Due to the increased emphasis on co-produced and community led research, neurodiversity within research communities has sparked interest, particularly within the context of autism research. This study investigates the presence of neurodivergent researchers within a neuroscience research consortium, with a particular focus on autism prevalence. Using survey data collected from active contributors to the consortium, we examined the self-reported neurodivergent status of researchers, including formal diagnoses of autism, ongoing diagnostic processes, and self-identification as neurodivergent. Our findings reveal that autism is common among consortium researchers, with a substantial proportion reporting formal diagnoses or self-identification as autistic (23%), higher among stages below and including postdoctoral roles (Chi-Square p-value = 0.01). Further, we identified an association between neurodivergence and lower mental well-being among researchers (Coef. = 1.93, p-value = 0.002), highlighting the importance of accommodating neurodiversity within research environments. This study underscores the need for greater inclusivity and support for neurodivergent researchers, particularly in the context of neuroscience that does or does not yet embed participatory research initiatives. By amplifying the voices of neurodivergent researchers, research communities can enhance the equity and impact of their outcomes and foster better public engagement by sharing experiences and understanding the needs of community members.

Left atrial appendage occlusion devices (LAAOD) are approved to reduce thromboembolism risk in patients with atrial fibrillation and contraindication to anticoagulation. LAAOD-associated endocarditis is rarely reported, and Streptococcus alactolyticus is a rarely identified organism in endocarditis. In this case, a 71-year-old man was diagnosed with Streptococcus alactolyticus LAAOD-associated endocarditis five years after implant. He was bacteremic, and a transesophageal echocardiogram demonstrated a mobile 1.2 cm vegetation adherent to the device. Optimal treatment for LAAOD infection is unknown. He was treated with antibiotics because surgical removal carried unacceptable risk. This case demonstrates a rare LAAOD infection years after implant.

How is the presence of reward reflected in activity in the corticostriatal networks underlying human categorization? We examined how basal ganglia and corticostriatal network activity differed on trials in which participants received a reward for correct performance versus trials with no associated reward. Participants learned to categorize abstract fractal images as members of two different categories via trial and error with feedback. Images were associated with different monetary reward values (high, low, and none) which could be obtained by the participant for correct categorization. We found that neural activity in the caudate nucleus (head and body) and putamen was greater for rewarded stimuli in comparison with nonrewarded. In addition reward resulted in greater activity across the cortical regions underlying categorization, including areas of the intraparietal sulcus (IPS) associated with stimulus - response mapping, the frontoparietal salience network, and visual cortical areas associated with object and form processing. Reward effects were found both during early learning when stimuli were novel, and when participants categorized stimuli on which they had been extensively trained prior to the scan. These results have implications for understanding how reward and categorization are integrated in corticostriatal networks.

Notions of function and dysfunction are fundamental for neuroscience, psychology and psychiatry, but remain contentious. We propose that some of these controversies arise from tacit creationism, which incorrectly views aspects of evolved systems as if intentionally designed. Many philosophers agree that “failure to perform a normal function” is fundamental to the concepts of physical disease and mental disorder. However, unlike machines and computers, bodies and brain-minds are variable in multiple respects, and these variations may have advantages and disadvantages in different environments. Indeed, in the case of bodies and brain-minds it may be difficult to draw a bright line between normal and excessive activation of an adaptive defense in a particular context. The metaphors of body as machine, or the brain-mind as computer, encourage the notions that components of bodies and brain-minds have specific functions like those of the parts of machines, and that disorders have clear boundaries. Rejecting tacit creationism, and accepting the messy reality of organic complexity, as well as the fuzzy boundaries of disorder, offers a better way forward for neuroscience, psychology, and psychiatry.

New therapeutic agents developed for treating neurological disorders are often tested successfully on rodents, and yet 80–90% of these prove ineffective when transitioning to clinical application. Testing in an appropriate large-animal model should improve translational success and is frequently expected by regulatory bodies. In this project, we aimed to establish a novel sheep model of Parkinson’s disease as a large-brained experimental model for translational research. Our objective was to create a sheep model of Parkinson’s disease by unilaterally infusing the neurotoxin 6-hydroxydopamine into the substantia nigra pars compacta. This approach, previously used to induce parkinsonism in rat and non-human primate models, causes dopaminergic imbalance and induces rotational behaviour in quadrupeds challenged with dopaminergic receptor agonists. In the present sheep study, the mixed dopamine receptor agonist apomorphine, 0.25 mg/kg, and dopamine D2 agonist ropinirole, 0.16 mg/kg, were used to induce rotational behaviour and confirm dopamine depletion. Behavioural signs were then measured and characterised in the field using automated movement tracking with simultaneous video recordings. Post-mortem, the extent of the 6-hydroxydopamine lesions were evaluated through tyrosine hydroxylase immunohistochemistry and quantifying levels of catecholamines (dopamine, 3,4-dihydroxyphenylacetic acid, and homovanilic acid) quantified using high-performance liquid chromatography. Our new sheep model of Parkinson’s disease using 6-hydroxydopamine is safe and offers a number of regulatory, ethical, and financial advantages over non-human primate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine models. It provides a platform to evaluate novel anti-parkinsonian agents and medical devices with the promise of greater success for translation into clinical application than has been achieved using small animal models.

Non-human animal models continue to be indispensable in neuroscience research for the foreseeable future. In recent years, animal-right activists have been increasing the pressure on politicians and policymakers to phase out animal research. To address this pressure, we should adapt our communication habits, to be more open and transparent about (our) animal research and most importantly to expand the methods we use to communicate about our research and increase the extend of this outreach. In this editorial we discuss the why and how of animal research communication.

In our prior work, we addressed a bottleneck in the Gauss-Huard algorithm at the panel factorization step, which had been identified as a challenge in the existing research. We introduced the look-ahead technique using the delayed Gauss-Huard algorithm and random butterfly transformations to tackle this issue. However, as noted in the literature and confirmed by our findings, the performance of the delayed approach was inferior to that of LU factorization. In this extended study, we propose a transition to LU factorization for the panel factorization step, retaining the use of the look-ahead technique, and thereby significantly enhancing the Gauss-Huard algorithm’s efficiency. Validation involved a performance comparison with Gaussian elimination in the MAGMA library, and accuracy and stability testing across 21 diverse test matrices. The Gauss-Huard algorithm with LU factorization significantly outperformed Gaussian elimination in hybrid computing environments, achieving a speedup of 3.24x. Moreover, the accuracy and stability were consistently within acceptable error bounds. These results show that the integration of LU factorization with the Gauss-Huard algorithm not only overcomes the deficiencies of the delayed approach but also realizes the combined strengths of both methodologies.

Near-infrared red (NIR) fluorescence imaging guided phototherapeutics hold a great promise for deep tissue imaging and tumor treatment. Organic photosensitizers (PSs) serves as one of the most important parts in the process of optical diagnosis and therapy, among which those having strong absorption and fluorescence at the region of NIR spectrum have always attracted tremendous research interests because of numerous merits of deep penetration, diminished tissue autofluorescence, reduced tissue absorption and scattering, minimal phototoxicity, better spatiotemporal controllability and almost no drug resistance. Recently, aggregation-induced emission active agents (AIEgens) with NIR optical property develop rapidly because of the advantages of aggregation enhance simultaneously the efficiency of fluorescence, reactive oxygen species (ROS) and photothermal conversion. Recent efforts in designing molecular structures of NIR-type AIEgens and developing advanced therapeutic applications have achieved a series of breakthroughs. In this review, the materials designing and biomedical applications of NIR-type AIEgens are summarized. Starting with the introduction of general design theory of AIEgens and NIR property, recent efforts in developing various NIR-type AIE-active PSs for different biomedical applications including vascular bioimaging and single phototherapeutic and their synergistic therapy are then discussed. Finally, perspectives and challenges in the field of NIR-type AIEgens are outlooked. This review is expected to promote the development of newly emerging NIR-type AIEgens in biomedical applications for future clinical translation.

The optimal foraging theory posits that animals select food patches based on a trade-off between energy consumption and resource quantity. We hypothesized that giant pandas (Ailuropoda melanoleuca) forage at locations with gentle slopes to minimize energy consumption. However, animal-trace data from two national surveys in the Qinling Mountains suggest that giant pandas actually prefer steep locations. To explore the cause of this apparently counterintuitive preference, we analyzed panda utilization of two slope intervals (5–15° and 15–25°) and measured daily movement areas adjacent to those slopes. Our results showed that the daily movement area of the pandas at these two locations were similar in terms of slope composition, implying that the steepness of the surrounding environment did not influence space selection. In addition, giant pandas exhibited a strong preference for utilizing flat land (0–5°) around gentle slope traces, and the 5–15° slope had a greater density of panda traces than the 15–25° slope, strongly supporting the hypothesis that giant pandas prefer flatter regions. Furthermore, we observed that the 5–15° slope was considerably smaller in area than the 15–25° slope (83.39 < 257.57 km²). This difference likely explains the initially observed unusual slope utilization, suggesting that giant pandas may have been forced to inhabit steep areas due to the scarcity of their preferred sites. This study verified that pandas of Qinling foraged optimally within the constraints of habitat availability, providing insights that should benefit future assessment and restoration of their habitats.

In this paper the structural, electronic and transport properties of the strongly correlated intermetallics LaX 3 (X=Pb, In and Tl) in the space group Pm-3m (221) have been investigated using B3PW91 hybrid functional within the framework of density functional theory. These compounds have 4f orbitals and hence strong electron-electron correlation effect is expected, therefore, the electronic properties are also calculated with the B3PW91 hybrid functional and the effect of B3PW91 hybrid functional on the density of states is discussed in details. The band structure and density of states, demonstrate the metallic nature of these compounds. Using the semi-empirical Boltzmann’s approach implemented in the BoltzTraP code, the transport parameters, such as the Seebeck coefficient, electrical conductivity, thermal conductivity and figure of merit as a function of the chemical potential are computed at a temperature gradient of 500 K. For all materials the thermal and electrical conductivities, and Seebeck coefficient has higher values for n-type doping in comparison with p-type doping. The moderate values of figure of merit obtained for these materials indicate that these materials have applicability where small values of thermoelectric efficiency are required and higher values can harm the process but need experimental verification. LaIn 3 has the highest value of electrical conductivity per relaxation time and thermal conductivity per relaxation time are 9.43 x 10 20 1/Ωms and 107.65 x 10 14 W/mKs respectively. LaTl 3 has the highest figure of merit among these materials.

The mechanisms underlying plant species distribution and abundance have been long studied in ecology. However, the role of heterospecific pollen interference in shaping these patterns needs more attention. Species distribution and abundance are important factors determining whether a species is endangered or not, thus understanding the impact of heterospecific pollen interference on rare species could help to inform conservation strategies aimed at preserving plant communities. In this study, we conducted a multispecies experiment using eight co-occurring and co-flowering plant species with varying rarity levels in Switzerland. We performed hand-pollination experiments between all species pairs and measured seed set (whether a flower produces seed) and seed number (number of seeds per flower) as outcomes. We looked at the effects of rarity status, self-compatibility and recipient-donor relatedness on heterospecific pollen interference. Contrary to expectations, neither seed set nor seed number were affected by heterospecific pollen deposition. Self-compatible species had a higher seed set probability, but this was independent from species rarity. In our study setting, heterospecific pollen interference seems to have only minor effects on seed set and seed number, and consequently on recruitment. Thus, heterospecific pollen interference seems to play only a minor role in shaping plant species distribution and abundance. Nevertheless, the higher impact of heterospecific pollen deposition on rare and closely related species, as well as the importance of conspecific pollen loss, might need further investigation for both in-situ and ex-situ conservation strategies.

Here, a chemically reactive unsteady magnetohydrodynamic Casson fluid flow in a plate with convective slip boundary conditions and activation energy is considered. To examine the implications of the model's various parameters on the temperature, concentration, and velocity profiles, graphs were produced. The model's foremost equations are solved with the aid of the MATLAB - bvp4c. The Sherwood number, the Nusselt number, and skin friction are three physical parameters of engineering relevance. To get an understanding of these factors, numerical values have been estimated for a variety of scenarios. Velocity and concentration drops as activation energy parameter improves. The tabulated statistics demonstrate that skin friction rises when the thermal and solutal Grashof numbers grow, but boosting the Biot number has the opposite effect. The current findings are compared to those found in the literature, and they are consistent.

Climate change affects migratory birds in time (phenology), space (use of stopover sites, staging and wintering areas) and numbers (numerical change). We assessed these long-term changes by using data from the monitoring of the phenology and size of the Pannonic flyway population of Arctic-breeding greater white-fronted geese (GWfG, Anser albifrons) in regular weekly counts in Hortobágy National Park (east Hungary) between 1989 and 2019. We found that the flyway population size increased considerably from < 2000 to > 30,000 in 30 years, more so in the spring than in the autumn migration. Since 2007, an increasing number of GWfG have overwintered in the study area, which had not been used for wintering before. A positive relationship between December peak counts and mean temperature suggested that milder winters played a role in this increase. However, there was no long-term trend in mean temperature of any month over the study period, indicating little direct, local impact of climate change. Because land use and management also changed little in the study period, we conclude that the increase of GWfG results from the general increase in flyway population size, which was recently reported in other studies. The establishment of the new wintering area is probably based on this increase and made possible by milder winters since 2007. Our long-term study thus provides evidence of climate change-related modifications in migration phenology, spatial re-arrangement of the wintering grounds, and large-scale increase in population size detectable at the local scale in an important staging area.

In this paper, we compute the lower-dimensional volume Vol(1,1) about transformation operators for 4-dimensional spin manifolds with boundary and we also get the Kastler-Kalau-Walze type theorem about transformation operators on 4-dimensional compact manifolds with boundary.

Purpose: The objective of this study was to examine racial/ethnic disparities in COVID-19 vaccination uptake by rurality of residence. Methods: The study used national data derived from the Understanding America Study – a national probability sample of US adults – who completed online COVID-19 surveys between December 2020 and January 2023. Variations in vaccination uptake by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other race) and rurality of residence (urban, suburban, rural) were examined using a multivariable logistic model with interactions of race/ethnicity and rurality of residence. Analyses incorporated survey weights. Findings: As of January 15, 2023, 76.5% (6,133 of 7,540 adults) had received at least one COVID-19 vaccination, with substantial variations in vaccination uptake rates by rurality of residence and race/ethnicity. In rural areas, vaccination uptake among non-Hispanic Black individuals was higher (average predicted probability: 62.3% [95% Confidence Interval [CI] = 58.16, 66.35]) than among non-Hispanic White individuals (86.5% [95% CI = 74.91, 98.01] p = 0.001). However, in urban areas, vaccination uptake was similar for both groups. In urban areas, Hispanic individuals were more likely to take up vaccination (86.6%, [95% CI = 82.78, 90.58]) than their non-Hispanic White counterparts (urban: 82.3%, [95% CI = 79.98, 84.70] p = 0.016). Rural Hispanic and non-Hispanic-White vaccination uptake rates were not significantly different. Conclusions: Racial/ethnic disparities in COVID-19 vaccination uptake differed by rurality of residence. Identifying the reasons underlying differential rates of COVID-19 vaccination uptake is imperative for the development of effective strategies to broadly improve vaccination uptake in the event of future pandemics.

Geese and swans are focal species in conservation and in management aimed at reducing crop damage. In the former disturbance should be minimized, and in the latter it is important to know how different species react to scaring activities. Previous research about trade-offs between predation risk and foraging in birds often use ‘Flight Initiation Distance’ (FID) as a proxy to compare fearfulness under different circumstances and among species. We studied variation in FID in geese and swans by species, flock size and composition, time of day, and body size (408 scaring trials on agricultural land in the winters 2018—2021). In single-species flocks mean FID decreased in the order: bean goose (171 m) > greylag goose (104 m) > whooper swan (102 m) > Canada goose (92 m) > barnacle goose (77 m). In line with predictions based on body mass, the lightest species (barnacle goose) was the least fearful, but contrary to prediction neither of the two heaviest species (whooper swan, Canada goose) was the most fearful. FID was negatively correlated with flock size in bean goose. Flock size and FID did not correlate in greylag, Canada, and barnacle geese. FID did not differ between morning and afternoon in the 4 species with a sample of >20 single-species trials. When in multi-species flocks, FID differed less among species, converging in the 108—138 m range. Accordingly, bean goose FID decreased significantly whereas it increased significantly in barnacle and greylag geese. Barnacle goose (protected from hunting by the EU bird directive) was less fearful than species with an open hunting season in the EU, implying that exposure to hunting affect species-specific FID. We show that the level of fearfulness varied among swan and goose species, making it necessary to adopt diverse strategies in conservation as well as crop protection.

Sickle Cell Anaemia (SCA) management requires regular monitoring which is often challenging in resource-limited settings. This study explores the novel use of Platelet-Neutrophil Ratio (PNR) as a comprehensive monitoring tool in SCA. We present a case of a Jehovah’s Witness child with SCA, managed with hydroxyurea for elevated transcranial Doppler (TCD) velocities. PNR was retrospectively analysed against clinical parameters over 18 months. PNR showed significant correlations with Packed Cell Volume (r=0.588, p=0.002), Mean Corpuscular Volume (r=0.739, p<0.0001), and a negative correlation with TCD velocity (r=-0.53, p=0.115). A positive correlation with Haemoglobin F (r=0.461, p=0.434) was also observed. Notably, PNR fluctuations corresponded with clinical status; lower values coincided with a vaso-occlusive crisis, while higher values were associated with stable condition and optimised hydroxyurea therapy. This case highlights PNR’s potential as a valuable supplementary marker for routine SCA monitoring, particularly in resource-constrained environments. By providing a cost-effective means of assessing disease progression and predicting complications, PNR could significantly enhance patient outcomes. Further research is warranted to validate PNR’s efficacy and establish comprehensive guidelines for its clinical integration, potentially revolutionising SCA management in low- and middle-income countries.

The perceived impact of soil microplastics on soil aggregation is primarily attributed to their potential toxicity toward soil microorganisms. However, only a limited number of studies have undertaken comprehensive controlled experiments involving sterilized soils to substantiate this notion. The present study embarked on soil incubation experiments encompassing both non-sterilized soils and soils subjected to oven-heating sterilization to investigate the ramifications of polyethylene (PE) and polypropylene (PP) microplastics, characterized by mesh sizes of 30, 150, and 1000, on both the water-stability and mechanical stability of soil aggregates. The presence of microplastics decreased aggregation stability in Tianjin soils (on average -48.89% and -81.61% for 0.5-1 and 1-2 mm aggregates, respectively). The impact of microplastics was notably more evident in the non-sterilized soils. Microplastics also demonstrated the capacity to modify aggregate properties such as surface roughness. This study indicates the pivotal role played by interactions between soil microplastics and microorganisms on soil aggregation, but microplastics hold the potential to influence soil aggregation through non-biogenic pathways.

Advances in genomic sequencing have magnified our understanding of ecological and evolutionary mechanisms relevant to biodiversity conservation. As a result, the field of conservation genomics has grown rapidly. Genomic data can be effective in guiding conservation decisions by revealing fine-scale patterns of genetic diversity and adaptation. Adaptive potential, sometimes referred to as evolutionary potential, is particularly informative for conservation due to its inverse relationship with extinction risk. Yet, global coldspots in genomic resources impede progress towards conservation goals. We undertook a systematic literature review to characterize the global distribution of genomic resources for amphibians and reptiles relative to species richness, IUCN status, and predicted global change. We classify the scope of available genomic resources by their applicability to global change. Finally, we examine global patterns of collaborations in genomics studies. Our findings underscore the urgent need for expanded genomic resources, especially those that directly inform about adaptive potential. Our results also highlight the need for improved global collaborations in genomic research, resource sharing, and capacity building in the Global South.

Background: Herpes Simplex Virus (HSV) infections, primarily caused by HSV-1 and HSV-2, are prevalent worldwide and carry significant health implications. The impact of tobacco use on HSV infections, however, remains underexplored. Methods: This cross-sectional study utilized the National Health and Nutrition Examination Survey (NHANES) database (2009-2016) to investigate the link between Tobacco use and HSV infections among U.S. adults. Smoking status, volume, and serum cotinine levels were analyzed, alongside demographic and behavioral factors. Propensity score matching (PSM) was employed to adjust for confounders such as sexual behavior. Results: Our study involved 5,693 participants to explore the relationship of tobacco use and HSV infection. We found that smokers, particularly current smokers, have a significantly increased risk of both HSV-1 and HSV-2 infections compared to non-smokers. Specifically, the adjusted odds ratio (OR) for HSV-1 in current smokers was 1.36 (95% CI: 1.16-1.59, p<0.001), and for HSV-2, it was 2.37 (95% CI: 1.88-3, p<0.001). The risk escalates with the intensity of smoking. Elevated serum cotinine levels correlated with an increased risk of HSV infection[HSV-1:1.13 (95% CI:1.09~1.18, p<0.001); HSV-2:1.33 (95% CI:1.25~1.41, p<0.001)]. After propensity score matching (PSM) for factors such as age, gender, sexual behavior, and condom use, these associations remained significant. Conclusion: Tobacco use is significantly associated with an increased risk of HSV infections, highlighting the importance of reducing tobacco exposure in public health strategies against HSV. Further longitudinal studies are warranted to establish causality and explore underlying mechanisms.

Background: Wilson disease (WD) is a rare metabolic disorder of copper metabolism, requiring life-long therapy, usually with D-penicillamine or trientine. This review compares their clinical effectiveness and safety. Methodology: Two databases and two trial registers along with other sources were searched. The cohorts and RCTs reporting WD patients of any age or stage, receiving either trientine or D-penicillamine, were included. The Mantel-Haenszel method along with either a fixed- or random-effects model was used for analysing dichotomous outcomes. Results: Twenty-six cohorts and one RCT were included. The odds of having (1) treatment failures were greater with trientine (OR=4.09; 95%-CI:2.34-7.15; p<0.00001); (2) adverse events were lesser with trientine (OR=0.34; 95%-CI:0.14-0.80; p=0.01); (3) treatment discontinuation due to adverse events were lesser with trientine (OR=0.30; 95%-CI:0.21-0.43; p<0.00001); and (4) symptomatic worsening were not significantly different (OR=1.68; 95%-CI:0.88-3.20; p=0.012). Subgroup analysis within symptomatic worsening showed non-significant difference for neurological worsening (OR=1.33; 95%-CI:0.44-3.97; p=0.61) and greater odds with trientine for hepatic worsening (OR=2.45; 95%-CI:1.17-5.12; p=0.02). Trientine had similar serum copper parameters and slightly lower urinary copper-excretion rates compared to D-penicillamine. Trientine affected coagulation profiles but with no clinical association, and both treatments had similar effects on pregnancy outcomes. Conclusion: Trientine therapy had significantly lower incidences of adverse events and treatment discontinuations, but higher incidences of treatment failure and neurological worsening compared to D-penicillamine. However, the low quality and indirectness of the evidence may have lowered the validity of the results. Studies directly comparing the clinical outcomes of both treatments are needed to establish robust evidence.

Comparing cases of parasitism and predation that lead to victim death, parasites need more time to complete victim exploitation. This longer “interaction durability” delays energy transfer from host to parasite. During exploitation, parasite virulence differentiates the infected from the susceptible host dynamics. However, how this parasite characteristic influences the dynamics of their host and nonhost (insusceptible) species in the same community is largely unknown. Here, we use mathematical modelling to investigate the influence, exemplifying an experimental plankton community. In this community, nonhost zooplankton feeds on edible nonhost phytoplankton (resource competitor of the host) and parasite propagules released from infected inedible phytoplankton (“mycoloop” pathway). To assess the effects of parasite-host durability, we contrast parasite-host implementations as Lotka-Volterra predator-prey interaction (immediate energy transfer) with susceptible-infected (SI) host-parasite interactions. For the latter, parasite energy intake depends on infected host density but not susceptible hosts directly (delayed transfer). We further consider the difference between susceptible and infected host dynamics modulated by parasite virulence via its effect on host nutrient uptake. To assess the within-community effects, subcommunities are also investigated, excluding/including the parasite without/with the mycoloop. Our results show that, besides host elimination, longer interaction durability of the host-parasite interaction delays parasite attacks on susceptible hosts, allowing them to increase further (a hydra effect), independent of parasite virulence level. This effect observed in the isolated host-parasite systems is preserved in larger communities with negative consequences for the nonhost species, independent of the mycoloop. These theoretical results are supported by empirical observations within and beyond plankton realms. Our study reveals distinctive influences of parasites on community shot-term dynamics, which stem from the longer interaction durability.

Multidisciplinary treatment with adjunctive orthodontics, surgical crown lengthening, and esthetic rehabilitation

Key clinical Message:We present a patient who incurred strokes on two different factor Xa inhibitors and was successfully treated with a direct thrombin inhibitor and discuss the literature on switching to an anticoagulant with a different mechanism of action in case of failure. There is limited research on this common scenario.