Management of venous thromboembolism in patients experiencing direct oral anticoagulant treatment failure: a single-center review of practice and outcomes.

Direct oral anticoagulants (DOACs) have gained in popularity over vitamin K antagonists for the treatment of venous thromboembolism, however their efficacy is not routinely monitored. It is therefore a clinical challenge to know how to respond when treatment with DOACs fails, and there is little formal guidance on how to manage these patients. We sought to characterize VTE patients who experienced DOAC failure at our institution, and rationalize subsequent treatment strategies. We collated the details of 54 consecutive patients with suboptimal response or breakthrough thrombosis on a DOAC, from our large specialist-led thrombosis clinic. Initial treatment changes were recorded, as well as long-term anticoagulation therapy and treatment outcomes. On first recognition of DOAC failure, 69% of patients were temporarily switched to therapeutic-dose low molecular weight heparin; most of the remaining patients were treated with an alternative DOAC regimen. After a limited period of parenteral treatment, 84% of patients returned to oral anticoagulation, the majority of whom experienced no further treatment failures. By the end of follow-up, 72% of patients were either on long-term DOAC therapy or had completed treatment altogether. In the absence of evidence or guidelines, brief rescue of anticoagulation with parenteral therapy can be an effective strategy when treatment with a DOAC fails.

Emotions are a window into one's heart": a qualitative analysis of parental beliefs about children's emotions across three ethnic groups.

We conducted a qualitative study to explore parental beliefs about emotions in the family across three cultures (African American, European American, and Lumbee American Indian), using the underutilized yet powerful methodology of focus groups. The main goal of this monograph is to understand parents' beliefs about the role of emotions in the family and how cultural or ethnic background may influence those beliefs. Based on philosophical traditions and previous research, three dimensions of parental beliefs were predicted: Value of Emotion, Socialization of Emotion, and Controllability of Emotion. We expected new themes to emerge during the focus groups.Twelve focus groups were conducted with 87 parents from the three cultural groups mentioned above. Groups met for two sessions scheduled 2 weeks apart. Focus group discussions were led by same-ethnicity moderators. Aninductive analysis was conducted; key themes and subthemes were identified.All three theoretically derived dimensions were well represented in each focus group. Cultural similarities in themes within these dimensions included children's appropriate expression of negative emotions, role of emotion in the home, children's capacity for controlling emotions, and parents' role in socialization of emotion. Cultural variations included concern about parents' expression of negative emotion, children's modulation of positive emotion, the role emotions play in behavior, and choice in emotional experience. Two new dimensions also emerged: Relational Nature of Emotions and Changeability of Emotions. Cultural similarities in themes within these dimensions included emphasis on emotional connections with children, emotional contagion in families, developmental change in children's emotions, and intergenerational change in emotion socialization. Cultural variation included discussion of emotions as guides for action and children's emotional privacy. Dimensions and the themes and subthemes within them are presented with supporting evidence and sources. Implications of parental beliefs for emotion socialization theory and future research, as well as limitations, are discussed.

Mecamylamine blocks enhancement of reference memory but not working memory produced by post-training injection of nicotine in rats tested on the radial arm maze.

The focus of this study was to analyze whether the psychostimulant nicotine would enhance reference and working memory consolidation in rats tested on the 8-arm radial arm maze. Mecamylamine, a nicotine antagonist, was used to attempt to block the enhancement of memory consolidation. All rats were given one training trial/day for 12 consecutive days, and 4 arms were baited. Rats were separated into five groups: the saline-nicotine group received an intraperitoneal (i.p.) injection of saline immediately after each trial followed 15 min later by an subcutaneous (s.c.) injection of nicotine (0.6 mg/kg free base); the nicotine-delay group received an s.c. injection of nicotine 2 h after each training trial, two groups received an i. p. injection of one of two different doses of mecamylamine (2.5 and 6.0 mg/kg) immediately after each trial, which was followed 15 min later by an s.c. nicotine injection, and a control group received an i.p. injection of saline immediately and 15 min after each training trial. Results showed that the saline-nicotine group made fewer reference and working memory errors than the saline- or nicotine-delay groups, but only the effect of nicotine on reference memory was blocked by the higher dose of mecamylamine. It appears from these results that nicotine's effects on reference and working memory may be mediated through different mechanisms.

Development and validation of the Parents' Beliefs About Children's Emotions Questionnaire.

Parents' beliefs about children's emotions comprise an important aspect of parental emotion socialization and may relate to children's mental health and well-being. Thus, the goal of this study was to develop the multifaceted Parents' Beliefs About Children's Emotions (PBACE) questionnaire. Central to our work was inclusion of multiple ethnic groups throughout the questionnaire development process, from initial item creation through assessment of measurement invariance and validity. Participants included 1,080 African American, European American, and Lumbee American Indian parents of 4- to 10-year-old children who completed the initial item pool for the PBACE. Exploratory factor analyses were conducted with 720 of these parents to identify factor structure and reduce items. Confirmatory factor analysis was then conducted with a holdout sample of 360 parents to evaluate model fit and assess measurement invariance across ethnicity and across parent gender. Finally, validity of the PBACE scales was assessed via correlations with measures of parental emotional expressivity and reactions to children's emotions. The PBACE is composed of 33 items in 7 scales. All scales generally demonstrated measurement invariance across ethnic groups and parent gender, thereby allowing interpretations of differences across these ethnic groups and between mothers and fathers as true differences rather than by-products of measurement variance. Initial evidence of discriminant and construct validity for the scale interpretations was also obtained. Results suggest that the PBACE will be useful for researchers interested in emotion-related socialization processes in diverse ethnic groups and their impact on children's socioemotional outcomes and well-being. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The impact of experienced emotion on evaluative judgments: the effects of age and emotion regulation style.

Adults aged from 24 to 79 were exposed to four commercial advertisements within the context of television programs designed to induce either a positive or negative mood. Although age was associated with memory for the content of the commercials, it did not moderate the impact of mood on evaluations of the advertised products. Instead, participants who reported engaging in expressive suppression as a common emotion regulation strategy were more likely to make evaluations that were biased by moods than those individuals who reported low use of this strategy. The results suggest that the maintenance of emotion regulation ability in later adulthood may help people control certain affective influences on thought.