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Abstract Background Endovascular techniques are advancing with the change of treatment paradigm for abdominal aortic aneurysms. Fenestrated EVAR (fEVAR) and branched EVAR (bEVAR) are used for complex aortic aneurysm repair. Both fEVAR and bEVAR have their own advantages and disadvantages. Semi-branches are a new feature that attempt to combine the advantages of both fEVAR and bEVAR. Technique We describe the use of a 4-vessel semi-branched EVAR in a failed EVAR case with a type 1a endoleak. Conclusion The novel feature of semi-branches in custom-made EVAR devices in endovascular aortic treatment following failed EVAR appear to be a feasible option.

Objective Insights about what actions contributed to the development of an interprofessional learning and working culture were lacking for nursing homes. This study aimed to provide insight into the context and actions that trigger mechanisms for the development of an interprofessional learning and working culture in nursing homes.Study design Realist evaluation action research was conducted from 2019 to 2023.Setting and participants 11 teams in 6 Dutch nursing homes.Primary and secondary outcome measures Questionnaires, focus group interviews and observations were used to identify actions, context factors and mechanisms. We used retroductive analysis to discuss how actions were related to the development of the culture. Actions were evaluated in terms of context and manner in which they contribute to the development.Results 21 actions were identified and clustered into two themes. Theme 1: improving person-centred care. Actions activated the mechanisms of critical reflective behaviour and collective ownership in a context of, among other things, clear roles and tasks, a stable and competent team, the presence of case managers and facilitating organisational factors such as time for reflection. Theme 2: getting to know and understand each other’s expertise. Actions activated respectful relationships, collective ownership of goals and feeling appreciated for your work in a context of, among other things, team members who meet regularly and management supporting interprofessional working.Conclusions This research sheds light on how and in what manner-specific actions contribute to the development of an interprofessional learning and working culture in nursing homes. Depending on the context, the actions triggered the following mechanisms: critical reflective behaviour, collective ownership of goals, respectful/caring relationships and feeling appreciated for your work. These mechanisms are the underlying drivers of an interprofessional learning and working culture. This study provides valuable guidance for fostering collaborative and effective interprofessional dynamics in nursing homes.

Hyperthermia treatment consists of elevating the temperature of the tumor to increase the effectiveness of radiotherapy and chemotherapy. Hyperthermia treatment planning (HTP) is an important tool to optimize treatment quality using pre-treatment temperature predictions. The accuracy of these predictions depends on modeling uncertainties such as tissue properties and positioning. In this study, we evaluated if HTP accuracy improves when the patient is imaged inside the applicator at the start of treatment. Because perfusion is a major uncertainty source, the importance of accurate treatment position and anatomy was evaluated using different perfusion values. Volunteers were scanned using MR imaging without (“planning setup”) and with the MR-compatible hyperthermia device (“treatment setup”). Temperature-based quality indicators were used to assess the differences between the standard, apparent and the optimized hyperthermia dose. We conclude that pre-treatment imaging can improve HTP predictions accuracy but also, that tissue perfusion modelling is crucial if temperature-based optimization is applied.

Objectives Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users’ decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making.Design A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework.Ethics and dissemination This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).

AbstractPurpose: A crucial aspect of quality assurance in thermal therapy is periodic demonstration of the heating performance of the device. Existing methods estimate the specific absorption rate (SAR) from the temperature rise after a short power pulse, which yields a biased estimate as thermal diffusion broadens the apparent SAR pattern. To obtain an unbiased estimate, we propose a robust frequency-domain method that simultaneously identifies the SAR as well as the thermal dynamics.Methods: We propose a method consisting of periodic modulation of the FUS power while recording the response with MR thermometry (MRT). This approach enables unbiased measurements of spatial Fourier coefficients that encode the thermal response. These coefficients are substituted in a generic thermal model to simultaneously estimate the SAR, diffusivity, and damping. The method was tested using a cylindrical phantom and a 3 T clinical MR-HIFU system. Three scenarios with varying modulation strategies are chosen to challenge the method. The results are compared to the well-known power pulse technique.Results: The thermal diffusivity is estimated at 0.151 mm2s–1 with a standard deviation of 0.01 mm2s–1 between six experiments. The SAR estimates are consistent between all experiments and show an excellent signal-to-noise ratio (SNR) compared to the well established power pulse method. The frequency-domain method proved to be insensitive to B0-drift and non steady-state initial temperature distributions.Conclusion: The proposed frequency-domain estimation method shows a high SNR and provided reproducible estimates of the SAR and the corresponding thermal diffusivity. The findings suggest that frequency-domain tools can be highly effective at estimating the SAR from (biased) MRT data acquired during periodic power modulation.

Purpose Hyperthermia treatments are successful adjuvants to conventional cancer therapies in which the tumor is sensitized by heating. To monitor and guide the hyperthermia treatment, measuring the tumor and healthy tissue temperature is important. The typical clinical practice heavily relies on intraluminal probe measurements that are uncomfortable for the patient and only provide spatially sparse temperature information. A solution may be offered through recent advances in magnetic resonance thermometry, which allows for three-dimensional internal temperature measurements. However, these measurements are not widely used in the pelvic region due to a low signal-to-noise ratio and presence of image artifacts.Methods To advance the clinical integration of magnetic resonance-guided cancer treatments, we consider the problem of removing air-motion-induced image artifacts. Thereto, we propose a new combined thermal and magnetic susceptibility model-based temperature estimation scheme that uses temperature estimates to improve the removal of air-motion-induced image artifacts. The method is experimentally validated using a dedicated phantom that enables the controlled injection of air-motion artifacts and with in vivo thermometry from a clinical hyperthermia treatment.Results We showed, using probe measurements in a heated phantom, that our method reduced the mean absolute error (MAE) by 58% compared to the state-of-the-art near a moving air volume. Moreover, with in vivo thermometry our method obtained a MAE reduction between 17% and 95% compared to the state-of-the-art.Conclusion We expect that the combined thermal and magnetic susceptibility modeling used in model-based temperature estimation can significantly improve the monitoring in hyperthermia treatments and enable feedback strategies to further improve MR-guided hyperthermia cancer treatments.

Background: Executive functions have been proposed to account for individual variation in reading comprehension beyond the contributions of decoding skills and language skills. However, insight into the direct and indirect effects of multiple executive functions on fifth-grade reading comprehension, while accounting for decoding and language skills, is limited. Aim: The present study investigated the direct and indirect effects of fourth-grade executive functions (i.e., working memory, inhibition, and planning) on fifth-grade reading comprehension, after accounting for decoding and language skills. Sample: The sample included 113 fourth-grade children (including 65 boys and 48 girls; Age M = 9.89; SD = 0.44 years). Methods: The participants were tested on their executive functions (working memory, inhibition and planning), and their decoding skills, language skills (vocabulary and syntax knowledge) and reading comprehension, one year later. Results: Using structural equation modelling, the results indicated direct effects of working memory and planning on reading comprehension, as well as indirect effects of working memory and inhibition via decoding (X[superscript 2] = 2.46). Conclusions: The results of the present study highlight the importance of executive functions for reading comprehension after taking variance in decoding and language skills into account: Both working memory and planning uniquely contributed to reading comprehension. In addition, working memory and inhibition also supported decoding. As a practical implication, educational professionals should not only consider the decoding and language skills children bring into the classroom, but their executive functions as well.

IntroductionBreeding for tick resistance is a sustainable alternative to control cattle ticks due to widespread resistance to acaricidal drugs and the lack of a protective vaccine. The most accurate method used to characterise the phenotype for tick resistance in field studies is the standard tick count, but this is labour-intensive and can be hazardous to the operator. Efficient genetic selection requires reliable phenotyping or biomarker(s) for accurately identifying tick-resistant cattle. Although breed-specific genes associated with tick resistance have been identified, the mechanisms behind tick resistance have not yet been fully characterised.MethodsThis study applied quantitative proteomics to examine the differential abundance of serum and skin proteins using samples from naïve tick-resistant and -susceptible Brangus cattle at two-time points following tick exposure. The proteins were digested into peptides, followed by identification and quantification using sequential window acquisition of all theoretical fragment ion mass spectrometry.ResultsResistant naïve cattle had a suite of proteins associated with immune response, blood coagulation and wound healing that were significantly (adjusted P < 10- 5) more abundant compared with susceptible naïve cattle. These proteins included complement factors (C3, C4, C4a), alpha-1-acid glycoprotein (AGP), beta-2-glycoprotein-1, keratins (KRT1 & KRT3) and fibrinogens (alpha & beta). The mass spectrometry findings were validated by identifying differences in the relative abundance of selected serum proteins with ELISA. The proteins showing a significantly different abundance in resistant cattle following early and prolonged tick exposures (compared to resistant naïve) were associated with immune response, blood coagulation, homeostasis, and wound healing. In contrast, susceptible cattle developed some of these responses only after prolonged tick exposure.DiscussionResistant cattle were able to transmigrate immune-response related proteins towards the tick bite sites, which may prevent tick feeding. Significantly differentially abundant proteins identified in this research in resistant naïve cattle may provide a rapid and efficient protective response to tick infestation. Physical barrier (skin integrity and wound healing) mechanisms and systemic immune responses were key contributors to resistance. Immune response-related proteins such as C4, C4a, AGP and CGN1 (naïve samples), CD14, GC and AGP (post-infestation) should be further investigated as potential biomarkers for tick resistance.

BackgroundAsthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users. ObjectiveIn this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers. MethodsIn the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT. ResultsIn total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86% of the patients). ConclusionsDifferent patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users.