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Background: This study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit (ICU) stay in patients with severe injuries. Methods: This observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands. Adult patients (aged ≥18 years) who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries (polytrauma, as defined by Injury Severity Scores of ≥16) caused by blunt trauma were eligible for inclusion. Partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition (modified Nutrition Risk in Critically Ill score). Malnutrition was diagnosed based on Subjective Global Assessment scores. The relationship of lipoprotein properties and small metabolite concentrations with malnutrition (during ICU admission) was evaluated using mixed effects logistic regression. Results: Overall, 51 patients were included. Lower (very) low-density lipoprotein ([V]LDL) (free) cholesterol and phospholipid levels, low particle number, and higher levels of LDL triglycerides were associated with a higher risk of malnutrition (variable importance in projection [VIP] value >1.5). Low levels of most (V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition (VIP value >1.5). Increased levels of dimethyl sulfone, trimethylamine N-oxide, creatinine, N, N-dimethylglycine, and pyruvic acid and decreased levels of creatine, methionine, and acetoacetic acid were also indicative of malnutrition (VIP value >1.5). Overall, 14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission (P

Enterovirus (EV) infections occur frequently in humans. In some geographical areas they are more common. These viruses cause diseases with varying degrees of severity, from a simple respiratory tract infection to severe diseases. Since EVs include more than 70 serotypes currently circulating in the population, a methodology that detects most of them is needed. ELISA is a rapid, sensitive, and economical diagnostic method for the identification of EV serotypes and can also be used as a retrospective diagnostic tool or in the investigation of outbreaks of infection. Commercial EV-ELISAs often appear and gradually disappear from the market supply. We have used the KTL-510 peptide, a synthetic viral protein of poliovirus VP1, as an antigen in a peptide-based ELISA for the detection of a broader spectrum of anti-EV antibodies. We aimed to design, optimize, and standardize this in-house ELISA with the peptide, and implement the method for routine detection of anti-EV IgG in human sera. For determining the cut-off value, we used 100 patients’ sera which were previously tested negative for IgG antibodies against EVs using a commercial ELISA kit available. We monitored patients’ sera samples sent for serological testing of anti-coxsackievirus antibodies to the National Reference Center for the Identification of Enteric Viruses between 2018–2022. These serum samples were examined using a standard virus neutralization test as well as the newly developed ELISA method.

IntroductionMost studies about rib fractures focus on mortality and morbidity. Literature is scarce on long term and quality of life (QoL) outcomes. Therefore, we report QoL and long-term outcomes after rib fixation in flail chest patients.MethodsA prospective cohort study of clinical flail chest patients admitted to six level 1 trauma centres in the Netherlands and Switzerland between January 2018 and March 2021. Outcomes included in-hospital outcomes and long-term outcomes, such as QoL measurements 12 months after hospitalization using the EuroQoL five dimensions (EQ-5D) questionnaire.ResultsSixty-one operatively treated flail chest patients were included. Median hospital length of stay was 15 days and intensive care length of stay was 8 days. Sixteen (26%) patients developed pneumonia and two (3%) died. One year after hospitalization the mean EQ5D score was 0.78. Complication rates were low and included hemothorax (6%) pleural effusion (5%) and two revisions of the implant (3%). Implant related irritation was commonly reported by patients (n = 15, 25%).ConclusionsRib fixation for flail chest injuries can be considered a safe procedure and with low mortality rates. Future studies should focus on quality of life rather than solely short-term outcomes.Trial registration: Registered in the Netherlands Trial Register NTR6833 on 13/11/2017 and the Swiss Ethics Committees Registration Number 2019-00668

BackgroundAtypical white matter integrity may be one of the biological factors related to delinquency. In adults, decreased white matter integrity has been related to antisocial behavior, but findings from research in adolescent and young adult populations are either mixed or lacking. Here we investigated this association within a naturalistic sample of delinquent young adults (age 18–27).MethodsIn a sample of 95 young adult, delinquent men and 22 age and gender matched controls, we assessed white matter integrity through fractional anisotropy and mean diffusivity measures. We compared white matter integrity between the groups, and within the delinquent group assessed the association between white matter integrity and aggression, psychopathic traits, and cannabis use.ResultsWe found no differences in fractional anisotropy or mean diffusivity between delinquent young adults and non-delinquent controls. Additionally, within the group of delinquent young adults, we found no associations between white matter integrity and aggression, psychopathic traits, or cannabis use.ConclusionOur null findings suggest that white matter integrity differences may be unrelated to antisocial behavior in emerging adults, and/or that white matter differences between delinquent populations and controls may only arise later in life.

Impaired cognitive–motivational functioning is present in many psychiatric disorders, including alcohol use disorder (AUD). Emotion regulation is a key intermediate factor, relating to the (cognitive) regulation of emotional and motivational states, such as in regulation of craving or negative emotions that may lead to relapse in alcohol use. These cognitive–motivational functions, including emotion regulation, are a target in cognitive behavioral therapy and may possibly be improved by neurostimulation techniques. The present between-subjects, single-blind study assesses the effects of sham-controlled high-frequency neuronavigated repetitive transcranial magnetic stimulation (10 Hz) of the right dorsolateral prefrontal cortex (dlPFC) on several aspects relevant for emotion regulation (emotion processing and reappraisal abilities) and related brain activity, as well as self-reported craving in a sample of alcohol use disorder patients (AUD; n = 39) and healthy controls (HC; n = 36). During the emotion reappraisal task, participants were instructed to either attend or reappraise their emotions related to the negative, positive, neutral, and alcohol-related images, after which they rated their experienced emotions. We found that repetitive transcranial magnetic stimulation (rTMS) reduces self-reported experienced emotions in response to positive and negative images in AUD patients, whereas experienced emotions were increased in response to neutral and positive images in HCs. In the functional magnetic resonance imaging (fMRI) analyses, we found that rTMS reduces right dlPFC activity during appraisal of affective images relative to sham stimulation only in AUD patients. We could not confirm our hypotheses regarding the effect of rTMS craving levels, or on reappraisal related brain function, since no significant effects of rTMS on craving or reappraisal related brain function were found. These findings imply that rTMS can reduce the emotional impact of images as reflected in blood oxygenation level-dependent (BOLD) response, especially in AUD patients. Future studies should replicate and expand the current study, for instance, by assessing the effect of multiple stimulation sessions on both explicit and implicit emotion regulation paradigms and craving, and assess the effect of rTMS within subgroups with specific addiction-relevant image preferences.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02557815.

Alcohol dependence has long been related to impaired emotion regulation—including reappraisal—but little is known about the performance and associated neural activity of alcohol-dependent patients (ADPs) on an emotion reappraisal task. This study, therefore, compares reappraisal of negative, positive, neutral, and alcohol-related images at a behavioral and neural level between ADPs and healthy controls (HCs).Thirty-nine ADPs and 39 age-, gender-, and education-matched HCs performed an emotion reappraisal task during functional magnetic resonance imaging (fMRI), and craving was measured before and after the reappraisal task. During the emotion reappraisal task, participants were instructed to either attend or reappraise positive, negative, neutral, or alcohol-related images, and to indicate their experienced emotion on a visual analogue scale (VAS).Both ADPs and HCs completed the emotion reappraisal task successfully, showing significant differences in self-reported experienced emotion after attending versus reappraising visual stimuli and in brain activity in emotion processing/reappraisal relevant areas. ADPs were not impaired in cognitive reappraisal at a behavioral or neural level relative to HCs, nor did ADPs indicate any difference in self-reported emotion while attending emotional images. However, ADPs were different from HC in emotion processing: ADPs revealed a blunted response in the (posterior) insula, precuneus, operculum, and superior temporal gyrus while attending emotional images compared neutral images compared to HCs, and in ADPs, higher baseline craving levels were associated with a less blunted response to alcohol-related images than in HCs. These results reveal that ADPs do not show impaired reappraisal abilities when instructed, although future studies should assess voluntary reappraisal abilities in alcohol-dependent patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02557815.

In the Netherlands, all schools are required to develop a wellbeing and social safeness policy. Despite this legislation, there is currently no adequate instrument available to measure the wellbeing and social safeness. Therefore, the present study investigates the psychometric properties of the Wellbeing and Social Safeness Questionnaire (WSSQ). The WSSQ is a Dutch online questionnaire and was filled in by 1468 students (grade 5–8, age 8–12) from 14 Dutch primary schools. Exploratory and confirmatory factory analysis showed an adequate fit for a two factor structure consisting of (1) School-Related Wellbeing and Social Safeness, and (2) Generic Wellbeing. Adequate reliability and construct validity were demonstrated for both factors. Conceptually, it was found that school-related social safeness and wellbeing are not empirically separate factors, however, generic wellbeing may deserve separate consideration. The initial psychometric properties of the WSSQ are promising. This online instrument could potentially be used as a screening tool for teachers to measure social safeness and wellbeing of students.

Coxsackie B viruses (CVBs) and echoviruses (EVs) form the Human Enterovirus-B (HEV-B) species within the family Picornaviridae. HEV-B infections are widespread and generally cause mild disease; however, severe infections occur and HEV-B are associated with various chronic diseases such as cardiomyopathy and type 1 diabetes. Dendritic cells (DCs) are the professional antigen-presenting cells of our immune system and initiate and control immune responses to invading pathogens, yet also maintain tolerance to self-antigens. We previously reported that EVs, but not CVBs, can productively infect in vitro generated monocyte-derived DCs. The interactions between HEV-B and human myeloid DCs (mDCs) freshly isolated from blood, however, remain unknown. Here, we studied the susceptibility and responses of BDCA1(+) mDC to HEV-B species and found that these mDC are susceptible to EV, but not CVB infection. Productive EV7 infection resulted in massive, rapid cell death without DC activation. Contrary, EV1 infection, which resulted in lower virus input at the same MOI, resulted in DC activation as observed by production of type I interferon-stimulated genes (ISGs), upregulation of co-stimulatory and co-inhibitory molecules (CD80, CD86, PDL1) and production of IL-6 and TNF-α, with a relative moderate decrease in cell viability. EV1-induced ISG expression depended on virus replication. CVB infection did not affect DC viability and resulted in poor induction of ISGs and CD80 induction in part of the donors. These data show for the first time the interaction between HEV-B species and BDCA1(+) mDCs isolated freshly from blood. Our data indicate that different HEV-B species can influence DC homeostasis in various ways, possibly contributing to HEV-B associated pathology.

The family Picornaviridae contains well-known human pathogens (e.g., poliovirus, coxsackievirus, rhinovirus, and parechovirus). In addition, this family contains a number of viruses that infect animals, including members of the genus Cardiovirus such as Encephalomyocarditis virus (EMCV) and Theiler's murine encephalomyelits virus (TMEV). The latter are important murine pathogens that cause myocarditis, type 1 diabetes and chronic inflammation in the brains, mimicking multiple sclerosis. Recently, a new picornavirus was isolated from humans, named Saffold virus (SAFV). The virus is genetically related to Theiler's virus and classified as a new species in the genus Cardiovirus, which until the discovery of SAFV did not contain human viruses. By analogy with the rodent cardioviruses, SAFV may be a relevant new human pathogen. Thus far, SAFVs have sporadically been detected by molecular techniques in respiratory and fecal specimens, but the epidemiology and clinical significance remained unclear. Here we describe the first cultivated SAFV type 3 (SAFV-3) isolate, its growth characteristics, full-length sequence, and epidemiology. Unlike the previously isolated SAFV-1 and -2 viruses, SAFV-3 showed efficient growth in several cell lines with a clear cytopathic effect. The latter allowed us to conduct a large-scale serological survey by a virus-neutralization assay. This survey showed that infection by SAFV-3 occurs early in life (>75% positive at 24 months) and that the seroprevalence reaches >90% in older children and adults. Neutralizing antibodies were found in serum samples collected in several countries in Europe, Africa, and Asia. In conclusion, this study describes the first cultivated SAFV-3 isolate, its full-length sequence, and epidemiology. SAFV-3 is a highly common and widespread human virus causing infection in early childhood. This finding has important implications for understanding the impact of these ubiquitous viruses and their possible role in acute and/or chronic disease.

In the current study, a Dutch whole school Positive Education Programme (PEP) was investigated. PEP is a bottom-up programme, aimed at shifting teacher's attention from solely focusing on learning outcomes towards a more comprehensive approach that takes the wellbeing and engagement of students during classes into account. PEP was investigated through a clustered quasi-experimental trial. Four primary schools, 639 pupils, were included, of which two were allocated to PEP. Multilevel analyses showed no significant differences on any of the outcomes. However, the data indicated a trend towards more engagement in the intervention schools (p = 0.09). Also, at post-measurement, the proportion of sufficiently engaged students was significantly higher in the intervention schools. Although it seems too premature to draw conclusions regarding the effectiveness of such a whole school approach, the findings on engagement are promising and have the potential to engender a wide range of other beneficial outcomes.

This article presents findings from a meta-analysis which sought to determine the effectiveness of interventions adopting a whole school approach to enhancing children and young people's social and emotional development. Whole school interventions were included if they involved a coordinated set of activities across curriculum teaching, school ethos and environment, and family and community partnerships. A total of 45 studies (30 interventions) involving 496,299 participants were included in the analysis. Post-intervention outcomes demonstrated significant but small improvements in participants' social and emotional adjustment (d = 0.220), behavioural adjustment (d = 0.134), and internalising symptoms (d = 0.109). Interventions were not shown to impact on academic achievement. Origin of study and the inclusion of a community component as part of a whole school approach were found to be significant moderators for social and emotional outcomes. Further research is required to determine the active ingredients of whole school interventions that we can better understand the components necessary to achieve successful outcomes.

Enterovirus (EV) infections occur frequently in humans. In some geographical areas they are more common. These viruses cause diseases with varying degrees of severity, from a simple respiratory tract infection to severe diseases. Since EVs include more than 70 serotypes currently circulating in the population, a methodology that detects most of them is needed. ELISA is a rapid, sensitive, and economical diagnostic method for the identification of EV serotypes and can also be used as a retrospective diagnostic tool or in the investigation of outbreaks of infection. Commercial EV-ELISAs often appear and gradually disappear from the market supply. We have used the KTL-510 peptide, a synthetic viral protein of poliovirus VP1, as an antigen in a peptide-based ELISA for the detection of a broader spectrum of anti-EV antibodies. We aimed to design, optimize, and standardize this in-house ELISA with the peptide, and implement the method for routine detection of anti-EV IgG in human sera. For determining the cut-off value, we used 100 patients' sera which were previously tested negative for IgG antibodies against EVs using a commercial ELISA kit available. We monitored patients' sera samples sent for serological testing of anti-coxsackievirus antibodies to the National Reference Center for the Identification of Enteric Viruses between 2018-2022. These serum samples were examined using a standard virus neutralization test as well as the newly developed ELISA method. [ABSTRACT FROM AUTHOR]

In the Netherlands, all schools are required to develop a wellbeing and social safeness policy. Despite this legislation, there is currently no adequate instrument available to measure the wellbeing and social safeness. Therefore, the present study investigates the psychometric properties of the Wellbeing and Social Safeness Questionnaire (WSSQ). The WSSQ is a Dutch online questionnaire and was filled in by 1468 students (grade 5-8, age 8-12) from 14 Dutch primary schools. Exploratory and confirmatory factory analysis showed an adequate fit for a two factor structure consisting of (1) School-Related Wellbeing and Social Safeness, and (2) Generic Wellbeing. Adequate reliability and construct validity were demonstrated for both factors. Conceptually, it was found that school-related social safeness and wellbeing are not empirically separate factors, however, generic wellbeing may deserve separate consideration. The initial psychometric properties of the WSSQ are promising. This online instrument could potentially be used as a screening tool for teachers to measure social safeness and wellbeing of students.

So far, few studies have assessed emotional rapid response impulsivity (RRI) in incarcerated men. Available studies use varying methodological approaches and show mixed results, but incarcerated individuals are more likely to be impaired by emotional RRI. None of these studies, however, reported on any correlational or regression analysis assessing whether emotional RRI was linearly related to antisocial behavior in general or aggression and misconduct in particular. The current study investigated whether incarcerated individuals (n = 283) show impaired performance on an emotional Go/No-Go task compared to non-incarcerated controls (n = 51), and whether performance is associated with increased trait aggression, and within-prison misconduct. The results indicate that incarcerated individuals indeed show impaired emotional RRI compared to non-incarcerated controls, irrespective of emotional condition, but impaired emotional RRI was not related to trait aggression or within-prison misconduct. The impairment, relative to non-offending controls, could therefore be related to other factors than their anti-social behavior, which could hamper the use of emotional RRI in risk assessment or forensic clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on a process and impact evaluation of the Positief Educatief Programma (Positive Education Programme (PEP)), a whole school approach to supporting children's well-being and creating a positive school climate in primary schools in the Netherlands. PEP adopts a competence skill enhancement approach with a focus on developing children's positive emotions and strengths. Design/methodology/approach: A process and impact evaluation was performed within the context of two schools piloting the programme. Employing questionnaires and interviews, the evaluation sought to examine the implementation of PEP, participants' experiences with key components and the programme impact of PEP. Findings: The findings reveal largely positive attitudes towards PEP. Staff and parents were positive about the core components of PEP. Results from standardised questionnaires provide preliminary evidence about the positive impact of PEP on children's self-reported well-being and problem behaviour, teachers' awareness of children's strengths and overall school climate. The provision of practical strategies and activity-based resources was considered essential to the ongoing implementation of PEP. Research limitations/implications: This study reports on findings from two implementation schools and therefore lacks generalisability. Further research using more robust research methods exploring the effectiveness of PEP when compared with "business as usual" is needed. Originality/value: School frameworks aimed at creating a positive school climate and promoting well-being at the whole school level have not been carried out in the Netherlands to date. The results from this study provide a unique insight into the implementation and perceived impact of a whole school framework in the context of two primary schools.

Studies suggest both alexithymia and impulsivity (partially) explain aggressive behavior in traumatic brain injury (TBI) patients, but none of these studies use both questionnaire and performance‐based measures as recommended, nor simultaneously investigate both impulsivity and alexithymia. The available studies therefore likely miss part of the constructs of alexithymia and impulsivity, and do not comprehensively assess the mediating effects of both constructs in the relationship between TBI and aggression. A sample of N = 281 incarcerated individuals were recruited from Dutch penitentiary institutions, and completed the Buss Perry Aggression Questionnaire (aggression), BIS‐11 (impulsivity) and Toronto Alexithymia Scale‐20 (alexithymia) questionnaires, as well as a stop‐signal task and an emotion recognition paradigm. Several multiple mediation analyses were conducted using structural equation modelling, to assess the viability of a causal theoretical model of aggression. The final planned models were the original models with a good fit with the data (comparative fit index > 0.95, root mean square error of approximation and Standardized root mean square residual < 0.05), and results indicate that only questionnaire‐based impulsivity mediated the relationship between TBI and aggression. TBI was unrelated to alexithymia, stop‐signal or emotion recognition performance. Aggression was predicted by both alexithymia and impulsivity, but not by the performance measures. Post hoc analyses shows that alexithymia moderates the relationship between impulsivity and aggression. These results imply that aggressive incarcerated individuals showing impulsive behavior should be screened for TBI, since TBI is often overlooked or misdiagnosed, and indicate that both impulsivity and alexithymia are potential focus points for aggression reduction treatment in TBI patients. [ABSTRACT FROM AUTHOR]

Introduction: The Olerud Molander Ankle Score (OMAS) is a widely used validated Patient Reported Outcome Measure (PROM). For clinical research, it is important to determine the Minimal Clinically Important Difference (MCID). The objective of this study was to determine the MCID of the OMAS at several moments in the follow-up, in a cohort of patients that underwent open reduction and internal fixation of unstable ankle fractures with syndesmotic injury. Materials and methods: Data for this descriptive study were extracted from a prospective randomized controlled trial, the RODEO trial. The Dutch version of the OMAS was completed at 3, 6 and 12-month follow-up and estimated at baseline. The used anchor-based methods were: mean change and ROC curve. The distribution-based methods were: 0.5SD and minimal detectable change (MDC). Results: This cohort included 148 patients. The mean OMAS score in the group with minimal improvement between 3 and 6 months was 15.0 (SD 17.5, 95%CI 9.4–20.6) and between 6 and 12 months 9.5 (SD 17.1, 95% CI 3.1–15.9). The ROC curve between 3 and 6 months resulted in a MCID of 12.5 (AUC 0.72) and between 6 and 12 months, the MCID was 7.5 (AUC 0.78). Using 0.5 SD, the MCID was 10.52 (SD 21.04) at 3 months, 11.37 (SD 22.73) at 6 months and 10.47 (SD 20.94) at 12 months. The MDC was 4.72 at 3 months, 5.20 at 6 months and 4.71 at 12 months. Conclusions: The calculated MCID in patients following surgery for unstable ankle fractures ranges from 10.5 to 15.0 at 3–6-month follow-up and from 7.5 to 11.4 at 6–12-month follow-up, depending on moment and method. [ABSTRACT FROM AUTHOR]