Breaks in play represent a responsible gambling strategy designed to disrupt states of dissociation and enhance the likelihood of drawing attention to a player's session behaviour and expenditure with respect to time and money. The aim of the break in play is to motivate the player to modify or cease gambling so the activity remains within affordable levels. The aim of this study was to investigate whether imposed breaks in play in the absence of accompanying warning messages were effective in reducing cravings. Participants (141 university students) were randomly allocated to one of three conditions: 15 min computer simulated Black Jack play followed by no break, a 3 or 8 min break in play. Participants were administered a battery of measures to assess problem gambling card play, cravings, and dissociation to assess the effects of length of break on cravings. Results indicated that cravings increased rather than decreased with imposed breaks in play, and that the strength of cravings were higher following the eight- compared to 3-min break. It was concluded that breaks in play in isolation might produce counterproductive, unintended, and even perverse effects. The policy implications for responsible gambling strategies is that breaks in play ought to be accompanied with warning and/or personal appraisal messages if optimal effects in reducing within session gambling expenditure are to be achieved.

Background and objectives Because of its beneficial off‐target effects against non‐mycobacterial infectious diseases, bacillus Calmette–Guérin (BCG) vaccination might be an accessible early intervention to boost protection against novel pathogens. Multiple epidemiological studies and randomised controlled trials (RCTs) are investigating the protective effect of BCG against coronavirus disease 2019 (COVID‐19). Using samples from participants in a placebo‐controlled RCT aiming to determine whether BCG vaccination reduces the incidence and severity of COVID‐19, we investigated the immunomodulatory effects of BCG on in vitro immune responses to SARS‐CoV‐2. Methods This study used peripheral blood taken from participants in the multicentre RCT and BCG vaccination to reduce the impact of COVID‐19 on healthcare workers (BRACE trial). The whole blood taken from BRACE trial participants was stimulated with γ‐irradiated SARS‐CoV‐2‐infected or mock‐infected Vero cell supernatant. Cytokine responses were measured by multiplex cytokine analysis, and single‐cell immunophenotyping was made by flow cytometry. Results BCG vaccination, but not placebo vaccination, reduced SARS‐CoV‐2‐induced secretion of cytokines known to be associated with severe COVID‐19, including IL‐6, TNF‐α and IL‐10. In addition, BCG vaccination promoted an effector memory phenotype in both CD4+ and CD8+ T cells, and an activation of eosinophils in response to SARS‐CoV‐2. Conclusions The immunomodulatory signature of BCG’s off‐target effects on SARS‐CoV‐2 is consistent with a protective immune response against severe COVID‐19.

No abstract

No abstract

Background Quetiapine is frequently prescribed off‐label in the community but little is known about the initiation and use of quetiapine in general (non‐psychiatry) hospital settings. Aim This study examined the extent of off‐label quetiapine prescribing and rates of initiation of quetiapine in a general inpatient population of an Australian inner city teaching hospital, as well as the frequency of communication with community prescribers following discharge. Methods A retrospective observational study was conducted of all patients admitted under all non‐psychiatric teams and prescribed quetiapine within a tertiary teaching hospital between 1 January 2011 and 31 December 2016. All quetiapine prescribing information was extracted from an electronic medication management system (EMMS) and medical records were reviewed for a random sample of 100 patients prescribed quetiapine. Results EMMS data indicated that 793 people were prescribed quetiapine over the study period. Quetiapine was most frequently prescribed once daily, with a median daily dose of 100 mg (interquartile range 37.5–200 mg). Eighty‐seven of the 100 medical records reviewed had corresponding discharge summaries, and potentially off‐label quetiapine prescribing was found in 48 people (55%); the most frequent off‐label indication was for agitation or delirium. Of the 33 people who had quetiapine initiated in hospital, 26 prescriptions (79%) were for off‐label indications. Of the 11 prescriptions (33%) continued at discharge, only three (27%) discharge summaries contained instructions to community prescribers regarding quetiapine. Conclusion Off‐label prescribing of quetiapine was common in this sample of inpatients, and senior hospital staff should remain cautious of quetiapine prescribing for indications where the evidence of harms and benefits remains unclear. Communication with community prescribers could also be improved to reduce the risk of conversion from intended short‐term off‐label use to longer‐term use.