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Abstract Nailfold capillary density is lower in patients with pulmonary arterial hypertension (PAH). It is unclear whether this observation signifies a unique systemic manifestation of PAH, or reflects microcirculatory dysfunction secondary to pulmonary hypertension (PH). Capillary density and loop dimensions were measured by nailfold-capillaroscopy (NC) in 30 PAH (23 idiopathic, or iPAH, 7 hereditary, or hPAH), 17 chronic thromboembolic PH (CTEPH) patients and 48 controls. NC-Measurements were repeated after pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) in CTEPH patients. We examined whether NC-measurements were related to markers of disease severity and predictive of time to clinical worsening (TTCW) as tested by univariate linear/logistic regression and cox-regression analysis, respectively. Capillary density was significantly lower in PAH (7.5 ± 1.1, p

Introduction Clinicians in mental healthcare have few objective tools to identify and analyse their patient’s care needs. Clinical decision aids are tools that can support this process. Objectives This study examines whether 1) clinicians working with a clinical decision aid (TREAT) discuss more of their patient’s care needs compared to usual treatment, and 2) agree on more evidence-based treatment decisions. Methods Clinicians participated in consultations (n=166) with patients diagnosed with psychotic disorders from four Dutch mental healthcare institutions. Primary outcomes were measured with the modified Clinical Decision-making in Routine Care questionnaire and combined with psychiatric, physical and social wellbeing related care needs. A multilevel analysis compared discussed care needs and evidence-based treatment decisions between treatment as usual (TAU) before, TAU after and the TREAT-condition. Results First, a significant increase in discussed care needs for TREAT compared to both TAU conditions (b = 20.2, SE = 5.2, p = 0.00 and b = 15.8, SE = 5.4, p = 0.01) was found. Next, a significant increase in evidence-based treatments decisions for care needs was observed for TREAT compared to both TAU conditions (b = 16.7, SE = 4.8, p = 0.00 and b = 16.0, SE = 5.1, p = 0.01). Conclusions TREAT improved the discussion about physical health issues and social wellbeing related topics. It also increased evidence-based treatment decisions for care needs which are sometimes overlooked and difficult to treat. Our findings suggest that TREAT makes sense of ROM data and improves guideline-informed care. Disclosure No significant relationships.

Bottlenose dolphins (Tursiops truncatus) are keystone and sentinel species in the world's oceans. We studied correlations between per- and polyfluoroalkyl substances (PFAS) and their stress axis. We investigated associations between plasma biomarkers of 12 different PFAS variants and three cortisol pools (total, bound, and free) in wild T. truncatus from estuarine waters of Charleston, South Carolina (n = 115) and Indian River Lagoon, Florida (n = 178) from 2003 to 2006, 2010-2013, and 2015. All PFAS and total cortisol levels for these dolphins were previously reported; bound cortisol levels and free cortisol calculations have not been previously reported. We tested null hypotheses that levels of each PFAS were not correlated with those of each cortisol pool. Free cortisol levels were lower when PFOS, PFOA, and PFHxS biomarker levels were higher, but free cortisol levels were higher when PFTriA was higher. Bound cortisol levels were higher when there were higher PFDA, PFDoDA, PFDS, PFTeA, and PFUnDA biomarkers. Total cortisol was higher when PFOA was lower, but total cortisol was higher when PFDA, PFDoDA, PFTeA, and PFTriA were higher. Additional analyses indicated sex and age trends, as well as heterogeneity of effects from the covariates carbon chain length and PFAS class. Although this is a cross-sectional observational study and, therefore, could reflect cortisol impacts on PFAS toxicokinetics, these correlations are suggestive that PFAS impacts the stress axis in T. truncatus. However, if PFAS do impact the stress axis of dolphins, it is specific to the chemical structure, and could affect the individual pools of cortisol differently. It is critical to conduct long-term studies on these dolphins and to compare them to populations that have no or little expose to PFAS.

Attention to shaping the direction of one's career according to personal needs and preferences is growing. However, there is limited understanding how contextual antecedents affect career authenticity. Moreover, little is known about whether antecedents of career authenticity operate in the same way for men compared to women and if the impact of these antecedents differs per position. In this study, we contribute to these gaps in the literature by analysing the role of five antecedents of career authenticity in the academic context. Our analysis is based on a cross-sectional survey collected among a sample of 398 academics working in The Netherlands. It shows that justice in promotion practices is the most important contextual antecedent in explaining career authenticity in academia. After analysing the data using multi-group Structural Equation Modelling (SEM), we found that some antecedents relate differently to career authenticity for men compared to women. Our data also showed how most antecedents operate differently per academic rank. These insights show that higher education institutes can boost their academics' career authenticity but should tailor such actions to academics of different genders and in different positions.

Conflict of interest: No Introduction and Objectives: Cholangiocarcinoma (CCA) represents a global health challenge, with rising incidence and mortality rates. This study aimed to elucidate the clinical course and practices of CCA in Latin America. Patients / Materials and Methods: This observational cohort study investigated individuals diagnosed with CCA between 2010-2023 in five referral centers across Latin America. Demographic, biochemical, and clinical data were analyzed. Results and Discussion: A total of 309 patients were enrolled, demonstrating a balanced distribution of CCA subtypes (intrahepatic, perihilar, and distal), with Hispanics and Caucasians as the predominant ethnic groups, followed by Africans. Major risk factors identified included age, diabetes, obesity, MASLD, bile duct stones, and cholecystitis. Disparities in overweight/obesity prevalence were noted among CCA subtypes and ethnicities, with higher rates in extrahepatic CCAs and among Hispanics and Caucasians. At diagnosis, 72% of patients had ECOG-PS scores of 0-1, with disease presentations ranging from localized (47%) to locally advanced (19%) and metastatic (34%). Patients who did not receive any anti-cancer therapy exhibited a median survival of 2.3 months. Survival rates significantly improved across treatment modalities, with surgery yielding the longest (34 months), followed by chemotherapy (8 months). Notably, Africans presented with worse ECOG-PS scores and more advanced disease, while Hispanics were less frequently treated with chemotherapy, contributing to lower survival rates. Conclusions: The high prevalence of late-stage CCA diagnosis in Latin America, particularly among Africans, alongside a substantial proportion of Hispanic patients not receiving chemotherapy, underscores a dismal prognosis for patients. These findings highlight structural challenges in cancer screening and healthcare access among diverse ethnic backgrounds and lower socioeconomic statuses in the region. Urgent measures are warranted, including identifying preventable risk factors, increasing awareness among high-risk populations, and establishing equitable health coverage to address these disparities.

Background Electrocardiographic abnormalities are common in arrhythmogenic right ventricular cardiomyopathy and are included in the 2010 Task Force Criteria. Their time course, however, remains uncertain. In this retrospective observational study, we aimed to assess the long‐term evolution of electrocardiographic characteristics and their relation to ventricular arrhythmias. Methods and Results Three hundred fifty‐three patients with arrhythmogenic right ventricular cardiomyopathy as per the 2010 Task Force Criteria with 6871 automatically processed 12‐lead digital ECGs were included. The relationship between the electrocardiographic parameters and the risk of ventricular arrhythmias was assessed at 10 years from the first ECG. Electrocardiographic parameters were compared between the first contact ECG, the ECG at diagnosis, and the most recent ECG. Median time between the first and the latest ECG was 6 [interquartile range, 1–14] years. Reductions of QRS voltage, R‐ and T‐wave amplitudes between the first, diagnostic, and the latest ECGs were observed across precordial and extremity leads. Mean QRS duration increased from 96 to 102 ms (P

Lower ambient temperature (Ta) requires greater energy expenditure to sustain body temperature. However, effects of Ta on human energetics may be buffered by environmental modification and behavioral compensation. We used the IAEA DLW database for adults in the USA (n = 3213) to determine the effect of Ta (-10 to +30°C) on TEE, basal (BEE) and activity energy expenditure (AEE) and physical activity level (PAL). There were no significant relationships (p > 0.05) between maximum, minimum and average Ta and TEE, BEE, AEE and PAL. After adjustment for fat-free mass, fat mass and age, statistically significant (p

Professional collaboration is widely seen as an important component in educator professional development, but we know little about the interactional processes that undergird teacher learning in collaborative workgroups. This paper focuses on four collaborative workgroups in a yearlong, mathematics-focused professional development series for pre-Kindergarten teachers. Using a communities of practice framework, we analyzed teacher workgroup conversations to understand how these interactions mediated teachers' learning. We identified three modes of participation that characterized workgroup conversations and influenced the availability and quality of learning opportunities afforded to participants: interpersonal management, validation, and collective reasoning. Findings provide insight into how interactional processes in teacher workgroups may advance or inhibit teachers' learning.

Recently, there has been an increased interest in the well-being of students in higher education. Despite the widespread consensus on the importance of student well-being, a clear definition continues to be lacking. This study qualitatively examined the student perspective on the topic through semi-structured interviews at a university of applied sciences in the Netherlands (n = 27). A major recurring theme was well-being as a balance in the interplay between efforts directed towards studies and life beyond studies. This method of perceiving well-being deviates from theoretical definitions. Students mentioned various factors that influence their well-being. Responses ranged from personal and university related factors to external factors beyond their educational institution. This study contributes to the body of knowledge on the well-being of students in higher education and provides suggestions for educational institutions, such as incorporating a holistic perspective on students and learning; and focus points for the development of policies and practices.

Office of Social Innovation undertakes transformative initiatives that challenge systemic issues and create a space to imagine alternative pathways and perspectives. Our team of staff, students, and faculty has undertaken an intentional process to reflect on these initiatives and elaborate a scholarly approach: one that enters into dialogue with existing scholarship and identifies potential avenues of further research. We explore the guiding principles, areas of research focus, and knowledge mobilization to identify the values and distinguishing features of our approach to social innovation. Guided by our commitment to collaboration and transformation, we identify four research areas of interest: systems thinking pedagogy, community engagement, challenging institutional boundaries in knowledge generation, and the scholarship of teaching and learning. We reflect on each and explore ideas and methods for future research. Finally, we examine how we share research findings, expanding our understanding of staff, students, and faculty as key actors. Our reflection highlights the importance of collaboration and the expanded networks of belonging in research partnerships and knowledge mobilization. This entails positioning ourselves within the broader framework of action research and working from a place that centres community, collaboration, and openness.

This study addresses the role of teachers in students' well-being in higher education, which has not been well defined in the literature. A qualitative study was conducted at a Dutch university of applied sciences. It explores student beliefs about educators' roles in their well-being, and the requirements to fulfil such roles. In total, 27 students were interviewed. The variety in beliefs were reason to discuss results of the semi-structured interviews in a group discussion (n = 4). Thematic analysis of results shows that students distinguish between tutors and teachers and perceive tutors as the most crucial figures. The study identifies four roles: confidant, linking pin, a monitoring role (all three for tutors only), and a signaller role for both tutors and teachers. Requirements mentioned include the following: a close and informal teacher-student relationship, availability of time and timing of contacts, ability to provide structure, empathic attitude for both tutors and teachers and a high level of dependability mentioned for tutors only. Furthermore, findings suggest that students especially need involvement that targets their emotional needs and, to a lesser extent, their intellectual needs. Findings also show diversity in needs and preferences and highlight the importance of managing student expectations.