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This study examines the social networks and networking behavior of students graduating from higher education and transitioning to the labor market. To obtain an in-depth understanding of graduating students' social networks, a mixed method social network study was conducted. Network data from 12 graduating students were collected. The results showed that students seek labor market-oriented contacts with individuals in the personal, education, and work contexts. Students received more practical and job-specific support from weak ties (e.g., colleagues at internships) and more social and emotional support from strong ties (e.g., parents and fellow students). The development of a labor market-oriented network occurred spontaneously through social media channels or when students proactively connected with others at educational institutions or job events. However, not all students felt confident developing a network. In these cases, the lack of awareness of relevant network actors, and interpersonal and intrapersonal characteristics play a critical role.

Delayed puberty in girls is often related to late maturation but is occasionally the first sign of premature ovarian insufficiency (POI). POI is a condition that affects ovarian function and fertility, and its etiology is unknown in most cases. Genetic factors have recently been identified in 20–25% of women with POI, involving genes that regulate various aspects of ovarian development and maintenance. We report a case of delayed puberty due to POI in an adolescent from a non-consanguineous family who carried two variants in the MCM9 gene. MCM9 is essential for DNA replication and repair, and its dysfunction can lead to chromosomal instability and ovarian failure. Our case highlights the importance of targeted gene panel analysis, particularly in POI patients with negative autoimmunity screening, and evidence of ovarian or uterine dysgenesis on pelvic imaging.

This study examines graduates' understanding of the labour market and its association with structural and agentic factors in the transition from higher education to work. Research has shown that besides possessing and exerting different forms of capital, it is foremost important for graduates to be aware and understand which forms and expressions of capital are valued within their working field. By comparing first-generation and continuing-generation graduates, the research recognises the role of background characteristics on outcomes and highlights potential differences in their perceptions of the labour market. Using a sequential mixed methods approach, including a survey for purposive sampling and interviews (n = 35), this study aims to provide insights into graduates' understanding of the value of social, cultural, and identity capital and identify patterns accounting for socio-economic status and career self-management. The results demonstrate that career self-management has a more significant influence on graduates' narratives of the value of social and identity capital compared to their social background. Conversely, when it comes to understanding the value of cultural capital, social background has a greater impact. Further, the findings show that continuing-generation graduates often maintain an advantage in the labour market by displaying a more competitive mindset.

Abstract Background Unilateral condylar hyperplasia (UCH) of the mandible is a rare condition characterized by asymmetric growth of the mandibular condyles. Bone scintigraphy with SPECT(/CT) is commonly used to diagnose UCH and guide treatment. Still, varying results have been reported using the traditional threshold of 55%:45% in relative tracer uptake. While absolute quantification of uptake on SPECT/CT could improve results, optimal correction and reconstruction settings are currently unknown. Methods Three anthropomorphic phantoms representing UCH were developed from patient CT volumes and produced using 3D printing technology. Fillable spherical inserts of different sizes (Ø: 8–15 mm) were placed in the condylar positions representing symmetrical and asymmetrical distributions. Recovery coefficients were determined for SPECT/CT using various reconstruction corrections, including attenuation and scatter correction (ACSC), resolution modeling (RM), and partial volume correction (PVC) using phantom measurements. Uptake ratios between condyles and condyle to clivus were evaluated. Finally, the impact of these correction techniques on absolute activity and diagnostic accuracy was assessed in a retrospective patient cohort for the diagnostic threshold of 55%:45%. Results The activity was only partially recovered in all spherical inserts (range: 22.5–64.9%). However, RM improved relative recovery by 20.2–62.3% compared to ACSC. In the symmetric phantoms, the 95% confidence interval (CI) of condyle ratios included the diagnostic threshold (57.6%:42.4%) for UCH when using ACSC potentially leading to false positives, but not for ACSCRM datasets. Partial volume corrections coefficients from the NEMA IQ phantom was positionally dependent, with improvements seen performing PVC using coefficients derived from anthropomorphic phantoms. Retrospective application in a patient cohort showed only a weak linear correlation (R²: 0.25–0.67) and large limits of agreement (9.6–12.5%) between different reconstructions. Up to 44% of patients were reclassified using the 55%:45% threshold. Using clinical outcome data, ACSCRM had highest sensitivity (91%; 95% CI 59–100%) and specificity (66%; 95% CI 47–81%), significantly improving specificity (P = 0.038). Conclusions Anthropomorphic phantoms were shown to be essential in determining optimal settings for acquisition, reconstruction, and analysis. SPECT/CT reconstructions with attenuation and scatter correction and resolution modeling are recommended and could improve specificity when using the 55%:45% threshold to assess condylar growth.

Efficient and secure decommissioning of nuclear facilities demands advanced technologies. In this context, gamma-ray detection and imaging are crucial in identifying radioactive hotspots and monitoring radiation levels. Our study is dedicated to developing a gamma-ray detection system tailored for integration into robotic platforms for nuclear decommissioning, offering a safe and automated solution for this intricate task and ensuring the safety of human operators by mitigating radiation exposure and streamlining hotspot localization.Our approach integrates a Compton camera based 3D reconstruction algorithm with a single Timepix3 detector. This eliminates the need for a second detector and significantly reduces system weight and cost. Additionally, combining a 3D camera with the setup enhances hotspot visualization and interpretation, rendering it an ideal solution for practical nuclear decommissioning applications.In a proof-of-concept measurement utilizing a 137Cs source, our system accurately localized and visualized the source in 3D with an angular error of 1° and estimated the activity with a 3% relative error. This promising result underscores the system's potential for deployment in real-world decommissioning settings. Future endeavors will expand the technology's applications in authentic decommissioning scenarios and optimize its integration with robotic platforms.The outcomes of our study contribute to heightened safety and accuracy for nuclear decommissioning works through the advancement of cost-effective and efficient gamma-ray detection systems.

Growth hormone (GH) deficiency (GHD) in children and adolescents can vary in severity and origin, with GH replacement therapy proving effective in achieving genetic target height. Optimal outcomes are seen in those treated early and with higher doses. As patients approach adult height, priorities shift towards optimizing metabolic effects, maintaining body composition, and enhancing bone mass and muscle strength. Transitioning from pediatric to adult care presents challenges, including accurately identifying candidates for continued GH therapy, reevaluating persistent GHD, and preventing treatment discontinuation. Assessing readiness for transition and self-management skills is crucial. This Policy and Practice Review provides a comprehensive overview of current policies, regulations, and guidelines pertinent to managing GHD transition in Belgium. We integrate perspectives from national academic and nonacademic clinical stakeholders in pediatric and adult endocrine care to provide an updated policy framework. This framework underscores the importance of sustained GH therapy during transition, particularly for individuals with persistent GHD, with the goal of optimizing practices and improving outcomes during this critical period.

Abstract Research on metastatic cancer has been hampered by limited sample availability. Here we present the breast cancer post-mortem tissue donation program UPTIDER and show how it enabled sampling of a median of 31 (range: 5-90) metastases and 5-8 liquids per patient from its first 20 patients. In a dedicated experiment, we show the mild impact of increasing time after death on RNA quality, transcriptional profiles and immunohistochemical staining in tumor tissue samples. We show that this impact can be counteracted by organ cooling. We successfully generated ex vivo models from tissue and liquid biopsies from distinct histological subtypes of breast cancer. We anticipate these and future findings of UPTIDER to elucidate mechanisms of disease progression and treatment resistance and to provide tools for the exploration of precision medicine strategies in the metastatic setting.

Background Worldwide, there are concerns about declining mental health of children and young people (CYP).Objectives To examine trends in GP consultation rates for psychosocial problems and the impact of the COVID-19 pandemic.Methods We performed a population-based cohort study using electronic GP records of CYP (0–24 years) living in the Rotterdam metropolitan area between 2016 and 2021. We calculated monthly consultation rates for psychosocial problems, stratified by age group and sex. We used negative binomial models to model the pre-COVID-19 trend, and estimate expected rates post-COVID-19 onset. We modelled the effect of COVID-19 infection rate and school closure on consultation rates per sex and age group.Results The cohort increased from 64801 to 92093 CYP between January 2016 and December 2021. Median age was 12.5 years and 49.3% was female. Monthly consultation rates increased from 2,443 to 4,542 consultations per 100,000 patient months over the six years. This trend (RR 1.009, 95%CI 1.008–1.011) started well before the COVID-19 pandemic. Consultation rates of adolescent girls and young women increased most strongly. Between March and May 2020, there was a temporary reduction in consultation rates, whereupon these returned to expected levels. COVID-19 infection rate and school closures showed small but significant associations with consultation rates for psychosocial problems but this did not affect the overall trend. Although consultation rates for psychosocial problems increased, this increment was stable over the entire study period.Conclusion The COVID-19 pandemic did not significantly increase consultation rates for psychosocial problems in CYP. The consultation rates increased, especially in adolescent girls and young women.

Background: Many countries observed a sharp decline in the use of general practice services after the outbreak of the COVID-19 pandemic. However, research has not yet considered how changes in healthcare consumption varied among regions with the same restrictive measures but different COVID-19 prevalence. Aim: To investigate how the COVID-19 pandemic affected healthcare consumption in Dutch general practice during 2020 and 2021, among regions with known heterogeneity in COVID-19 prevalence, from a pre-pandemic baseline in 2019. Design & setting: Population-based cohort study using electronic health records. The study was undertaken in Dutch general practices involved in regional research networks. Method: An interrupted time-series analysis of changes in healthcare consumption from before to during the pandemic was performed. Descriptive statistics were used on the number of potential COVID-19-related contacts, reason for contact, and type of contact. Results: The study covered 3 595 802 contacts (425 639 patients), 3 506 637 contacts (433 340 patients), and 4 105 413 contacts (434 872 patients) in 2019, 2020, and 2021, respectively. Time-series analysis revealed a significant decrease in healthcare consumption after the outbreak of the pandemic. Despite interregional heterogeneity in COVID-19 prevalence, healthcare consumption decreased comparably over time in the three regions, before rebounding to a level significantly higher than baseline in 2021. Physical consultations transitioned to phone or digital over time. Conclusion: Healthcare consumption decreased irrespective of the regional prevalence of COVID-19 from the start of the pandemic, with the Delta variant triggering a further decrease. Overall, changes in care consumption appeared to reflect contextual factors and societal restrictions rather than infection rates.

Primary tumors with a mixed invasive breast carcinoma of no-special type (IBC-NST) and invasive lobular cancer (ILC) histology are present in approximately five percent of all patients with breast cancer and are understudied at the metastatic level. Here, we characterized the histology of metastases from two patients with primary mixed IBC-NST/ILC from the postmortem tissue donation program UPTIDER (NCT04531696). The 14 and 43 metastatic lesions collected at autopsy had morphological features and E-cadherin staining patterns consistent with pure ILC. While our findings still require further validation, they may challenge current clinical practice and imaging modalities used in these patients.

Abstract Background In the adult population, about 50% have hypertension, a risk factor for cardiovascular disease and subsequent premature death. Little is known about the quality of the methods used to diagnose hypertension in primary care. Objectives The objective was to assess the frequency of use of recognized methods to establish a diagnosis of hypertension, and specifically for OBPM, whether three distinct measurements were taken, and how correctly the blood pressure levels were interpreted. Methods A retrospective population-based cohort study using electronic medical records of patients aged between 40 and 70 years, who visited their general practitioner (GP) with a new-onset of hypertension in the years 2012, 2016, 2019, and 2020. A visual chart review of the electronic medical records was used to assess the methods employed to diagnose hypertension in a random sample of 500 patients. The blood pressure measurement method was considered complete if three or more valid office blood pressure measurements (OBPM) were performed, or home-based blood pressure measurements (HBPM), the office- based 30-minute method (OBP30), or 24-hour ambulatory blood pressure measurements (24 H-ABPM) were used. Results In all study years, OBPM was the most frequently used method to diagnose new-onset hypertension in patients. The OBP-30 method was used in 0.4% (2012), 4.2% (2016), 10.6% (2019), and 9.8% (2020) of patients respectively, 24 H-ABPM in 16.0%, 22.2%, 17.2%, and 19.0% of patients and HBPM measurements in 5.4%, 8.4%, 7.6%, and 7.8% of patients, respectively. A diagnosis of hypertension based on only one or two office measurements occurred in 85.2% (2012), 87.9% (2016), 94.4% (2019), and 96.8% (2020) of all patients with OBPM. In cases of incomplete measurement and incorrect interpretation, medication was still started in 64% of cases in 2012, 56% (2016), 60% (2019), and 73% (2020). Conclusion OBPM is still the most often used method to diagnose hypertension in primary care. The diagnosis was often incomplete or misinterpreted using incorrect cut-off levels. A small improvement occurred between 2012 and 2016 but no further progress was seen in 2019 or 2020. If hypertension is inappropriately diagnosed, it may result in under treatment or in prolonged, unnecessary treatment of patients. There is room for improvement in the general practice setting.

Abstract Sea ice is a critical component of the Earth’s Climate System and a unique habitat. Sea-ice changes prior to the satellite era are poorly documented, and proxy methods are needed to constrain its past variability. Here, we demonstrate the potential of sedimentary DNA from Polarella glacialis, a sea-ice microalga, for tracing past sea-ice conditions. We quantified P. glacialis DNA (targeting the nuclear ribosomal ITS1 region) in Arctic marine and fjord surface sediments and a sediment core from northern Baffin Bay spanning 12,000 years. Sea ice and sediment trap samples confirmed that cysts of P. glacialis are common in first-year sea ice and sinking particulate matter following sea-ice melt. Its detection is more efficient with our molecular approach than standard micropaleontological methods. Given that the species inhabits coastal and marine environments in the Arctic and Antarctic, P. glacialis DNA has the potential to become a useful tool for circum-polar sea-ice reconstructions.

Abstract Liver is the third most common organ for breast cancer (BC) metastasis. Two main histopathological growth patterns (HGP) exist in liver metastases (LM): desmoplastic and replacement. Although a reduced immunotherapy efficacy is reported in patients with LM, tumor-infiltrating lymphocytes (TIL) have not yet been investigated in BCLM. Here, we evaluate the distribution of the HGP and TIL in BCLM, and their association with clinicopathological variables and survival. We collect samples from surgically resected BCLM (n = 133 patients, 568 H&E sections) and post-mortem derived BCLM (n = 23 patients, 97 H&E sections). HGP is assessed as the proportion of tumor liver interface and categorized as pure-replacement (‘pure r-HGP’) or any-desmoplastic (‘any d-HGP’). We score the TIL according to LM-specific guidelines. Associations with progression-free (PFS) and overall survival (OS) are assessed using Cox regressions. We observe a higher prevalence of ‘any d-HGP’ (56%) in the surgical samples and a higher prevalence of ‘pure r-HGP’ (83%) in the post-mortem samples. In the surgical cohort, no evidence of the association between HGP and clinicopathological characteristics is observed except with the laterality of the primary tumor (p value = 0.049) and the systemic preoperative treatment before liver surgery (p value = .039). TIL is less prevalent in ‘pure r-HGP’ as compared to ‘any d-HGP’ (p value = 0.001). ‘Pure r-HGP’ predicts worse PFS (HR: 2.65; CI: (1.45–4.82); p value = 0.001) and OS (HR: 3.10; CI: (1.29–7.46); p value = 0.011) in the multivariable analyses. To conclude, we demonstrate that BCLM with a ‘pure r-HGP’ is associated with less TIL and with the worse outcome when compared with BCLM with ‘any d-HGP’. These findings suggest that HGP could be considered to refine treatment approaches.

The transition from higher education to the labour market is considered an important and uncertain life stage wherein young adults exchange an academic environment for an often-chaotic entry into the labour market. Specifically, for graduates with a lower socioeconomic status (SES), this transition involves several difficulties. Investigating these persisting SES differences in the transition is becoming more relevant given the increasing participation of students from lower SES backgrounds in higher education. This systematic review studies SES differences in the transition by looking through the lens of resource acquisition. The results demonstrate that graduates from lower SES backgrounds have more difficulty finding suitable employment and often experience lower job quality. Moreover, our findings show that the strong interdependence between the importance of different forms of capital and the (implicit) symbolic value attached to these capitals makes it difficult for graduates from lower SES backgrounds to overcome barriers in the transition.

The gelatinisation temperature and bimodal granule size distribution of barley starch are important characteristics regarding resource efficiency and product quality in the brewing industry. In this work, the diversity in starch amylose content and granule proportions in a set of modern barley varieties (N = 23) was investigated and correlated with their starch gelatinisation behaviour. Milled barley samples had peak starch gelatinisation temperatures ranging from 60.1 to 66.5 °C. Upon separating the barley starch from the non-starch compounds, sample-dependent decreases in starch gelatinisation temperatures were observed, indicating the importance of differences in barley composition. The peak gelatinisation temperatures of milled barley and isolated barley starches were strongly correlated (r = 0.96), indicating that the behaviour of the starch population is strongly reflected in the measurements performed on milled barley. Therefore, we investigated whether amylose content or starch granule size distribution could predict the gelatinisation behaviour of the starches. Broad ranges in the small starch granule volumes (13.9–32.0 v/v%) and amylose contents (18.2–30.7 w/w%) of the barley starches were observed. For the barley samples collected in the north of the USA (N = 8), the small starch granule volumes correlated positively with the peak gelatinisation temperatures of barley starches (r = 0.90, p

Background: A mallet finger (MF) is diagnosed clinically and can be managed in primary care. The actual incidence of MF and how it is managed in primary care is unknown. Aim: To determine the incidence of MF in primary care and to obtain estimates for the proportions of osseous and tendon MF. An additional aim was to gain insight into the management of patients diagnosed with MF in primary care. Design & setting: A cohort study using a healthcare registration database from general practice in the Netherlands. Method: Patients aged ≥18 years with a new diagnosis of MF from 1 January 2015–31 December 2019 were selected using a search algorithm based on International Classification of Primary Care (ICPC) coding. Results: In total, 161 cases of MF were identified. The mean incidence was 0.58 per 1000 person–years. A radiograph was taken in 58% (n = 93) of cases; 23% (n = 37) of cases had an osseous MF. The most applied strategies were referral to secondary care (45%) or conservative treatment in GP practice (43%). Overall, 7% were referred to a paramedical professional. Conclusion: On average, a Dutch GP assesses ≥1 patient with MF per year. Since only a minimal number of patients required surgical treatment and a limited number of GPs requested radiography, the recommendation in the guidelines to perform radiography in all patients with MF should potentially be reconsidered. The purpose of requesting radiographs should not be to distinguish between a tendinogenic or osseous MF, but to assess whether there is a possible indication for surgery.

The Piacenzian stage (3.6–2.6 Ma) of the Pliocene is the most recent period where Earth experienced sustained intervals of global warmth analogous to predicted near-future climates. Despite considerable efforts to characterize and understand the climate dynamics of the Piacenzian, the deep ocean and its response to this warming remain poorly understood. Here we present new mid-Piacenzian Mg/Ca and Δ47 (“clumped isotope”) temperatures from the deep Pacific and North Atlantic oceans. These records cover the transition from Marine Isotope Stage (MIS) M2 – considered the most pronounced “glacial” stage of the Pliocene prior to the intensification of Northern Hemisphere glaciation – to the warm KM5 interglacial. We find that a large (> 4 ∘C) temperature gradient existed between these two basins throughout that interval, with the deep North Atlantic considerably warmer and likely saltier than at present. We interpret our results to indicate that the deep Pacific and North Atlantic oceans were bathed by water masses with very different physical properties during the mid-Piacenzian, and that only a limited deep oceanic exchange occurred between the two basins. Our results point to a fundamentally different mode of ocean circulation or mixing compared to the present, where heat and salt are distributed from the North Atlantic into the Pacific. The amplitude of cooling observed at both sites during MIS M2 suggests that changes in benthic δ18O associated with this cold stage were mostly driven by temperature change in the deep ocean rather than by ice volume.

Interest in deploying deep reinforcement learning (DRL) models on low-power edge devices, such as Autonomous Mobile Robots (AMRs) and Internet of Things (IoT) devices, has seen a significant rise due to the potential of performing real-time inference by eliminating the latency and reliability issues incurred from wireless communication and the privacy benefits of processing data locally. Deploying such energy-intensive models on power-constrained devices is not always feasible, however, which has led to the development of model compression techniques that can reduce the size and computational complexity of DRL policies. Policy distillation, the most popular of these methods, can be used to first lower the number of network parameters by transferring the behavior of a large teacher network to a smaller student model before deploying these students at the edge. This works well with deterministic policies that operate using discrete actions. However, many real-world tasks that are power constrained, such as in the field of robotics, are formulated using continuous action spaces, which are not supported. In this work, we improve the policy distillation method to support the compression of DRL models designed to solve these continuous control tasks, with an emphasis on maintaining the stochastic nature of continuous DRL algorithms. Experiments show that our methods can be used effectively to compress such policies up to 750% while maintaining or even exceeding their teacher’s performance by up to 41% in solving two popular continuous control tasks.