scan and the potential influencing factors for patients with stroke. Methods: A retrospective record review of all patients who presented with clinical features of stroke to a tertiary academic ED in Johannesburg, South Africa, from 01 January to 31 December 2014. Results: Data from 232 eligible stroke patients were analysed. The median time to presentation to the ED was 33 h with the majority of patients (81.3%) presenting after the 4.5 h window for thrombolysis. The median time to CT was 8 h. Only 3.9% of patients had a CT scan within one hour of arrival. Patients with loss of consciousness were associated with earlier hospital presentation (p = 0.001). None of the patients were thrombolysed. Conclusion: Patients with stroke commonly present late to hospital. If we are to make a difference in this group of vulnerable patients, further education and training needs to be emphasised regarding ‘time is brain’. Communication and commitment is also required by the emergency medical services, ED and radiology staff in order to prioritise stroke patients and to reduce delays.

Em 2007 teve início uma crise financeira que tem vindo a ter um forte impacto na economia europeia, e em particular em Portugal, com fortes reflexos também no sector do turismo. Os dados disponíveis mostram que, apesar do peso do turismo doméstico no sector turístico em Portugal não ser tão grande quanto o do turismo internacional, a sua importância é considerável, tendo apresentado uma tendência crescente ligeira na última década. No entanto em 2011 e 2012 verificou-se uma tendência inversa. A investigação conduzida em Portugal tem-se centrado sobretudo sobre a procura turística internacional, não existindo estudos sobre a procura turística doméstica. Numa conjuntura de crise económica e financeira, considera-se importante estudar os factores que determinam essa procura turística. Assim, o objetivo deste estudo consiste em modelar e produzir previsões para a procura turística doméstica em Portugal. Foram usados dados trimestrais, desde 2009 a 2012, para um conjunto alargado de variáveis económicas, como por exemplo o PIB per capita, o rendimento médio disponível das famílias, o índice de preços no consumidor, o indicador de confiança dos consumidores, a taxa de desemprego, o número de desempregados e o preço do barril de petróleo. Também foi considerada uma variável binária que indica a presença da Troika em Portugal. Foram estimadas várias especificações de modelos econométricos considerando como variável dependente o número de dormidas de turistas residentes em Portugal. As previsões da procura turística foram efectuadas com recurso a modelos de alisamento exponencial tradicionais. Os resultados obtidos indicam que em Portugal, numa conjuntura de crise económica e financeira, a procura turística doméstica é explicada pelo rendimento médio disponível das famílias, pelo número de desempregados e pelo índice de preços no consumidor relativo aos transportes. As estimativas obtidas indicam que a elasticidade do rendimento disponível na procura é aproximadamente +2,1%, do número de desempregados é cerca de -0,6% e do índice de preços dos transportes é aproximadamente +1,2%.

ObjectivesImplementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial.MethodsGuided by the Consolidated Framework for Implementation Research, we employed qualitative methods to evaluate clinician, administrator, and patient perceptions of the program using semi-structured interviews. We used a team-coding approach for the data; thematic development focused on barriers and facilitators to implementation using a grounded theory approach. The codebook was refined through open discussions of subjectivity and unintentional bias, coding, and memo applications (including emergent coding), and the hierarchical structure and relationships of themes.ResultsWe conducted 20 interviews with 11 clinicians/administrators and 9 patients. Five major themes emerged: (1) gradual acceptance and support of the intervention and workflow; (2) compatibility with system and personal norms and goals; (3) reinforcement of the value of and need for adaptability; (4) self-efficacy within the nursing team; and (5) importance of identifying accountable front-line staff beyond leadership "champions."ConclusionsFindings suggest a high degree of acceptability and feasibility due to the selection of appropriate implementation strategies, alignment of norms and goals, and a high degree of workflow adaptability. These findings will be uniquely helpful in generating actionable, real-world knowledge to inform the design, implementation, and sustainment of guideline-recommended depression screening programs in oncology.Trial registrationClinicalTrials.gov #NCT02941614.

Introduction. Stroke remains a global leading cause of death and disability. Traditional description of plasma biology in the aftermath of acute ischaemic stroke favours development of hypercoagulability, resulting from complex interplay between plasma and endothelial factors. However, no single assay measures the overall global coagulation process. We postulate that thrombin generation would assist in identifying coagulation abnormalities after acute stroke. Aim. To investigate the coagulation abnormalities after acute ischaemic stroke using thrombin generation. Methods. We evaluated thrombin generation, measured with calibrated automated thrombography in stroke of different aetiological types (n=170) within 48 hours of symptoms onset (baseline) and in the second week (time 2) and in normal healthy volunteers (n=71). Results. Two-point thrombin generation assays showed prolonged lag time and time to peak at baseline (3.3 (2.9, 4.0) versus 3.6 (3.2, 4.7); p=0.005) and (3.3 (2.9, 4.0) versus 3.6 (3.2, 4.7); p=0.002), respectively, and at time 2 (3.5 (2.9, 4.2) versus 4.0 (3.1, 4.9); p=0.004) and (5.9 (5.3, 6.6) versus 6.8 (5.8, 7.7) p=0.05), respectively, in cardioembolic stroke (n=39), when compared to noncardioembolic stroke (n=117). The result was reproduced in multiple comparisons between acute ischaemic stroke subgroups and normal healthy volunteers. Endogenous thrombin potential and peak thrombin did not indicate hypercoagulability after acute ischaemic stroke, and thrombolytic therapy did not affect thrombin generation assays. Conclusion. Our findings suggest that thrombin generation in platelet poor plasma is not useful in defining hypercoagulability in acute ischaemic stroke. This is similar to observed trend in coronary artery disease and contrary to other hypercoagulable states.

Schizophrenia is a complex and often disabling disorder that is characterized by a wide range of social, emotional, and cognitive deficits. Increasing research suggests that the greatest social and cognitive therapeutic impact comes from early identification. The present study applied a well-established neurophysiological paradigm in the schizophrenia literature, mismatch negativity (MMN), to college students identified as high risk (HR) for psychosis to investigate MMN as a potential biomarker for the onset of psychosis. The hypothesis was that HR would exhibit attenuated MMN amplitudes compared to controls, as has been established in individuals with chronic schizophrenia. Participants (N=121) were separated into Group 1 (controls) (n1=72) and Group 2 (HR) (n2=49) based on the established cutoff score of the 16-item Prodromal Questionnaire. Participants then completed a time based MMN paradigm during which brain activity was recorded with EEG. For all electrode locations, controls demonstrated significantly more negative amplitudes than HR (Cz: F(1,119)=8.09, p=.005; Fz: F(1,119)=5.74, p=.018; Pz: F(1,119)=5.88, p=.017). Results suggested that MMN may assist in identifying those who appear high-functioning but may be at risk for later development of psychosis or cognitive and psychological difficulties associated with psychosis.

Introduction: This research aims to explore the performance of the SF-6D and the EQ-5D in patients suffering from asthma, chronic obstructive pulmonary disease, cataracts, and rheumatoid arthritis. In particular, the aim of this research is twofold: 1) to study the level of agreement between the indexes and the descriptive systems of the dimensions of the SF-6D and the EQ-5D, and 2) to analyze the discriminative ability of the instruments. Material and Methods: A sample of 643 patients completed both the SF-36v2 and the EQ-5D. The discriminative ability of the instruments was analyzed. Furthermore, the level of agreement between the indexes and the descriptive systems of the dimensions of the SF-6D and the EQ-5D were studied. The level of agreement between instruments was investigated using correlation coefficients and the Bland-Altman plots, while the influence of medical condition and other socio-demographic variables was analyzed using nonparametric tests. Paired-samples tests were used to identify differences between the scores. Results and Discussion: The results show a strong correlation and agreement between both indexes. Overall, questionnaire indexes differ by medical condition and socio-demographic groups and both instruments are able to discriminate between socio-demographic groups. Conclusion: This study confirmed the hypothesis that the SF-6D generates higher utility values in less healthy individuals. The SF-6D and the EQ-5D seem to perform differently in each of the diseases studied since the descriptive statistics differ between instruments and the level of correlation is not uniform. Results show that the instruments generate different utility values, but there is a strong agreement between both indexes. Thus, the two instruments are not interchangeable and their results cannot be directly comparable.

Purpose: To study the tomographic features of pellucid-like keratoconus (PLK), and to report a new sign on the pachymetry map (PM) in pellucid marginal degeneration (PMD). Patients and methods: A retrospective descriptive case series was performed in Damascus University in 2011. Clinical and tomographic findings of 15 eyes (9 patients) that had the claw pattern of the anterior sagital map (ASM) were reviewed. Patients were distributed into two groups: (1) 4 eyes were considered PMD since they had inferior corneal thinning on both slitlamp biomicroscopy and PM; (2) 11 eyes were considered as PLK since they did not show inferior corneal thinning. Patients were studied using slitlamp biomicroscopy and Scheimpflug-based tomography (Pentacam HR). The ASM, anterior elevation map (AEM) and PM were analyzed and compared to study the “kissing birds” sign, the “bell” sign, and cone location. Results: Patients’ average age was 25.93±8.05 (16–44 years). In total, 60% of patients were male. In group 1, the AEM in the best fit sphere (BFS) mode revealed no kissing birds sign, and the cone was central in 1 eye (25%) and paracentral in 3 eyes (75%). PM showed the bell sign in 4 eyes (100%). In group 2, the AEM in the BFS mode revealed the kissing birds sign in 2 eyes (18.2%), and the cone was central in 1 eye (9.1%), paracentral in 8 eyes (72.7%) and peripheral in 2 eyes (18.2%). PM didn’t show the bell sign in any eye. Conclusion: The claw pattern on the ASM is not a hallmark of PMD; it can be seen in PLK. Cone location does not relate to diagnosis. The “bell” sign on the PM is a deferential diagnostic sign in PMD.

Mutation of the staphylococcal accessory regulator (sarA) limits biofilm formation in diverse strains of Staphylococcus aureus, but there are exceptions. One of these is the commonly studied strain Newman. This strain has two defects of potential relevance, the first being mutations that preclude anchoring of the fibronectin-binding proteins FnbA and FnbB to the cell wall, and the second being a point mutation in saeS that results in constitutive activation of the saePQRS regulatory system. We repaired these defects to determine whether either plays a role in biofilm formation and, if so, whether this could account for the reduced impact of sarA in Newman. Restoration of surface-anchored FnbA enhanced biofilm formation, but mutation of sarA in this fnbA-positive strain increased rather than decreased biofilm formation. Mutation of sarA in an saeS-repaired derivative of Newman (P18L) or a Newman saeRS mutant (ΔsaeRS) resulted in a biofilm-deficient phenotype like that observed in clinical isolates, even in the absence of surface-anchored FnbA. These phenotypes were correlated with increased production of extracellular proteases and decreased accumulation of FnbA and/or Spa in the P18L and ΔsaeRS sarA mutants by comparison to the Newman sarA mutant. The reduced accumulation of Spa was reversed by mutation of the gene encoding aureolysin, while the reduced accumulation of FnbA was reversed by mutation of the sspABC operon. These results demonstrate that saeRS and sarA act synergistically to repress the production of extracellular proteases that would otherwise limit accumulation of critical proteins that contribute to biofilm formation, with constitutive activation of saeRS limiting protease production, even in a sarA mutant, to a degree that can be correlated with increased enhanced capacity to form a biofilm. Although it remains unclear whether these effects are mediated directly or indirectly, studies done with an sspA::lux reporter suggest they are mediated at a transcriptional level.

PurposeAlcohol use among adolescents and emerging adults is an important public health issue requiring prevention approaches. Herein, we describe outcomes from a randomized controlled trial testing the efficacy of group-based social media interventions targeting risky drinking among youth.ProceduresUsing social media advertisements to screen potential participants, we recruited 955 youth (ages 16-24) reporting recent risky drinking. After completing a baseline assessment, participants were randomized to 8-week secret Facebook group conditions: Social Media Intervention + Incentives for engagement, Social Media Intervention only, and attention-placebo control. Electronic coaches trained in motivational interviewing facilitated interaction in intervention groups. Primary outcomes include past 3-month alcohol use and consequences over 3-, 6-, and 12-month follow-ups. Secondary outcomes include other drug use, consequences, and impaired driving. We also measured intervention engagement and acceptability.ResultsThe interventions were well-received, with significantly greater acceptability ratings and engagement in the SMI+I condition relative to other groups. In adjusted analyses, there were no significant differences between interventions and control on alcohol-related outcomes, with all groups showing reductions. Regarding secondary outcomes (70.4% used other drugs), compared to control, the incentivized group reduced other drug use, consequences, and cannabis-impaired driving; the non-incentivized group did not significantly differ from the control condition.ConclusionsAmong this predominantly poly-substance using sample, findings were mixed, with significant effects of the incentivized social media intervention on drug (but not alcohol) outcomes. Future studies are needed to further refine social media-delivered interventions to reduce alcohol and other drug use.Trial registrationClinicalTrials.gov NCT02809586; University of Michigan HUM#00102242.