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The need for improve medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health, and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD. Objectives While effective, medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health, and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD. This study examined the pre-post effects of the mindfulness-based intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to MOUD. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Method Participants stabilized on medication for opioid use disorder (OUD) ( n  = 303) from six community clinics in Northwestern United States were recruited and randomly assigned to MABT plus MOUD or MOUD only. In a mixed-methods study, we used an intent-to-treat approach (analyzing participants based on their assigned group, regardless of adherence) to examine the proportion of days abstinent from non-prescribed opioids, and other substance use (primary outcomes) at baseline and 3 months post-intervention. Secondary outcomes included symptoms of mental health distress, emotional regulation difficulties, pain and physical symptom indicators, interoceptive awareness, and mindfulness skills. Participant experience of MABT was collected through post-intervention surveys. Changes in outcomes were assessed using linear mixed models; content analysis was used to analyze the qualitative data. Results Levels of overall substance use were low and did not differ between groups. Significant improvements in PTSD symptoms, interoceptive awareness, pain severity, pain activity interference, and physical symptom frequency were found for those who received MABT compared to MOUD only. Conclusions In this stable MOUD population, substance use outcomes were not improved; however, MABT demonstrated significant positive changes across multiple health outcomes critical for improving MOUD treatment. Preregistration ClinicalTrials.gov identifer: NCT04082637.

Background The International Federation of Gynaecology and Obstetrics (FIGO) score identifies gestational trophoblastic neoplasia (GTN) patients as low- or high-risk of single-agent chemotherapy resistance (SACR). Computed tomography (CT) has greater sensitivity than chest X-ray (CXR) in detecting pulmonary metastases, but effects upon outcomes remain unclear. Methods Five hundred and eighty-nine patients underwent both CXR and CT during GTN assessment. Treatment decisions were CXR based. The number of metastases, risk scores, and risk category using CXR versus CT were compared. CT-derived chest assessment was evaluated as impact upon treatment decision compared to patient outcome, incidence of SACR, time-to-normal human chorionic gonadotrophin hormone (TNhCG), and primary chemotherapy resistance (PCR). Results Metastasis detection ( p  < 0.0001) and FIGO score ( p  = 0.001) were higher using CT versus CXR. CT would have increased FIGO score in 188 (31.9%), with 43 re-classified from low- to high-risk, of whom 23 (53.5%) received curative single-agent chemotherapy. SACR was higher when score ( p  = 0.044) or risk group ( p  < 0.0001) changed. Metastases on CXR ( p  = 0.019) but not CT ( p  = 0.088) lengthened TNhCG. Logistic regression analysis found no difference between CXR (area under the curve (AUC) = 0.63) versus CT (AUC = 0.64) in predicting PCR. Conclusions CT chest would improve the prediction of SACR, but does not influence overall treatment outcome, TNhCG, or prediction of PCR. Lower radiation doses and cost mean ongoing CXR-based assessment is recommended.

ObjectiveTo provide evidence for a reduced surveillance protocol to detect gestational trophoblastic neoplasia after normalisation of human chorionic gonadotrophin (hCG) levels following uterine evacuation of a complete hydatidiform mole.DesignNational retrospective population studySettingTwo UK Trophoblastic Disease Treatment Centres (Sheffield and London), 1 January 1980 to 30 November 2020.Participants17 424 patients with hCG normalisation after evacuation of their complete hydatidiform mole were included. Complete hydatidiform moles were verified by centralised pathological review. Patients were excluded if lost to follow-up or required treatment before normalisation of hCG levels.Main outcome measuresIncidence and clinical presentation of gestational trophoblastic neoplasia after normalisation of hCG levels following uterine evacuation of a complete hydatidiform mole.ResultsOf 17 424 patients whose hCG normalised after complete hydatidiform mole evacuation, 99.8% (n=17 393 of 17 424) did not subsequently develop gestational trophoblastic neoplasia. The overall risk of gestational trophoblastic neoplasia after previous normalisation of hCG levels was 0.2% (n=31 of 17 424 patients). The risk of developing gestational trophoblastic neoplasia after uterine evacuation was substantially lower if hCG levels returned to normal in <56 days rather than ≥56 days (posterior medians 0.06%, 95% credible interval 0.01% to 0.14% v 0.22%, 0.15% to 0.31%), with a posterior relative risk of 0.25 (0.06 to 0.72). Most patients who developed gestational trophoblastic neoplasia (71.0%, n=22 of 31) had received a diagnosis after the current six month surveillance protocol. The cumulative risk of developing gestational trophoblastic neoplasia in patients whose hCG levels normalised early increased minimally with time. If a patient had normal hCG levels in <56 days, a clinically relevant time point, the risk of developing gestational trophoblastic neoplasia was small (0.04%, about 1 in 2619 patients) at 39 months after normalisation. The equivalent risk for a patient who had normal hCG levels in ≥56 days was 0.16% (about 1 in 642 patients). All 31 women who developed gestational trophoblastic neoplasia achieved sustained remission after subsequent treatment.ConclusionsThe findings of the study indicate that surveillance protocols could safely change to one confirmatory normal hCG value for patients whose hCG levels return to normal in <56 days of evacuation of a complete hydatidiform mole. Patients whose hCG levels return to normal in ≥56 days should be counselled on the remaining risk of gestational trophoblastic neoplasia over time to help decide the length of subsequent follow-up.

There has been a rise in nonsurgical cosmetic procedures seen within the UK population in the past decade. A change in legislation has placed restrictions on the distribution and provision of such treatments. Therefore, patients may seek alternative methods to bring about a change to their appearance, such as self-injection of a filler. Complications may include oral ulceration, foreign body tissue reaction, and infection due to a lack in sterility during injection. Such presentations may mimic that of oral cancer and can lead to misdiagnoses and undue cost to the National Health Service. This case highlights the common features leading to correct identification of patients self-injecting with facial fillers and discusses the controversy surrounding the economic aspects of their care. We would like to report one such case presenting to our oral and maxillofacial surgical unit.

Julio Cortázar's \"Continuidad de los parques\" can be described as a stalker narrative in two different senses. Not only is it a story about a stalker with murderous intentions, it is also a story in which the reader is turned into a stalker. Modalization in verbs, or the use of the subjunctive and qualifiers, has been discussed by critics such as Tzvetan Todorov as a characteristic of the fantastic in literature. What has not been studied is the alternating use of aspect in the past, here between the verb tenses the preterite and the imperfect, as a technique that aids in the subtle creation of the reader as a stalker. Cortázar uses these two verb tenses to form and shape the narrative, moving it in the desired direction and, in the process, aiding in his creation of the image of the stalker. Both the careful manipulation of the preterite and the imperfect and the careful interplay between the two are the vehicle of invasion, an invasion perpetrated by the stalker, in which the reader is made complicit.

This article draws attention to an anomalous prescriptive rule in Spanish. Although research shows that native speakers use both the indicative and the subjunctive with expressions of emotion in Spanish, textbooks and grammars of Spanish insist that only the subjunctive may be used with these expressions. This creates confusion for students, teachers, and linguists because the rule does not reflect reality. The purpose of this paper is to answer two important questions: 1) What is the origin and history of mood use with expressions of emotion? 2) How did a rule prescribing exclusive use of the subjunctive with expressions of emotion become established? The answers to these questions are enlightening and serve to highlight a unique example of a prescriptive rule with no legitimate claim to being that nevertheless has attained such a degree of influence over the standard language that it effectively limits the creative possibility of nuance.

In west Alabama, catfish producers routinely face the challenge of fish that exceed market size (aka “Big Fish”) in their commercial ponds. These fish are skilled at evading seine nets during harvest and can increase in size significantly before subsequent harvests occur. This is problematic for catfish producers because processing plants prefer catfish within the 0.45 – 1.81 kg range, and farmers are paid a premium price for catfish of this size. Depending on the market and processing plant, a catfish producer can receive little-to-no monetary value for an oversized catfish. Due to their larger size and growth potential, hybrid catfish (Ictalurus punctatus ♀ × I. furcatus♂) can become a more significant issue than Channel Catfish if they evade harvest. Unfortunately, little is known about the age structure and growth rate of hybrid catfish that repeatedly evade capture and remain in commercial ponds for extended periods or multiple production seasons. The objectives of this study were to quantify the age structure and growth of hybrid catfish that evade capture, remain in commercial ponds following harvest, and grow beyond acceptable market size as defined by catfish processing plants (i.e., Big Fish). From December 2021 to August 2022, twelve recently harvested hybrid catfish ponds were sampled prior to re-stocking fingerlings using an electrofishing boat. Lapilli otoliths were removed from 1,005 hybrid catfish to estimate the total length and weight at age from seven commercial catfish farms in west Alabama, with the successful aging of 1,001 fish. Results of this study indicate that hybrid catfish exceeded the premium size threshold at age 2.72 years and should be harvested after one production cycle. Additionally, from age 2 to age 3, hybrid catfish can gain 2.9 kg, growing from an average of 0.4 kg to 3.3 kg.

Two major regulatory activities have framed global media policies since World War II: the New World Information and Communication Order (NWICO) and the more recent World Summit on the Information Society (WSIS). Through extensive research and testimonies from those involved, this book presents an in-depth account from the 1970s to today of the major issues concerning information flow in international geopolitics, including a look at the negotiations surrounding the major policy debates. Few studies of NWICO and WSIS have considered the continuity between the two activities—or included in the debate the crucial intermediary period between—and this book provides new insight into an issue of multilingual and multicultural importance.    

The diagnosis of ovarian carcinoma in pregnancy is rare (incidence of 0.018–0.073/1000 pregnancies). Its rarity is reflected by a paucity of cases reported in the literature. The present report concerns a case of advanced serous ovarian carcinoma in a full-term pregnancy. This was an incidental finding discovered during an emergency caesarean section for presumed fetal distress. The majority of ovarian carcinomas diagnosed in pregnancy present at early stages, are associated with a good prognosis and are non-epithelial type tumours. Advanced epithelial ovarian carcinoma diagnosed in pregnancy however is associated with a poor prognosis. Case reporting should certainly contain detailed information on clinicopathological variables and treatment regimens. Longer-term maternal and neonatal outcomes are more difficult to substantiate in case reporting. The authors therefore feel that data centralisation would be beneficial in identifying optimal management strategies in these rare tumours and in other malignant tumours diagnosed and treated during pregnancy.