2021 Update of the International Council for Standardization in Haematology Recommendations for Laboratory Measurement of Direct Oral Anticoagulants

International audienceIn 2018, the International Council for Standardization in Haematology (ICSH) published a consensus document providing guidance for laboratories on measuring direct oral anticoagulants (DOACs). Since that publication, several significant changes related to DOACs have occurred, including the approval of a new DOAC by the Food and Drug Administration, betrixaban, and a specific DOAC reversal agent intended for use when the reversal of anticoagulation with apixaban or rivaroxaban is needed due to life-threatening or uncontrolled bleeding, andexanet alfa. In addition, this ICSH Working Party recognized areas where additional information was warranted, including patient population considerations and updates in point-of-care testing. The information in this manuscript supplements our previous ICSH DOAC laboratory guidance document. The recommendations provided are based on (1) information from peer-reviewed publications about laboratory measurement of DOACs, (2) contributing author's personal experience/expert opinion and (3) good laboratory practice

A novel measure of compulsive food restriction in anorexia nervosa: Validation of the Self-Starvation Scale (SS).

The characteristic relentless self-starvation behaviour seen in Anorexia Nervosa (AN) has been described as evidence of compulsivity, with increasing suggestion of transdiagnostic parallels with addictive behaviour. There is a paucity of standardised self-report measures of compulsive behaviour in eating disorders (EDs). Measures that index the concept of compulsive self-starvation in AN are needed to explore the suggested parallels with addictions. With this aim a novel measure of self-starvation was developed (the Self-Starvation Scale, SS). 126 healthy participants, and 78 individuals with experience of AN, completed the new measure along with existing measures of eating disorder symptoms, anxiety and depression. Initial validation in the healthy sample indicated good reliability and construct validity, and incremental validity in predicting eating disorder symptoms. The psychometric properties of the SS scale were replicated in the AN sample. The ability of this scale to predict ED symptoms was particularly strong in individuals currently suffering from AN. These results suggest the SS may be a useful index of compulsive food restriction in AN. The concept of 'starvation dependence' in those with eating disorders, as a parallel with addiction, may be of clinical and theoretical importance

Compulsivity in anorexia nervosa: a transdiagnostic concept.

The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN

A novel measure of compulsive food restriction in anorexia nervosa: Validation of the Self-Starvation Scale (SS).

The characteristic relentless self-starvation behaviour seen in Anorexia Nervosa (AN) has been described as evidence of compulsivity, with increasing suggestion of transdiagnostic parallels with addictive behaviour. There is a paucity of standardised self-report measures of compulsive behaviour in eating disorders (EDs). Measures that index the concept of compulsive self-starvation in AN are needed to explore the suggested parallels with addictions. With this aim a novel measure of self-starvation was developed (the Self-Starvation Scale, SS). 126 healthy participants, and 78 individuals with experience of AN, completed the new measure along with existing measures of eating disorder symptoms, anxiety and depression. Initial validation in the healthy sample indicated good reliability and construct validity, and incremental validity in predicting eating disorder symptoms. The psychometric properties of the SS scale were replicated in the AN sample. The ability of this scale to predict ED symptoms was particularly strong in individuals currently suffering from AN. These results suggest the SS may be a useful index of compulsive food restriction in AN. The concept of 'starvation dependence' in those with eating disorders, as a parallel with addiction, may be of clinical and theoretical importance

Passenger’s Satisfaction on Long Distance Terminals: Case Study City of Zagreb

Every city has one or more long distance terminals for domestic or international transport. Usually, long distance terminal are connected to the city transport network (metro, tramway, buses, car or bike sharing, and private car) and can be unimodal or multimodal terminals. From the passengers’ perspective multimodal terminals are much more convenient and preferred. In the last decade terminals across Europe have developed not only in transport function, but also in hospitality management (bars, restaurants, accommodation…). Today, terminals have also developed into shopping areas, so they are attracting more and more people. Nevertheless, we must not neglect the primary function of a terminal: transport start/stop point for passengers. The focus group of a terminal is passengers. For day-to-day operation, but also for the development of terminal it’s crucial to make regularly surveys about passenger satisfaction. This paper will present the results of passenger satisfaction survey in the long distance terminal in the City of Zagreb. The City of Zagreb is the capital of the Republic of Croatia, one of the 28 member states of the European Union. It is interesting that Zagreb has two unimodal long distance terminals, one for railways and the second one for buses. Therefore, the transfer passengers have practical problems when they change modes of transport for long distance travel. Passengers in both terminals have been interviewed. The survey for both terminals has the same question, so a comparative analysis could be done

Hungry for reward: How can neuroscience inform the development of treatment for Anorexia Nervosa?

Dysfunctional reward from the pursuit of thinness presents a major challenge to recovery from Anorexia Nervosa (AN). We explore the neuroscientific basis of aberrant reward in AN, with the aim of generating novel hypotheses for translational investigation, and elucidate disease mechanisms to inform the development of targeted interventions. Relevant neuroimaging and behavioural studies are reviewed. These suggest that altered eating in AN may be a consequence of aberrant reward processing combined with exaggerated cognitive control. We consider evidence that such aberrant reward processing is reflected in the compulsive behaviours characterising AN, with substantial overlap in the neural circuits implicated in reward processing and compulsivity. Drawing on contemporary neuroscientific theories of substance dependence, processes underpinning the shift from the initially rewarding pursuit of thinness to extreme and compulsive weight control behaviours are discussed. It is suggested that in AN, weight loss behaviour begins as overtly rewarding, goal-directed and positively reinforced, but over time becomes habitual and increasingly negatively reinforced. Excessive habit formation is suggested as one underlying mechanism perpetuating compulsive behaviour. Ongoing research into the behavioural and neural basis of aberrant reward in AN is required to further elucidate mechanisms. We discuss clinical and transdiagnostic implications, and propose that future treatment innovation may benefit from the development of novel interventions targeting aberrant reward processing in AN

Same-sex sexual violence in the military – A scoping review

Introduction: Sexual violence (SV) is a globally prevalent issue, and the majority of research focuses on the historical view of SV as an act perpetrated by men against women. Same-sex sexual violence (SSSV) incidents represent a small proportion of recorded sexual offences, and therefore prevalence and consequences of this have received little attention. Male-dominated occupations, such as the military, are associated with higher rates of SV and data points to a particular vulnerability to SSSV of male service personnel (SP). Methods: This review aims to map the literature pertaining to SSSV in the military. A comprehensive scoping review methodology was adopted, following a rigorous accepted framework. Four databases were searched for English language, peer-reviewed, original research papers that were focused on SSSV in the military context. Results: Eleven papers were identified that met the criteria for inclusion; 10 originated from the United States and one from South Korea. Themes identified included prevalence and nature of SSSV in the military, characteristics of survivors and perpetrators, barriers to reporting, and the outcomes associated with SSSV in the military. Discussion: The evidence that does exist suggests that male SP are particularly at risk of SSSV, and experience poorer psychological and social outcomes due to SSSV compared to female SP and those who experience opposite-sex sexual violence (OSSV). More research is required internationally to provide accurate and up-to-date estimates of prevalence, and to account for cultural and structural differences in military organizations