Duration of anticoagulation after venous thromboembolism in real world clinical practice.

INTRODUCTION: Venous thromboembolism (VTE) carries a considerable risk of recurrence and anticoagulants should be administered for a minimum of three months. Since little is known about real life management of VTE, we aimed to describe current practice in the secondary prevention of VTE. MATERIALS AND METHODS: Using the database of an international, prospective registry on patients treated for VTE, RIETE, information was collected on risk factors for VTE and bleeding, anticoagulant treatment, and clinical outcomes during follow up. Multivariate analysis using logistic regression was performed to identify predictors of treatment duration. RESULTS: Of 6944 patients with a first episode of VTE 41.1% had unprovoked VTE, 31.8% had transient risk factors, 27.1% had cancer. After the exclusion of patients who died during the first year of observation, the rate of patients treated for >12 months was 55.1%, 41.9%, and 43.2%, respectively (p<0.001). Pulmonary embolism at presentation, recurrence while on treatment, chronic heart failure and age >65 years were independently associated with treatment for >12 months. Body weight <75 kg, anemia, cancer, and the presence of transient risk factors were associated with treatment for 12 months or less. Major bleeding occurred more frequently than recurrent VTE in patients with VTE secondary to transient risk factors and cancer; fatal bleeding was more frequent than fatal recurrent PE in all subgroups. CONCLUSIONS: We observed heterogeneous duration of anticoagulant treatment for the secondary prevention of VTE. A substantial proportion of patients, in particular those with VTE secondary to transient risk factors, may be exposed to a possibly unnecessary risk of bleeding.

People favour imperfect catching by assuming a stable world

The visual angle that is projected by an object (e.g. a ball) on the retina depends on the object's size and distance. Without further information, however, the visual angle is ambiguous with respect to size and distance, because equal visual angles can be obtained from a big ball at a longer distance and a smaller one at a correspondingly shorter distance. Failure to recover the true 3D structure of the object (e.g. a ball's physical size) causing the ambiguous retinal image can lead to a timing error when catching the ball. Two opposing views are currently prevailing on how people resolve this ambiguity when estimating time to contact. One explanation challenges any inference about what causes the retinal image (i.e. the necessity to recover this 3D structure), and instead favors a direct analysis of optic flow. In contrast, the second view suggests that action timing could be rather based on obtaining an estimate of the 3D structure of the scene. With the latter, systematic errors will be predicted if our inference of the 3D structure fails to reveal the underlying cause of the retinal image. Here we show that hand closure in catching virtual balls is triggered by visual angle, using an assumption of a constant ball size. As a consequence of this assumption, hand closure starts when the ball is at similar distance across trials. From that distance on, the remaining arrival time, therefore, depends on ball's speed. In order to time the catch successfully, closing time was coupled with ball's speed during the motor phase. This strategy led to an increased precision in catching but at the cost of committing systematic errors.

World Polarization in carbon emissions, potential conflict and groups: an updated revision

Typically, conflicts in world environmental negotiations are related, amongst other aspects, to the level of polarization of the countries in groups with conflicting interests. Given the predictable relationship between polarization and conflict, it would seem logical to evaluate the degree to which the distribution of countries – for example, in terms of their CO2 emissions per capita – would be structured through groups which in themselves are antagonistic, as well as their evolution over time. This paper takes the concept of polarization to explore this distribution for the period 1992-2010, looking at different analytic approaches related to the concept. Specifically, it makes a comparative evaluation of the results associated with endogenous multi-polarization measures (i.e. EGR and DER indices), exogenous measures (i.e. Z-K or multidimensional index) and strict bipolarization measures (i.e. Wolfson’s measure). Indeed, the interest lies not only in evaluating the global situation of polarization by comparing the different approaches and their temporal patterns, but also in examining the explanatory capacity of the different proxy groups used as a possible reference for designing global environmental policy from a group premise. JEL codes: D39; Q43; Q56. Key words: polarization; carbon emissions; conflict;

Predictors of remission in the treatment of major depressive disorder: real-world evidence from a 6-month prospective observational study

BACKGROUND: This study examined potential predictors of remission among patients treated for major depressive disorder (MDD) in a naturalistic clinical setting, mostly in the Middle East, East Asia, and Mexico. METHODS: Data for this post hoc analysis were taken from a 6-month prospective, noninterventional, observational study that involved 1,549 MDD patients without sexual dysfunction at baseline in 12 countries worldwide. Depression severity was measured using the Clinical Global Impression of Severity and the 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16). Depression-related pain was measured using the pain-related items of the Somatic Symptom Inventory. Remission was defined as a QIDS-SR16 score ≤5. Generalized estimating equation regression models were used to examine baseline factors associated with remission during follow-up. RESULTS: Being from East Asia (odds ratio [OR] 0.48 versus Mexico; P<0.001), a higher level of depression severity at baseline (OR 0.77, P=0.003, for Clinical Global Impression of Severity; OR 0.92, P<0.001, for QIDS-SR16), more previous MDD episodes (OR 0.92, P=0.007), previous treatments/therapies for depression (OR 0.78, P=0.030), and having any significant psychiatric and medical comorbidity at baseline (OR 0.60, P<0.001) were negatively associated with remission, whereas being male (OR 1.29, P=0.026) and treatment with duloxetine (OR 2.38 versus selective serotonin reuptake inhibitors, P<0.001) were positively associated with remission. However, the association between Somatic Symptom Inventory pain scores and remission no longer appeared to be significant in this multiple regression (P=0.580), (P=0.008 in descriptive statistics), although it remained significant in a subgroup of patients treated with selective serotonin reuptake inhibitors (OR 0.97, P=0.023), but not in those treated with duloxetine (P=0.182). CONCLUSION: These findings are largely consistent with previous reports from the USA and Europe. They also highlight the potential mediating role of treatment with duloxetine on the negative relationship between depression-related pain and outcomes of depression.

”The music the world makes has no words”: Musiikillisen tradition funktiot ja merkitys Toni Morrisonin romaanissa Jazz

Pro gradu -tutkielmassani tarkastelen niitä merkityksiä, joita afrikkalaisamerikkalainen musiikillinen esitystraditio saa Nobel-kirjailija Toni Morrisonin romaanissa Jazz (1992).Morrison on toistuvasti löytänyt vertailukohdan omalle kirjoittamiselleen mustasta musiikkitraditiosta. Kuvaillessaan Jazz-romaanin luomisprosessia hän on kertonut pyrkineensä rakentamaan teoksen improvisatorisen jazz-performanssin muotoon. Tutkielmassa kysyn, millä tavalla tämä jazz-improvisatorinen kerrontamuoto ilmenee Jazz-romaanissa ja miksi musiikki ja kerronnan musiikillisuus on saanut niin merkittävän roolin afrikkalaisamerikkalaisen kirjallisuuden traditiossa. Keskeiselle sijalle tutkielmassani nousee ajatus improvisatorisesta jazz-performanssista sekä romaania ohjaavana kerronnallisena periaatteena että mustan diasporisen kulttuurin ja identiteetin rakentamisen välineenä. Tukeutumalla muun muassa Ralph Ellisonin, James Baldwinin, Albert Murrayn, Henry Louis Gates Jr:n, Houston A. Baker Jr:n, Paul Gilroyn, Kimberly W. Benstonin ja Nathaniel Mackeyn kirjoituksiin mustasta esitystraditiosta tarkastelen, mitä eri merkityksiä jazz- ja blues-musiikille on annettu afrikkalaisamerikkalaisessa kirjallisuudessa. Jazzissa musiikki toimii ensisijaisesti keinona työstää menneisyyttä: musiikillinen improvisaatio avaa tien ihmisen henkilökohtaisten muistojen ja menneisyyden konfliktien tarkastelulle. Kyse on identiteettiprosessista, joka ohjaa toistuvasti määrittelemään uudelleen ne rakenteet, joissa ihmisen minuus kehittyy. Samalla musiikillisuuden taustalta voidaan löytää pyrkimys vapauttaa teos kertovuudesta ja kohdistaa lukijan huomio tekstin tuottamaan liikkeeseen, romaaniin performanssina. Tämä ohjaa kirjallisuuden kohti rituaalista: musiikillisuuden funktiona on tuoda tarina voimakkaammin osaksi lukijan kokemuksellista nykyhetkeä. Morrisonin romaanikirjoittamista ohjaa halu kehittää jatkuvasti uusia mahdollisuuksia ymmärtää ja lähestyä menneisyyttä sekä rakentaa kriittinen suhde afrikkalaisamerikkalaista kulttuuria määrittäneisiin historiallisiin narratiiveihin. Jazzromaanin tapahtumat sijoittuvat keskelle afrikkalaisamerikkalaisen urbaanin kulttuurin ja amerikkalaisen modernismin kehityksen keskeisintä vuosikymmentä, 1920-lukua. Romaanin sisällön analyysissa tarkastelen muun muassa romaanin kaupunkitilan kuvausta ja sen kiinnittymistä urbaanin kulutuskulttuurin tuottamaan visuaaliseen spektaakkeliin. Jazzissa Morrisonin voidaan nähdä työstävän suhdetta tiettyyn historialliseen aikakauteen, joka on merkittävällä tavalla muokannut sekä afrikkalaisamerikkalaista kulttuurista yhteisöllisyyttä että tiettyjä ”mustan” tai ”mustuuden” representaatioita osana amerikkalaista urbaania ympäristöä.

The Importance of Semantics: Visual World Studies on Drawing Inferences and Resolving Anaphors

The present thesis investigated the importance of semantics in generating inferences during discourse processing. Three aspects of semantics, gender stereotypes, implicit causality information and proto-role properties, were used to investigate whether semantics is activated elaboratively during discourse comprehension and what its relative importance is in backward inferencing compared to discourse/structural cues. Visual world eye-tracking studies revealed that semantics plays an important role in both backward and forward inferencing: Gender stereotypes and implicit causality information is activated elaboratively during online discourse comprehension. Moreover, gender stereotypes, implicit causality and proto-role properties of verbs are all used in backward inferencing. Importantly, the studies demonstrated that semantic cues are weighed against discourse/structural cues. When the structural cues consist of a combination of cues that have been independently shown to be important in backward inferencing, semantic effects may be masked, whereas when the structural cues consist of a combination of fewer prominent cues, semantics can have an earlier effect than structural factors in pronoun resolution. In addition, the type of inference matters, too: During anaphoric inferencing semantics has a prominent role, while discourse/structural salience attains more prominence during non-anaphoric inferencing. Finally, semantics exhibits a strong role in inviting new inferences to revise earlier made inferences even in the case the additional inference is not needed to establish coherence in discourse. The findings are generally in line with the Mental Model approaches. Two extended model versions are presented that incorporate the current findings into the earlier literature. These models allow both forward and backward inferencing to occur at any given moment during the course of processing; they also allow semantic and discourse/structural cues to contribute to both of these processes. However, while the Mental Model 1 does not assume interactions between semantic and discourse/structural factors in forward inferencing, the Mental Model 2 does assume such a link.

NĀGĀRJUNA AND SCHELLING: OUTLINES OF A DIALOGUE ON SELF, WORLD, AND VIEWPOINTS

ABSTRACT The paper intends to build a dialogue between Nāgārjuna and Schelling on Self, world, and standpoints, taking as main references Nāgārjuna's The Fundamental Verses of the Middle Way and Schelling's Philosophical Letters on Dogmatism and Criticism. Whereas Nāgārjuna criticizes the substantialization of beings by resorting to the discourse of the dependent co-origination in order to overcome suffering, Schelling, on his turn, refutes the fanaticism based on dogmatism's tenets in favor of the criticism interpreted according to its spirit, and not according to its letter, in order to emancipate humanity. Starting with a succint contextualization of the Eastern and Western philosophical discourse, proceeding further to discuss the philosophies of both thinkers, the paper is concluded by assessing their theories.