Using Indicators Projects as Prompts for Exploring Equity: A Case Study of Greater Portland Pulse

This paper describes the process that the Greater Portland Pulse (GPP) initiated to incorporate the measurement of progress toward social equity into the project. While equity may appear to be a widely accepted priority for communities, the GPP process created a dialogue that was sometimes contentious but also profoundly educational for the participants revealing some of the complexities, not only of the issue of equity, but the challenges (particularly the inadequacy of available data) and trade-offs that are inescapable when using conventional data sets. Additionally, this paper discusses some of the consequences of a process that, while incorporating equity values and concerns into all of its outcomes and indicators (rather than creating a separate equity outcome category) may have rendered equity less visible than originally intended

Perfectionism and performance in a new basketball training task: Does striving for perfection enhance or undermine performance?

Objectives: In the psychology of sport and exercise, the question of how perfectionism affects performance is highly debated. While some researchers have identified perfectionism as a hallmark quality of elite athletes, others see perfectionism as a maladaptive characteristic that undermines, rather than helps, athletic performance. Against this background, the purpose of the present study was to investigate how different aspects of perfectionism predict performance and performance increments. Method: A study was conducted with 122 undergraduate athletes to investigate how perfectionism during training affects performance and performance increments in a series of trials with a new basketball training task. Two aspects of perfectionism were examined: striving for perfection and negative reactions to imperfection. Design: The design was a correlational prospective design. Results: Results showed that striving for perfection during training predicted higher performance in the new task. In contrast, negative reactions to imperfection predicted lower performance when athletes attempted the task for the first time, once the positive influence of striving for perfection on task performance was partialled out. However, negative reactions to imperfection did not undermine performance in the consecutive trials. On the contrary, athletes with both high levels of striving for perfection and high levels of negative reactions to imperfection showed the greatest performance increments over the series of trials. Conclusion: The findings suggest that perfectionism is not necessarily a maladaptive characteristic that generally undermines sport performance. Instead, when learning a new training task, perfectionism may enhance performance and lead to performance increments over repeated trials

Retrospective review of a Prothrombin Complex Concentrate (Beriplex P/N) for the management of perioperative bleeding unrelated to oral anticoagulation

A multicenter, retrospective, observational study of 4-factor prothrombin complex concentrate (PCC) and/or fresh frozen plasma (FFP) use within routine clinical care unrelated to vitamin K antagonists was conducted. The PCC was administered preprocedure for correction of coagulopathy (prophylactic cohort) and treatment of bleeding postsurgery (treatment cohort). Of the 445 patients included, 40 were in the prophylactic cohort (PCC alone [n ¼ 16], PCC and FFP [n ¼ 5], FFP alone [n ¼ 19]) and 405 were in the treatment cohort (PCC alone [n ¼ 228], PCC and FFP [n ¼ 123], FFP alone [n ¼ 54]). Cardiovascular surgery was the most common setting. PCC doses ranged between 500 and 5000 IU. Effectiveness (assessed retrospectively) was reported as effective in 93.0% in the PCC-only group (95% confidence interval, 89.1% to 95.9%), 78.9% (70.8% to 85.6%) with PCC and FFP, and 86.3% (76.2% to 93.2%) with FFP alone. In the treatment cohort, international normalized ratio was significantly reduced in all 3 groups. In patients who received PCC, the rate of thromboembolic events (1.9%) was below rates in the literature for similar procedures. PCCs offer a potential alternative to FFP in the management of perioperative bleeding unrelated to oral anticoagulant therapy

Current misconceptions in diagnosis and management of iron deficiency

The prevention and treatment of iron deficiency is a major public health goal. Challenges in the treatment of iron deficiency include finding and addressing the underlying cause and the selection of an iron replacement product which meets the needs of the patient. However, there are a number of non-evidence-based misconceptions regarding the diagnosis and management of iron deficiency, with or without anaemia, as well as inconsistency of terminology and lack of clear guidance on clinical pathways. In particular, the pathogenesis of iron deficiency is still frequently not addressed and iron not replaced, with indiscriminate red cell transfusion used as a default therapy. In our experience, this imprudent practice continues to be endorsed by non-evidence-based misconceptions. The intent of the authors is to provide a consensus that effectively challenges these misconceptions, and to highlight evidence-based alternatives for appropriate management (referred to as key points). We believe that this approach to the management of iron deficiency may be beneficial for both patients and healthcare systems. We stress that this paper solely presents the Authors' independent opinions. No pharmaceutical company funded or influenced the conception, development or writing of the manuscript

Direct oral anticoagulants-Remove versus Taipan snake venom time for detection of a lupus anticoagulant in patients taking oral direct factor Xa inhibitors.

BACKGROUND: The optimal method of detecting a lupus anticoagulant (LA) for patients taking direct factor Xa inhibitor (DFXaI) direct oral anticoagulants (DOACs) remains controversial. Methods include charcoal adsorption of the DOACs to allow testing with the activated partial thromboplastin time (APTT) and dilute Russell viper venom time (dRVVT), or use of the DFXaI-insensitive Taipan snake venom time (TSVT) and Ecarin time (ET) assays on neat plasma. OBJECTIVES: The objective was to compare the utility of APTT and dRVVT analysis following DOAC Remove against TSVT/ET on untreated plasma for LA detection in spiked plasmas and routine clinical samples for patients on DFXaIs. PATIENTS/METHODS: Various LA-negative and LA-positive samples were assayed by APTT, dRVVT, and TSVT/ET, and then separately spiked with rivaroxaban, apixaban, and edoxaban calibrators to a concentration of ~190 ng/ml and the assays repeated on spiked plasma before and after DOAC Remove treatment. Testing of 284 consecutive samples from DFXaI-anticoagulated patients by APTT/dRVVT and TSVT/ET before and after DOAC Remove treatment was undertaken. RESULTS: In the spiking model, we found that both TSVT/ET and DOAC Remove strategies generally distinguished LA-negative and LA-positive samples, but some false-positive LA results occurred. In the investigation of 284 consecutive patient samples on DFXaIs, the percentage agreement for LA detection in neat samples tested by TSVT/ET versus APTT and dRVVT after DOAC Remove treatment was 90% (Cohen kappa 0.12). CONCLUSION: Our data highlight uncertainty and disagreement for testing LA in patients on DFXaI. Further studies are required

A hypercoagulable state leading to venous limb gangrene associated with occult lung adenocarcinoma.

We report a case of lung adenocarcinoma-associated hypercoagulability leading to venous limb gangrene, managed successfully with argatroban and then dabigatran. Use of idarucizumab permitted diagnostic investigations, leading to targeted antineoplastic therapy with crizotinib, surgical resection with curative intent, and continued survival over 2 years after the index event

Financial incentives to promote active travel: an evidence review and economic framework

ContextFinancial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between “nudging,” which may be insufficient for changing habitual behavior, and regulations that restrict individual choice.Evidence acquisitionThe literature review identified studies published between January 1997 and January 2012 of financial incentives relating to any mode of travel in which the impact on active travel, physical activity, or obesity levels was reported. It encompassed macroenvironmental schemes, such as gasoline taxes, and microenvironmental schemes, such as employer-subsidized bicycles. Five relevant reviews and 20 primary studies (of which nine were not included in the reviews) were identified.Evidence synthesisThe results show that more-robust evidence is required if policymakers are to maximize the health impact of fiscal policy relating to transport schemes of this kind.ConclusionsDrawing on a literature review and insights from the SLOTH (sleep, leisure, occupation, transportation, and home-based activities) time-budget model, this paper argues that financial incentives may have a larger role in promoting walking and cycling than is acknowledged generally

Study of VLF/LF wave propagations above seismic areas

Abstract: We report on radio transmitter signals recorded in Europe by INFREP network which is mainly devoted to search for earthquakes electromagnetic precursors (Biagi et al., 2011). We consider in this analysis the detection of transmitter signals recorded by INFREP receivers located in different regions of Europe, i.e. Romania, Italy, Greece and Austria. The aim is the investigation of the electromagnetic environment above earthquakes regions. We selected seismic events which occurred in the year 2016 and characterized by a moment magnitude (Mw) above 5.0 and a depth of less than 50 km. A common method is applied to all events and which involves the analysis of the VLF/LF signal detection taking into consideration the following parameters: (a) the distance transmitters-receivers, (b) the signal to noise ratio during the diurnal and night observations, (c) the daily and night averaged amplitude and (d) the sunset and sunrise termination times. This leads us to specify the key factors which can be considered as criteria to distinguish and to identify earthquakes precursors. We discuss in this contribution the radio wave propagation in the D- and E-layers and their impacts on the VLF/LF amplitude signal. We show that the 'seismic anomaly' requests a more precise analysis of the 'quiet' and 'disturbed' ionospheric conditions and their corresponding spectral traces on the VLF/LF transmitter signals

Screening for Type 1 Diabetes in the General Population:A Status Report and Perspective

Most screening programs to identify individuals at risk for type 1 diabetes have targeted relatives of people living with the disease to improve yield and feasibility. However, ∼90% of those who develop type 1 diabetes do not have a family history. Recent successes in disease-modifying therapies to impact the course of early-stage disease have ignited the consideration of the need for and feasibility of population screening to identify those at increased risk. Existing population screening programs rely on genetic or autoantibody screening, and these have yielded significant information about disease progression and approaches for timing for screening in clinical practice. At the March 2021 Type 1 Diabetes TrialNet Steering Committee meeting, a session was held in which ongoing efforts for screening in the general population were discussed. This report reviews the background of these efforts and the details of those programs. Additionally, we present hurdles that need to be addressed for successful implementation of population screening and provide initial recommendations for individuals with positive screens so that standardized guidelines for monitoring and follow-up can be established