Overtime: Long-Term Betting Trajectories Among Highly-Involved and Less-Involved Online Sports Bettors.

Online sports gambling involvement is discontinuous in nature, with small groups of highly involved gamblers exhibiting betting behavior that is distinctly greater than other gamblers. There is some question about whether these groups, defined by exceedingly high levels of play, also have equivalently high rates of gambling problems, and whether they maintain these play levels over time. The current study builds on past work by examining the long-term trajectories of play and voluntary self-exclusion patterns across two years among a cohort of 32,262 highly-involved and less-involved online sports gamblers. We also examine the relative importance of betting behavior change as a risk factor for gambling problems by testing whether high involvement as compared to escalation of involvement is a better predictor of future self-exclusion. Measures included betting activities, transactional activities, and self-exclusion activities on a European online betting platform between February 2015 and January 2017. Results showed that bettors who were most highly involved in the first 8 months of the study in terms of number of bets and net loss were more likely to continue gambling on the platform in months 9-24 than others. Bettors who were most highly involved in the first 8 months of the study in terms of net loss and amount wagered were more likely to use self-exclusion than others, and more likely to have multiple self-exclusions. Escalations in frequency of play and average bet size within the first 8 months emerged as significant predictors of self-exclusion, even when controlling for high involvement.

Multimodal monitoring in patients with acute brain injury - A survey from critical care providers.

BACKGROUND: Multimodal neuromonitoring (MMM) aims to improve outcome after acute brain injury, and thus admission in specialized Neurocritical Care Units with potential access to MMM is necessary. Various invasive and noninvasive modalities have been developed, however there is no strong evidence to support monitor combinations nor is there a known standardized approach. The goal of this study is to identify the most used invasive and non-invasive neuromonitoring modalities in daily practice as well as ubiquitousness of MMM standardization. METHODS: In order to investigate current availability and protocolized implementation of MMM among neurocritical care units in US and non-US intensive care units, we designed a cross-sectional survey consisting of a self-administered online questionnaire of 20 closed-ended questions disseminated by the Neurocritical Care Society. RESULTS: Twenty-one critical care practitioners responded to our survey with a 76% completion rate. The most commonly utilized non-invasive neuromonitoring modalities were continuous electroencephalography followed by transcranial doppler. The most common invasive modalities were external ventricular drain followed by parenchymal intracranial pressure (ICP) monitoring. MMM is most utilized in patients with subarachnoid hemorrhage and there were no differences regarding established institutional protocol, 24-h cEEG availability and invasive monitor placement between teaching and non-teaching hospitals. MMM is considered standard of care in 28% of responders' hospitals, whereas in 26.7% it is deemed experimental and only done as part of clinical trials. Only 26.7% hospitals use a computerized data integration system. CONCLUSION: Our survey revealed overall limited use of MMM with no established institutional protocols among institutions. Ongoing research and further standardization of MMM will clarify its benefit to patients suffering from severe brain injury.

Reversible Cerebral Vasoconstriction Syndrome and Female Sex: A Narrative Review.

Reversible cerebral vasoconstriction syndrome (RCVS) refers to segmental, multifocal constriction of intracranial arteries along with acute headache and resolves within weeks. It occurs more commonly in women, and 1 well-known manifestation of RCVS is postpartum angiopathy. Furthermore, the female sex is included in scoring systems designed to assist with diagnosing RCVS. Nonetheless, the literature is mixed regarding the true role of female and pregnancy-related factors in the pathophysiology of RCVS, and it is similarly unclear whether management of this disorder differs by sex. Given the association of RCVS with female sex and the importance of highlighting, recognizing, and managing stroke etiologies in women, herein, the author reviews what is currently known and unknown about the topic of RCVS in women.

Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics.

Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.

Second Session at the Virtual Poker Table: A Contemporary Study of Actual Online Poker Activity.

Technological advancements and worldwide television exposure led to a poker boom in the early 2000s, and poker (both live and online) has retained some of that popularity today. The present study examined online poker playing trends based on actual electronic betting records data for 2489 subscribers to a major global internet gambling operator from 2015 to 2017. We found that overall financial involvement (median total overall spend: €439.7) and time commitment (median number of sessions: 43) during the two-year study period were relatively moderate. We identified the top 1% by total overall spend as a subgroup of highly involved players with disproportionately higher financial involvement (median total overall spend: €272,581.4) and time commitment (median number of sessions: 1149). Our results were similar to those reported in LaPlante et al.'s (Comput Hum Behav 25(3):711-717, 2009. https://doi.org/10.1016/j.chb.2008.12.027 ) study of online poker betting records, suggesting that players' levels of involvement are similar to those from ten years ago despite numerous changes to the online poker environment. We also analyzed records of deposits and withdrawals, and we observed similar indicators of moderate gambling behavior within the overall sample (median two-year total amount deposited: €176.4). In contrast to popular beliefs about internet gambling, in our sample, most online poker play was arguably moderate. However, a small percentage of highly involved players play poker at extreme levels and require closer scrutiny.

COVID-19 and telehealth in the intensive care unit setting: a survey.

BACKGROUND: Coronavirus disease (COVID-19) has led to changes in how healthcare is delivered. Here, through the administration of surveys, we evaluated telehealth use and views in US intensive care units (ICUs) during the pandemic. METHODS: From June 2020 to July 2021, voluntary, electronic surveys were provided to ICU leaders of Johns Hopkins Medical Institution (JHMI) hospitals, members of the Neurocritical Care Society (NCS) who practice in the US, and Society of Critical Care Medicine (SCCM) members practicing adult medicine. RESULTS: Response rates to our survey were as follows: 18 of 22 (81.8%) JHMI-based ICU leaders, 22 of 2218 (1.0%) NCS members practicing in the US, and 136 of 13,047 (1.0%) SCCM members. COVID-19 patients were among those cared for in the ICUs of 77.7, 86.4, and 93.4% of respondents, respectively, in April 2020 (defined as the peak of the pandemic). Telehealth technologies were used by 88.9, 77.3, and 75.6% of respondents, respectively, following the start of COVID-19 while only 22.2, 31.8, and 43.7% utilized them prior. The most common telehealth technologies were virtual meeting software and telephone (with no video component). Provider, nurse, and patient communications with the patient's family constituted the most frequent types of interactions utilizing telehealth. Most common reasons for telehealth use included providing an update on a patient's condition and conducting a goals of care discussion. 93.8-100.0% of respondents found telehealth technologies valuable in managing patients. Technical issues were noted by 66.7, 50.0, and 63.4% of respondents, respectively. CONCLUSIONS: Telehealth use increased greatly among respondents following the start of COVID-19. In US ICUs, telehealth technologies found diverse uses during the pandemic. Future studies are needed to confirm our findings.

External ventricular drain use is associated with functional outcome in aneurysmal subarachnoid hemorrhage.

PURPOSE: External ventricular drains (EVD) are commonly used in aneurysmal subarachnoid hemorrhage (aSAH) patients and can be life-saving by diverting cerebrospinal fluid. However, the overall relationship between EVD use and outcome is poorly understood. METHODS: In an exploratory analysis of an aSAH patient cohort, we examined EVD use in relation to modified Rankin Scale (mRS) at hospital discharge and at 6 months (unfavorable outcome = mRS > 2) using univariable and multivariable analyses. RESULTS: EVDs were placed in 31 of 56 (55.4%) patients and more often in women than men (66.7% vs 35.0%, p = 0.022) despite similar rates of hydrocephalus. Women had greater ICU [18 (13.5-25) vs 11.5 (6.5-18.5) days, p = 0.014] and hospital lengths of stay (LOS) [20.5 (16.5-34) vs 13.5 (10.5-27) days, p = 0.015] than men and greater mRS at discharge [4 (3-5) vs 3 (2-3.5), p = 0.011] although mRS at 6 months was similar. Patients with EVDs had longer ICU and hospital LOS and greater mRS at discharge [5 (3-6) vs 2 (2-3), p < 0.001] and at 6 months [4 (2-6) vs 1 (0-2), p = 0.001] than those without an EVD. In multivariable models, EVD use was associated with unfavorable 6-month outcome accounting for age, sex, and admission modified Fisher scale, but not in models adjusting for Hunt and Hess scale and World Federation of Neurological Surgeons scale. CONCLUSION: In an aSAH cohort, the use of EVDs was associated with female sex and longer LOS, and may be linked to functional outcomes at discharge and at 6 months, although these associations warrant further investigation.

Time out: Prediction of self-exclusion from daily fantasy sports.

OBJECTIVE: Responsible gambling (RG) tools that include play management software, self-limit features, and self-exclusion are relatively common offerings on major online gambling platforms. However, how online gaming and daily fantasy sports (DFS) players use such tools is less clear. The goals of this article were to understand how players use self-exclusion at a major DFS platform and to identify DFS activity-related predictors of self-exclusion. METHOD: During November 2015, DraftKings, a major DFS provider, rolled out a self-exclusion feature that allows players to self-exclude from the platform for a specified amount of time, up to 5 years. We used player records from DraftKings, examining play patterns and self-exclusion across 3 + years of data. RESULTS: We found that less than 0.5% of subscribers in our sample self-excluded during the study period and almost one third of those who self-excluded did so more than once. In general, self-excluders engaged with a greater variety of contests and sports and entered contests with higher entry fees than those who did not self-exclude. Repeat self-excluders selected shorter initial self-exclusion terms and also engaged with a greater variety of game types and sports than one-time self-excluders. However, self-excluders did not engage in riskier contests or experience higher percent losses. CONCLUSION: Our findings have implications for our understanding of RG feature use among DFS subscribers and markers of risk for experiencing problems with DFS and gambling more generally. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Using "Markers of Harm" to Track Risky Gambling in Two Cohorts of Online Sports Bettors.

Online gambling poses novel risks for problem gambling, but also unique opportunities to detect and intervene with at-risk users. A consortium of gambling companies recently committed to using nine behavioral "Markers of Harm'' that can be calculated with online user data to estimate risk for gambling-related harm. The current study evaluates these markers in two independent samples of sports bettors, collected ten years apart. We find over a two-year period that most users never had high enough overall risk scores to indicate that they would have received an intervention. This observation is partly due to characteristics of our samples that are associated with lower risk for gambling-related harm, but might also be due to overly high risk thresholds or flaws in the design of some markers. Users with higher average risk scores had more intraindividual variability in risk scores. Younger age and male gender were not associated with higher average risk scores. The most active users were more likely than other users to have ever exceeded risk thresholds. Several risk scores significantly predicted proxies of gambling-related harm (e.g., account closure). Overall, the current Markers of Harm system has some correctable limitations that future risk detection systems should consider adopting.

Sustainability of Intravenous Alteplase Administration via Telephone-Based Consult: Data from a US Health System.

OBJECTIVES: Telephone-based consults using remote imaging review and standardization of evaluation but without visualizing the patient are an alternative to video-telestroke consults but are less well-studied. We aim to demonstrate the safety and efficacy of telephone-based acute consults in which IV tPA was administered over nearly a decade within one health system. MATERIALS AND METHODS: Clinical characteristics and outcomes were compared between a community hospital (spoke; uses telephone-based consults) and the academic comprehensive stroke center (hub; uses oversight of on-site neurology trainees) from 2008-2017. In both institutions acute therapy decisions are made by the same stroke neurologists. RESULTS: 2518 acute ischemic stroke consults were evaluated at hub and 2049 at spoke. Of these, 191 patients received IV tPA at hub and 184 at spoke. Patients at hub were younger (median (IQR): 61 (51-74) vs 69 (56-81) years, p = 0.0021) but admission National Institutes of Health Stroke Scale (NIHSS) was similar. There were no differences between door-to-needle times (69 (56-101) vs 69 (51-92) minutes, p = 0.13), last known well-to-tPA times (157 (113-202) vs 144 (110-175) minutes, p = 0.053), and rates of overall intracranial hemorrhage (ICH) after tPA (n = 23 (13.5%) vs 31 (17.0%), p = 0.35). In multivariable analyses, hospital was not an independent predictor of ICH after tPA. CONCLUSIONS: In a large dataset over nearly a decade, assessment for IV tPA administration using telephone assessment along with imaging review and emergency department standardization resulted in similar safety and outcomes as in the presence of on-site stroke/neurology expertise. Future studies are needed to confirm these findings.

Age-Friendly Cities and Older Indigenous People: An Exploratory Study in Prince George, Canada.

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization's guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning.

Developing and validating lower risk online gambling thresholds with actual bettor data from a major Internet gambling operator.

OBJECTIVE: To help individuals avoid potential negative consequences associated with their gambling, researchers have developed lower risk limits for time and financial involvement among populations of land-based gamblers. The present study extended these efforts to online gambler populations with prospective longitudinal data. METHOD: We used receiver operating characteristic curve analysis and logistic regression models predicting a positive Brief Biosocial Gambling Screen (BBGS; Gebauer et al., Canadian Journal of Psychiatry, 55, 2010, 82-90) to develop lower risk limits for six measures of gambling involvement among subscribers to an online gambling operator. We also tested the utility of these six newly developed online limits and three existing land-based limits for the BBGS outcome and proxies for gambling problems including: (a) voluntary self-limiting, (b) voluntary self-exclusion, (c) closing one's account, and (d) being assigned a flag for potential problem gambling by customer service. RESULTS: We identified five optimal limits for lower risk online gambling with adequate sensitivity and specificity for predicting BBGS-positive status, and four of those that also received additional empirical support. These four empirically supported gambling limits were: (a) wagering 167.97 Euros or less each month; (b) spending 6.71% or less of one's annual income on online gambling wagers; (c) losing 26.11 Euros or less on online gambling per month; and (d) demonstrating variability (i.e., standard deviation) in daily amount wagered of 35.14 Euros or less during one's duration active. CONCLUSIONS: Our findings have implications for lower risk gambling limits research and suggest that unique limits might apply to online and land-based gambler populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Evaluating the Computerized Assessment and Referral System (CARS) Screener: Sensitivity and Specificity as a Screening Tool for Mental Health Disorders among DUI Offenders.

Background/Purpose: A growing body of evidence suggests that people who are arrested for driving under the influence (DUI) of alcohol are more likely to screen positive for psychiatric disorders than the general population. Additionally, psychiatric comorbidity has been shown to increase vulnerability to criminal re-offense. However, DUI programs face many barriers to screening for psychiatric disorders. This paper evaluates the sensitivity and specificity of a screening tool developed for these programs, the Computerized Assessment and Referral System (CARS) Screener. Methods: We used data from 381 DUI offenders in Massachusetts, as well as a secondary data source, the National Comorbidity Survey-Replication (NCS-R: N = 9,282) to examine the accuracy of the CARS Screener when compared to full assessment. Results: Based on both sets of analyses, we found that the CARS Screener offers a sensitive and specific method to screen for many psychiatric disorders. Specifically, the CARS Screener has a high sensitivity and specificity for bipolar disorder, intermittent explosive disorder, depressive disorders, generalized anxiety disorder, alcohol and drug use disorders, gambling disorder, post-traumatic stress disorder, panic attacks, and social phobia. Conclusion: The CARS Screener appears to be an effective tool that will help DUI programs better understand and address the mental health issues facing their clients.

Recommendations for improving adolescent addiction recovery support in six northwest tribal communities.

American Indian and Alaska Native (AI/AN) communities offer tangible and intangible resources, including centuries of indigenous wisdom and resiliency, to support their young people in recovery from substance use disorders. At the same time, tribal youth returning home from residential or inpatient treatment are vulnerable to relapse, especially if they encounter the same environmental triggers in which their substance misuse developed. This study endeavored to learn about community stakeholder perceptions of existing strengths and needs for supporting recovering adolescents among six tribal communities of the Inland Northwest. Using a Tribal Participatory Research approach, we conducted Group Level Assessments with key stakeholders representing educators/coaches, medical and behavioral health providers, social service providers, cultural leaders/elders, and legal professionals among each participating tribe (N = 166). We used content analysis to identify emergent themes among participants' recommendations for improving recovery support. The five emergent themes were (1) Communication, Collaboration, and Accountability among Tribal Departments and Agencies; (2) Community-wide Education; (3) The Importance of Providing Wraparound/Supportive Services; (4) Youth-focused Education, Services, and Events; and (5) Recovery Coaching Model. AI/AN culture was infused within nearly all recommendations for improving recovery support that composed these themes. We discuss specific ways to implement these recommendations, including the forthcoming development of a culturally-grounded community-wide mental health training program developed specifically for, and with, these tribes.

Changes to the playing field: A contemporary study of actual European online sports betting.

BACKGROUND AND AIMS: Online sports wagering is a popular and still growing gambling activity around the world. Like other types of gambling, it can lead to problems that include devastating financial, social, and health-related harms. The first analysis of actual online sports wagering activity (LaBrie et al., 2007) suggested that levels of financial and time involvement were more moderate than anticipated from earlier self-report studies. However, these findings are now more than a decade old. METHODS: The current study examined actual online sports wagering activity of a similar cohort of 32,262 gamblers who subscribed to a European online betting platform in February 2015 to understand how sports betting might have changed in ten years. Measures included subscriber characteristics, betting activities, and transactional activities. RESULTS: Players placed a median of 15 bets during the 8-month study period, made a median of 2.5 bets per betting day, had a median bet size of 6.1 euros, and experienced a median net loss of 25 euros. We were able to distinguish highly involved bettors in the top 2% of total wagered, net loss, and number of bets, whose behavior differed from that of the rest of the sample. DISCUSSION AND CONCLUSIONS: Sports wagering behavior has remained relatively stable over time despite legislative changes and an increase in popularity, with a small subset of subscribers exhibiting disproportionately high engagement, transactional activity, and in-game betting. Further investigation of individual trajectories of wagering behavior and engagement with different types of sports wagering products is merited.

Understanding American Indian Youth in Residential Recovery from Substance Use Disorder: Risk and Protective Experiences and Perceived Recovery Support.

Historical trauma has contributed to the reality that addiction disproportionately affects tribal communities, including American Indian youth. We sought to understand American Indian youths' own experiences and perceptions of the environments to which they return after completing residential treatment for substance use disorder. We recruited three cohorts of American Indian residents of a substance use disorder treatment facility (N = 40). These residents completed a survey that measured risk and protective factors, as well as actual risk behaviors, including drug use, gambling, and violence. Participants were at risk not only for substance use disorders, but for other negative outcomes, and had elevated scores on several community, family, and school risk factors, including perceived availability of drugs, community disorganization, family history of antisocial behavior, favorable parental attitudes toward drug use, academic failure, and low school commitment. At the same time, they were exposed to community-level and family protective factors, and they engaged in many tribal cultural activities. When compared to a national sample of American Indian students of similar age, youth in our sample scored similarly on protective factors, including indicators of community, family, and school opportunities and rewards for prosocial involvement, as well as family attachment, suggesting potential resources and strengths for supporting recovery.

Prognostic Value of a Structural Brain MRI Score in the Acute Phase of Aneurysmal Subarachnoid Hemorrhage: A Pilot Study.

BACKGROUND/OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality despite advances in management. We evaluated the prognostic significance of a qualitative score using brain magnetic resonance imaging (MRI) features obtained early after aSAH. METHODS: Patients with aSAH were enrolled in a prospective observational cohort and underwent brain MRI during their acute hospitalization. MRIs were rated using a scoring system that considers the anatomical location of signal intensity changes on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences. The relationship between MRI scores and functional outcome defined by modified Rankin scale (mRS) at 6 months was evaluated in uni- and multivariable models. RESULTS: The cohort included 45 aSAH patients (median World Federation of Neurologic Surgeons (IQR) 2 (1-4)) who underwent brain MRI a mean (SD) of 9.0 ± 8.0 days after aSAH. At 6 months after aSAH, 26 patients had achieved a favorable outcome (mRS ≤ 2) while 15 had an unfavorable outcome (mRS > 2). Deep gray nuclei (DGN) score (p = 0.016), cortex + DGN score (p = 0.015), FLAIR score (p = 0.016), DWI score (p = 0.0045), and overall score (p = 0.0081) were significantly lower in patients with favorable outcome compared to those with unfavorable outcome. However, MRI scores were not independent predictors of outcome in multivariable models adjusting for admission Hunt and Hess, Glasgow Coma Scale, or World Federation of Neurologic Surgeons scales. CONCLUSIONS: In this pilot study, a qualitative scoring system using anatomically defined MRI FLAIR and DWI signal abnormalities identified in the acute phase of aSAH was linked to 6-month functional outcome. However, these scores did not add prognostic value to established indices of neurological severity.