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This study set out to understand how representational practices of journalism and age congregate in the fiction movie The French Dispatch. Employing textual analysis, we found that the film engages with three overlapping tropes in which journalism and age congregate. First, it represents journalists as different from “normal civilians” especially in their state of loneliness which is a constant throughout the narrative. This difference narrative is especially invigorated for journalists that demographically deviate from the norm in which older women are labeled as “old maids.” Second, the film represents an intergenerational conflict, specifically in relation to explorations of journalistic neutrality. Last, the commercial nature of journalism is addressed through the representation of an older mentoring editor-in-chief who protects journalistic quality against commercial pressures. By combining the lens of journalism and ageism, we uncovered how both concepts congregate and create a unique romanticized perspective on the profession as “it used to be.” [ABSTRACT FROM AUTHOR]

Background and Objective: The interstitial fluid of tissues is the effect site for antibiotics targeting extracellular pathogens. Microdialysis studies investigating these concentrations in muscle and subcutaneous tissue have reported notable variability in tissue penetration. This study aimed to comprehensively summarise the existing data on interstitial fluid penetration in these tissues and to identify potential factors influencing antibiotic distribution. Methods: A literature review was conducted, focusing on subcutaneous and intramuscular microdialysis studies of antibiotics in both adult healthy volunteers and patients. Random-effect meta-analyses were used to aggregate effect size estimates of tissue penetration. The primary parameter of interest was the unbound penetration ratio, which represents the ratio of the area under the concentration–time curve in interstitial fluid relative to the area under the concentration–time curve in plasma, using unbound concentrations. Results: In total, 52 reports were incorporated into this analysis. The unbound antibiotic exposure in the interstitial fluid of healthy volunteers was, on average, 22% lower than in plasma. The unbound penetration ratio values were higher after multiple dosing but did not significantly differ between muscle and subcutaneous tissue. Unbound penetration ratio values were lower for acids and bases compared with neutral antibiotics. Neither the molecular weight nor the logP of the antibiotics accounted for the variations in the unbound penetration ratio. Obesity was associated with lower interstitial fluid penetration. Conditions such as sepsis, tissue inflammation and tissue ischaemia were not significantly associated with altered interstitial fluid penetration. Conclusions: This study highlights the variability and generally lower exposure of unbound antibiotics in the subcutaneous and intramuscular interstitial fluid compared with exposure in plasma. Future research should focus on understanding the therapeutic relevance of these differences and identify key covariates that may influence them. [ABSTRACT FROM AUTHOR]

The volume of distribution at steady state (Vss) in neonates is still often estimated through isometric scaling from adult values, disregarding developmental changes beyond body weight. This study aimed to compare the accuracy of two physiologically based pharmacokinetic (PBPK) Vss prediction methods in neonates (Poulin & Theil with Berezhkovskiy correction (P&T+) and Rodgers & Rowland (R&R)) with isometrical scaling. PBPK models were developed for 24 drugs using in-vitro and in-silico data. Simulations were done in Simcyp (V22) using predefined populations. Clinical data from 86 studies in neonates (including preterms) were used for comparison, and accuracy was assessed using (absolute) average fold errors ((A)AFEs). Isometric scaling resulted in underestimated Vss values in neonates (AFE: 0.61), and both PBPK methods reduced the magnitude of underprediction (AFE: 0.82–0.83). The P&T+ method demonstrated superior overall accuracy compared to isometric scaling (AAFE of 1.68 and 1.77, respectively), while the R&R method exhibited lower overall accuracy (AAFE: 2.03). Drug characteristics (LogP and ionization type) and inclusion of preterm neonates did not significantly impact the magnitude of error associated with isometric scaling or PBPK modeling. These results highlight both the limitations and the applicability of PBPK methods for the prediction of Vss in the absence of clinical data. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is a condition that, if symptomatic, is characterized by discharge and odor, with high recurrence rates even when treated. This study aims to review what literature exists on the association between BV and the emotional, sexual, and social health of women. Methods: MEDLINE, Embase and Web of Science databases were searched from inception until November 2020. Studies reporting an association between women's emotional, sexual and/or social health and symptomatic BV in a qualitative and/or quantitative manner were included. Selected studies were divided in three categories, i.e. reporting on the emotional, sexual and/or social association. All studies were critically evaluated and discussed. Results: Sixteen studies were included. Concerning emotional health, we found eight studies that calculated the association between stress and BV, in four this was statistically significant. Four qualitative studies on emotional health showed that the severity of the symptoms influenced the impact on women's lives. All studies on sexual health reported that many women experienced an impact on their relationship and sexual intimacy. Results for social life ranged from no association found to most of the study population showing avoidance behavior. Conclusion: This review shows that symptomatic BV can be associated with diminished emotional, sexual, and social health, but there is too little evidence to state the extent of this association. [ABSTRACT FROM AUTHOR]

Background: The increasing use of immune checkpoint inhibitors (ICIs) in the treatment of both advanced and early stages of various malignancies has resulted in a substantial increase in the incidence of cardiovascular (CV) immune-related adverse events (irAEs). The current follow-up guidelines are based on anecdotal evidence and expert opinions, due to a lack of solid data and prospective studies. As many questions remain unanswered, cardiac monitoring, in patients receiving ICIs, is not always implemented by oncologists. Hence, an urgent need to investigate the possible short- and long-term CV effects of ICIs, as ICI approval is continuing to expand to the (neo)adjuvant setting. Methods: We have initiated a prospective, multicenter study, i.e., the CAVACI trial, in which a minimum of 276 patients with a solid tumor, eligible for ICI treatment, will be enrolled. The study consists of routine investigations of blood parameters (troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, in particular) and a thorough CV follow-up (electrocardiograms, transthoracic echocardiograms, and coronary calcium scoring) at fixed time points for a total period of two years. The primary endpoint is the cumulative incidence of troponin elevation in the first three months of ICI treatment, compared to baseline levels. Furthermore, secondary endpoints include incidence above the upper limit of normal of both troponin and NT-proBNP levels, evolution in troponin and NT-proBNP levels, the incidence of CV abnormalities/major adverse cardiac events, evaluation of associations between patient characteristics/biochemical parameters and CV events, transthoracic echocardiography parameters, electrocardiography parameters, and progression of coronary atherosclerosis. Recruitment of patients started in January 2022. Enrolment is ongoing in AZ Maria Middelares, Antwerp University Hospital, AZ Sint-Vincentius Deinze, and AZ Sint-Elisabeth Zottegem. Trial registration: ClinicalTrials.gov Identifier: NCT05699915, registered 26 January 2023. [ABSTRACT FROM AUTHOR]

Background: Electronic informed consent (eIC) may offer various advantages compared to paper-based informed consent. However, the regulatory and legal landscape related to eIC provides a diffuse image. By drawing from the perspectives of key stakeholders in the field, this study aims to inform the creation of a European guidance framework on eIC in clinical research. Methods: Focus group discussions and semi-structured interviews were conducted with 20 participants from six stakeholder groups. The stakeholder groups included representatives of ethics committees, data infrastructure organizations, patient organizations, and the pharmaceutical industry as well as investigators and regulators. All were involved in or knowledgeable about clinical research and were active in one of the European Union Member States or at a pan-European or global level. The framework method was used for data analysis. Results: Stakeholders underwrote the need for a multi-stakeholder guidance framework addressing practical elements related to eIC. According to the stakeholders, a European guidance framework should describe consistent requirements and procedures for implementing eIC on a pan-European level. Generally, stakeholders agreed with the definitions of eIC issued by the European Medicines Agency and the US Food and Drug Administration. Nevertheless, it was raised that, in a European guidance framework, it should be emphasized that eIC aims to support rather than replace the personal interaction between research participants and the research team. In addition, it was believed that a European guidance framework should include details on the legality of eIC across European Union Member States and the responsibilities of an ethics committee in the eIC assessment process. Although stakeholders supported the idea to include detailed information on the type of eIC-related materials to be submitted to an ethics committee, opinions varied on this regard. Conclusion: The creation of a European guidance framework is a much needed factor to advance eIC implementation in clinical research. By collecting the views of multiple stakeholder groups, this study advances recommendations that may facilitate the development of such a framework. Particular consideration should go to harmonizing requirements and providing practical details related to eIC implementation on a European Union-wide level. [ABSTRACT FROM AUTHOR]

Background: The development of technological applications in clinical research, such as electronic informed consent (eIC), is on the rise. The involvement of end users throughout the design process of eIC is of utmost importance to improve the current informed consent process.Methods: Using a provocative design, we conducted interviews with 30 clinical research participants. Provotypes were used as a starting base to discuss various aspects relevant to eIC. By providing a medium to encourage divergent thinking, participants' views and concerns were solicited. Thematic analysis was undertaken using NVivo.Results: The majority of participants placed trust in the principal investigator or the hospital to perform the role of eIC hosting party. Differing opinions were reported on the amount of information required related to stakeholders' access to an eIC system, and thus, to participants' personal data, to enable trust in an eIC system. Nevertheless, this study indicates a general willingness of participants to share personal data with physicians and pharmaceutical companies on an international level, and to receive requests for new research studies via an eIC system. Participants suggested to tailor an eIC system based upon their preferences, for example, regarding whom they want to share their personal data with. Moreover, they expressed a desire to choose how they can contact the research team, and to indicate which study-related information they would like to receive electronically. In addition, positive opinions were voiced on the integration of a test to assess participants' understanding before providing their eIC.Conclusions: Following a research through design approach, insights have been generated which inform the design of eIC. Provotypes were designed to help participants think beyond what is familiar to them. Study findings revealed that not all situations were perceived as provocative, because of participants' motivation to advance scientific research and the trust they place in the research team. Nevertheless, the use of provocative design resulted in additional insights, generated by clinical research participants, which could be considered in the further design of eIC. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) has been linked to altered drug disposition in various studies. However, the magnitude of these changes, influencing factors, and underlying mechanisms remain a matter of debate. The primary aim of this work was therefore to quantify changes in drug disposition (top‐down) and the pathophysiological parameters known to affect pharmacokinetics (PKs; bottom‐up). This was done through meta‐analyses and meta‐regressions in addition to theoretical PK simulations. Volumes of distribution and clearances were found to be elevated in people living with CF. These increases were larger in studies which included patients with pulmonary exacerbations. Differences in clearance were smaller in more recent studies and when results were normalized to body surface area or lean body mass instead of body weight. For the physiological parameters investigated, measured glomerular filtration rate and serum cytokine concentrations were found to be elevated in people living with CF, whereas serum albumin and creatinine levels were decreased. Possible pathophysiological mechanisms for these alterations relate to renal hyperfiltration, increases in free fraction, and inflammation. No differences were detected for cardiac output, body fat, fat free mass, hematocrit, creatinine clearance, and the activity of drug metabolizing enzymes. These findings imply that, in general, lower total plasma concentrations of drugs can be expected in people living with CF, especially when pulmonary exacerbations are present. Given the potential effect of CF on plasma protein binding and the variability in outcome observed between studies, the clinical relevance of adapting existing dosage regimens should be evaluated on a case‐by‐case basis. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the incidence, clinical characteristics, and treatment response of macular neovascularization (MNV) occurring after retinal pigment epithelium (RPE) and choroid graft translocation surgery (RPE-choroid TS). Methods: Retrospective analysis of 36 eyes of 36 consecutive patients who underwent RPE-choroid TS. Longer term follow-up of graft survival focusing on the occurrence of MNV was performed using multimodal imaging. Results: Indications for RPE-choroid TS included complications of neovascular age-related macular degeneration in 34 patients and drusenoid pigment epithelial detachment in 2 patients. With a mean follow-up of 30 months, 8 patients out of 36 developed signs of MNV. Of these 8 patients, 4 presented with a drop in visual acuity (VA) due to centrally located type 3 MNV. Early diagnosis and treatment prevented significant functional consequences. Four patients developed type 2 MNV at the border of the graft, which did not tend to affect the VA. Conclusion: We report a high incidence of MNV after RPE-choroid TS. Early diagnosis and treatment may preserve function in these patients. The type of MNV and location can be used to guide the management. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is associated with an increased risk of fatal and non-fatal coronary heart disease (CHD). The aims of the this study were 1) to investigate the prevalence of PAD and suspected PAD in a large population of established CHD patients, and 2) to assess the prevalence and control of risk factors in these patients as well health-related quality of life. In the EUROASPIRE V survey, 8243 patients with documented CHD were recruited from 27 ESC member countries and were invited to attend a study visit. Patients were investigated using questionnaires, in-depth interviews and a clinical examination. Intermittent claudication (IC) was assessed using the Edinburgh Claudication Questionnaire. Patients without previously diagnosed PAD were suspected of having PAD if they were found to have IC. Overall, 6.4% of the patients had already a confirmed diagnosis of PAD and another 6.3% were suspected of having PAD. Independent of age and gender, patients with previously diagnosed PAD were significantly more frequently current smokers, had the lowest smoking cessation rates, were less physically active, reported more often previously diagnosed diabetes and had significantly higher blood pressure levels, compared to patients without PAD. They had also significantly higher levels of serum triglycerides, lower HDL-C levels, and had more often renal insufficiency. In comparison with patients without PAD, those with suspected PAD demonstrated significantly higher smoking cessation rates but their obesity rates were significantly higher. In CHD patients with a history of PAD, the use of calcium channel blockers and diuretics was significantly higher than in patients without PAD. Compared to the latter group, the use of diuretics, anti-arrhythmics and anti-depressants in patients with suspected PAD was significantly higher. Moreover, patients with previously diagnosed PAD had significantly higher levels of anxiety and depression and reported a significantly worse health-related quality of life (HRQoL), in comparison with those without PAD. HRQoL levels were significantly reduced in patients with suspected PAD as well. In CHD patients without a previous diagnosis of PAD, IC is not infrequent. Diagnosed PAD was significantly associated with a worse CHD risk factor profile. Patients with known PAD as well as those with suspected PAD had a considerable loss of health-related quality of life. Therefore, physicians should consider to screen for IC in all their CHD patients. • Peripheral artery disease (PAD) is associated with an increased risk of fatal and non-fatal coronary heart disease (CHD). • In CHD patients without a previous diagnosis of PAD, intermittent claudication is not infrequent. • Diagnosed PAD is significantly associated with a worse CHD risk factor profile. • Patients with known PAD as well as those suspected of having PAD demonstrated a considerable loss of health-related quality of life. • Physicians should consider to screen for intermittent claudication in all their CHD patients. [ABSTRACT FROM AUTHOR]

Background: Cystic fibrosis is a lethal inherited disease that affects multiple organs. To provide optimal pharmacological treatment of comorbidities associated with cystic fibrosis, relevant alterations in pharmacokinetics must be known.Objective: The objective of this study was to compare the pharmacokinetics of drugs between patients with cystic fibrosis and controls, based on clinical study reports published from 1999 to 2019.Methods: Clinical studies were considered if patients with cystic fibrosis and patients without cystic fibrosis/healthy volunteers were included, a drug was administered orally/intravenously and pharmacokinetic parameters were compared.Results: In total, 32 clinical studies were included. Twenty-one studies reported absorption parameters. For multiple drugs, speed and/or extent of oral absorption were lower in cystic fibrosis. This phenomenon is possibly related to pathophysiological changes in the gastrointestinal tract associated with cystic fibrosis. However, a large proportion of drugs had comparable absorption kinetics. Twenty-one studies discussed volume of distribution, which was comparable between groups for most drugs. Initial differences became smaller when scaled to body composition. For some highly protein-bound drugs, inflammation-related changes in plasma proteins helped explain residual variability between cystic fibrosis and controls. Twenty-four studies elaborated on clearance, whereby higher clearances were observed in cystic fibrosis. In contrast with previously published reviews, no evidence was found for increased activities of drug-metabolising enzymes nor for up-regulation of active transport processes involved in drug disposition. In most cases, scaling clearance parameters to body composition and/or incorporating differences in plasma protein concentration accounted for these larger clearances.Implications: There is no evidence that genetic defects causing cystic fibrosis directly lead to altered pharmacokinetics. However, co-morbidities can have a potential impact on drug absorption and disposition. Because of gastrointestinal complications, it is not advisable to extrapolate drug absorption parameters from healthy volunteers to patients with cystic fibrosis. Differences observed in the volume of distribution and clearance in patients with cystic fibrosis can potentially be explained by correcting for lean body mass. [ABSTRACT FROM AUTHOR]

The acquisition of [PART+AUX] and [AUX+PART] word order in Flanders. A descriptive, methodological and theoretical addition toMeyer & Weerman (2016) This paper presents new data on the acquisition of verb clusters in Flemish children. The data were collected by means of a sentence repetition task and the results are in line with the development path for verb clusters in Dutch children as proposed by Meyer & Weerman (2016). While Flemish children also show a development from more 2-1 orders in the youngest group to more 1-2 orders in the older group, this development seems to happen more slowly in Flemish children than in Dutch children. In spite of the fact that the results of both the Flemish and the Dutch study refute an analysis that takes the input adult language as the main factor in verb cluster formation in children, the Flemish data suggest that the higher frequency of 2-1 orders in the Flemish context could help to explain why 1-2 orders are acquired more slowly in Flemish children than Dutch children. In addition, this paper also discusses the results of a production test in Flanders that shows a high preference for 2-1 orders until the age of 7, thus questioning the type of linguistic skills that are assessed in a sentence repetition task. [ABSTRACT FROM AUTHOR]

This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction. To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm. A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion. We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05). Statistical analyses show that women in both groups presented increased sexual functioning (P =.001) and decreased sexual distress (P <.001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P <.05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants. To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties. When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2020;17:312–324. [ABSTRACT FROM AUTHOR]

Gender dysphoria, a discrepancy between gender identity and genetically determined sex, is encountered in approximately 0.5% of people uniformly across the world. In the case of transgender men, formerly called female-to-male transsexuals, the available gender-affirming measures, hormone therapy and possible surgical procedures, are multiple and discussed in detail in this series of articles. [ABSTRACT FROM AUTHOR]

Is there a difference in blastocyst formation between fresh and vitrified–warmed sibling oocytes and can this difference be attributed to changes in embryo morphokinetics? Between February 2016 and December 2017, 472 metaphase II (MII) oocytes in 67 donor–recipient cycles from 27 different healthy anonymous oocyte donors were allocated for fresh transfer (FSHO) (n = 220) to a synchronous recipient (n = 36) or vitrified (VITO) (n = 252) to be warmed and transferred to another recipient (n = 31). Embryos derived from the FSHO and their sibling VITO were analysed for morphokinetic development using time-lapse imaging, blastocyst formation and clinical outcome. Time-lapse analysis showed an overall delay in cleavage rate from the time of pronuclei disappearance up to the time of blastulation in the VITO compared with their sibling FSHO. Twelve morphokinetic variables were significantly different between the groups. On Day 5 significantly more FSHO embryos developed to blastocyst (expansion 1–6) and reached the full blastocyst stage (expansion 3–6) compared with the VITO embryos [53.2% (84/158) versus 40.0% (64/160); P = 0.0244 and 48.1% (76/158) versus 31.3% (50/160); P = 0.0028, respectively]. The embryo utilization rate was similar in both groups at the time of cryopreservation; 51.3% (FSHO) versus 45.0% (VITO) (P = 0.3124). The pregnancy rate per cycle was 47.2% (17/36) in FSHO patients and 48.4% (15/31) in VITO patients (P = 1). Limitations in this study: non-randomized, small study size and not powered to detect differences in clinical outcomes. Timing of development is altered and blastocyst formation is delayed in embryos derived from vitrified–warmed donor oocytes compared with their fresh sibling counterparts. Although preliminary results suggest that the clinical impact of this delay may be limited, this needs further investigation in larger randomized studies. [ABSTRACT FROM AUTHOR]

This research will focus on characterising and analysing next generation batteries consisting of silicon-alloy/graphite blend anode combined with a nickel rich lithium nickel manganese cobalt oxide (NMC 622) as cathode. The study is performed on prototype pouch cells (1.4 Ah). Furthermore, the effect of applying external pressure on the pouch cell is investigated. The application of external pressure has a significant beneficial impact, more specifically a 19% increase in capacity combined with a significant decrease of 50% of the discharge ohmic resistance. To investigate and quantify the pressure variation over the state of charge (SoC) a dedicated set-up has been developed which allows to apply an external pressure while measuring the pressure variation. Up to 30 N of pressure variation is observed during static tests, while no pressure variation can be observed during short pulses, demonstrating its potential to use pressure as SoC estimator. Finally, a study on the effect of initial applied external pressure on the cells' lifetime has shown that the initial applied pressure, within the range of tested pressures, has little impact on the cells' performance and lifetime. [ABSTRACT FROM AUTHOR]

Abstract An extensive parametric study of an alternative battery model, the fractional differential model (FDM), is presented for the first time over the entire lifetime of 20Ah NMC cells. The evolution of the FDM's model parameters, identified in the time-domain, is compared to electrochemical impedance spectroscopy results to assess their physico-chemical significance. This comprehensive parametric analysis shows that the FDM is able to capture relevant physico-chemical information with regards to the ohmic resistance over the entire SoC range and battery lifetime. Furthermore, the FDM's electrical performance is compared to the conventional first order RC battery model over the entire battery lifetime. Thanks to the FDM's non-integer derivatives for system states, it is able to capture intrinsic fractional derivative properties such as diffusion dynamics, charge transfer and memory hysteresis, which results in an improved simulation accuracy compared to the RC model. The comparative study showed an improved simulation accuracy of the FDM up to 85% in the lowest SoC range and a minimum improvement of 40% over the entire SoC range, considering the entire battery lifetime. Inherently proving that the FDM's ability to capture highly nonlinear battery behavior in the low SoC region persists over battery lifetime. [ABSTRACT FROM AUTHOR]

• Acoustic emission of hybrid composite concrete beams is examined. • Prediction of the final mode of fracture can be done before reaching 20% of the ultimate load. • Acoustic emission waveforms from cracking and debonding are very different. • Combination of Acoustic Emission and Digital Image Correlation is very effective for fracture monitoring. Lightweight hybrid concrete beams are advantageous in terms of installation, but their mechanical behaviour is not easy to predict due to their heterogeneity. In the present study composite hollow beams made of Textile Reinforced Cement (TRC) reinforced with Carbon Fibre Reinforced Polymer (CFRP) strips and a concrete layer are subjected to bending. Their fracture behaviour is complicated as they exhibit multiple failure mechanisms: cracking of the cement matrix, debonding of the CFRP and delamination between successive layers of TRC. Herein, their mechanical performance is evaluated and monitored by Acoustic Emission (AE) and Digital Image Correlation (DIC). AE indices show that beams suffering from one major failure mechanism (matrix cracking) release AE signals with high frequency content while beams suffering from delaminations exhibit longer AE waveforms of lower frequency. These tendencies are obvious even at early loading stage, enabling prediction of the mode of the subsequent failure. [ABSTRACT FROM AUTHOR]

This paper addresses the question to what extent Flemish subtitlers reproduce Belgian-Dutch colloquialisms of the spoken source text in the subtitles. Next to the official Belgian Standard Dutch language, Colloquial Belgian Dutch or tussentaal is frequently spoken on Flemish television. In this context, it is particularly interesting to investigate whether the subtitlers copy those spoken colloquialisms to the subtitles or whether they translate them into standard language. This study compares the language used in twenty television programs to the corresponding subtitles in order to verify the linguistic choices of the subtitlers. In addition, it will be examined whether the subtitles contain more lexical colloquialisms than morphological or syntactic colloquialisms, and whether the program genre influences these choices. The results reveal that Colloquial Belgian Dutch lexemes are more often reproduced in subtitles on Flemish television than morphological and syntactic colloquialisms. Furthermore, it is shown that especially the subtitles of entertainment and comedy programs contain tussentaal. Based on these results, we conclude that the demotization process in Flanders is not confining itself to the spoken registers, since it also manifests itself in certain written contexts. [ABSTRACT FROM AUTHOR]

Introduction: Evaluation of patient characteristics inducing toxicity in breast radiotherapy, using simultaneous modeling of multiple endpoints. Methods and Materials: In 269 early-stage breast cancer patients treated with whole-breast irradiation (WBI) after breast-conserving surgery, toxicity was scored, based on five dichotomized endpoints. Five logistic regression models were fitted, one for each endpoint and the effect sizes of all variables were estimated using maximum likelihood (MLE). The MLEs are improved with James-Stein estimates (JSEs). The method combines all the MLEs, obtained for the same variable but from different endpoints. Misclassification errors were computed using MLE- and JSE-based prediction models. For associations, p-values from the sum of squares of MLEs were compared with p-values from the Standardized Total Average Toxicity (STAT) Score. Results: With JSEs, 19 highest ranked variables were predictive of the five different endpoints. Important variables increasing radiation-induced toxicity were chemotherapy, age, SATB2 rs2881208 SNP and nodal irradiation. Treatment position (prone position) was most protective and ranked eighth. Overall, the misclassification errors were 45% and 34% for the MLE- and JSE-based models, respectively. p-Values from the sum of squares of MLEs and p-values from STAT score led to very similar conclusions, except for the variables nodal irradiation and treatment position, for which STAT p-values suggested an association with radiosensitivity, whereas p-values from the sum of squares indicated no association. Breast volume was ranked as the most significant variable in both strategies. Discussion: The James-Stein estimator was used for selecting variables that are predictive for multiple toxicity endpoints. With this estimator, 19 variables were predictive for all toxicities of which four were significantly associated with overall radiosensitivity. JSEs led to almost 25% reduction in the misclassification error rate compared to conventional MLEs. Finally, patient characteristics that are associated with radiosensitivity were identified without explicitly quantifying radiosensitivity. [ABSTRACT FROM AUTHOR]

Introduction: In a world where the prevalence of chronic conditions is increasing, the importance of a strong primary care system cannot be underestimated. One of the suggested strategies for person-centered integration of care is to explicitly focus on the patients' goals; or in other words a focus on goal-oriented care (GOC). To make GOC more applicable, it is important to build an understanding on how it should be provided in practice. Therefore, it is vital to not only learn from literature, but foremost of primary healthcare professionals themselves on how they operationalize GOC. Aims, objectives, theory or methods: This study explored how primary healthcare professionals operationalize GOC in their practice. Therefore, professionals were recruited in different primary care settings in Ottawa (Canada), Vermont (USA), and Flanders (Belgium). A two-step approach of a deductive and inductive analysis was used to analyze the in-depth interviews. Firstly - with the aim to validate the literature - the theoretical framework that emerged from the concept analysis on GOC, was used as a lens for the deductive analysis. Secondly, an inductive thematic analyses following Sundler was performed to expand the theoretical knowledge with insights from practice. All interviews were audio taped and transcribed verbatim. Highlights or results or key findings: When looking at the data trough a deductive lens, the theoretical framework - presenting a stepwise approach of GOC with the phases of goal-elicitation, goal-setting, and goal-evaluation and the patients' needs and preferences as a common thread - could be confirmed. However such a linear approach in one-on-one interactions, as emerged from the literature, could not be determined. The dynamic and iterative character of GOC should be more emphasized. The inductive analysis revealed three main themes that were not described in the concept analysis: 1) involving the patients, 2) interprofessional collaboration, and 3) the use of tools or guidance. The participants involved their patients by communicating in a constructive dialogue and informing them about their health status. Interprofessional collaboration allowed the participants to bring all different expertise - who could support the patients to work towards their goals - together. Finally, participants used tools to support the process of eliciting and setting patients' personal goals. Conclusions:The findings validated the theoretical framework emerged from the literature. Besides this validation, we learn from practice that professionals made use of tools to support goalelicitation, goal-setting, and to prepare interprofessional meetings. All this with the overall aim to encourage patients to actively take part in their care. Implications for applicability/transferability, sustainability, and limitations: This study allowed us to go beyond the theoretical knowledge of GOC and build on experiences of primary healthcare professionals from different disciplines, settings, and countries. This is needed to gain a full understanding on GOC and explore the elements that go along with providing GOC. [ABSTRACT FROM AUTHOR]

The presumed superiority of renin-angiotensin-aldosterone system (RAAS)-blocking agents over other antihypertensive agents in patients with diabetes to delay development of endstage kidney disease (ESKD) has recently been challenged. In addition, there is ongoing uncertainty whether RAAS-blocking agents reduce mortality and/or delay ESKD in patients with diabetes and chronic kidney disease (CKD) stages 3-5. In this subgroup, there might be an expedited need for renal replacement therapy (RRT) when RAAS-blocking agents are used. We conducted a meta-analysis of randomized controlled trials (RCTs) of at least 6-months duration in adult patients with diabetes who also have non-dialysis CKD stages 3-5. RCTs comparing single RAAS-blocking agents to placebo or alternative antihypertensive agents were included. Outcomes of interest were allcause mortality, cardiovascular morbidity, progression of renal function, ESKD and adverse events. A total of nine trials (n=9797 participants with CKD stages 3-5) fit our inclusion criteria. There was no difference between the RAAS group and control group regarding all-cause mortality {relative risk [RR]=0.97 [95% confidence interval (CI) 0.85-1.10]}, cardiovascular mortality [RR=1.03 (95% CI 0.75-1.41)] and adverse events [RR=1.05 (95% CI 0.89-1.25)]. There was a trend for a favourable effect for non-fatal cardiovascular events [RR=0.90 (95% CI 0.81-1.00)] and a lower risk of the composite endpoint need for RRT/doubling of serum creatinine [RR=0.81 (95% CI 0.70-0.92)] in the RAAS-blocking agents group versus the control group. We found evidence that in patients with diabetes mellitus and CKD stages 3-5, treatment with RAAS-blocking agents did not result in a clear survival advantage. The effect on renal outcomes did depend on the selected outcome measure. However, we did not find evidence that the use of RAASblocking agents expedited the need for RRT in patients with CKD stages 3-5. [ABSTRACT FROM AUTHOR]

Background: Laboratory testing is an important clinical act with a valuable role in screening, diagnosis, management and monitoring of diseases or therapies. However, inappropriate laboratory test ordering is frequent, burdening health care spending and negatively influencing quality of care. Inappropriate tests may also result in false-positive results and potentially cause excessive downstream activities. Clinical decision support systems (CDSSs) have shown promising results to influence the test-ordering behaviour of physicians and to improve appropriateness. Order sets, a form of CDSS where a limited set of evidence-based tests are proposed for a series of indications, integrated in a computerised physician order entry (CPOE) have been shown to be effective in reducing the volume of ordered laboratory tests but convincing evidence that they influence appropriateness is lacking. The aim of this study is to evaluate the effect of order sets on the quality and quantity of laboratory test orders by physicians. We also aim to evaluate the effect of order sets on diagnostic error and explore the effect on downstream or cascade activities.Methods: We will conduct a cluster randomised controlled trial in Belgian primary care practices. The study is powered to measure two outcomes. We will primarily measure the influence of our CDSS on the appropriateness of laboratory test ordering. Additionally, we will also measure the influence on diagnostic error. We will also explore the effects of our intervention on cascade activities due to altered results of inappropriate tests.Discussion: We have designed a study that should be able to demonstrate whether the CDSS aimed at diagnostic testing is not only able to influence appropriateness but also safe with respect to diagnostic error. These findings will influence a lager, nationwide implementation of this CDSS.Trial Registration: ClinicalTrials.gov, NCT02950142 . [ABSTRACT FROM AUTHOR]

Biopharmaceuticals have established themselves as highly efficient medicines, and are still one of the fastest growing parts of the health-product industry. Unfortunately, the introduction of these promising new drugs went hand in hand with the creation of a black market for illegal and counterfeit biotechnology drugs. Particularly popular are the lyophilised peptides with a molecular weight of less than 5 kDa. Most of them are meant for subcutaneous injection and are easily accessible via the internet. In recent years, different methods based on reversed phase liquid chromatography have been developed to detect and quantify these peptides. The emerging of more polar peptides however requires the introduction of other separation techniques. Therefore, we set out to develop and validate an analytical method based on hydrophilic interaction liquid chromatography (HILIC) to identify and quantify the most frequently encountered illegal peptides on the European market. For this objective, five different HILIC columns were selected and screened for their chromatographic performance. Among those columns, the ZIC HILIC column showed the best performance under the tested screening conditions in terms of resolution and symmetry factor for the targeted peptide set. Hence, the operational conditions were further optimised for the identification of illegal preparations via mass spectrometry (MS) and quantification via UV. Validation was performed via accuracy profiles based on the ISO 17025 guideline. The obtained validated HILIC-method allows for the detection and quantification of the most frequently encountered illegal peptides on the internet in a total run time of 35 min including post gradient equilibration and online cleaning step. Combined with a previously developed RPLC-method, the ZIC HILIC system allows for the detection and quantification of a wide spectrum of illicit peptide drugs available on the internet. Furthermore, the developed method could also be envisaged for the detection of new emerging polar peptide drugs. [ABSTRACT FROM AUTHOR]

The article discusses the fertility options for gender diverse and transgender adolescents. Topics discussed include the mission of the World Professional Association for Transgender Health (WPATH), the areas of intervention which could possibly affect the fertility of person who will undergo medical transition, and the benefit of pubertal suppression in younger adolescents.

Objectives Our objective was to examine whether or not women with symptoms of a urinary tract infection but with a negative culture (20%–30%) do have an infection. Methods We performed quantitative PCR (qPCR) for Escherichia coli and Staphylococcus saprophyticus , on top of a standard culture, in urine samples from 220 women with dysuria and/or frequency and/or urgency and from 86 women without symptoms. For symptomatic women, qPCR was also carried out for four sexually transmitted agents. Results In the symptomatic group, 80.9% (178/220) of the urine cultures were positive for any uropathogen and 95.9% (211/220) were E. coli qPCR-positive. For the control group, cultures for E. coli and E. coli qPCR were positive in, respectively, 10.5% (9/86) and 11.6% (10/86). In the symptomatic group, qPCR yielded 19 positive samples for S. saprophyticus qPCR, one positive sample for Mycoplasma genitalium and one for Trichomonas vaginalis. Conclusions These findings suggest that almost all women with typical urinary complaints and a negative culture still have an infection with E. coli . [ABSTRACT FROM AUTHOR]

Lightweight composite-concrete beams are advantageous in terms of installation, but their mechanical and fracture behaviour is not easy to predict due to their inherent heterogeneity. In the present study hybrid beams made of Textile Reinforced Cement (TRC) hollow boxes reinforced with a Carbon Fibre Reinforced Polymer (CFRP) strip and a concrete layer on top are subjected to bending. Their fracture behaviour is complicated as they can suffer from multiple failure mechanisms: matrix cracking, interface debonding or delamination. Herein, their mechanical performance is evaluated and monitored by Acoustic Emission (AE) and Digital Image Correlation (DIC). AE indices show that beams suffering from one single failure mechanism (cement cracking) exhibit nearly constant AE characteristics throughout loading. Beams additionally suffering from delamination exhibit longer AE waveforms of lower frequency compared to the pure matrix cracking. These tendencies are obvious from the initial part of the test, enabling predictions about the subsequent failure. More importantly and for the first time in related literature, the use of DIC enables to relate AE to the strain fields during loading, the final damage pattern and the ultimate failure mechanism. [ABSTRACT FROM AUTHOR]

The ratio of the transmitral early peak velocity (E) evaluated by conventional Doppler imaging over early diastolic mitral annulus velocity (E') evaluated by tissue Doppler imaging has been proposed as a noninvasive marker for left ventricular filling pressure. We evaluated 174 normal patients and 86 patients with hypertension and LV hypertrophy to assess the effects of age, gender, and left ventricular hypertrophy on E' and E/E'. Age appeared to be the strongest determinant of E' and E/E', suggesting that in normal patients and in those with left ventricular hypertrophy, age-dependent cut-off values should be considered. [ABSTRACT FROM AUTHOR]

The advantages of high performance composite materials have stimulated their use as reinforcement in concrete structures as well as the research on hybrid composite-concrete elements. For the design of these hybrid structures – with often complex geometries – the standard concrete calculation rules, based on official codes such as Eurocode 2, are often not elaborated enough. Moreover, these standard models are limited or simplified to a linear behaviour and do not even allow the integration of nonlinear reinforcement behaviour. In this paper, the authors propose a general calculation methodology to simulate analytically the structural behaviour of hybrid beams, including their ultimate loadbearing capacity and deflection. This methodology introduces an original search algorithm that reduces the computation time significantly without losing accuracy. The analytical model is validated by ten experiments on 3-m-span hybrid beams with differing geometry. The experiments demonstrate the accurate prediction of the analytical model both for the load–deflection behaviour and for the occurring strains, and confirm the model assumptions made. Moreover, the structural feasibility of the proposed hybrid beams is demonstrated as they exhibit a sufficient loadbearing capacity and stiffness. This structural performance in combination with the ability to predict the behaviour reveals a great potential for future structural applications. [ABSTRACT FROM AUTHOR]

Objective: The benefit of performing an appendectomy during the surgical treatment of a mucinous borderline ovarian tumor (mBOT) is still controversial, even though clinical guidelines recommend this procedure.Purpose: Our aim was to systematically assess the available evidence on appendectomy in the case of diagnosis of mBOT.Methods: A comprehensive search of the literature was conducted using electronic databases using the search terms: (borderline OR low malignant potential) AND (appendectomy OR appendix).Results: A total of 12 articles were retained after systematic review, including a total of 667 patients with borderline ovarian tumor. Appendectomy was performed in 232 of the patients presenting with a mBOT. Two (0.86 %) appendiceal carcinomas were confirmed on pathological examination. Both appendices were grossly abnormal at the time of surgery.Conclusion: Our systematic review demonstrates that available evidence regarding the role of appendectomy in mBOT is fragmented and weak. Nevertheless, this review provides adequate evidence to highlight that appendiceal involvement in mBOTs appears to be extremely rare and microscopic appendiceal involvement is highly unlikely in apparently normal appendices. In spite of the diversity of the included studies, the lack of appendiceal involvement in all cases with apparently normal appendix is strikingly common. We can conclude that in the case of normal appearance of the appendix at the time of primary surgery, appendectomy is not mandatory. Furthermore, a patient with a normal appendiceal appearance during primary surgery with post-operative diagnosis of mBOT addition of a second look intervention seems unnecessary and even hazardous. [ABSTRACT FROM AUTHOR]

Hybrid composite-concrete elements are increasingly developed because of their lightweight and durable properties. This paper investigates the structural behaviour of a new hybrid composite concrete floor – based on the beam-and-block concept – analytically and experimentally. Experiments on two identical hybrid floors of 3 m span demonstrate the structural feasibility of this floor concept as the loadbearing and stiffness requirements are largely met, both in casting and permanent stage. These floors exhibit sufficient stiffness in the transverse direction and thus allow an analytical prediction based on beam calculations. These simulations predict the casting deflection as well as the overall load-deflection behaviour accurately. [ABSTRACT FROM AUTHOR]

The combination of high performance composites and concrete results in hybrid composite-concrete elements which no longer resemble the traditional reinforced concrete structures. Consequently, these hybrid elements have a different structural behaviour that requires new evaluation procedures. This paper focusses on hybrid TRC-composite-concrete elements which are used as a substitute for reinforced concrete beams within a floor system. Their shear behaviour is experimentally investigated by the examination of ten short-span hybrid beams with different geometries. Visual inspection shows that shear failure occurs by an inclined flexural shear crack in the concrete. A rosette strain gauge analysis proves that the principal strain and stress orientations are in accordance with theoretical predictions. Finally, the small influence of shear deformation on the total deflection of these beams is illustrated. [ABSTRACT FROM AUTHOR]

Elaborated formulas to calculate the shear resistance for hybrid composite-concrete beams do not exist. This paper returns to the basic principles of shear transfer in steel reinforced concrete beams and modifies these formulas into predictive calculations for the theoretical shear capacity of hybrid composite-concrete beams. These calculations are based on the theoretical shear mechanisms – uncracked concrete zone, aggregate interlock and dowel action. For the investigated hybrid beams, approximately half of the shear force is taken by the uncracked concrete zone and aggregate interlock of the concrete and the remaining half by dowel action. This theoretical approach is validated by the experimental shear failure of eight hybrid beams with four different cross-sections. The calculation method clearly quantifies the differences in shear behaviour of the investigated beam cross-sections and approaches the ultimate shear capacity of all beam types relatively well, which proves this a valuable approach also for other hybrid beam types. [ABSTRACT FROM AUTHOR]

However, for antibiotics with known ELF penetration data, we believe it is worthwhile to further explore and develop EBC as an alternative, patient-friendly sampling technique to enable larger-scale studies with broader inclusion criteria in ICU patients. Herregodts et al. recently studied piperacillin and meropenem concentrations in 11 spontaneously breathing ICU patients and were able to detect these antibiotics in 10 of these patients [[8]]. We agree with the authors that further research should focus on intensive care unit (ICU) patients; however, we strongly believe that non-invasive sampling techniques and physiologically based pharmacokinetic (PBPK) models are highly relevant approaches that should additionally be considered for studying the intrapulmonary concentrations in ICU patients. [Extracted from the article]

The construction industry currently shows an increasing interest towards composites. However, despite their high mechanical capacity to weight ratio their practical use in construction remains rather limited, the relatively high cost often being mentioned as the most restricting factor. This paper demonstrates how this need for minimization of both cost and mass can be tackled by a multi-objective optimization. First, a two-objective size optimization procedure is developed, and subsequently its strength is illustrated on hybrid composite-concrete beams. An original methodology combining Non-dominated Sorting Genetic Algorithm (NSGA-II) and a meta-model is used to find all optimal solutions. The optimization algorithm moreover gives insight on the influence of different parameters such as the span and the concrete class on the weight and cost of the beams, and the dominance of certain design constraints in various locations of the design space. [ABSTRACT FROM AUTHOR]

Scientific algorithms are designed and implemented in a variety of programming languages. Depending on the exact application, some languages are a better choice than others: some offer a productive environment while others focus on performance. Selecting a language is often difficult, with poor choices resulting in much higher development times.By implementing a case study algorithm in multiple programming languages, we compare their pros and cons. As a case study, we selected the trace transform, an image processing algorithm from the widely used class of integral transforms. We describe each implementation, including a highly optimized version for NVIDIA graphics processing units, and present a productivity overview and an in-depth performance analysis, from which we draw more generic conclusions.We have found that MATLAB is still the best choice overall, but Julia proves an interesting emerging choice. For realistic images, our compute unified device architecture (CUDA) implementation offers the best performance, albeit at a high development cost. [ABSTRACT FROM AUTHOR]

The present paper aims at refining current knowledge about the so-called complexity principle as one of the driving forces in Dutch constituent ordering as well as re-evaluating the common assumption in traditional Dutch reference grammars that the middle field position is the standard slot for non-predicate PPs. Building on journalistic data in the Dutch Parallel Corpus, it is first shown that non-predicate PPs are significantly more often placed in postfield position (the structural position after the final verb cluster) than in middle field position (the position before the final verb cluster), which indicates that the postfield position rather than the middle field position should be considered the standard slot for PPs in written Dutch. Second, a binary logistic regression analysis is fitted in order to empirically test the complexity principle. The results show that the syntactic weight of the PP affects PP placement significantly, which is in line with was found earlier, but contrary to previous findings the weight of the middle field position itself has no significant effect and, interestingly, the interaction between PP weight and postfield weight appears to be a significant predictor too. On the basis of these findings, we propose a refined account of the complexity principle, in which both PP weight and postfield weight govern the positioning of nonpredicate PPs in written Dutch. [ABSTRACT FROM AUTHOR]

In patients treated successfully with primary angioplasty for a first myocardial infarction, the Selvester 32-point score correlates well with infarct size measured with quantitative thallium-201 perfusion imaging. Therefore, it is a useful parameter for infarct sizing, particularly in patients with anterior infarction or reduced ejection fraction at discharge. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is associated with an increased mortality risk, with cardiovascular disease being the leading excess cause (in a dose–response manner with psoriasis severity). Statins have demonstrated a reduction in all‐cause mortality with no excess of adverse events among the general population. The underuse of interventions in cardiovascular prevention, such as statins, for patients with psoriasis may be the result of an insufficient evaluation. Objectives: To provide the dermatologist with a tool for systematizing the treatment of dyslipidemia in psoriasis, which generally escapes the scope of dermatological practice, and to facilitate decision‐making about the referral and treatment of patients. Methods: The Psoriasis Task Force of the European Academy of Dermatology and Venereology performed this two‐phase study to achieve a consensus and create recommendations on the use of statin therapy in patients with psoriasis. The first phase included a systematic review to identify a list of outline concepts and recommendations according to guidelines. The second phase consisted in a two‐round Delphi study to evaluate those recommendations not literally taken from guidelines. Results: A list of 47 concepts and recommendations to be followed by dermatologists involved in the treatment of patients with moderate–severe psoriasis was created. It included six main concepts about cardiovascular risk and psoriasis, six items related with the role of low‐density lipoprotein cholesterol (LDL‐c) and the benefits of statin treatment in psoriasis patients, eight recommendations about how cardiovascular risk should be assessed, three on the role of non‐invasive cardiovascular imaging, three on LDL‐c thresholds, eight key points related to statin prescription, 10 on statin treatment follow‐up and three on patient referral to another specialist. Conclusions: The application of this position statement (close final list of concepts and recommendations) will help dermatologists to manage dyslipidemia and help psoriasis patients to reduce their cardiovascular risk. [ABSTRACT FROM AUTHOR]

The Flemish coastal region has two major key challenges: coastal flood risk and risk of drought. As an answer to the first challenge, a new phase of land reclamation on sea is proposed, fitting into its historical path dependence. This, however, will aggravate the second challenge, and contradict the principles of integrated water resources management (IWRM). The two challenges take place on two different governance frontiers of land and water governance, but have a growing mutual influence. It is argued that the coastal spatial governance regarding these two challenges suffers from a lock-in. [ABSTRACT FROM AUTHOR]

Highlights: [•] Cement composites are introduced as a new material for structural Stay-in-Place formwork. [•] The new lightweight formwork concept eliminates the need for supporting mechanisms. [•] The structural capacity of the formwork eliminates the steel reinforcement. [•] 2.8m span hybrid beams are tested under four point bending. [•] The hybrid beams are 28% lighter and 87% stronger than traditional concrete beams. [Copyright &y& Elsevier]

A literary criticism of the book "Don Quixote" by Miguel de Cervantes Saavedra is presented. It outlines the characters and explores the symbolic significance of these characters. It chronicles the famous picaresque adventures of the noble knight-errant Don Quixote of La Mancha and also discusses Spain's history as well as issue of debt in Spanish civil law. An overview of the story is also given.

STUDY QUESTION Is bacterial vaginosis (BV) associated with the cause of infertility and does BV impinge on conception rates and early pregnancy loss following IVF? SUMMARY ANSWER The incidence of BV is significantly higher among patients with tubal infertility when compared with patients with non-tubal infertility. BV does not impinge on conception rates but is significantly associated with preclinical pregnancy loss, though not with first trimester abortion. WHAT IS KNOWN ALREADY BV is prevalent in patients with infertility, as evident from studies across the world. STUDY DESIGN, SIZE, DURATION This study is a meta-analysis of data on the prevalence of BV in women with infertility, the association between BV and the cause of infertility, and the associations between BV and conception rates and early pregnancy loss following IVF. The meta-analyses of the various topics involved different numbers of studies: prevalence of BV with infertility—12 studies, association with tubal infertility—3 studies and associations with conception rates—6 studies, with early preclinical pregnancy loss—2 studies and with clinical pregnancy loss—4 studies. PARTICIPANTS/MATERIALS, SETTING, METHODS Systematic literature searches of the electronic databases, PubMed, EMBASE, CINAHL, the Cochrane Library and ISI Web of Knowledge were performed up to September 2012. Studies were included if they reported on, at least, one of the following: prevalence of BV in infertility patients, association between BV and the cause of infertility, association between BV and conception rates with IVF or association between BV and early pregnancy loss. Studies were considered eligible if BV was diagnosed through standardized criteria like Nugent's criteria or Hay-Ison's criteria. In none of the studies, infertility as such was defined, but patients were described as unselected patients undergoing IVF. MAIN RESULTS AND THE ROLE OF CHANCE The estimated prevalence of BV (Nugent score >6) in infertile women is 19% [95% confidence interval (CI): 14–25%]. Abnormal microflora including BV and intermediate microflora (Nugent scores 4–10) occurs in 39% of the infertile patients (95% CI: 26–52%). BV is significantly more prevalent in women with infertility compared with antenatal women in the same population [OR (odds ratio) 3.32, 95% CI 1.53–7.20]. LIMITATIONS, REASONS FOR CAUTION All included studies were centre based. In addition, publication bias cannot be ruled out. Furthermore, all estimates are obtained using an absolute minimum of studies. The standard error on the estimates is so large that it does not allow for any formal statistical conclusions regarding heterogeneity between the effects reported in different studies. WIDER IMPLICATIONS OF THE FINDINGS It needs to be recognized that most inferences drawn in our study rely on a limited number of studies, potentially, endangering the generalizability of our findings. Moreover, all studies on cause of infertility in relation to BV included had a cross-sectional design and, therefore, do not allow for causal inferences. Still, there is strong circumstantial evidence that supports a causal link between BV and tubal infertility. Studies with a longitudinal design, on the other hand, strongly support a relation between BV and early pregnancy loss. Unfortunately, no study looked beyond first trimester fetal loss, although it is plausible that the high preterm birth rates with IVF are, at least, in part attributable to BV. STUDY FUNDING/COMPETING INTEREST None. [ABSTRACT FROM AUTHOR]