Search

The purpose of this study was to determine the intraday and interday variability and systematic change over the day of active cervical range of motion (aCROM) measurements in asymptomatic persons using a clinically applicable measurement device. A prospective observational study was performed. Sixteen adults (8 men and 8 women, median age 51 years) without neck pain in the last 3 months were recruited in 2 physiotherapy practices. Active cervical range of motion was estimated using the Apple iPhone application "3D Range of Motion." Measurements were performed 3 times a day for 7 days and spread over a period of 3 weeks. Mean values of aCROM were calculated. Intraday and interday variability was estimated by calculating limits of agreement. The limits of agreement for intraday variability ranged from ±12.1° for left rotation to ±15.5° for total rotation. For interday variability, the limits of agreement ranged from ±14.2° for right rotation to ±20.1° for total rotation. No systematic change over the day was found. This study showed substantial intraday and interday variability of aCROM measurements in asymptomatic people. No trend toward an increased or decreased aCROM was observed during the course of the day. When interpreting aCROM values, clinicians should consider the degree of variation in aCROM measurements over time. [ABSTRACT FROM AUTHOR]

Axillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement. The study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts. 94.5% of patients had ARM nodes identified (95%CI = [88.4–98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis. ARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement. NCT02994225. [ABSTRACT FROM AUTHOR]

In vitro flow-induced mechanical stimulation of developing bone tissue constructs has been shown to favor mineral deposition in scaffolds seeded with cells directly exposed to the fluid flow. However, the effect of fluid dynamic parameters, such as shear stress (SS), within 3D bioprinted constructs is still unclear. Thus, this study aimed at correlating the SS levels and the mineral deposition in 3D bioprinted constructs, evaluating the possible dampening effect of the hydrogel. Human mesenchymal stem cells (hMSCs) were embedded in 3D bioprinted porous structures made of alginate and gelatin. 3D bioprinted constructs were cultured in an osteogenic medium assessing the influence of different flow rates (0, 0.7 and 7 ml/min) on calcium and collagen deposition through histology, and bone volume (BV) through micro-computed tomography. Uniform distribution of calcium and collagen was observed in all groups. Nevertheless, BV significantly increased in perfused groups as compared to static control, ranging from 0.35±0.28 mm3, 11.90±8.74 mm3 and 25.81±5.02 mm3 at week 3 to 2.28±0.78 mm3, 22.55±2.45 mm3 and 46.05±5.95 mm3 at week 6 in static, 0.7 and 7 ml/min groups, respectively. SS values on construct fibers in the range 10-100 mPa in 7 ml/min samples were twice as high as those in 0.7 ml/min samples showing the same trend of BV. The obtained results suggest that it is necessary to enhance the flow-induced mechanical stimulation of cell-embedding hydrogels to increase the amount of mineral deposited by hMSCs, compared to what is generally reported for the development of in vitro bone constructs. In this study, we evaluated for the first time how the hydrogel structure dampens the effect of flow-induced mechanical stimulation during the culture of 3D bioprinted bone tissue constructs. By combining computational and experimental techniques we demonstrated that those shear stress thresholds generally considered for culturing cells seeded on scaffold surface, are no longer applicable when cells are embedded in 3D bioprinted constructs. Significantly, more bone volume was formed in constructs exposed to shear stress values generally considered as detrimental than in constructs exposed shear stress values generally considered as beneficial after 3 weeks and 6 weeks of dynamic culture using a perfusion bioreactor. [Display omitted] [ABSTRACT FROM AUTHOR]

The rising rate of cesarean deliveries has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecologic complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. We aimed to evaluate the effect of single-layer vs double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecologic, fertility, and obstetrical outcomes at the same follow-up. A multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years old undergoing a first cesarean delivery were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate; with secondary outcomes, including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetrical and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). Between 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830 of 1144 and 818 of 1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates; also there were no differences in pregnancy rate, need for fertility treatments, mode of delivery, or uterine ruptures in subsequent pregnancies. High rates of gynecologic symptoms, including spotting (30%–32%), dysmenorrhea (47%–49%), and sexual dysfunction (Female Sexual Function Index score, 23) are reported in both groups. The study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first cesarean delivery. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecologic symptoms after a cesarean delivery should be discussed with patients. [ABSTRACT FROM AUTHOR]

Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as it often has better cosmetic results and it enables larger tumour resection. However, OP-BCS and M-IBR compared to C-BCS lengthens operative time and might lead to more complications and consequently to additional costs. Therefore, this study aimed to compare costs and complication rates of C-BCS, OP-BCS and M-IBR. This single-centre, retrospective cohort study, calculated costs for all patients who had undergone breast cancer surgery between January 2014 and December 2016. Patient-, tumour- and surgery-related data of C-BCS, OP-BCS and M-IBR patients were retrieved by medical record review. Treatment costs were calculated using hospital financial data. Differences in costs and complications were analysed. A total of 220 patients were included: 74 patients in the C-BCS, 78 in the OP-BCS and 68 in the M-IBR group. From most expensive to least expensive, differences in total costs were found between C-BCS vs. OP-BCS and C-BCS vs. M-IBR (p=<0.01 and p=0.04, respectively). Costs of OP-BCS and M-IBR were comparable. Complication rates were 5.5% for C-BCS, followed by 17% for OP-BCS, and 34% for M-IBR (p<0.01). Considering total treatment costs, OP-BCS was financially non-inferior to M-IBR, whereas complication rates were higher following M-IBR. Therefore, when considering other benefits of OP-BCS, such as higher patient-reported outcomes and similar oncological outcomes, a shift from M-IBR to BCS using oncoplastic techniques seems justified. [ABSTRACT FROM AUTHOR]

A key reason for the occurrence of household food waste is poor meal planning, which is partly due to inappropriate discrete package sizes at supply level and lack of accounting for unused food at consumer level. Diet modeling has proven to be effective for solving food planning problems. As far as we know, discrete package sizes have not been incorporated in a dietary meal planning model before. The mathematical programming based model formulated in this article proposes meal plans and shopping lists by selecting combinations of recipes based on available retail package sizes such that food waste, costs, GHGE, and nutritional value are optimized. It generates healthy, affordable meal plans with no waste. Moreover, not only food weight but also GHGE should be considered as performance indicator for food waste. This study shows how careful weekly meal planning can help reducing household waste and the carbon footprint of diets. [ABSTRACT FROM AUTHOR]

Fire and overgrazing reduce aboveground biomass, leading to land degradation and potential impacts on soil organic carbon (SOC) and total nitrogen (TN) dynamics. However, empirical data are lacking on how prescribed burning and livestock exclusion impact SOC in the long-term. Here we analyse the effects of 19 years of prescribed annual burning and livestock exclusion on tree density, SOC and TN concentrations in the Sudanian savanna ecoregion at two sites (Tiogo and Laba) in Burkina Faso. Results revealed that neither livestock exclusion nor prescribed burning had significant impact on SOC and TN concentrations. The results at both sites indicate that 19 years of livestock and fire exclusion did not result in a significant increase in tree density compared to grazing and annual prescribed burning. The overall mean (± SEM) of SOC stocks in the 0–50 cm depth increment in the unburnt (53.5 ± 4.7 Mg C ha−1) and annually burnt (56.4 ± 4.3 Mg C ha−1) plots at Tiogo were not statistically different. Similarly, at Laba there was no significant difference between the corresponding figures in the unburnt (37.9 ± 2.6 Mg ha−1) and in the annually burnt plots (38.6 ± 1.9 Mg ha−1). Increases in belowground inputs from root turnover may have countered changes in aboveground biomass, resulting in no net change in SOC and TN. We conclude that, contrary to our expectation and current policy recommendations, restricting burning or grazing did not result in increase in SOC stocks in this dry savanna ecosystem. [ABSTRACT FROM AUTHOR]

There is generally limited but conflicting literature on the incidence, causes, and outcomes of pediatric out-of-hospital cardiac arrest. This study was performed to determine the incidence and outcome of pediatric out-of-hospital cardiac arrest reported by all helicopter emergency medical services in the Netherlands and to provide a description of causes and treatments and, in particular, a description of the specific interventions that can be performed by a physician-staffed helicopter emergency medical service. A retrospective analysis was performed of all documented pediatric (0 < 18 years of age) out-of-hospital cardiac arrests from July 2015 to July 2017, attended by all 4 Dutch helicopter emergency medical service teams. Two hundred two out-of-hospital cardiac arrests were identified. The overall incidence in the Netherlands is 3.5 out-of-hospital cardiac arrests in children per 100,000 pediatric inhabitants. The overall survival rate for out-of-hospital cardiac arrest was 11.4%. Eleven (52%) of the survivors were in the drowning group and between 12 and 96 months of age. Helicopter emergency medical services are frequently called to pediatric out-of-hospital cardiac arrests in the Netherlands. The survival rate is normal to high compared with other countries. The 12- to 96-month age group and drowning seem to have a relatively favorable outcome. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the cost-utility of four common surgical treatment pathways for breast cancer: mastectomy, breast-conserving therapy (BCT), implant breast reconstruction (BR) and autologous-BR. Patient-level healthcare consumption data and results of a large quality of life (QoL) study from five Dutch hospitals were combined. The cost-effectiveness was assessed in terms of incremental costs and quality adjusted life years (QALYs) over a 10-year follow-up period. Costs were assessed from a healthcare provider perspective. BCT resulted in comparable QoL with lower costs compared to implant-BR and autologous-BR and showed better QoL with higher costs than mastectomy (€17,246/QALY). QoL outcomes and costs of especially autologous-BR were affected by the relatively high occurrence of complications. If reconstruction following mastectomy was performed, implant-BR was more cost-effective than autologous-BR. The occurrence of complications had a substantial effect on costs and QoL outcomes of different surgical pathways for breast cancer. When this was taken into account, BCT was most the cost-effective treatment. Even with higher costs and a higher risk of complications, implant-BR and autologous-BR remained cost-effective over mastectomy. This pleas for adapting surgical pathways to individual patient preferences in the trade-off between the risks of complications and expected outcomes. [ABSTRACT FROM AUTHOR]

In evolution, genes survived that could code for metabolic pathways, promoting long term survival during famines or fasting when suffering from trauma, disease or during physiological growth. This requires utilization of substrates, already present in some form in the body. Carbohydrate stores are limited and to survive long, their utilization is restricted to survival pathways, by inhibiting glucose oxidation and glycogen synthesis. This leads to insulin resistance and spares muscle protein, because being the main supplier of carbon for new glucose production. In these survival pathways, part of the glucose is degraded in glycolysis in peripheral (muscle) tissues to pyruvate and lactate (Warburg effect), which are partly reutilized for glucose formation in liver and kidney, completing the Cori-cycle. Another part of the glucose taken up by muscle contributes, together with muscle derived amino acids, to the production of substrates consisting of a complete amino acid mix but extra non-essential amino acids like glutamine, alanine, glycine and proline. These support cell proliferation, matrix deposition and redox regulation in tissues, specifically active in host response and during growth. In these tissues, also glucose is taken up delivering glycolytic intermediates, that branch off and act as building blocks and produce reducing equivalents. Lactate is also produced and released in the circulation, adding to the lactate released by muscle in the Cori-cycle and completing secondary glucose cycles. Increased fluxes through these cycles lead to modest hyperglycemia and hyperlactatemia in states of healthy growth and disease and are often misinterpreted as induced by hypoxia. [ABSTRACT FROM AUTHOR]

• The heterogeneity of systemic lupus erythematosus can result in diagnostic delay. • Early detection of the disease allows timely treatment, which reduces organ damage. • Biomarkers to predict disease progression in patients with mild symptoms are lacking. • Combined testing of specific immune mediators can potentially help predict progression to SLE. Systemic lupus erythematosus (SLE) is a complex and heterogeneous autoimmune disease. A main challenge faced by clinicians is early identification of SLE, frequently resulting in diagnostic delay. Timely treatment, however, is important to limit disease progression, and prevent organ damage and mortality. Often, patients present with clinical symptoms and immunologic abnormalities suggestive of SLE, while not meeting classification criteria yet. This is referred to as incomplete SLE (iSLE). However, not all these patients will develop SLE. Therefore, there is need for predictive biomarkers that can distinguish patients at high risk of developing SLE, in order to allow early treatment. This article reviews the current literature on immunological changes in patients with stages preceding SLE, focusing on autoantibodies, type-I and -II interferons, and the complement system. We also provide an overview of possible predictive markers for progression to SLE that are applicable in daily clinical practice. [ABSTRACT FROM AUTHOR]

The last 2 decades have witnessed the development and broad adoption of image-guided adaptive brachytherapy (IGABT) combined with radiochemotherapy in patients with locally advanced cervical cancer. A variety of brachytherapy techniques and dose/fractionation schedules have been applied, and until recently, there was no strong evidence available for preferring one approach to another. However, large volumes of data have now provided high level clinical evidence for dose-effect relations for both disease and morbidity endpoints. It is therefore now possible to apply evidence based dose planning aims and dose prescription protocols in IGABT for locally advanced cervical cancer. This review gives an overview of targets/organs-at-risk and disease/morbidity endpoints which are relevant in the context of treatment planning and dose prescription in IGABT. The dosimetric and clinical evidence is summarized to support the implementation of dose prescription protocols which include hard and soft constraints for targets and organs at risk. [ABSTRACT FROM AUTHOR]

Sentinel lymph node identification by near infrared (NIR) fluorescence with indocyanine green (ICG) is recognized in the literature as a useful technique. NIR fluorescence technology could become key in the prevention and management of lymphedema after axillary dissection for breast cancer. Here, we conducted a systematic review focusing on ICG imaging to improve lymphedema prevention and treatment after axillary surgery. A systematic literature review was performed using MEDLINE and Embase to identify articles focused on ICG imaging for breast-cancer-related lymphedema (BCRL). Qualitative analysis was performed to summarize the characteristics of reported ICG procedures. In situ tissue identification and functionality assessment based on fluorescence signal were evaluated. Clinical outcomes were appraised when reported. Studies relating to axillary reverse mapping, lymphography and upper limb supermicrosurgery combined with ICG imaging were identified. We included a total of 33 relevant articles with a total of 2016 patients enrolled. ICG imaging for axillary reverse mapping was safe for all 951 included patients, with identification of arm nodes in 80%–88% of patients with axillary lymph nodes dissection. However, the papers discuss the oncologic safety of the approach and how - regardless of the contrast agent - concerns limit its adoption. ICG lymphography is openly supported in BCRL management, with 1065 patients undergoing this procedure in 26 articles. The technique is reported for lymphedema diagnosis, with high sensitivity and specificity, staging, intraoperative mapping and patency control in lymphaticovenular anastomosis. The substantial advantages/disadvantages of ICG imaging procedures are finally described. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aim to investigate the prevalence rates of various types of sleep disturbances among head and neck cancer (HNC) patients before, during, and after cancer treatment. We performed a systematic search on PubMed, Embase, CINAHL, and PsycINFO to find studies that reported the prevalence of any type of sleep disturbance among adult HNC patients. Meta-analyses of prevalence were performed using random effects models, with I2 values to indicate the extent of heterogeneity. In total, 29 studies of accumulatively 2315 HNC patients were included. The quality of the studies was fairly low and the heterogeneity was high. Studies on three types of sleep disturbances were found: insomnia (17 studies), hypersomnolence (12 studies), and sleep-related breathing disturbances (14 studies). The prevalence of insomnia was 29% (95% CI 20-41%) before treatment, 45% (95% CI 33-58%) during treatment, and 40% (95% CI 24-58%) after treatment, while for hypersomnolence the prevalence was 16% (95% CI 7-32%) before treatment and 32% (95% CI 20-48%) after treatment. The prevalence of sleep-related breathing disturbances before and after treatment was 66% (95% CI 44-82%) and 51% (95% CI 34-67%), respectively. These results imply that sleep disturbances are highly prevalent among HNC patients before, during, and after treatment. [ABSTRACT FROM AUTHOR]

• An immersive virtual environment was used to test cyclists' environmental preferences. • The realism in such environments is expected to support greater ecological validity. • Higher presence levels were recorded in virtual compared to still images environments. • Relatively low test–retest reliability scores were recorded in the experiments. • The method enables the study of affective reactions to the environment. The article discusses the feasibility and benefits of using immersive virtual environments (IVEs) to gauge the environmental preferences of individuals. The discussion is based on the results of a stated preference conjoint experiment employed within an IVE. In the experiment, participants were asked to rate and rank their cycling experience during and after they had cycled a few virtual routes with changing environmental characteristics. Participants repeated the experiment a week later to allow the examination of the test–retest reliability of the method. Presence level—namely the extent to which one has an actual sense of being in the simulated world—was computed using the ITC–SOPI questionnaire. The scores were compared with an equivalent, more traditional, still images conjoint task that was administrated to a control group. Presence level was significantly higher in the IVE compared to the still images experiment. This finding supports the notion that IVEs may yield greater external validity due to their higher level of realism. Relatively low test–retest reliability scores between the two IVE experiment rounds were obtained. This might be explained by the participants' low familiarity with IVEs, which in the first round diverted their attention from the conjoint task itself. In contrast, the test–retest scores of post-IVE evaluations, which are considered more cognitive in their nature, were satisfactory. Implications of the experiments and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

This paper reviews the conceptual, methodological, and technical innovations underpinning strategies for adaptive target volume selection and risk-adapted dose prescription in cervical cancer. An adaptive target volume concept has been developed which reflects tumor shrinkage at the end of initial chemo-radiation, which serves for an image-guided boost delivered through brachytherapy, with a risk-adapted dose prescription to different gross tumor- and clinical target volumes defined at diagnosis and after 40-50Gy external beam radiotherapy, and adaptation of the treatment technique according to the topography of the tumor after response and adjacent organs at risk. Clinical results of these innovations are presented based on prospective and retrospective multi-center trials (IntErnational study on MRI-based BRachytherapy in locally Advanced CErvical cancer [EMBRACE], retroEMBRACE) with large patient cohorts (n = 1416, n = 731). The potential benefit of applying these strategies and using a specific multi-parametric dose prescription protocol are explored (EMBRACE-II) and overall current and future research strategies are outlined. The challenges of dissemination and implementation of these complex new techniques into clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Highlights • A new, easy to implement, globally applicable approach for grassland carrying capacity assessment. • Above ground biomass derived from MODIS NPP accurately predicted grassland biomass in the field. • Stocking rates reported for summer pastures in Azerbaijan exceeded predicted carrying capacity. Abstract Remote sensing based grassland carrying capacity assessments are not commonly applied in rangeland management. Possible reasons for this include non-equilibrium thinking in rangeland management, and the costliness of existing remotely sensed biomass estimation that carrying capacity assessments require. Here, we present a less demanding approach for grassland biomass estimation using the MODIS Net Primary Production (NPP) product and demonstrate its use in carrying capacity assessment over the mountain grasslands of Azerbaijan. Based on publicly available estimates of the fraction of total NPP partitioned to aboveground NPP (fANPP) we calculate the aboveground biomass produced from 2005 to 2014. Validation of the predicted aboveground biomass with independent field biomass data collected in 2007 and 2008 confirmed the accuracy of the aboveground biomass product and hence we considered it appropriate for further use in the carrying capacity assessment. A first assessment approach, which allowed for consumption of 65% of aboveground biomass, resulted in an average carrying capacity of 12.6 sheep per ha. A second more realistic approach, which further restricted grazing on slopes steeper than 10%, resulted in a stocking density of 6.20 sheep per ha and a carrying capacity of 3.93 million sheep. Our analysis reveals overgrazing of the mountain grasslands because the current livestock population which consists of at least 8 million sheep, 0.5 million goats and an unknown number of cattle exceeds the predicted carrying capacity of 3.93 million sheep. We consider that the geographically explicit advice on sustainable stocking densities is particularly attractive to regulate grazing intensity in geographically varied terrain such as the mountain grasslands of Azerbaijan. We further conclude that the approach, given its generic nature and the free availability of most input data, could be replicated elsewhere. Hence, we advise considering its use where traditional carrying capacity assessments are difficult to implement. [ABSTRACT FROM AUTHOR]

During the last decade the adoption of image-guided adaptive brachytherapy has dramatically improved local control in patients with locally advanced cervical cancer (LACC) treated with radiotherapy and concomitant chemotherapy; however, nodal failure remains an obstacle. Metastatic lymph nodes can be detected by surgical and imaging approaches with different sensitivities and specificities, that improve the definition of relevant targets for macroscopic and microscopic nodal disease, and that influence our understanding of dose levels of external beam radiotherapy. Systematic use of modern radiotherapy techniques including intensity modulated radiotherapy and simultaneously integrated nodal boosts in combination with daily position verification is emerging as increasingly important for obtaining nodal control in LACC. This review summarizes published and ongoing efforts for optimizing nodal disease treatment in LACC, elaborates the state of the art approach for nodal disease detection, radiotherapy planning and delivery, and discusses future investigational efforts needed for precise optimization. [ABSTRACT FROM AUTHOR]

Abstract WOCAT – The World Overview of Conservation Approaches and Technologies with its unique methodology and global Sustainable Land Management (SLM) database - can help promote scaling out of SLM and thus contribute to land degradation neutrality. This paper focuses primarily on three Land Degradation Neutrality (LDN) indicators: (i) land cover, (ii) land productivity and (iii) carbon stocks. It is demonstrated what can be achieved by analyzing SLM practices in the database and how these shed light on the LDN indicators. Different stages of interventions - from prevention (avoiding), to reduction (reducing), and restoration (reversing) of Land Degradation (LD) - are differentiated and analyzed. This highlights the fact that most efforts and achievements recorded by WOCAT focus on reducing and preventing LD: that stands in contrast to the current emphasis by many policy makers on the much more costly task of restoration. The use of the WOCAT-LADA (Land Degradation Assessment) mapping approach is illustrated, with a case study from Madagascar. Understanding and integrating mosaic pieces at the local level can help in comprehending impacts at the national and global levels as observed by remotely sensed imagery. Supporting land users with financial resources, an enabling legal framework and, in particular with knowledge and information about SLM practices is a logical and promising way forward to promoting adoption of SLM and, eventually, reaching LDN. With respect to creating an enabling environment for scaling out SLM and supporting land users, the analysis reveals that knowledge is the second greatest constraint after financial resources. This implies that further investment must be made in capacity building and sharing knowledge on impacts of SLM, costs-benefits and the spatial spread of SLM. Furthermore, this knowledge should be linked to a clear SLM mainstreaming and scaling out strategy, which will support countries to reach their LDN targets. A decision support framework was developed by the Food and Agriculture Organization of the United Nations (FAO) and WOCAT which guides countries in LD and SLM assessments, and the use of the results for formulating and informing SLM mainstreaming and scaling out. [ABSTRACT FROM AUTHOR]

Abstract This paper is a call to geographers, a call for evocative understandings of complicated places and times, for writing practices that foreground feelings, embrace experiential considerations, and privilege embodied relationships with text during periods of struggle, protest, and resistance. I anchor this call in a formalist reading Sunil Yapa's Your Heart is a Muscle the Size of a Fist. Drawing from poetic impulses, my formalist reading of the novel includes attention to the novels' grammatical structures and lineated assemblages: I extend my reading of the novel into a call for geographers to experiment and emote in our writing practices, whatever those practices might be. The paper also draws on poet Don Paterson's writing about textual work done by the lyrical and the lyric. Paterson suggests poetry offers opportunities to make writing an ingestible project, one with the potential of being physically manifest in a reader. In this paper, I suggest there is much potential for social change if geographers consider emotionally evocative writing and knowledge as opposed to information being conveyed in expected forms. Ultimately, and circling back to Yapa, I call to geographers to consider our writing as activist work, with the emotional potential of making a new and better world. Highlights • Geographers can learn to write evocatively and emotionally by looking at the formal structures employed by creative writers. • Geographer and novelist Sunil Yapa offers an example of conveying both geographic and cultural knowledge emotively. • Writing can be an activist project. [ABSTRACT FROM AUTHOR]

Since two decades, short tandem repeats (STRs) are the preferred markers for human identification, routinely analysed by fragment length analysis. Here we present a novel set of short hypervariable autosomal microhaplotypes (MH) that have four or more SNPs in a span of less than 70 nucleotides (nt). These MHs display a discriminating power approaching that of STRs and provide a powerful alternative for the analysis;1;is of forensic samples that are problematic when the STR fragment size range exceeds the integrity range of severely degraded DNA or when multiple donors contribute to an evidentiary stain and STR stutter artefacts complicate profile interpretation. MH typing was developed using the power of massively parallel sequencing (MPS) enabling new powerful, fast and efficient SNP-based approaches. MH candidates were obtained from queries in data of the 1000 Genomes, and Genome of the Netherlands (GoNL) projects. Wet-lab analysis of 276 globally dispersed samples and 97 samples of nine large CEPH families assisted locus selection and corroboration of informative value. We infer that MHs represent an alternative marker type with good discriminating power per locus (allowing the use of a limited number of loci), small amplicon sizes and absence of stutter artefacts that can be especially helpful when unbalanced mixed samples are submitted for human identification. [ABSTRACT FROM AUTHOR]

Research on the intergenerational transmission of educational attainment tends to assume that children are raised in traditional two-parent families. However, due to the rising prevalence of divorce, non-residential fatherhood is increasingly common in Western societies. This study investigates the differences in intergenerational transmission between residential and non-residential fathers because non-residential fatherhood might disrupt mechanisms that are assumed to be crucial for intergenerational transmission, such as regular contact between parents and children. In addition, we examine three factors that might explain why some non-residential fathers are better able to transmit their educational attainment than others: (1) the number of years a father lived with the child prior to divorce (exposure), (2) the age of the child at the time of divorce (timing) and (3) the year in which non-residential fatherhood started (cohort differences). The hypotheses are based on Coleman’s concept of ‘within-family social capital’. Our study focuses on the Dutch context and we use the Netherlands Kinship Panel Study (NKPS) (birth cohorts 1960–1985) as well as register data from the System of Social statistical Datasets (SSD) (birth cohort 1995) of Statistics Netherlands. The results of the NKPS indicate that the association between the educational attainment of fathers and children is weaker for non-residential fathers than for residential fathers. However, the difference between residential and non-residential fathers is almost absent in the more recent cohorts of the SSD. We ascribe those cohort differences to an increase in shared custody arrangements since the late 1990s. [ABSTRACT FROM AUTHOR]

Lithium-ion batteries are vital in one of the key nanotechnologies required for the transition to a carbon-free society. As such, they are under constant investigation to improve their performance in terms of energy and power densities. At the same time, safety monitoring is crucial, as defects in the battery cell can lead to serious safety risks such as fires and explosions as a result of the enormous heat generated in the electrolyte, causing the release of toxic and flammable gases in the so-called thermal runaway. Therefore, early and rapid detection of the gases that form before thermal runaway is of particular interest. To this end, solid-state sensors based on new heterostructured materials have gained interest owing to their high stability and versatility when used in the harsh battery environment. In this work, heterostructures based on semiconductor oxides are employed as sensors for typical components of battery electrolytes and their decomposition products. The sensors showed a significant response to vapors produced by battery solvents or degassing products, making them perfect candidates for the development of successful new prototypes for safety monitoring. Here, we have used a simple and versatile method to fabricate the Al 2 O 3 /ZnO heterostructure, consisting of atomic layer deposition (ALD) and thermal annealing steps. These Al 2 O 3 /ZnO heterostructures have shown a response to the vapours of 1,3-dioxolane (DOL, C 3 H 6 O 2), 1,2-dimethoxyethane (DME, C 4 H 10 O 2), LiPF 6 , ethylene carbonate (EC) and dimethyl carbonate (DMC), which are typically used as components of the electrolytes in LIBs. The sensors showed a significant response to vapors produced by battery solvents or degassing products, significantly increasing the chances of developing new successful prototypes for safety monitoring. Density functional theory (DFT) calculations were employed to systematically compare the surface reactivity of the α -Al 2 O 3 (0001) and the ZnO 10 1 ̅ 0 facets, as well as the Al 2 O 3 /ZnO 10 1 ̅ 0 interface, towards C 3 H 6 O 2 , C 4 H 10 O 2 , nitrogen dioxide (NO 2) and phosphorous pentafluoride (PF 5) , in addition to H 2 O to assess the impact of relative humidity on the performance of the gas detector. The scanning tunnelling microscopy (STM) images and molecular binding energies compare well with our experiments. The energies of molecular adsorption at the heterostructure suggest that humidity will not affect the detection of the volatile organic compounds. The results presented here show that the potential to detect vapors of the components used in the electrolytes of LIBs, combined with the size control provided by the synthesis method, makes these heterostructures extremely attractive in devices to monitor battery safety. [Display omitted] • Thermally annealing Al 2 O 3 -coated ZnO heterostructure enhances the gas sensing of electrolyte components in Li-ion batteries. • Columnar Al 2 O 3 /ZnO films with a 10 nm thick coating show the highest sensitivity and selectivity for C 3 H 4 O 10 vapor detection. • DFT calculations confirm high vapor response, sensitivity and selectivity of the Al 2 O 3 /ZnO heterostructures towards C 3 H 4 O 10. • DFT predicts unaffected sensing properties of Al 2 O 3 /ZnO by humidity towards the electrolyte components in Li-ion batteries. [ABSTRACT FROM AUTHOR]

Abstract: To be effective in promoting the conservation of migratory wildlife, recipients of payment for ecosystem services (PES) must be willing to accept payment along the entire migratory corridor. This paper investigates spatial variation in willingness to accept (WTA) payments made by the Wildlife Conservation Lease Program in the Athi-Kaputiei plains of Kenya. The program, designed as an incentive to keep land open for wildlife and livestock, offers land owners 10 US$ per ha per year, irrespective of location. We model the relation between WTA and distances to roads, towns and rivers, annual precipitation and slope and display the predicted spatial variation in WTA. The results reveal significant spatial variation in willingness to accept payments for availing land for conservation, with higher WTA concentrated away from roads and also in the Southeast of the plains. The results further suggest that wildlife movement will be blocked due to low WTA in the proximity of towns and tarmacked roads. We conclude that an effective strategy to keep the land open for migratory wildlife should consider spatial variation in WTA payment for land lease. It is suggested to consider stratifying the lease rates geographically to reflect the underlying spatial variation in WTA. [Copyright &y& Elsevier]

Massively parallel sequencing (MPS) is on the advent of a broad scale application in forensic research and casework. The improved capabilities to analyse evidentiary traces representing unbalanced mixtures is often mentioned as one of the major advantages of this technique. However, most of the available software packages that analyse forensic short tandem repeat (STR) sequencing data are not well suited for high throughput analysis of such mixed traces. The largest challenge is the presence of stutter artefacts in STR amplifications, which are not readily discerned from minor contributions. FDSTools is an open-source software solution developed for this purpose. The level of stutter formation is influenced by various aspects of the sequence, such as the length of the longest uninterrupted stretch occurring in an STR. When MPS is used, STRs are evaluated as sequence variants that each have particular stutter characteristics which can be precisely determined. FDSTools uses a database of reference samples to determine stutter and other systemic PCR or sequencing artefacts for each individual allele. In addition, stutter models are created for each repeating element in order to predict stutter artefacts for alleles that are not included in the reference set. This information is subsequently used to recognise and compensate for the noise in a sequence profile. The result is a better representation of the true composition of a sample. Using Promega Powerseq™ Auto System data from 450 reference samples and 31 two-person mixtures, we show that the FDSTools correction module decreases stutter ratios above 20% to below 3%. Consequently, much lower levels of contributions in the mixed traces are detected. FDSTools contains modules to visualise the data in an interactive format allowing users to filter data with their own preferred thresholds. [ABSTRACT FROM AUTHOR]

Baroreflex activation therapy (BAT) is a device-based therapy for patients with treatment-resistant hypertension. In a randomized, controlled trial, the first-generation system significantly reduced blood pressure (BP) versus sham. Although an open-label validation study of the second-generation system demonstrated similar BP reductions, controlled data are not presently available. Therefore, this investigation compares results of first- and second-generation BAT systems. Two cohorts of first-generation BAT system patients were generated with propensity matching to compare against the validation group of 30 second-generation subjects. The first cohort was drawn from the first-generation randomized trial sham group and the second cohort from the active therapy group. Safety and efficacy were compared for the second-generation group relative to the first generation. At 6 months, second-generation BAT outperformed first-generation sham systolic BP reduction by 20 ± 28 mm Hg (mean ± standard deviation, P = .008), while BP reduction in first- and second-generation active groups was similar. At 12 months, efficacy was comparable between all three groups after the sham group had received 6 months of therapy; 47% of second-generation patients achieved goal systolic BP of 140 mm Hg or less after 12 months, comparable to 50% of patients at goal in the first-generation group ( P > .999). Implant procedure time, system/procedural safety, and pulse generator longevity improved with the second-generation system. Propensity-matched cohort analysis of the first- and second-generation BAT systems suggests similar therapeutic benefit and superior BP reduction of the second-generation system relative to sham control. Implantation procedure duration and perioperative safety were improved with the second-generation device. These findings should be validated in a prospective randomized trial. [ABSTRACT FROM AUTHOR]

Fragmentation, degradation and loss of natural habitats are now recognised as major threats to wildlife conservation and mobile pastoralism in East African savannas. These processes are driven primarily by land tenure and policy, increasing human population, expansion of settlements and agricultural farms, road networks, urban development and fencing. To understand and characterise the forces driving habitat fragmentation, we analyse how biophysical (soils, slope, rainfall, rivers) and human-created (roads, towns, parks, quarries) features influence where people choose to fence the land in the Athi-Kaputiei ecosystem of Kenya. We also explore the consequences of land fragmentation through fencing on the abundance and distribution of wildlife and livestock populations. We show that fences are most highly concentrated along the major roads and around the major urban centres. Movements of migratory wildebeest and zebra between the Nairobi National Park and the pastoral Kitengela Plains adjoining the park on the south are getting increasingly impeded by increasing concentration of fences. Populations of wildebeest and other herbivores have collapsed to a small fraction of their former abundance largely owing to destruction of their habitats and obstruction of their movements between the park and the pastoral lands by fences and other land use developments. Conserving the key seasonal wildlife dispersal areas in the Athi-Kaputiei Plains is critical to ensuring the future viability of several key wildlife species in Nairobi National Park. Several initiatives, including a conservation land lease program has been launched, but their spatial coverage and funding levels would need to be greatly expanded to secure sufficient open spaces for both wildlife and livestock. [ABSTRACT FROM AUTHOR]

In prehospital helicopter emergency medical services (HEMS), the medical team frequently manages critical patients with only limited, noninvasive monitoring options on-site and during HEMS transport. To gain deeper insight into the patient's pathology and to track prehospital treatment effects, a point-of-care blood (gas) analyzer appears desirable also in HEMS. Thus, we hypothesized that prehospital blood (gas) analysis is feasible in the HEMS setting. A prehospital evaluation of a portable blood (gas) analyzer (i-Stat 1; Abbott, Chicago, IL) with appropriate laboratory cartridges was performed within the Dutch HEMS Lifeliner 1, serving a region of ∼4.5 million inhabitants. Venous blood (gas) measurements were performed in our HEMS collective in both trauma and nontrauma cases. The HEMS team identified benefits (eg, portability and speed) and limitations (eg, a narrow operational temperature range) regarding the tested blood (gas) analyzer. Regarding the actual blood (gas) results, the team collected results without major abnormalities but also cases identifying major pathologies, including several cases of marked acidosis, refractory hypoglycemia, or severe anemia. In conclusion, portable blood (gas) analysis proved feasible in an HEMS operation but with relevant limitations. Future studies will have to show how these limitations can be overcome and how the implementation of portable blood (gas) analyzers may support improved patient outcome. [ABSTRACT FROM AUTHOR]

Background: Reduced residual myometrial thickness before and during pregnancy is associated with uterine rupture or dehiscence after vaginal birth after cesarean delivery. Laparoscopic niche resection performed in case of gynecologic symptoms has shown to increase residual myometrial thickness 6 months after surgery.Objective: This study aimed to evaluate the change in residual myometrial thickness from baseline value before pregnancy to the third trimester of pregnancy in women with and without laparoscopic niche resection and evaluate niche presence, niche size during pregnancy vs before pregnancy, and obstetrical outcomes, including uterine rupture and dehiscence in both study groups.Study Design: This was a prospective cohort study conducted in an academic medical center. Of note, 2 groups of pregnant women with a previously diagnosed niche were included: (1) women with a large symptomatic niche (residual myometrial thickness of <3 mm) followed by laparoscopic niche resection (LNR group) and (2) women with a niche without niche resection because of minimal symptoms or a residual myometrial thickness of ≥3 mm diagnosed before current pregnancy (expectant group). Participants underwent a transvaginal ultrasound at 12, 20, and 30 weeks of gestation. Changes in residual myometrial thickness and changes in niche measurements over time were analyzed with linear mixed models.Results: A total of 100 women were included, 61 in the LNR group and 39 in the expectant group. The change in residual myometrial thickness from baseline value before niche resection to the third trimester of pregnancy was +2.0 mm in the LNR group vs -1.6 mm in the expectant group (P<.001). Residual myometrial thickness decreased from the first trimester of pregnancy onward in both groups. Although residual myometrial thickness was thinner at baseline in the LNR group, it was thicker in the LNR group than in the expectant group during all trimesters: 3.2 mm (P<.001) in the first trimester of pregnancy, 2.5 mm (P<.001) in the second trimester of pregnancy, and 1.8 mm (P=.001) in the third trimester of pregnancy. Uterine dehiscence was reported in 1 of 50 women (2%) in the LNR group and 7 of 36 women (19%) in the expectant group (P=.007) and was related to the depth of niche-to-residual myometrial thickness ratio before pregnancy (after niche resection) and residual myometrial thickness in the second trimester of pregnancy. No uterine rupture was reported. Most patients received a scheduled cesarean delivery in both groups. There was more blood loss during subsequent cesarean delivery in the LNR group than in the expectant group.Conclusion: Here, laparoscopic niche resection resulted in an increased residual myometrial thickness during a subsequent pregnancy. Moreover, a lower number of dehiscence was found in the LNR group than in the expectant group without niche surgery. Per-section blood loss was higher in the LNR group than in the expectant group. In general, laparoscopic niche resection is performed to improve gynecologic symptoms. Currently, there is no evidence to support a laparoscopic niche resection to improve obstetrical outcomes, but the trend toward more uterine dehiscence encourages further research. [ABSTRACT FROM AUTHOR]

Current forensic DNA analysis predominantly involves identification of human donors by analysis of short tandem repeats (STRs) using Capillary Electrophoresis (CE). Recent developments in Massively Parallel Sequencing (MPS) technologies offer new possibilities in analysis of STRs since they might overcome some of the limitations of CE analysis. In this study 17 STRs and Amelogenin were sequenced in high coverage using a prototype version of the Promega PowerSeq™ system for 297 population samples from the Netherlands, Nepal, Bhutan and Central African Pygmies. In addition, 45 two-person mixtures with different minor contributions down to 1% were analysed to investigate the performance of this system for mixed samples. Regarding fragment length, complete concordance between the MPS and CE-based data was found, marking the reliability of MPS PowerSeq™ system. As expected, MPS presented a broader allele range and higher power of discrimination and exclusion rate. The high coverage sequencing data were used to determine stutter characteristics for all loci and stutter ratios were compared to CE data. The separation of alleles with the same length but exhibiting different stutter ratios lowers the overall variation in stutter ratio and helps in differentiation of stutters from genuine alleles in mixed samples. All alleles of the minor contributors were detected in the sequence reads even for the 1% contributions, but analysis of mixtures below 5% without prior information of the mixture ratio is complicated by PCR and sequencing artefacts. [ABSTRACT FROM AUTHOR]

Objective: Assessment of the impact of a sentinel node biopsy (SNB)-based strategy in cT1/T2 N0 oral cancer on the course of health related quality of life, psychological distress, and shoulder disability, and evaluation of the patients' perspective on neck management strategies.Study Design: Fifty-two patients (39 SNB negative; 13 SNB positive) completed the European Organization for Research and Treatment of Cancer (EORTC) questionnaires-QLQ-C30 and QLQ-H&N35, and the HADS, IES, and SDQ questionnaires at baseline, after SNB diagnosis and at 6 months of follow-up. Objective shoulder measurements were performed after 2 years and interviews were conducted after 4.5 months of follow-up.Results: All the scores of the questionnaires were not significantly different between SNB negative and SNB positive patients. Objective shoulder functioning was similar. Most patients preferred a SNB-based strategy to an elective neck dissection strategy.Conclusions: The impact of a SNB-based strategy in patients with cT1/T2 N0 oral cancer is comparable for SNB-negative and SNB-positive patients in terms of health-related quality of life, psychological distress and shoulder functioning. Most patients preferred the SNB-based strategy over the elective neck dissection strategy. [ABSTRACT FROM AUTHOR]

Periodic, self-consistent, density functional theory calculations with corrections via a Hubbard U parameter, and inclusion of dispersive forces (DFT-D2), have been employed to study CO 2 activation and conversion on the Cu 2 O (1 1 1) surface. CO 2 hydrogenation on the Cu 2 O (1 1 1) surface was investigated systematically, and the respective microscopic reaction mechanisms were elucidated. We show that, whereas CO 2 dissociation is not energetically allowed on the Cu 2 O (1 1 1) surface, CO 2 hydrogenation to a formate intermediate is more favourable than the formation of a carboxyl intermediate. Further hydrogenation from formate to formic acid is energetically allowed, where formate combines with strongly adsorbed surface hydrogen to form bidentate formic acid moieties. Formation of both the formate and the formic acid from adsorbed CO 2 and surface hydrogen are exothermic reactions. [ABSTRACT FROM AUTHOR]

This study estimated current benzo(a)pyrene (BaP) concentration levels, population exposure and potential health impacts of exposure to ambient air BaP in Europe. These estimates were done by combining the best available information from observations and chemical transport models through the use of spatial interpolation methods. Results show large exceedances of the European target value for BaP in 2012 over large areas, particularly in central-eastern Europe. Results also show large uncertainties in the concentration estimates in regions with a few or no measurement stations. The estimation of the population exposure to BaP concentrations and its health impacts was limited to 60% of the European population, covering only the modelled areas which met the data quality requirement for modelling of BaP concentrations set by the European directive 2004/107/EC. The population exposure estimate shows that 20% of the European population is exposed to BaP background ambient concentrations above the EU target value and only 7% live in areas with concentrations under the estimated acceptable risk level of 0.12 ng m −3 . This exposure leads to an estimated 370 lung cancer incidences per year, for the 60% of the European population included in the estimation. Emissions of BaP have increased in the last decade with the increase in emissions from household combustion of biomass. At the same time, climate mitigation policies are promoting the use of biomass burning for domestic heating. The current study shows that there is a need for more BaP measurements in areas of low measurement density, particularly where high concentrations are expected, e.g. in Romania, Bulgaria, and other Balkan states. Furthermore, this study shows that the health risk posed by PAH exposure calls for better coordination between air quality and climate mitigation policies in Europe. [ABSTRACT FROM AUTHOR]

Purpose: In their maxillofacial practice, the authors have encountered some children with severe dental caries whose teeth had to be removed; many later appeared to be abused children. The authors hypothesized that in the group of children who underwent multiple tooth extractions for caries under general anesthesia, a larger percentage would be found to be abused compared with the normal population.Patients and Methods: The authors identified children who underwent multiple tooth extractions under general anesthesia in a well-defined region in the Netherlands in 2005 and 2006. Subsequently, they sought these children in the database of the Dutch national organization against domestic violence and child abuse (Veilig Thuis) in 2015.Results: Of the total group of 376 children, 205 (55%) underwent the procedure because of caries during this period. Child abuse and neglect was established by Veilig Thuis in 47 of these children (23%; 95% confidence interval, 20-26), whereas the procedure occurred before the child abuse was established in 27.Conclusion: There appears to be a strong association between severe dental caries and child abuse and neglect. Hence, severe dental caries could be regarded as an early symptom of child abuse and neglect. [ABSTRACT FROM AUTHOR]

Calcinosis cutis affects 20-40% of patients with systemic sclerosis (SSc). When calcinosis cutis becomes clinically apparent, it is irreversible in most cases. Detection of active calcification formation might allow early disease-modifying interventions. We assessed the feasibility of visualizing active calcifications using [18F]Sodium Fluoride ([18F]NaF) PET/low-dose CT (LDCT) in SSc patients with calcinosis cutis. In this cross-sectional, observational pilot study patients underwent a whole body [18F]NaF PET/LDCT. All patients met the 2013 ACR/EULAR SSc criteria and had clinically detectable calcinosis cutis. (Sub)cutaneous calcifications were described by three investigators. Nine female patients were included (median age 59.0 years [IQR 51.5-70.5]). [18F]NaF uptake was mostly visible in the fingers (n=7) and knees (n=5). [18F]NaF PET showed calcifications in the fingers of 3 patients where calcifications were undetected on LDCT and in the clinic. Ninety-seven percent of [18F]NaF positive lesions was visible on LDCT. Of all lesions visible on LDCT, 70% was also visible on [18F]NaF PET. Imaging of active calcifications in SSc is feasible using [18F]NaF PET/LDCT. Seventy percent of calcifications on LDCT were [18F]NaF PET positive. Although these findings require replication, [18F]NaF PET/LDCT may detect active calcification formation, being potentially suitable for early disease-modifying interventions. [ABSTRACT FROM AUTHOR]

Background: Long-term prognosis in terms of quality of life (QoL) in young stroke patients is of importance because they usually have a long life expectancy and extensive daily life demands. We aimed at determining which medical and psychological factors influence the QoL in young stroke patients (<50 years), after long-term follow-up.Methods: Young ischemic stroke patients admitted to the St. Elisabeth Hospital and the TweeSteden Hospital, Tilburg, the Netherlands, between 2000 and 2010 were included. One hundred seventy patients and 61 controls filled out the following questionnaires: (1) the Hospital Anxiety and Depression Scale, (2) the Fatigue Assessment Scale, and (3) the shortened World Health Organization Quality of Life scale. Using linear multiple regression analysis, we assessed the factors influencing QoL.Results: QoL did not differ significantly between patients (median modified Rankin Scale score at follow-up, 0) and controls after a mean follow-up of 4.5 (standard deviation, 2.8) years. The presence of excessive fatigue was associated with lower scores on all domains of the QoL (P ≤ .003), but not for general health domain (P = .010). Similarly, depression was associated with worse QoL on the physical (P = .004) and psychological (P = .001) domains and anxiety with lower scores on the psychological (P < .001) QoL domain. No relationship was found between stroke-specific factors and QoL.Conclusions: Fatigue and to a lesser extent depression and anxiety affect the QoL in young adults after ischemic stroke of mild severity. Therefore, young stroke patients should be informed about, screened, and, if possible, treated for fatigue, depression, and anxiety. [ABSTRACT FROM AUTHOR]

The article discusses research investigating the white matter (WM) integrity of the white matter tracts in elderly with depressive symptoms, independent of global cognitive function. Research methodology, which includes diffusion tensor imaging (DTI)-derived indices using tract-based spatial statistics (TBSS), the prevalence of depressive symptoms in elderly with cerebral small vessel disease (SVD), and adjustments for white matter hyperintensities and lacunar infarcts are discussed.

Several studies point out the importance of agricultural emissions to particulate matter (PM) concentrations, and particularly of NH 3 emissions to PM 2.5 . Our study used three different chemical transport models (CHIMERE, EMEP and LOTOS-EUROS) to quantify the reductions of PM 2.5 and PM 10 concentrations due to reductions of NH 3 emissions beyond the Gothenburg Protocol (GP), as well as due to the GP alone compared to 2009. Simulations of PM 2.5 and PM 10 concentrations using 2009 meteorology were undertaken for five emission scenarios: 2009 emissions (as the reference simulation), GP emissions in 2020, and further 10%, 20% and 30% NH 3 emission reductions in EU27 beyond the GP. The modelling results for the scenarios with further 10%, 20% and 30% NH 3 agriculture emission reductions in EU27 beyond the GP show that the reduction achieved in PM concentrations is not linear with the emission reductions. In fact, the results from the study show that the impact of ammonia emissions reduction is significantly more efficient when the emission reduction rises. Moreover, based on the evaluation on 2009, the modelling study shows that the expected impact of ammonia emissions on the formation of particulate ammonium was underestimated by all models. This would imply that the role of ammonia on PM concentration and exceedances of PM 2.5 and PM 10 limit values is likely to be even larger than quantified in this study. This study shows that the implementation of the emission reductions imposed by the revised GP for 2020 will not suffice to achieve compliance with PM limit values everywhere in Europe; hence further European and local measures may be considered. NH 3 emissions from agriculture can be further reduced with the implementation of proven and feasible measures (substitution of fertilizers, improved storage of manure, way fertilizer injections, etc. , …), in order to reduce PM concentrations and their impacts on human health across Europe. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available as over-the-counter medications, despite their numerous side effects and drug interactions. The aim of this article is to increase awareness of the hypertensive potential of NSAIDs and their interference with antihypertensives. Patients with hypertension appear to be more susceptible than normotensive individuals to the blood pressure–increasing effect of NSAIDs. Most studies have found that short-term use of NSAIDs does not pose a major risk for hypertension or increase in cardiovascular disease in healthy individuals. The calcium channel blockers and β-blockers seem to be least affected by the concomitant use of NSAIDs. A dentist must weigh the benefits and disadvantages of using NSAIDs in patients taking antihypertensive drugs. For those who may be at greater risk, such as patients with hypertension and the elderly, careful selection of the class of NSAID and close monitoring are appropriate measures, especially if long-term use is anticipated. [ABSTRACT FROM AUTHOR]

Abstract: This paper engages our struggles with the discipline of medicine. Specifically, and sometimes from very personal perspectives, we question if the geographies in which undergraduate medical education unfolds are healthy. As three women broadly trained as geographers who are emotionally, politically, personally, and professionally tied to the discipline of medicine, we wonder if undergraduate medical curriculum is meeting the competencies to which is aspires. Anchored in broader literatures about medical education and the potential of medical humanities, and in our own and others’ observations and experiences about medicine being – at least to some degree – a discipline in crisis and in some state of ruin and disrepair, we reflect in this paper on two things. First, we consider how undergraduate medical education disciplines its students and scholars in specific ways that often sublimates emotional knowledge. Second, we reflect on how the discipline’s undergraduate curricular structures might improve through creative interventions that encourage non-linear, creative, possibly emotive, ways of knowing and understanding. [Copyright &y& Elsevier]

Abstract: Single-photon emission computed tomography (SPECT) can be used to study the regional distribution of the cerebral blood flow in the feline brain without interference of anesthetics. When the tracer, 99mtechnetium-ethyl cysteinate dimer (99mTc-ECD), is injected in the awake animal, the acquisition can be performed afterward under general anesthesia, whereas the tracer distribution still represents the regional cerebral blood flow (rCBF) in the awake animal. The aim of this study was to look at the in vivo stability of 99mTc-ECD in the feline brain. For this purpose, 6 cats (n = 6) were used, and 3 serial acquisitions were performed starting at 40 (T40), 60 (T60), and 85 (T85) minutes after tracer injection. Total counts and perfusion indices (PIs), normalized to the total brain and to the cerebellum, were calculated. When T85 was compared with T40, total counts decreased, depending on the brain region, with 29% (left thalamus) to 51% (bulbus olfactorius). These regional differences in tracer clearance resulted in significantly altered PIs at T85 as compared with T40. This study shows that 99mTc-ECD SPECT can be used in cats for studying the rCBF and that the clearance of 99mTc-ECD in the feline brain is region dependent. As a result, the acquisition should be started between 40 and 60 minutes after tracer injection. [Copyright &y& Elsevier]

[Display omitted] • The CMIP6 and MERRA-2 were not in line with Terra-MODIS DTB. • AOD upward trends were found during 2000–2014 and 2000–2005. • China's strict air pollution control policies had co-benefits to reduce AOD. • AOD reduction was more prominent during the 12th FYP than the 11th FYP period. • Seasonally, AOD decrease was more prominent in summer during the 12th FYP period. Rapid industrialization and urbanization along with a growing population are contributing significantly to air pollution in China. Evaluation of long-term aerosol optical depth (AOD) data from models and reanalysis, can greatly promote understanding of spatiotemporal variations in air pollution in China. To do this, AOD (550 nm) values from 2000 to 2014 were obtained from the Coupled Model Inter-comparison Project (CIMP6), the second version of Modern-Era Retrospective analysis for Research, and Applications (MERRA-2), and the Moderate Resolution Imaging Spectroradiometer (MODIS; flying on the Terra satellite) combined Dark Target and Deep Blue (DTB) aerosol product. We used the Terra-MODIS DTB AOD (hereafter MODIS DTB AOD) as a standard to evaluate CMIP6 Ensemble AOD (hereafter CMIP6 AOD) and MERRA-2 reanalysis AOD (hereafter MERRA-2 AOD). Results show better correlations and smaller errors between MERRA-2 and MODIS DTB AOD, than between CMIP6 and MODIS DTB AOD, in most regions of China, at both annual and seasonal scales. However, significant under- and over-estimations in the MERRA-2 and CMIP6 AOD were also observed relative to MODIS DTB AOD. The long-term (2000–2014) MODIS DTB AOD distributions show the highest AOD over the North China Plain (0.71) followed by Central China (0.69), Yangtse River Delta (0.67), Sichuan Basin (0.64), and Pearl River Delta (0.54) regions. The lowest AOD values were recorded over the Tibetan Plateau (0.13 ± 0.01) followed by Qinghai (0.19 ± 0.03) and the Gobi Desert (0.21 ± 0.03). Large amounts of sand and dust particles emitted from natural sources (the Taklamakan and Gobi Deserts) may result in higher AOD in spring compared to summer, autumn, and winter. Trends were also calculated for 2000–2005, for 2006–2010 (when China introduced strict air pollution control policies during the 11th Five Year Plan or FYP), and for 2011–2014 (during the 12th FYP). An increasing trend in MODIS DTB AOD was observed throughout the country during 2000–2014. The uncontrolled industrialization, urbanization, and rapid economic development that mostly occurred from 2000 to 2005 probably contributed to the overall increase in AOD. Finally, China's air pollution control policies helped to reduce AOD in most regions of the country; this was more evident during the 12th FYP period (2011–2014) than during the 11th FYP period (2006–2010). Therefore this study strongly advises the authority to retain or extend these policies in the future for improving air quality. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Recent studies increasingly show adolescent health-related behaviors to be interrelated, interacting synergistically and sharing several common determinants. Therefore, research increasingly focuses on studying interventions that target a range of health behaviors simultaneously. This report describes the results of a pilot study of a secondary school–based, health-promoting intervention that simultaneously targets a range of adolescent health behaviors via a whole-school approach. Methods: We collected self-reported behavioral data via an annual online questionnaire to 336 students. We collected data before the intervention implementation and after the intervention’s first completed, 3-year curriculum cycle on the fourth-grade students (15- to 16-year-olds). We analyzed differences between pre- and postintervention groups. Results: Significant behavioral changes were reported for extreme alcohol use, smoking, sedentary time, and bullying behaviors. Certain behaviors were significantly different only in girls: namely, weekly alcohol use, ever having used cannabis, compulsive Internet or computer use score, compulsive gaming score, and recent bully victimization. Differences in several sedentary time behaviors (television watching and Internet or computer use) were significant only in boys. No changes were reported regarding body mass index; physical activity; or the time spent on, or the compulsiveness of, video game playing. In addition, the postintervention group showed significantly fewer psychosocial problems. Conclusions: The intervention successfully changed student health behaviors on many accounts. It remains largely unclear as to what causes the different effects for boys and girls. Further studies regarding multiple health behavior targeting interventions for adolescents are required. [Copyright &y& Elsevier]

Abstract: Purpose: The consequences of head and neck cancer (HNC) treatment have great impact on patients'' lives. Despite the importance of preparing patients for the period after discharge, patients frequently experience a lack of information. Aims of the study were to develop a nurse-led educational intervention to provide information during a discharge interview and to investigate the effects of the intervention on informational needs and satisfaction with information in HNC patients. Methods: A total of 48 patients participated in this quasi-experimental study. The control group (n = 26) received standard care, which included a short interview using the patients'' discharge letter dictated by the nurse. The intervention group (n = 22) received the educational intervention, namely a discharge interview where trained nurses used a checklist to inform patients about: general information, wound-care, physical-social problems, work and finances. Effects associated with discharge interview were measured with the Patient Information Need Questionnaire (PINQ) and the Satisfaction with Cancer Information Profile. Results: The findings showed that patients need information concerning: illness, treatment, side-effects, physical fitness, impact on functioning, duration of recovery time and impact on quality of life. The educational intervention had no significant effect on the informational needs or the level of satisfaction with information. Conclusions: A nurse-led intervention to provide discharge information was developed however no effects on patient outcomes were found. Nurses need to use an instrument to assess the informational needs of patients prior to the discharge interview. The effects of the educational intervention need to be tested in a larger group of patients. [Copyright &y& Elsevier]

Abstract: In the present study, we tested whether the General Factor of Personality (GFP) is related to the level of parental support. The GFP is assumed to occupy the apex of the hierarchy of human personality structure and is believed to reflect a socially and sexually selected aggregate of behavioral characteristics that are generally valued as “desirable” in interpersonal relationships. The relationship between the GFP and parental support tested in this study is predicted by Life History Theory, a midlevel evolutionary account of systematic differences in evolved reproductive strategies. A total of 428 families with mother, father, and two children (range 14–16 years) participated. Parents filled out personality questionnaires (Big Five) and their level of parental support. The children also independently rated the amount of support they perceived from their parents. In the present sample, parents'' GFPs were found to explain 33% of the variance in the Big Five. Moreover, the parents'' GFPs showed significant relationships with the parents'' self-rated parental support, but also with the child-rated parental support. The monoinformant (parents ratings) and multi-informant (parent and child ratings) data support the notion of a substantive GFP that is related to the investment of parents into their offspring. [Copyright &y& Elsevier]

Summary: Objective: The purpose of the present pilot study is to investigate whether the beneficial short-term effects of voice therapy in patients with voice problems after treatment of early glottic cancer as reported in our earlier study remain present on the long term. Study Design: In this prospective study, 12 patients, selected based on a screening questionnaire about voice problems and randomly assigned for treatment with voice therapy (vs no treatment), were evaluated with a mean of 13 months after finishing voice therapy to evaluate the long-term voice effects. Methods: Voice assessment consisted of the Voice Handicap Index (VHI) and acoustic analyses (percent jitter, percent shimmer, and noise-to-harmonics ratio). Results: Statistical analysis showed that the beneficial short-term effect on the mean VHI, percent jitter, and shimmer remained stable after more than a year of follow-up. Conclusions: The present study provides initial evidence that the beneficial effect of voice therapy is not just a short-lived voice improvement but may result in a better voice for a period of at least 1 year. Future long-term randomized controlled trials are needed to confirm our findings. [Copyright &y& Elsevier]

Abstract: Background: Refusal self-efficacy is assumed to be linked to adolescent smoking. The aim of the present study was to examine the changing role of self-efficacy in adolescent smoking over time while controlling for parental, sibling, and friends'' smoking. Methods: This study used data from five annual waves of the “Family and Health” project. A total of 428 adolescents (mean age = 13.3 years; standard deviation = .48) and their parents participated at baseline. Only never smokers at baseline (n = 272) were included to measure smoking initiation. First, the effects of baseline self-efficacy, parental, sibling, and friends'' smoking on adolescent smoking initiation at measurement five were examined. Second, with latent growth curves analyses, individual growth curve parameters of adolescent smoking, self-efficacy, parental, sibling, and friends'' smoking were calculated. Subsequently, these growth parameters were used to predict growth of adolescent smoking. Results: Findings showed that baseline self-efficacy, parental and friends'' smoking did not predict adolescent smoking at wave five, but baseline sibling smoking did. However, growth curve parameters showed that a decrease in self-efficacy, an increase in proportion of smoking friends, and an increase in sibling smoking over time were related to an increase in adolescent smoking. Initial levels of sibling and friends'' smoking moderated the link between self-efficacy and adolescent smoking over time. Conclusion: A decrease in self-efficacy over time, rather than baseline self-efficacy, is associated with smoking initiation in adolescence. Findings emphasize the need for more fine-grained analyses when looking at self-efficacy or other individual characteristics that might fluctuate over time. [Copyright &y& Elsevier]