Importance:The primary analysis of the SELECT randomized clinical trial suggests that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke in patients with established CV disease (CVD) and overweight or obesity without diabetes. However, the effect of semaglutide on hospitalizations in this population remains unknown. Objective:To determine the impact of semaglutide on total hospital admissions and duration of hospital stay. Design, Setting, and Participants:The SELECT trial included patients aged 45 years or older with established CVD and a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 27 or higher without diabetes at 804 clinical settings across North America, South America, Europe, Asia, Africa, and Australia. Patients were randomized from October 2018 to March 2021. This prespecified exploratory analysis was conducted from February 2024 to September 2025. Interventions:Once-weekly subcutaneous semaglutide, 2.4 mg, or placebo. Main Outcomes and Measures:The total number of hospital admissions and days in hospital between the semaglutide and placebo groups. Results:A total of 17 604 patients (median [IQR] age, 61.0 [55.0-68.0] years; 4872 female patients [27.7%]; median [IQR] BMI, 32.1 [29.7-35.7]) were followed up for a median (IQR) period of 41.8 (33.0-47.0) months. There were 11 287 hospital admissions. The number of total hospitalizations was lower in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02). No heterogeneity was observed for the reduction of hospital admissions with semaglutide in selected subgroups, including BMI, age, and sex. Conclusions and Relevance:In this prespecified exploratory analysis of the SELECT randomized clinical trial, the trial cohort had a high rate of hospital admissions. Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction. Trial Registration:ClinicalTrials.gov Identifier: NCT03574597.
Abstract Background Septic shock is heterogeneous, and noradrenaline (NA) requirements evolve over time in ways that reflect vascular responsiveness and shock biology. Whether long-horizon NA dose-trajectory phenotypes are reproducible across healthcare systems and identifiable early in the clinical course remains uncertain. Methods We retrospectively analyzed 1111 adults with septic shock at Sheba Medical Center (Israel) and 9343 adults from MIMIC-IV. Hourly NA infusion trajectories were reconstructed for 10 days. A fully prespecified clustering pipeline combining static-feature K-means with dynamic time warping refinement was derived in Sheba and applied unchanged to MIMIC-IV. The primary outcome was 90-day mortality; 30-day mortality was analyzed as a supportive secondary outcome. Secondary analyses included feature interpretability, multivariable landmark Cox models (24–144 h), and early phenotype prediction using exposure features available at 24–96 h. Results Five stable phenotypes emerged in Sheba and six in MIMIC-IV. Despite this numerical difference and somewhat more prolonged high-dose exposure in Sheba sustained/late-escalating patterns, both cohorts exhibited the same core families of trajectory shapes with preserved mortality gradients (90-day mortality 37–89% in Sheba; 16–69% in MIMIC-IV). Mortality gradients were preserved at both 30 and 90 days across cohorts. Across cohorts, exposure-persistence features—particularly time to maximal NA dose and cumulative NA burden during days 2–4—were key determinants of phenotype structure and mortality. Early-prediction models identified final phenotypes using 24-h data with 85% accuracy in Sheba and 86% in MIMIC-IV, improving by 48 h to 89% and 88%, respectively; high-confidence assignments achieved approximately 91%–95% accuracy. Conclusions Long-horizon NA dose-trajectory phenotypes are clinically interpretable hemodynamic exposure/response patterns, prognostically coherent, and externally reproducible. Their defining features were detectable within the first 24 h and showed stronger discrimination by 48 h. At present, these phenotypes should be interpreted as descriptive hemodynamic-response patterns that may support dynamic risk stratification, prognostic enrichment for future trials, and hypothesis generation; whether early phenotype identification can improve management or outcomes requires prospective evaluation.
The session rating of perceived exertion (s-RPE) is a validated tool for monitoring subjective training intensity across various sports. We aimed to assess the association between s-RPE recorded within 30 min post-training and a single retrospective weekly RPE (wRPE) reported at the end of the week. We tracked the training loads (TLs) of eight professional tennis players over one season and analyzed the association among three parameters: the weekly average of session-specific RPE (mRPE) vs. wRPE; weekly TL (s-RPE × duration) derived from both mRPE and wRPE; and week-to-week percentage changes in TL. We employed a nested model and a Bland–Altman analysis to evaluate association, bias, and limits of agreement. Our analysis revealed very large associations between mRPE and wRPE (r = 0.804) and between week-to-week TL progressions (r = 0.885). The association between TL measures themselves was nearly perfect (r = 0.974). Bland–Altman plots demonstrated superior agreement at lower loads, whereas higher loads were associated with greater variability. We conclude that a single self-reported measure at the end of the week was strongly associated with session-derived RPE, TL, and weekly TL progression in professional tennis players. Nevertheless, these two approaches are not interchangeable, and consistency in the chosen method is key for reliable TL monitoring in professional tennis players.
Este documento corresponde a la tercera parte del Primer Consenso Argentino sobre el manejo de la esquizofrenia y tiene como objetivo sintetizar la evidencia científica actualizada sobre los abordajes terapéuticos en pacientes adultos con esta patología. Siguiendo la metodología establecida en la primera parte del Consenso, un panel multidisciplinario de expertos llevó a cabo una revisión exhaustiva y sistemática de la literatura disponible, complementada por un proceso estructurado de discusión y consenso, a partir del cual se elaboraron las recomendaciones presentadas en esta sección. Esta parte del Consenso aborda el tratamiento integral de la esquizofrenia en adultos, incluyendo consideraciones previas a la prescripción farmacológica, el manejo de la exacerbación aguda y las estrategias de tratamiento farmacológico de primera y segunda línea. Asimismo, se analizan en profundidad el rol de la clozapina, el uso de antipsicóticos de acción prolongada (LAI), los criterios y estrategias para el cambio de antipsicótico, así como las intervenciones de aumentación y combinación farmacológica. Además, se revisa la evidencia disponible sobre terapias biológicas complementarias, tales como la terapia electroconvulsiva (TEC) y la estimulación magnética transcraneal repetitiva, junto con aspectos centrales del abordaje clínico como la adherencia al tratamiento, los conceptos de respuesta, remisión y recuperación; la prevención de recaídas y el tratamiento de mantenimiento. El documento también contempla el manejo de comorbilidades, la identificación de pseudorresistencia al tratamiento y, finalmente, el tratamiento psicosocial de la esquizofrenia, enfatizando la necesidad de un enfoque integral, longitudinal y centrado en la persona. Con la colaboración de la Asociación de Ayuda de Familiares de Personas con Esquizofrenia (AAFE).
Exposure to unrealistic body ideals on social media may distort individuals’ body image, potentially leading to increased body dissatisfaction. One proposed mechanism for this phenomenon is visual adaptation: prolonged exposure to thin bodies can shift subsequent judgments of body size, leading to subsequent bodies being perceived as fatter than they are. This study investigated whether exposure to body images of varying thinness alters judgments of body size relative to one’s own bodyand whether individual differences in body image concerns moderate these aftereffects. Thirty-four young women completed a psychophysical task in which they judged whether test bodies were thinner or fatter than themselves, following adaptation to either an extremely thin or a slightly thinner (but closer-to-self) body. Results showed stronger aftereffects following exposure to extreme-thin adaptors, with lower points of subjective equality (PSEs), indicating a shift toward judging thinner bodies as equivalent to one’s own body size. The point of subjective equality (PSE) is the body size at which participants are equally likely to judge a test body as thinner or fatter than their own. Adaptation to both close-thin and extreme-thin bodies resulted in lower PSEs, consistent with a contrastive aftereffect in which test stimuli were perceived as larger following exposure to thin adaptors. Higher body concern was positively associated with larger baseline PSEs, indicating greater perceived body size. These findings support the role of visual adaptation in shaping perceptual judgments of body size and suggest that individual differences in body concern influence this process. Opponent coding may underlie this mechanism, as greater aftereffects were observed for more extreme adaptors.
