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BackgroundRecent developments have made the thrombin generation (TG) test accessible to the clinical laboratory. Therefore, the clinical interpretation of TG parameters has become of increasing interest, and reference values are required. Age and sex have been shown to affect TG parameters, but no consensus has been reached on the subject. We investigated the effect of age and sex on TG parameters to determine the need for age and sex specific reference values for TG.MethodsTG was measured in 22,014 individuals of the Moli-sani study, a cross-sectional cohort of the general adult Italian population. TG was measured using Calibrated Automated Thrombinography in platelet poor plasma (PPP) using PPP reagent Low and PPP reagent, in the presence and absence of thrombomodulin (TM).ResultsIndividuals were grouped into 6 age categories: 35–44 years of age (n = 5,073), 45–54 (n = 6,448), 55–64 (n = 5,516), 65–74 (n = 3,539), 75–84 (n = 1,261), and 85 years of age and older (n = 106). Men and women were distributed evenly in the age categories. Smoking was more common at younger age, whereas cardiovascular diseases, hypertension, hypercholesterolemia, and diabetes were more common at older age (p

Abstract A spontaneously occurring temperature increase in solid tumors has been reported sporadically, but is largely overlooked in terms of cancer biology. Here we show that temperature is increased in tumors of patients with pancreatic ductal adenocarcinoma (PDAC) and explore how this could affect therapy response. By mimicking this observation in PDAC cell lines, we demonstrate that through adaptive changes in lipid metabolism, the temperature increase found in human PDAC confers protection to lipid peroxidation and contributes to gemcitabine resistance. Consistent with the recently uncovered role of p38 MAPK in ferroptotic cell death, we find that the reduction in lipid peroxidation potential following adaptation to tumoral temperature allows for p38 MAPK inhibition, conferring chemoresistance. As an increase in tumoral temperature is observed in several other tumor types, our findings warrant taking tumoral temperature into account in subsequent studies related to ferroptosis and therapy resistance. More broadly, our findings indicate that tumoral temperature affects cancer biology.

Abstract Background SELENON-related myopathy (SELENON-RM) is a rare congenital myopathy characterized by slowly progressive axial muscle weakness, rigidity of the spine, scoliosis, and respiratory insufficiency. Laminin-a2-related muscular dystrophy (LAMA2-MD) has a similar clinical phenotype, which ranges from severe, early-onset congenital muscular dystrophy type 1A (MDC1A) to milder forms presenting as childhood- or adult-onset limb-girdle type muscular dystrophy. The first 1.5-year natural history follow-up showed that 90% of the patients had low bone quality, respiratory impairments were found in all SELENON-RM and most of the LAMA2-MD patients, and many had cardiac risk factors. However, further extensive knowledge on long-term natural history data, and clinical and functional outcome measures is needed to reach trial readiness. Therefore, we extended the natural history study with 3- and 5-year follow-up visits (Extended LAST STRONG). Methods The Extended LAST STRONG is a long-term natural history study in Dutch-speaking patients of all ages diagnosed with genetically confirmed SELENON-RM or LAMA2-MD, starting in September 2023. Patients visit our hospital twice over a period of 2 years to complete a 5-year follow up from the initial LAST-STRONG study. At both visits, they undergo standardized neurological examination, hand-held dynamometry (age ≥ 5 years), functional measurements, muscle ultrasound, respiratory assessments (spirometry, maximal inspiratory and expiratory pressure, sniff nasal inspiratory pressure; age ≥ 5 years), Dual-energy X-ray absorptiometry (DEXA-)scan (age ≥ 2 years), X-ray of the left hand (age ≤ 17 years), lower extremity MRI (age ≥ 10 years), accelerometry for 8 days (age ≥ 2 years), and questionnaires (patient report and/or parent proxy; age ≥ 2 years). All examinations are adapted to the patient’s age and functional abilities. Disease progression between all subsequent visits and relationships between outcome measures will be assessed. Discussion This study will provide valuable insights into the 5-year natural history of patients with SELENON-RM and LAMA2-MD and contribute to further selecting relevant and sensitive to change clinical and functional outcome measures. Furthermore, this data will help optimize natural history data collection in clinical care and help develop clinical care guidelines. Trial registration This study protocol including the patient information and consent forms has been approved by medical ethical reviewing committee (‘METC Oost-Nederland’; https://www.ccmo.nl/metcs/erkende-metcs/metc-oost-nederland , file number: 2023–16401). It is registered at ClinicalTrials.gov (NCT06132750; study registration date: 2023-10-05; study first passed date: 2023-11-15).

Although the field of Artificial Intelligence in Education (AIEd) has a substantial history as a research domain, never before has the rapid evolution of AI applications in education sparked such prominent public discourse. Given the already rapidly growing AIEd literature base in higher education, now is the time to ensure that the field has a solid research and conceptual grounding. This review of reviews is the first comprehensive meta review to explore the scope and nature of AIEd in higher education (AIHEd) research, by synthesising secondary research (e.g., systematic reviews), indexed in the Web of Science, Scopus, ERIC, EBSCOHost, IEEE Xplore, ScienceDirect and ACM Digital Library, or captured through snowballing in OpenAlex, ResearchGate and Google Scholar. Reviews were included if they synthesised applications of AI solely in formal higher or continuing education, were published in English between 2018 and July 2023, were journal articles or full conference papers, and if they had a method section. 66 publications were included for data extraction and synthesis in EPPI Reviewer, which were predominantly systematic reviews (66.7%), published by authors from North America (27.3%), conducted in teams (89.4%) in mostly domestic-only collaborations (71.2%). Findings show that these reviews mostly focused on AIHEd generally (47.0%) or Profiling and Prediction (28.8%) as thematic foci, however key findings indicated a predominance of the use of Adaptive Systems and Personalisation in higher education. Research gaps identified suggest a need for greater ethical, methodological, and contextual considerations within future research, alongside interdisciplinary approaches to AIHEd application. Suggestions are provided to guide future primary and secondary research.

Pancreatic neuroendocrine tumours (PanNETs) significantly impact life expectancy in multiple endocrine neoplasia type 1 (MEN1). Both solid and cystic pancreatic lesions are observed in MEN1, yet limited research has been focused on cystic lesions in MEN1. While solid PanNETs are generally considered to have an indolent course, the natural course of cystic lesions remains unclear. This study aims to provide more insights into the natural course of cystic PanNETs in MEN1. Patients with MEN1 and radiologically suspected PanNETs, treated at UMC Utrecht and Radboudumc between 2010 and 2023, were included. In the first part, we examined the characteristics of patients with tumours visible on imaging scans. In the second part, we investigated outcomes of pathological examinations, following resection of these lesions. A total of 136 patients were included, comprising 60 men and 76 women. The median follow-up was 5.1 years. [68Ga]Ga-DOTATOC PET/CT scans showed that both cystic and solid lesions demonstrated [68Ga]Ga-DOTATOC PET/CT uptake. The median growth of cystic and solid PanNETs was similar. Pathological examination of 38 resected tumours confirmed that cystic lesions identified on imaging were indeed PanNETs. Cystic lesions had a median diameter of 26 mm at the time of resection, compared to 18 mm for solid lesions, with comparable Ki-67 indices and mitotic counts. We conclude that cystic and solid PanNETs in MEN1 patients appear to be morphological variations of the same entity, suggesting that similar management approaches should be considered.

IntroductionUnfolded Von Willebrand Factor (VWF) is increased in thrombotic pathologies such as myocardial infarction. Unfolded VWF mediates the binding of platelets without the need for collagen. β2-glycoprotein I (β2-GPI) is a natural inhibitor of the platelet-VWF interaction. The antiphospholipid syndrome (APS) is associated with thrombosis, with an important pathophysiological role of auto-antibodies directed against β2-GPI.Methods(Unfolded) VWF levels were studied in normal controls (n=93), APS patients (n=64), non-APS thrombosis patients (n=39) and non-APS auto-immune disease (AID) patients (n=49.ResultsUnfolded VWF levels were respectively, 53%, 50% and 36% higher in APS patients, non-APS thrombosis patients and AID patients, compared to normal controls (p

BackgroundThe mechanism by which combined oral contraceptives (COCs) lead to hypercoagulation is not fully understood, although activated protein C (APC) pathway resistance has been implicated. APC and thrombomodulin (TM) tend to be considered as interchangeable reagents, even though their biological action in coagulation is different. However, it remains unclear which reagent is better suited for the detection of APC pathway resistance. We compared the effectiveness of TM and APC in TG to detect COC-induced APC pathway resistance using thrombin generation (TG).MethodsTG was measured on ST Genesia in 48 healthy women, of whom 24 used COCs. TG was triggered with STG-ThromboScreen (with and without TM), spiked with a low and high concentration of TM or APC (2 or 15 nM TM, or 1.5 or 5.5 nM APC), aimed to achieve 50% and 90% ETP inhibition, respectively.ResultsTG was higher in women using COCs. TM and APC inhibit TG in all women, although their inhibitory effect is more pronounced in women without COC compared to women with COC. The addition of 2 nM TM causes an ETP reduction of 40% (1,289 vs. 768 nM•min) in women without COC and an ETP reduction of 24% (1,704 vs. 1,287 nM•min) in women with COC. The addition of 1.5 nM APC causes an ETP reduction of 41% (1,289 vs. 759 nM•min) in women without COC and an ETP reduction of 23% (1,704 vs. 1,316 nM•min) in women with COC. The difference in effect between women with and without COC is largest when 15 nM TM, aimed at 90% ETP inhibition, is used. 15 nM TM leads to the smallest overlap in ETP inhibition between women with and without COC (27% overlap), compared to 2 nM TM (41% overlap), and 1.5 nM APC (38% overlap) and 5.5 nM APC (41% overlap).ConclusionAlthough TM and APC are often used interchangeably to assess the sensitivity of the APC system in TG, our findings suggest that TM is a better discriminator to detect COC-use induced APC pathway resistance. In addition, we found that the ETP is a better TG test readout for APC pathway resistance testing than the peak height.

Purpose: This study evaluated screening tasks able to identify children with medical conditions or disabilities who may benefit from physical literacy. Method: Children completed ≤20 screening tasks during their clinic visit and then the Canadian Assessment of Physical Literacy (2nd edition) at a separate visit. Total Canadian Assessment of Physical Literacy scores <30th percentile were categorized as potentially needing physical literacy support. Receiver operator characteristic curves identified assessment cut points with 80% sensitivity and 40% specificity relative to total physical literacy scores. Results: 223 children (97 girls; 10.1 [2.6] y) participated. Physical activity adequacy, predilection, and physical competence achieved ≥80% sensitivity and ≥40% specificity in both data sets. Adequacy ≤ 6.5 had 86% to 100% sensitivity and 48% to 49% specificity. Daily screen time >4.9 hours combined with Adequacy ≤6.15 had 88% to 10% sensitivity and 53% to 56% specificity. Conclusions: Activity adequacy, alone or with screen time, most effectively identified children likely to benefit from physical literacy support. Adequacy and screen time questionnaires are suitable for clinical use. Similar results regardless of diagnosis suggest physical competence deficits are not primary determinants of active lifestyles. Research to enhance screening specificity is required. [ABSTRACT FROM AUTHOR]

An improved divergence method has been developed to estimate annual methane (CH4) emissions from TROPOspheric Monitoring Instrument (TROPOMI) observations. It has been applied to the period of 2018 to 2021 over the Middle East, where the orography is complicated, and the mean mixing ratio of methane (XCH4) might be affected by albedos or aerosols over some locations. To adapt to extreme changes of terrain over mountains or coasts, winds are used with their divergent part removed. A temporal filter is introduced to identify highly variable emissions and to further exclude fake sources caused by retrieval artifacts. We compare our results to widely used bottom-up anthropogenic emission inventories: Emissions Database for Global Atmospheric Research (EDGAR), Community Emissions Data System (CEDS), and Global Fuel Exploitation Inventory (GFEI) over several regions representing various types of sources. The NOx emissions are from EDGAR and Daily Emissions Constrained by Satellite Observations (DECSO), and the industrial heat sources identified by Visible Infrared Imaging Radiometer Suite (VIIRS) are further used to better understand our resulting methane emissions. Our results indicate possibly large underestimations of methane emissions in metropolises like Tehran (up to 50 %) and Isfahan (up to 70 %) in Iran. The derived annual methane emissions from oil/gas production near the Caspian Sea in Turkmenistan are comparable to GFEI but more than 2 times higher than EDGAR and CEDS in 2019. Large discrepancies in the distribution of methane sources in Riyadh and its surrounding areas are found between EDGAR, CEDS, GFEI, and our emissions. The methane emission from oil/gas production to the east of Riyadh seems to be largely overestimated by EDGAR and CEDS, while our estimates as well as GFEI and DECSO NOx indicate much lower emissions from industrial activities. On the other hand, regions like Iran, Iraq, and Oman are dominated by sources from oil and gas exploitation that probably include more irregular releases of methane, with the result that our estimates, which include only invariable sources, are lower than the bottom-up emission inventories.

BACKGROUND: Cycling has a number of benefits, especially for individuals with a knee disarticulation or transfemoral prosthesis. However, the barriers they face in cycling are not well understood. OBJECTIVES: To explore the barriers in cycling experienced by users with a knee disarticulation or transfemoral prosthesis, and to gather solutions to overcome these barriers. METHODOLOGY: A qualitative research approach was used. In-depth, semi-structured, self-developed interviews were conducted with experienced prosthetic users (N=8) and an adapted version was used for certified prosthetists/orthotists (CPOs) (N=3). The interview included physical, psychological, prosthetic, and bicycle-related items. FINDINGS: Based on the findings from the interviews, the following barriers and corresponding recommendations were identified: • Physical barriers: Exertion, skin damage in the groin area and discomfort in the back and hip. • Recommendation: Use of an electric bicycle and use of a crank shortener or saddle adjustment to overcome asymmetry in cycling. • Psychological barriers: Fear of falling or fear of balance disturbances. • Recommendation: Task- and context-specific training, or graded exposure to cycling during prosthetic training, along with potentially using a more advanced bike with improved balance. • Prosthetic barriers: Problems with switching the knee prosthesis mode for cycling; challenges with prosthetic suspension; and discomfort caused by the socket brim design. • Recommendation: Manufacturers should integrate automatic detection of cycling in microprocessor prosthetic knee joints; use of a total elastic suspension belt (TES-belt); and lowering the ventral edge of the socket. • Bicycle-related barriers: Slipping of the prosthetic foot off the pedal. • Recommendation: Use of anti-slip pedals or a block heel under the shoe. CONCLUSION: By addressing the challenges and barriers, we aim to promote greater engagement in cycling, which offers significant physical and psychological benefits for persons with knee disarticulation or transfemoral amputation. Eventually, this can enhance their quality of life and foster greater independence. Layman's Abstract Cycling has a number of benefits, especially for people who use above the knee or through the knee prostheses. We interviewed experienced cyclists who use these types of prosthetic legs, as well as specialists who design and fit them, using a self-developed interview that covered physical, psychological, prosthetic, and bicycle-related items that could be barriers to cycling. Based on these interviews, we identified several key barriers and corresponding solutions: • Physical barriers: Exertion, skin damage in the groin area and pain in the back and hips. • Recommendation: Use an electric bicycle and use a crank shortener or adjust the saddle to help with cycling balance. • Psychological barriers: Fear of falling or losing balance while cycling. • Recommendation: Training focused on specific tasks and situations, or gradual practice of cycling during prosthetic training, possibly with a more advanced bike that offers better balance. • Prosthetic barriers: Problems with changing the knee’s cycling mode; problems with keeping the prosthesis in place; and discomfort from the edge of the socket. • Recommendation: Knee manufacturer could add automatic cycling mode detection; better suspension could be achieved by using a special belt; and lowering the socket brim for more comfort. • Bicycle barriers: The prosthetic foot slipping off the pedal. • Recommendation: Anti-slip pedals or adding a block heel under the shoe. We hope that addressing these barriers will encourage more people who use above the knee or through the knee prostheses to cycle and enjoy the physical and psychological benefits it offers. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44191/33491 How To Cite: de Laat F.A, Kühne S.W.M, de Vos W.C.A.J, Geertzen J.H.B. Overcoming barriers to cycling for knee disarticulation and transfemoral prosthesis users: A pilot study in The Netherlands. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.4. https://doi.org/10.33137/cpoj.v7i2.44191 Corresponding Author: Fred A. de Laat, MD, PhD, Affiliation: Libra Rehabilitation Medicine & Audiology, Tilburg/Eindhoven, The Netherlands. E-Mail: f.delaat@libranet.nl ORCID ID: https://orcid.org/0000-0002-4348-5998

Entrustable Professional Activities (EPAs) are an important tool to support individualisation of medical training in a competency-based setting and are increasingly implemented in the clinical speciality training for endocrinologist. This study aims to assess interrater agreement and factors that potentially impact EPA scores. Five known factors that affect entrustment decisions in health profesions training (capability, integrity, reliability, humility, agency) were used in this study. A case-vignette study using standardised written cases. Case vignettes (n = 6) on the topics thyroid disease, pituitary disease, adrenal disease, calcium and bone disorders, diabetes mellitus, and gonadal disorders were written by two endocrinologists and a medical education expert and assessed by endocrinologists experienced in the supervision of residents in training. Primary outcome is the inter-rater agreement of entrustment decisions for endocrine EPAs among raters. Secondary outcomes included the dichotomous interrater agreement (entrusted vs. non-entrusted), and an exploration of factors that impact decision-making. The study protocol was registered and approved by the Ethical Review Board of the Netherlands Association for Medical Education (NVMO-ERB # 2020.2.5). Nine endocrinologists from six different academic regions participated. Overall, the Fleiss Kappa measure of agreement for the EPA level was 0.11 (95% CI: 0.03–0.22) and for the entrustment decision 0.24 (95% CI 0.11–0.37). Of the five features that impacted the entrustment decision, capability was ranked as the most important by a majority of raters (56%–67%) in every case. There is a considerable discrepancy between the EPA levels assigned by different raters. These findings emphasise the need to base entrustment decisions on multiple observations, made by a team of supervisors and enriched with factors other than direct medical competence.

Global health photography has historically been commissioned and, therefore, dominated by the gaze of Western photographers on assignments in the Global South. This is changing as part of international calls to decolonise global health and stimulate ‘empowerment’, spawning a growing initiative to hire local photographers. This article, based on interviews with global health photographers, reflects on this paradigm shift. It highlights how behind the laudable aim of ‘empowerment’ of local global health photography there is a simultaneous exploitation of precarious photographer labour and the emergence of ‘glocal’ photography elites. The paper argues that empowerment of local photographers can become a euphemism for reducing image production costs and maintaining control over the image content, while extending the scope of mainstream global health visual culture without challenging it. Finally, the article amplifies the growing concern that uncritical engagement with institutionalised empowerment becomes a warrant for the reproduction of local inequalities behind the fashionable façade of cooperation and care.

Alpha thalassemia major (ATM) is a hemoglobinopathy that usually results in perinatal demise if in utero transfusions (IUTs) are not performed. We established an international registry (NCT04872179) to evaluate the impact of IUTs on survival to discharge (primary outcome) as well as perinatal and neurodevelopmental secondary outcomes. Forty-nine patients were diagnosed prenatally, 11 were diagnosed postnatally, and all 11 spontaneous survivor genotypes had preserved embryonic zeta-globin levels. We compared 3 groups of patients; group 1, prenatally diagnosed and alive at hospital discharge (n = 14), group 2, prenatally diagnosed and deceased perinatally (n = 5), and group 3, postnatally diagnosed and alive at hospital discharge (n = 11). Group 1 had better outcomes than groups 2 and 3 in terms of the resolution of hydrops, delivery closer to term, shorter hospitalizations, and more frequent average or greater neurodevelopmental outcomes. Earlier IUT initiation was correlated with higher neurodevelopmental (Vineland-3) scores (r = -0.72, P = .02). Preterm delivery after IUT was seen in 3/16 (19%) patients who continued their pregnancy. When we combined our data with those from 2 published series, patients who received ≥2 IUTs had better outcomes than those with 0 to 1 IUT, including resolution of hydrops, delivery at ≥34 weeks gestation, and 5-minute appearance, pulse, grimace, activity, and respiration scores ≥7. Neurodevelopmental assessments were normal in 17/18 of the ≥2 IUT vs 5/13 of the 0 to 1 IUT group (OR 2.74; P = .01). Thus, fetal transfusions enable the survival of patients with ATM and normal neurodevelopment, even in those patients presenting with hydrops. Nondirective prenatal counseling for expectant parents should include the option of IUTs.

Let $G$ be a locally compact group with an open subgroup $H$ with the Kunze–Stein property, and let $\pi $ be a unitary representation of $H$. We show that the representation $\widetilde{\pi }$ of $G$ induced from $\pi $ is an $L^{p+}$-representation if and only if $\pi $ is an $L^{p+}$-representation. We deduce the following consequence for a large natural class of almost automorphism groups $G$ of trees: For every $p \in (2,\infty )$, the group $G$ has a unitary $L^{p+}$-representation that is not an $L^{q+}$-representation for any $q < p$. This in particular applies to the Neretin groups.

Denitrification within the stratospheric vortex is a crucial process for Antarctic ozone hole formation, resulting in an analogous stratospheric “nitrogen hole”. Sedimentation of large nitric acid trihydrate polar stratospheric cloud particles within the Antarctic polar stratospheric vortex that form during winter depletes the inner vortex of nitrogen oxides. Here, 2018–2021 daily TROPOspheric Monitoring Instrument (TROPOMI) measurements are used for the first time for a detailed characterization of this nitrogen hole. Nitrogen dioxide total columns exhibit strong spatiotemporal and seasonal variations associated with photochemistry as well as transport and mixing processes. Combined with total ozone column data two main regimes are identified: inner-vortex ozone- and nitrogen-dioxide-depleted air and outer-vortex air enhanced in ozone and nitrogen dioxide. Within the vortex total ozone and total stratospheric nitrogen dioxide are strongly correlated, which is much less evident outside of the vortex. Connecting the two main regimes is a third regime of coherent patterns in the total nitrogen dioxide column–total ozone column phase space – defined here as “mixing lines”. These mixing lines exist because of differences in three-dimensional variations of nitrogen dioxide and ozone, thereby providing information about vortex dynamics and cross-vortex edge mixing. On the other hand, interannual variability of nitrogen dioxide–total ozone characteristics is rather small except in 2019 when the vortex was unusually unstable. Overall, the results show that daily stratospheric nitrogen dioxide column satellite measurements provide an innovative means for characterizing polar stratospheric denitrification processes, vortex dynamics, and long-term monitoring of Antarctic ozone hole conditions.