Search

This article analyses how the European Council, and its support structures, have been dealing with the energy crisis. On a theoretical level, it sheds light on how the EUCO system deals with polycrisis, which requires high-level political engagement, combined with deep technical expertise and out-of-the-box thinking. I contend that in a polycrisis the process as such can become an important part of the solution, thereby challenging outcome-oriented approaches to EU crisis management. I use embedded process tracing to analyse, in real-time, how the EUCO system sought to shape and steer policy-making on energy prices. The analysis shows how, in spite of deep divisions between member states, the EUCO system 'process managed' its way out of this politics trap, and managed to square the circle on the issue of a price cap. Through positive politicisation, the EUCO system prevented an oscillating process from derailing, and eventually tunnelled a way out. [ABSTRACT FROM AUTHOR]

Congenital myasthenic syndromes (CMS) are a group of genetic disorders characterized by impaired neuromuscular transmission. CMS typically present at a young age with fatigable muscle weakness, often with an abnormal response after repetitive nerve stimulation (RNS). Pharmacologic treatment can improve symptoms, depending on the underlying defect. Prevalence is likely underestimated. This study reports on patients with CMS followed in Belgium in 2022. Data were gathered retrospectively from the medical charts. Only likely pathogenic and pathogenic variants were included in the analysis. We identified 37 patients, resulting in an estimated prevalence of 3.19 per 1,000,000. The patients harbored pathogenic variants in CHRNE , RAPSN , DOK7 , PREPL , CHRNB1 , CHRNG , COLQ , MUSK , CHRND , GFPT1, and GMPPB. CHRNE was the most commonly affected gene. Most patients showed disease onset at birth, during infancy, or during childhood. Symptom onset was at adult age in seven patients, caused by variants in CHRNE , DOK7 , MUSK , CHRND, and GMPPB. Severity and distribution of weakness varied, as did the presence of respiratory involvement, feeding problems, and extraneuromuscular manifestations. RNS was performed in 23 patients of whom 18 demonstrated a pathologic decrement. Most treatment responses were predictable based on the genotype. This is the first pooled characterization of patients with CMS in Belgium. We broaden the phenotypical spectrum of pathogenic variants in CHRNE with adult-onset CMS. Systematically documenting larger cohorts of patients with CMS can aid in better clinical characterization and earlier recognition of this rare disease. We emphasize the importance of establishing a molecular genetic diagnosis to tailor treatment choices. [ABSTRACT FROM AUTHOR]

To develop independent healthcare professionals able to collaborate in interprofessional teams, health professions education aims to support students in transitioning from an individual perspective to interprofessional collaboration. The five elements that yield the conditions for effective interprofessional collaboration are: (1) positive interdependence, (2) individual accountability, (3) promotive interaction, (4) interpersonal skills, and (5) reflection on team processes. The aim of the current study is to gain insights into how to design tasks to assess a student team as a whole on their interprofessional collaboration. This was a pilot study using a qualitative design to evaluate an interprofessional assessment task. Four interprofessional student teams, comprising physiotherapy, occupational therapy, arts therapy and nursing students (N = 13), completed this task and five assessors used a rubric to assess video recordings of the teams' task completion, and then participated in a group interview. The completed rubrics and the interview transcript were analyzed using content analysis. Findings showed that the combination of individual preparation, an interprofessional team meeting resulting in care agreements and team reflection was a strength of the assessment task, enabling the task to elicit sufficient promotive interaction between students. Areas for improvement of the assessment task were however, due to a lack of interdependence, the care agreements which now proved to be the sum of students' intraprofessional ideas rather than an interprofessional integration of agreements. Additionally, assessors suggested that a series of varying assessment tasks is required to draw conclusions about students' interprofessional competence. [ABSTRACT FROM AUTHOR]

This study investigates feature acquisition and feature reassembly associated with Clitic Left Dislocation (CLLD). The article compares the acquisition of CLLD in second language (L2) Italian to L2 Romanian to examine effects of first language (L1) transfer, construction frequency and the type of interface involved (external vs. internal interface) within the same syntactic construction. The results from an acceptability judgment task and a written elicitation task show that while English near-native speakers of Italian/Romanian acquired the L2 constraints on CLLD, which is [+anaphor] for Italian and [+specific] for Romanian, data from both Romanian L2 learners of Italian and Italian L2 learners of Romanian showed persistent L1 transfer effects. Target-like acquisition for these groups requires both grammatical expansion and retraction; Romanian CLLD requires the addition of an L1-unavailable [+specific] feature and the loss of a [+anaphor] feature, while Italian CLLD requires the addition of an L1-unavailable [+anaphor] and the loss of a [+specific] feature. The reported findings extend evidence in favour of the Feature Reassembly Hypothesis to the syntax–discourse interface, as reassembly of interpretational features associated with CLLD proved more difficult than feature acquisition. While learners at the near-native levels were able to broaden the contexts that allow a clitic in the L2 (grammatical expansion), L1 preemption difficulties were attested as well. This was the case regardless of the frequency of the relevant construction in the input and the type of L2 feature that needed to be added/removed. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment.Data were gathered during routine clinical practice during a 3-year period (2019–2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates.Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain.At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients.Chronic musculoskeletal pain can be very disabling and impacting participation and quality of life.Often several psychosocial factors contribute to the maintenance of pain and its evolving consequences.In this study, a 61 hours highly individualized interdisciplinary multimodal pain treatment resulted in significant improvements with moderate to very large effect sizes for all important domains like pain, fatigue, disability, work capacity, and quality of life.Care providers as well as health insurers should acknowledge the interdisciplinary multimodal pain programme as an effective treatment in their clinical decision making.Chronic musculoskeletal pain can be very disabling and impacting participation and quality of life.Often several psychosocial factors contribute to the maintenance of pain and its evolving consequences.In this study, a 61 hours highly individualized interdisciplinary multimodal pain treatment resulted in significant improvements with moderate to very large effect sizes for all important domains like pain, fatigue, disability, work capacity, and quality of life.Care providers as well as health insurers should acknowledge the interdisciplinary multimodal pain programme as an effective treatment in their clinical decision making. [ABSTRACT FROM AUTHOR]

In this study, the potential of silk fibroin biomaterials for enhancing wound healing is explored, focusing on their integration into a human 3D ex vivo wound model derived from abdominoplasties. For this purpose, cast silk fibroin membranes and electrospun nonwoven matrices from Bombyx mori silk cocoons were compared to untreated controls over 20 days. Keratinocyte behavior and wound healing were analyzed qualitatively and quantitatively by histomorphometric and immune histochemical methods (HE, Ki67, TUNEL). Findings reveal rapid keratinocyte proliferation on both silk fibroin membrane and nonwoven matrices, along with enhanced infiltration in the matrix, suggesting improved early wound closure. Silk fibroin membranes exhibited a significantly improved early regeneration, followed by nonwoven matrices (p < 0.05) compared to untreated wounds, resulting in the formation of multi-layered epidermal structures with complete regeneration. Overall, the materials demonstrated excellent biocompatibility, supporting cell activity with no signs of increased apoptosis or early degradation. These results underscore silk fibroin's potential in clinical wound care, particularly in tissue integration and re-epithelialization, offering valuable insights for advanced and—as a result of the electrospinning technique—individual wound care development. Furthermore, the use of an ex vivo wound model appears to be a viable option for pre-clinical testing. [ABSTRACT FROM AUTHOR]

Organic photovoltaics (OPV) present a promising thin-film solar cell technology with particular benefits in terms of weight, aesthetics, transparency, and cost. However, despite being studied intensively since the mid 90's, OPV has not entered the mass consumer market yet. Although the efficiency gap with other thin-film photovoltaics has largely been overcome, active layer stability and performance reproducibility issues have not been fully resolved. State-of-the-art OPV devices employ a physical mixture of electron donor and acceptor molecules in a bulk heterojunction active layer. These blends are prone to morphological changes, leading to performance losses over time. On the other hand, in "single-component" organic solar cells, the donor and acceptor constituents are chemically connected within a single material, preventing demixing and thereby enhancing device stability. Novel single-component materials affording reasonably high solar cell efficiencies and improved lifetimes have recently emerged. In particular, the combination of donor and acceptor structures in conjugated block copolymers (CBCs) presents an exciting approach. Nevertheless, the current CBCs are poorly defined from a structural point of view, while synthetic protocols remain unoptimized. More controlled synthesis followed by proper structural analysis of CBCs is, however, essential to develop rational structure-property-device relations and to drive the field forward. In this perspective, we provide a short overview of the state-of-the-art in single- component organic solar cells prepared from CBCs, reflect on their troublesome characterization and the importance of chemical precision in these structures, give some recommendations, and discuss the potential impact of these aspects on the field. [ABSTRACT FROM AUTHOR]

BACKGROUND: Central sensitization cannot be demonstrated directly in humans. Therefore, studies used different proxy markers (signs, symptoms and tools) to identify factors assumed to relate to central sensitization in humans, that is, Human Assumed Central Sensitization (HACS). The aims of this systematic review were to identify non-invasive objective markers of HACS and the instruments to assess these markers in patients with fibromyalgia (FM). METHODS: A systematic review was conducted with the following inclusion criteria: (1) adults, (2) diagnosed with FM, and (3) markers and instruments for HACS had to be non-invasive. Data were subsequently extracted, and studies were assessed for risk of bias using the quality assessment tools developed by the National Institute of Health. RESULTS: 78 studies (n = 5234 participants) were included and the findings were categorized in markers identified to assess peripheral and central manifestations of HACS. The identified markers for peripheral manifestations of HACS, with at least moderate evidence, were pain after-sensation decline rates, mechanical pain thresholds, pressure pain threshold, sound 'pressure' pain threshold, cutaneous silent period, slowly repeated evoked pain sensitization and nociceptive flexion reflex threshold. The identified markers for central manifestations of HACS were efficacy of conditioned pain modulation with pressure pain conditioning and brain perfusion analysis. Instruments to assess these markers are: pin-prick stimulators, cuff-algometry, repetitive pressure stimulation using a pressure algometer, sound, electrodes and neuroimaging techniques. CONCLUSIONS: This review provides an overview of non-invasive markers and instruments for the assessment of HACS in patients with FM. Implementing these findings into clinical settings may help to identify HACS in patients with FM. [ABSTRACT FROM AUTHOR]

Aims: To assess the sleep strategies that nurses working irregular night shifts use to improve their sleep quality, and to compare the strategies of good and poor sleepers to determine whether the differences between the two groups could provide insights into possible effective strategies. Design: A qualitative descriptive study. Methods: The study was conducted from September 2019 to January 2020. Thirty‐four nurses working irregular night shifts participated; 17 were classified as good sleepers and 17 as poor sleepers based on the Sleep‐Wake Experience List, a validated self‐report instrument that measures one's sleep quality. Interviews were conducted using open questions to explore strategies around the night‐shift set. The interviews were analysed using thematic analysis. Findings: Both groups described similar and different strategies that help them work and sleep well during and after night shifts. However, good sleepers mentioned a greater number of strategies and seemed to have thought about them more than poor sleepers. The most common strategies were having a clear structure, being organized—especially regarding sleeping time—maintaining a daily routine and adjusting their sleep environment. Conclusion: Healthcare institutions should consider offering education and training programs aimed at empowering nurses who work irregular night shifts. These programs should provide nurses with various sleep strategies to enhance their sleep quality and overall well‐being. Implications for the Profession: Nurses working irregular night shifts can possibly enhance their sleep quality by making personalized plans, for example, including a clear day structure, or an optimized sleep environment. Impact: The study focused on how nurses working night shifts could possibly enhance their sleep quality. The findings highlight the importance of providing nurses with diverse sleep strategies to improve sleep quality, helping them to identify what works best for them and consistently apply these strategies. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Patient or Public Contribution: Nurses working irregular night shifts at Maastricht University Medical Center in Maastricht, the Netherlands, who agreed to participate in the study, engaged in a discussion to assess the relevance of sleep quality to their work. They were also encouraged to share their perspectives during the interviews. [ABSTRACT FROM AUTHOR]

Mark J. R. Smeets and Suzanne C. Cannegieter discuss the use of real world data to complement data generated by clinical trials of systemic anticoagulants. [ABSTRACT FROM AUTHOR]

Background: The term 'physiological motion of the spine' is commonly used although no proper definition exists. Previous work has revealed a consistent sequence of cervical segmental contributions in 80–90% of young healthy individuals. Age has been shown to be associated with a decreased quantity of motion. Therefore, it is of interest to study whether this sequence persists throughout aging. The aim of this prospective cohort study is to investigate if the consistent sequence of cervical segmental contributions in young asymptomatic individuals remains present in elderly asymptomatic individuals. Methods: In this prospective cohort study, dynamic flexion to extension cinematographic recordings of the cervical spine were made in asymptomatic individuals aged 55–70 years old. Individuals without neck pain and without severe degenerative changes were included. Two recordings were made in each individual with a 2-to-4-week interval (T1 and T2). Segmental rotation of each individual segment between C4 and C7 was calculated to determine the sequence of segmental contributions. Secondary outcomes were segmental range of motion (sRoM) and sagittal alignment. Results: Ten individuals, with an average age of 61 years, were included. The predefined consistent sequence of segmental contributions was found in 10% of the individuals at T1 and 0% at T2. sRoM and total range of motion (tRoM) were low in all participants. There was no statistically significant correlation between sagittal alignment, degeneration and sRoM in the respective segments, nor between cervical lordosis and tRoM. Conclusions: This study shows that aging is associated with loss of the consistent motion pattern that was observed in young asymptomatic individuals. The altered contribution of the cervical segments during extension did not appear to be correlated to the degree of degeneration or sagittal alignment. Trial registration clinicaltrials.gov NCT04222777, registered 10.01.2020. [ABSTRACT FROM AUTHOR]

Purpose: Plant-derived proteins have received considerable attention as an alternative to animal-derived proteins. However, plant-derived proteins are considered to have less anabolic properties when compared with animal-derived proteins. The lower muscle protein synthesis rates following ingestion of plant- compared with animal-derived protein have been attributed to the lower essential amino acid content of plant-derived proteins and/or their specific amino acid deficiencies. This study aimed to compare post-prandial muscle protein synthesis rates following the ingestion of 30 g pea-derived protein with 30 g milk-derived protein in healthy, young males. Methods: In a randomized, double-blind, parallel-group design, 24 young males (24 ± 3 y) received a primed continuous L-[ring-13C6]-phenylalanine infusion after which they ingested 30 g pea (PEA) or 30 g milk-derived protein (MILK). Blood and muscle biopsies were collected frequently for 5 h to assess post-prandial plasma amino acid profiles and subsequent post-prandial muscle protein synthesis rates. Results: MILK increased plasma essential amino acid concentrations more than PEA over the 5 h post-prandial period (incremental area under curve 151 ± 31 vs 102 ± 15 mmol∙300 min∙L−1, respectively; P < 0.001). Ingestion of both MILK and PEA showed a robust muscle protein synthetic response with no significant differences between treatments (0.053 ± 0.013 and 0.053 ± 0.017%∙h−1, respectively; P = 0.96). Conclusion: Post-prandial muscle protein synthesis rates following the ingestion of 30 g pea-derived protein do not differ from the response following ingestion of an equivalent amount of milk-derived protein. International Clinical Trials Registry Platform (NTR6548; 27–06-2017). [ABSTRACT FROM AUTHOR]

• Ongoing LAMA2-MD natural history studies from 7 countries were reported. • The importance of developing standardised LAMA2-MD registries was acknowledged. • A clinical workgroup on LAMA2-MD was formed. • Patient organisations and patient representatives from 9 countries participated in the workshop. • LAMA2-MD therapy development demonstrated substantial progress. • Monthly online research meetings for clinicians, researchers and patient organizations. The European Joint Programme on Rare Diseases (EJPRD) funded the workshop "LAMA2-Muscular Dystrophy: Paving the road to therapy", bringing together 40 health-care professionals, researchers, patient-advocacy groups, Early-Career Scientists and other stakeholders from 14 countries. Progress in natural history, pathophysiology, trial readiness, and treatment strategies was discussed together with efforts to increase patient-awareness and strengthen collaborations. Key outcomes were (a) ongoing natural history studies in 7 countries already covered more than 350 patients. The next steps are to include additional countries, harmonise data collection and define a minimal dataset; (b) therapy development was largely complementary. Approaches included LAMA2-replacement and correction, LAMA1-reactivation, mRNA modulation, linker-protein expression, targeting downstream processes and identifying modifiers, using viral vectors, muscle stem cells, iPSC and mouse models and patient lines; (c) LAMA2-Europe will inform patients (-representatives) worldwide on standards of care and scientific progress, and enable sharing experiences. Follow-up monthly online meetings and research repositories have been established to create sustainable collaborations. [ABSTRACT FROM AUTHOR]

In many histories of nineteenth-century literature of the Low Countries, only a handful of authors are associated with emerging genres of regional fiction such as the village tale. In view of the immense popularity of regional literature, these histories overlook a large part of the literary field. This article aims to provide complementary perspectives by looking at how nineteenth-century Dutch and Flemish regional literature was framed and understood in contemporary reception, by systematically tracing all mentions of other artists and authors in reviews of selected authors. This has resulted in a 'co-mention network', revealing associations contemporary reviewers made between Dutch and Flemish regionalist writers and other cultural figures. This network functions as a starting point for investigating the impact of genre, gender and nationality on associations between authors, while also attending to which connections are not made, and which authors are left out of dominant narratives. Network analysis suggests that genre boundaries were fluid, and that numerous transnational authors were associated with Dutch and Flemish regionalists. At times nuancing or amending existing accounts of regionalism in literary histories, this article is also a tentative investigation of processes of canon-formation more broadly. [ABSTRACT FROM AUTHOR]

Introduction: Midazolam-based continuous intravenous sedation in patients admitted to the intensive care unit (ICU) was a necessity during the COVID-19 pandemic. However, benzodiazepine-based sedation is associated with a high incidence of benzodiazepine-related delirium and additional days on mechanical ventilation. Due to the requirement of high midazolam doses in combination with the impaired renal clearance (CL) of the pharmacological active metabolite 1-OH-midazolam-glucuronide (10% compared to midazolam), ICU patients with COVID-19 and continuous renal replacement therapy (CRRT) were at risk of unintended prolonged sedation. Several CRRT-related factors may have influenced the delivered CL of midazolam and its metabolites. Therefore, the aim of the study was to identify and describe these CRRT-related factors. Methods: Pre-filter blood samples and ultrafiltrate samples were collected simultaneously. Midazolam, 1-OH-midazolam, and 1-OH-midazolam-glucuronide plasma samples were analyzed using an UPLC-MS/MS method. The prescribed CRRT dose was corrected for downtime and filter integrity using the urea ratio (urea concentration in effluent/urea concentration plasma). CL of midazolam and its metabolites were calculated with the delivered CRRT dose (corrected for downtime and saturation coefficient [SD]). Results: Three patients on continuous venovenous hemodialysis (CVVHD) and 2 patients on continuous venovenous hemodiafiltration (CVVHDF) were included. Midazolam, 1-OH-midazolam, and 1-OH-midazolam-glucuronide concentrations were 2,849 (0–6,700) μg/L, 153 (0–295) μg/L, and 27,297 (1,727–39,000) μg/L, respectively. The SD was 0.03 (0.02–0.03) for midazolam, 0.05 (0.05–0.06) for 1-OH-midazolam, and 0.33 (0.23–0.43) for 1-OH-midazolam-glucuronide. The delivered CRRT CL was 1.4 (0–1.7) mL/min for midazolam, 2.7 (0–3.5) mL/min for 1-OH-midazolam, and 15.7 (4.0–27.7) mL/min for 1-OH-midazolam-glucuronide. Conclusions: Midazolam and 1-OH-midazolam were not removed during CVVHD and CVVHDF. However, 1-OH-midazolam-glucuronide was removed reasonably, approximately up to 43%. CRRT modality, filter integrity, and downtime affect this removal. These data imply a personalized titration of midazolam in critically ill patients with renal failure and awareness for the additional sedative effects of its active metabolites. [ABSTRACT FROM AUTHOR]

There were numerous occasions when the US military considered conducting cyber attacks but refrained from doing so, but these have been largely overlooked as sources of insight. Six cases that we do know about – mostly from journalistic reporting – reveal much about US strategic thinking, posturing, and assessment of the limits of cyberspace. [ABSTRACT FROM AUTHOR]

• Strong induction of CYP3A4 and UGT by lumacaftor/ivacaftor (Orkambi®, LUM/IVA) can reduce the plasma concentration of triazole antifungals. • Concomitant use of LUM/IVA with itraconazole, posaconazole or voriconazole resulted in subtherapeutic triazole levels in 76% of the samples in adults and children. • Higher doses of triazoles are needed in CF patients treated with LUM/IVA to reach target concentrations. Lumacaftor/ivacaftor (Orkambi®, LUM/IVA) is indicated for the treatment of cystic fibrosis (CF) patients aged ≥ 2 years with homozygous F580del mutation in the CFTR gene. Triazole fungal agents are used to treat fungal disease in CF. The use of triazoles is limited by pharmacokinetic challenges, such as drug-drug interactions. The most notable drug-drug interaction between triazoles and LUM/IVA is due to strong induction of CYP3A4 and UGT by LUM. In this real-world retrospective observational study, we described the effect of LUM/IVA on the trough concentration of triazoles. Concomitant use of LUM/IVA with itraconazole, posaconazole or voriconazole resulted in subtherapeutic triazole levels in 76% of the plasma samples. In comparison, in patients with triazole agents without LUM/IVA only 30.6% of the plasma samples resulted in subtherapeutic concentrations. Subtherapeutic plasma concentrations of triazoles should be considered in CF patients on LUM/IVA and further research is warranted for other dosing strategies and alternative antifungal therapy. [ABSTRACT FROM AUTHOR]

Introduction: Anterior ischemic optic neuropathy (AION) can mimic glaucoma and consequently cause difficulties in differential diagnosis. The purpose of this paper was to summarize differences in diagnostic tests that can help perform a correct diagnosis. Methods: The search strategy was performed according to the PRISMA 2009 guidelines, and four databases were used: MEDLINE, Embase, Web of Science, and Cochrane. Totally, 772 references were eligible; 39 were included after screening with respect to inclusion criteria that included English language and published in the 20 years before search date. Results: Ninety percent (n = 35) of included studies used optical coherence tomography (OCT). Glaucomatous eyes had a significantly greater cup area, volume and depth, cup-to-disk ratio, a lower rim volume and area, and a thinner Bruch's membrane opening-minimum rim width. Retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes occurred primarily at the superotemporal, inferotemporal, and inferonasal sectors, while AION eyes demonstrated mostly superonasal thinning. Glaucoma eyes showed greater macular ganglion cell layer thickness, except at the inferotemporal sector. OCT angiography measurements demonstrated a significant decrease in superficial and deep macular vessel density (VD) in glaucoma compared to AION with similar degree of visual field damage; the parapapillary choroidal VD was spared in AION eyes compared to glaucomatous eyes. Conclusion: By use of OCT imaging, optic nerve head parameters seem most informative to distinguish between glaucoma and AION. Although both diseases affect the RNFL thickness, it seems to do so in different sectors. Differences in structure and vascularity of the macula can also help in making the differential diagnosis. [ABSTRACT FROM AUTHOR]

Objective: The TARGET program for integrated, person-centered care for people with chronic conditions offers primary care (PC) professionals a set of tools and trainings to actively engage in population segmentation and person-centered needs assessments (PCNAs). A pilot study was conducted to gain insight into the program's feasibility and acceptability, and identify preconditions for successful implementation. Design and setting: Seven Dutch PC practices participated in a half-year pilot study starting in August 2020. We performed a review of the population segmentation tool, observed four training sessions and 15 PCNAs, and interviewed 15 professionals and 12 patients. Results: Regarding feasibility and acceptability, we found that the tools and trainings provided professionals with skills to use the segmentation tool and take a more coaching role in the well-appreciated PCNAs. Concerning implementation preconditions, we found that team commitment and network connections need improvement, although work pleasure increased and professionals generally wanted the program to continue. Conclusions: While the content of the TARGET program is supported by its users, the implementation process, for instance team commitment to the program, needs more attention in future upscaling efforts. [ABSTRACT FROM AUTHOR]

Abstract Construct & Background Approach Findings Conclusions In order to determine students’ level of interprofessional competencies, there is a need for well-considered and thoroughly designed interprofessional assessments. Current literature about interprofessional assessments focuses largely on the development and validation of assessment instruments such as self-assessments or questionnaires to assess students’ knowledge or attitudes. Less is known about the design and validity of integral types of assessment in interprofessional education, such as case-based assessments, or performance assessments. The aim of this study is to evaluate the evidence for and threats to the validity of the decisions about students’ interprofessional performances based on such integral assessment task. We investigated whether the assessment prototype is a precursor to practice (authenticity) and whether the assessment provides valid information to determine the level of interprofessional competence (scoring).We used a design-based qualitative research design in which we conducted three group interviews with teachers, students, and interprofessional assessment experts. In semi-structured group interviews, participants evaluated the evidence for and threats to the validity of an interprofessional assessment task, which were analyzed using deductive and inductive content analysis.Although both evidence for and threats to validity were mentioned, the threats refuting the assessment’s validity prevailed. Evidence for the authenticity aspect was that the assessment task, conducting a team meeting, is common in practice. However, its validity was questioned because the assessment task appeared more structured as compared to practice. The most frequently mentioned threat to the scoring aspect was that the process of interprofessional collaboration between the students could not be evaluated sufficiently by means of this assessment task.This study showed that establishing interprofessional assessment validity requires three major balancing acts. The first is the balance between authenticity and complexity. As interprofessional practice and competencies are complex, interprofessional tasks require build-up or guidance toward this complexity and chaotic practice. The second is that between authenticity and scoring, in which optimal authenticity might lead to threats to scoring and vice versa. Simultaneous optimal authenticity and scoring seems impossible, requiring ongoing evaluation and monitoring of interprofessional assessment validity to ensure authentic yet fair assessments for all participating professions. The third balancing act is between team scoring and individual scoring. As interprofessional practice requires collaboration and synthesis of diverse professions, the team process is at the heart of solving interprofessional tasks. However, to stimulate individual accountability, the individual performance should not be neglected. [ABSTRACT FROM AUTHOR]

Research shows that teachers and education are often represented negatively or stereotypically in popular and literary culture, both in the Dutch language area and in Anglophone contexts. Regarding contemporary Dutch literature, though, research on educational representations has until now focussed on small corpora of novels that explicitly deal with education. In this article, we explore the representations of teachers and education in a much larger and broader corpus: the 170 submissions to the bulk list of the prestigious Dutch Libris Literatuurprijs of 2013. We provide a Keyword in Context Analysis of 292 educational representations in this corpus and offer a demographic analysis of the 71 teachers who inhabit the novels under analysis. In doing so, we show that educational representations and teacher characters are relatively common in contemporary Dutch language novels. Our analysis also reveals that literary representations of teachers are predominantly negative in nature, especially regarding their behaviour towards students, their external presentation, and their pedagogical skills. Representations of education in general tend to be even more negative. In that sense, literary representations of education appear to converge with the negative public appeal of the educational sector in the contemporary Low Countries. [ABSTRACT FROM AUTHOR]

This article analyses the EU's third attempt to reform its asylum and migration regime. Our focus is on process management. Instead of looking at positions or policy substance, we analyse how to manage the migration reform negotiations. We use the method of embedded process tracing to analyse, in real-time, the interplay between the member states and EU institutions, from the Commission's Pact on Migration of September 2020 until the end of the French Presidency in June 2022. On a conceptual level, we unpack the notion of an the EU that is 'failing forward' in this, and in other major, crisis reforms. We argue that this failing forward notion obscures a variety of patterns of intra- and inter-institutional coordination. We conclude that, in spite of déjà vu sentiments, the role of the European Council, the Commission, and the Council of Ministers was notably different during this round, and arguably more effective. [ABSTRACT FROM AUTHOR]

Background: A multitude of diagnostic and predictive algorithms have been designed for COVID-19. However, currently no score can accurately quantify and track day-to-day disease severity in hospitalised patients with COVID-19. We aimed to design such a score to improve pathophysiological insight in COVID-19. Methods: Development of the Severity of COronavirus Disease Assessment (SCODA) score was based on the 4C Mortality score but patient demographic variables that remain constant during admission were excluded. Instead, parameters associated with breathing and oxygenation were added to reflect the daily condition. The SCODA score was subsequently applied to the BEAT-COVID cohort to describe COVID-19 severity over time and to determine the timing of clinical recovery for each patient, an important marker in pathophysiological studies. The BEAT-COVID study included patients with PCR confirmed COVID-19 who were hospitalized between April 2020 and March 2021 in the Leiden University Medical Center, The Netherlands. Results: The SCODA score consists of 6 clinical and 2 routine lab parameters. 191 patients participated in the BEAT-COVID study. Median age was 66, and 74.4% was male. The modal timepoint at which recovery was clinically initiated occurred on days 8 and 24 since symptom onset for non-ICU and ICU-patients, respectively. Conclusions: We developed a daily score which can be used to track disease severity of patients admitted due to COVID-19. This score is useful for improving insight in COVID-19 pathophysiology, its clinical course and to evaluate interventions. In a future stage this score can also be used in other (emerging) infectious respiratory diseases. [ABSTRACT FROM AUTHOR]

Introduction: Off‐label drug use in the paediatric population is common, and the lack of high‐quality efficacy studies poses patients at risk for failing pharmacotherapy. Next to efficacy studies, pharmacokinetic (PK) studies are increasingly used to inform paediatric dose selection. As resources for paediatric trials are limited, we aimed to summarize existing PK and efficacy studies to identify knowledge gaps in available evidence supporting paediatric dosing recommendations, thereby taking paediatric cardiovascular drugs as proof of concept. Methods: For each cardiovascular drug, paediatric indication and prespecified age group, together comprising one record, the authorized state was assessed. Next, for off‐label records, the highest level of evidence was scored. High‐quality efficacy studies were defined as meta‐analysis or randomized controlled trials. Other comparative research, noncomparative research or consensus‐based expert opinions were considered low quality. The level of evidence for PK studies was scored per drug and per age group, but regardless of indication. Results: A total of 58 drugs included 417 records, of which 279 (67%) were off‐label. Of all off‐label records, the majority (81%) were not supported by high‐quality efficacy studies, but for 140 of these records (62%) high‐quality PK studies were available. Conclusion: We demonstrated that for the majority of off‐label cardiovascular drugs, only low‐quality efficacy studies were available. However, high‐quality PK studies were frequently available. Combining these PK data with extrapolation of efficacy data from adults may help to close the current information gap and prioritize the drugs for which clinical studies and safety data are urgently needed. [ABSTRACT FROM AUTHOR]

People generally look at a target when they want to reach for it. Doing so presumably helps them continuously update their judgments about the target's position and motion. But not looking at their hand does not prevent people from updating judgments about its position on the basis of visual information, because people do respond to experimental perturbations of visual information about the position of their hand. Here, we study such responses by adding jitter to the movement of a cursor that follows participants' fingers. We analyse the response to the jitter in a way that reveals how the vigour of the response depends on the moment during the movement at which the change in cursor position occurs. We compare the change in vigour to that for equivalent jitter in the position of the target. We find that participants respond to jitter in the position of a cursor in much the same way as they respond to jitter in the target's position. The responses are more vigorous late in the movement, when adjustments need to be made within less time, but similarly so for the cursor as for the target. The responses are weaker for the cursor, presumably because of the jitter-free kinaesthetic information about the position of the finger. [ABSTRACT FROM AUTHOR]

Introduction: Vancomycin is used in intensive care unit (ICU) patients for the treatment of infections caused by gram-positive bacteria. The vancomycin pharmacokinetic/pharmacodynamic index is a ratio of the area under the concentration to the minimum inhibitory concentration ≥400–600 h*mg/L. This target can generally be achieved by a plasma concentration of 20–25 mg/L. Together with the pathophysiological alterations and pharmacokinetic variability associated with critical illness, the use of continuous renal replacement therapy (CRRT) may complicate the attainment of adequate vancomycin concentrations. The primary objective was the prevalence of attainment of vancomycin concentrations 20–25 mg/L after 24 h in adult ICU patients receiving CRRT. Secondary outcomes were to evaluate target attainment at days 2 and 3 and to calculate vancomycin clearance (CL) by CRRT and residual diuresis. Methods: We performed a prospective observational study in adult ICU patients on CRRT, which received at least 24 h continuous infusion of vancomycin. Between May 2020 and February 2021, daily vancomycin residual blood gas and dialysate samples were collected from 20 patients, every 6 h and if possible vancomycin urine samples. Vancomycin was analysed with an immunoassay method. The CL by CRRT was calculated by a different approach correcting for the downtime and providing insight into the degree of filter patency. Results: The proportion of patients with vancomycin concentrations <20 mg/L was 50% 24 h after starting vancomycin (n = 10). No differences were observed in patient characteristics. The target vancomycin concentration 20–25 mg/L was only achieved in 30% of the patients. On days 2 and 3, despite the use of TDM and albeit in lower percentages, sub- and supratherapeutic levels were still observed. Taking downtime and filter patency into account resulted in lower vancomycin CL. Conclusions: 50% of the studied ICU patients on CRRT showed subtherapeutic vancomycin concentrations 24 h after starting therapy. The results reveal that optimization of vancomycin dosage during CRRT therapy is needed. [ABSTRACT FROM AUTHOR]

People rely upon sensory information in the environment to guide their actions. Ongoing goal-directed arm movements are constantly adjusted to the latest estimate of both the target and hand's positions. Does the continuous guidance of ongoing arm movements also consider the latest visual information of the position of obstacles in the surrounding? To find out, we asked participants to slide their finger across a screen to intercept a laterally moving virtual target while moving through a gap that was created by two virtual circular obstacles. At a fixed time during each trial, the target suddenly jumped slightly laterally while still continuing to move. In half the trials, the size of the gap changed at the same moment as the target jumped. As expected, participants adjusted their movements in response to the target jump. Importantly, the magnitude of this response depended on the new size of the gap. If participants were told that the circles were irrelevant, changing the gap between them had no effect on the responses. This shows that obstacles' instantaneous positions can be considered when visually guiding goal-directed movements. [ABSTRACT FROM AUTHOR]

Over the last decades, cybersecurity has become a top priority for the European Union (EU). As a contribution to scholarship on the 'regulatory security state', we analyze how the European Union Agency for Cybersecurity (ENISA), emerged and stabilized as the EU's key agency for cybersecurity. We use data from policy documents, secondary sources, and semi-structured interviews to show how ENISA struggled to become a relevant actor by carving out a specific role for itself. In particular, we show how challenging it was for the agency to acquire epistemic authority. Although the trajectory of ENISA supports attempts to govern through regulation, it also shows that its role was never a given, only functions as part of a larger whole, and continues to be subject to change. Our article indicates that the study of security governance must remain ontologically flexible to capture hybrid forms and political struggles. [ABSTRACT FROM AUTHOR]

Around 30% of cancer survivors suffer from chemotherapy-induced peripheral neuropathy (CIPN) ≥6 months after completion of chemotherapy, which comes with limitations in daily functioning and worsened quality of life(QoL). Treatment options are scarce. Our aim was to develop an online self-help intervention based on Acceptance and Commitment Therapy (ACT) to reduce pain interference in cancer survivors experiencing painful chronic CIPN. This article applied a patient-centered design process using the Center for eHealth Research (CeHRes) roadmap. User needs were examined using online semi-structured interviews with patients and experts (N = 23). Interviews were transcribed verbatim and analyzed using thematic analysis. Personas were created based on interviews. Intervention content was based on identified user needs and ACT. Content and design were finalized using low-fidelity prototype testing (N = 5), and high-fidelity prototype testing (N = 7). Patients appreciated and agreed with the elements of ACT, had varying guidance needs, and wanted to have autonomy (e.g., moment and duration of use). Additionally, it was important to be aware that patients have had a life-threatening disease which directly relates to the symptoms they experience. Patients reported to prefer a user-friendly and accessible intervention. Similar points also emerged in the expert interviews. The final intervention, named Embrace Pain, includes six sessions. Session content is based on psychoeducation and all ACT processes. Further interpretation of the intervention (such as quotes, guidance, and multimedia choices) is based on the interviews. This development demonstrated how a patient-centered design process from a theoretical framework can be applied. Theory-driven content was used as the basis of the intervention. Findings show an online ACT intervention designed for cancer survivors with painful chronic CIPN. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: A treatment choice for female stress urinary incontinence (SUI) is preference sensitive for both patients and physicians. Multiple treatment options are available, with none being superior to any other. The decision-making process can be supported by a patient decision aid (PDA). We aimed to assess physicians' perceptions concerning the use of a PDA. Methods: In a mixed methods study, urologists, gynecologists and general practitioners in the Netherlands were asked to fill out a web-based questionnaire. Questions were based on the Tailored Implementation for Chronic Diseases checklist using the following domains: guideline factors, individual health professional factors, professional interactions, incentives and resources, and capacity for organizational change. Participants were asked to grade statements using a five-point Likert scale and to answer open questions on facilitators of and barriers to implementation of a PDA. Outcomes of statement rating were quantitatively analyzed and thematic analysis was performed on the outcomes regarding facilitators and barriers. Results: The response rate was 11%, with a total of 120 participants completing the questionnaire. Ninety-two of the physicians (77%) would use a PDA in female SUI. Evidence-based and unbiased content, the ability to support shared decision making, and patient empowerment are identified as main facilitators. Barriers are the expected prolonged time investment and the possible difficulty using the PDA in less health-literate patient populations. Conclusions: The majority of physicians would use a PDA for female SUI. We identified facilitators and barriers that can be used when developing and implementing such a PDA. [ABSTRACT FROM AUTHOR]

When should states publicly attribute cyber intrusions? Whilst this is a question governments increasingly grapple with, academia has hardly helped in providing answers. This article describes the stages of public attribution and provides a Public Attribution Framework designed to explain, guide, and improve decision making of public attribution by states. Our general argument is that public attribution is a highly complex process which requires trade-offs of multiple considerations. Effective public attribution not only necessitates a clear understanding of the attributed cyber operation and the cyber threat actor, but also the broader geopolitical environment, allied positions and activities, and the legal context. This also implies that more public attribution is not always better. Public attribution carries significant risks, which are often badly understood. We propose the decision maker's attitude towards public attribution should be one of 'strategic, coordinated pragmatism'. Public attribution – as part of a strategy – can only be successful if there is a consistent goal, whilst the avenues for potential negative counter effects are assessed on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Fibroblast activation protein (FAP), expressed on cancer-associated fibroblasts, is a target for diagnosis and therapy in multiple tumour types. Strategies to systemically deplete FAP-expressing cells show efficacy; however, these induce toxicities, as FAP-expressing cells are found in normal tissues. FAP-targeted photodynamic therapy offers a solution, as it acts only locally and upon activation. Here, a FAP-binding minibody was conjugated to the chelator diethylenetriaminepentaacetic acid (DTPA) and the photosensitizer IRDye700DX (DTPA-700DX-MB). DTPA-700DX-MB showed efficient binding to FAP-overexpressing 3T3 murine fibroblasts (3T3-FAP) and induced the protein's dose-dependent cytotoxicity upon light exposure. Biodistribution of DTPA-700DX-MB in mice carrying either subcutaneous or orthotopic tumours of murine pancreatic ductal adenocarcinoma cells (PDAC299) showed maximal tumour uptake of 111In-labelled DTPA-700DX-MB at 24 h post injection. Co-injection with an excess DTPA-700DX-MB reduced uptake, and autoradiography correlated with FAP expression in the stromal tumour region. Finally, in vivo therapeutic efficacy was determined in two simultaneous subcutaneous PDAC299 tumours; only one was treated with 690 nm light. Upregulation of an apoptosis marker was only observed in the treated tumours. In conclusion, DTPA-700DX-MB binds to FAP-expressing cells and targets PDAC299 tumours in mice with good signal-to-background ratios. Furthermore, the induced apoptosis indicates the feasibility of targeted depletion of FAP-expressing cells with photodynamic therapy. [ABSTRACT FROM AUTHOR]

This article reconstructs the coming about of the 750 billion EU Covid Recovery Fund. We provide an embedded process‐tracing analysis of the dynamics from mid‐March 2020, when the idea of 'Corona‐bonds' was parachuted onto the Heads' Agenda, up until the 'historic' deal on the Multiannual Financial Framework and Recovery Fund of 21 July. Where most media accounts and scholarly assessments focus on the high‐level deal making between political leaders, we trace the proceedings inside the EU's institutional machinery, which produced the solutions and laid out the groundwork for a deal. The reconstruction assesses the role and influence of the EU institutions – the European Commission in particular – in producing this major step. We show that the process was characterized by a handicapped European Council, which hampered the ability of member states to oversee and control developments. The conclusions discuss the implications of our findings for our understanding of (institutional) leadership and policy making during crisis. [ABSTRACT FROM AUTHOR]

The introduction of (fully) automated vehicles has generated a re-interest in motion sickness, given that passengers suffer much more from motion sickness compared to car drivers. A suggested solution is to improve the anticipation of passive self-motion via cues that alert passengers of changes in the upcoming motion trajectory. We already know that auditory or visual cues can mitigate motion sickness. In this study, we used anticipatory vibrotactile cues that do not interfere with the (audio)visual tasks passengers may want to perform. We wanted to investigate (1) whether anticipatory vibrotactile cues mitigate motion sickness, and (2) whether the timing of the cue is of influence. We therefore exposed participants to four sessions on a linear sled with displacements unpredictable in motion onset. In three sessions, an anticipatory cue was presented 0.33, 1, or 3 s prior to the onset of forward motion. Using a new pre-registered measure, we quantified the reduction in motion sickness across multiple sickness scores in these sessions relative to a control session. Under the chosen experimental conditions, our results did not show a significant mitigation of motion sickness by the anticipatory vibrotactile cues, irrespective of their timing. Participants yet indicated that the cues were helpful. Considering that motion sickness is influenced by the unpredictability of displacements, vibrotactile cues may mitigate sickness when motions have more (unpredictable) variability than those studied here. [ABSTRACT FROM AUTHOR]

Aims: Pregnant women are hypothesized to have low adherence to prescribed medication, because of concerns about harmful effects on the unborn child. However, very little is known about the actual adherence to prescribed medication during pregnancy. We determined to what extent women follow treatment recommendations regarding prescribed medication use in mid‐pregnancy. Methods: Dutch women participating in the PRIDE Study completed a 6‐week diary on medication use. Additionally, pharmacy records were obtained. For each medication dispensed, we determined 3 measures of adherence: (i) whether use was reported in the diary (actual use); (ii) difference between dispensing date and date of first reported use (initiation time); and (iii) proportion of days with at least the correct number of doses taken (implementation adherence). Results: During the 6‐week study period, 235 of 816 women (29%) were dispensed medication. Actual use was highest for medications used for chronic conditions (88%; 95% confidence interval [95% CI] 81–93), followed by medication for pregnancy‐related conditions (79%; 95% CI 71–86) and medication for occasional and short‐time use (69%; 95% CI 60–77). We observed a ≥1‐day delay in treatment initiation for 42% of medications dispensed for the first time in the study period. Mean implementation adherence was 74.2% (95% CI 69.3–79.2) for medications that were actually used. Conclusion: Although actual use of medications dispensed was high, many pregnant women did not adhere to treatment recommendations. This nonadherence may impact maternal and child health and lead to overestimation of medication use in studies in perinatal pharmacoepidemiology relying on administrative databases. [ABSTRACT FROM AUTHOR]

Prominent social psychologists and major media outlets have put forward the notion that people of high socioeconomic status (SES) are more selfish and behave more unethically than people of low SES. In contrast, other research in economics and sociology has hypothesized and found a positive relationship between SES and prosocial and ethical behavior. We review the empirical evidence for these contradictory findings and conduct two direct, well-powered, and preregistered replications of the field studies by Piff and colleagues (2012) to test the relationship between SES and unethical/selfish behavior. Unlike the original findings, we find no evidence of a positive relationship between SES and unethical/selfish behavior in the two field replication studies. [ABSTRACT FROM AUTHOR]

Objectives: Strong reward responsiveness to food and insufficient inhibitory control are thought to be implicated in the development and maintenance of obesity. This narrative review addresses the role of inhibitory control in obesity and weight loss, and in how far inhibitory control is a promising target for weight loss interventions. Methods: PubMed, Web of Science, and Google Scholar were searched for papers up to May 2021. 41 papers were included. Results: Individuals with obesity have poorer food-specific inhibitory control, particularly when hungry, and less concurrent activation of inhibitory brain areas. Moreover, this was strongly predictive of future weight gain. More activation of inhibitory brain areas, on the other hand, was predictive of weight loss: individuals with successful weight loss initially show inhibitory brain activity comparable to that of normal weight individuals. When successful weight maintenance is achieved for at least 1 year, this inhibitory activity is further increased. Interventions targeting inhibitory control in obese individuals have divergent effects. Firstly, food-specific inhibitory control training is particularly effective for people with low inhibitory control and high BMI. Secondly, neuromodulation paradigms are rather heterogeneous: although rTMS to the left dorsolateral prefrontal cortex induced some weight-loss, multiple sessions of tDCS reduced food consumption (desire) and induced weight loss in two thirds of the papers. Thirdly, neurofeedback results in successful upregulation of brain activity and connectivity, but occasionally leads to increased food intake. In conclusion, inhibitory control is implicated in obesity. It can be targeted to promote weight loss although major weight losses have not been achieved. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) and augmented renal clearance (ARC), both alterations of the glomerular filtration rate (GFR), are prevalent in critically ill children and neonates. AKI and ARC prevalence estimates are based on estimation of GFR (eGFR) using serum creatinine (SCr), which is known to be inaccurate. We aimed to test our hypothesis that AKI prevalence will be higher and ARC prevalence will be lower in critically ill children when using iohexol-based measured GFR (mGFR), rather than using eGFR. Additionally, we aimed to investigate the performance of different SCr-based eGFR methods. Methods: In this single-center prospective study, critically ill term-born neonates and children were included. mGFR was calculated using a plasma disappearance curve after parenteral administration of iohexol. AKI diagnosis was based on the KDIGO criteria, SCr-based eGFR, and creatinine clearance (CrCL). Differences between eGFR and mGFR were determined using Wilcoxon signed-rank tests and by calculating bias and accuracy (percentage of eGFR values within 30% of mGFR values). Results: One hundred five children, including 43 neonates, were included. AKI prevalence was higher based on mGFR (48%), than with KDIGO or eGFR (11–40%). ARC prevalence was lower with mGFR (24%) compared to eGFR (38–51%). eGFR equations significantly overestimated mGFR (60–71 versus 41 ml/min/1.73 m2, p < 0.001–0.002). Accuracy was highest with eGFR equations based on age- and sex-dependent equations (up to 59%). Conclusion: Iohexol-based AKI prevalence was higher and ARC prevalence lower compared to standard SCr-based eGFR methods. Age- and sex-dependent equations for eGFR (eGFR-Smeets for neonates and eGFR-Pierce for children) best approached measured GFR and should preferably be used to optimize diagnosis of AKI and ARC in this population. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Background/Objective: To gain insight into both patients' and relatives' experiences with spiritual care (SC) in the intensive care unit (ICU). Methods: Method used was qualitative interviewing. This was a thematic, topic-centered, biographical, and narrative approach, using semistructured interviews with thematic analysis. A purposive sampling method was used to select a sample of ICU patients and ICU patients' relatives. An interview guide facilitated individual, semistructured interviews. The interview data were recorded by means of note-taking and audio-recording. Verbatim transcripts were compiled for analysis and interpretation. Results: All 12 participants—7 ICU patients and 5 family members of 5 other ICU patients—experienced ICU admission as an existential crisis. Participants would appreciate the signaling of their spiritual needs by ICU health care professionals (HCPs) at an early stage of ICU admission and subsequent SC provision by a spiritual caregiver. They regarded the spiritual caregiver as the preferred professional to address spiritual needs, navigate during their search for meaning and understanding, and provide SC training in signaling spiritual needs to ICU HCPs. Discussion: Early detection of existential crisis signals with ICU patients and relatives contributes to the mapping of spiritual and religious needs. Spiritual care training of ICU HCPs in signaling spiritual needs by ICU patients and relatives is recommended. Effective SC contributes to creating room for processing emotions, spiritual well-being, and satisfaction with integrated SC as part of daily ICU care. [ABSTRACT FROM AUTHOR]

Water safety plans address both routine operations and incident responses to support risk management in drinking water utilities. Their use and relevance in facing the challenges of the Covid-19 crisis were investigated via a survey distributed to water utilities and health or environmental agencies across the globe. Responses from 86 respondents from 38 countries were analysed to identify the water safety challenges faced and responses. Water safety plans appear to provide some preparedness and organizational advantages to utilities in facing the Covid-19 crisis, including stronger communication links between utilities and governing agencies. Guidance for future water safety planning is provided. [ABSTRACT FROM AUTHOR]

Background: Pharmacological trials in functional dyspepsia (FD) are associated with high placebo response rates. We aimed to identify the magnitude and contributing factors to the placebo response. Methods: We conducted a systematic review and meta‐analysis including randomized controlled trials (RCTs) with a dichotomous outcome in adult patients with FD that compared an active pharmacotherapeutic treatment with placebo. Our main outcome was identification of the magnitude of the pooled placebo response rate for the following endpoints: symptom responder, symptom‐free responder, adequate relief responder, and combined endpoint responder (i.e., the primary endpoint of each specific trial regarding treatment response). Several putative moderators (i.e., patient, disease, and trial characteristics) were examined. Key Results: We included 26 RCTs in our analysis. The pooled placebo response rate was 39.6% (95% CI 30.1–50.0) using the symptom responder definition, 20.5% (12.8–31.0) using the symptom‐free responder definition, 38.5% (33.8–43.6) using the adequate relief responder definition, and 35.5% (31.6–39.7) using the combined endpoint responder definition. A lower overall baseline symptom score was significantly associated with a higher placebo response rate. No other moderators were found to significantly impact the placebo response rate. Due to the lack of data, no analyses could be performed according to individual FD subtypes or symptoms. Conclusions and Inferences: The pooled placebo response rate in pharmacological trials in FD is about 39%, depending on which responder definitions is used. Future trials should consider applying an entry criterion based on minimal level of symptom severity to decrease the placebo response. We also suggest separate reporting of core FD symptoms pending more concrete harmonization efforts in FD trials. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to investigate differences in static and dynamic motor fatigability during grip and pinch tasks between children with unilateral spastic cerebral palsy (USCP) and children with typical development (TD) and between preferred and nonpreferred hands. Methods Fifty-three children with USCP and 53 age-matched children with TD (mean = 11 years 1 month; SD = 3 years 8 months) participated in 30-second maximum exertion sustained and repeated grip and pinch tasks. For sustained tasks, the Static Fatigue Index and the ratio of mean force between the first and last thirds of the curve were calculated. For repeated tasks, the ratio of mean force and the ratio of numbers of peaks between the first and last thirds of the curve were calculated. Results Higher Static Fatigue Index scores for grip and pinch were found with USCP in both hands and between hands in both groups. Dynamic motor fatigability showed inconsistent results, with higher levels of fatigability in children with TD than in children with USCP for grip in the ratio of mean force between the first and last thirds of the curve in nonpreferred hands and in the ratio of number of peaks between the first and last thirds of the curve in preferred hands. Conclusion Higher motor fatigability in children with USCP than in children with TD was found for static but not dynamic grip and pinch. Underlying mechanisms may play different roles in static and dynamic motor fatigability. Impact These results highlight that static motor fatigability in grip and pinch tasks should be part of a comprehensive upper limb assessment and that this could be the target of individualized interventions. [ABSTRACT FROM AUTHOR]

The size of an object equals the distance between the positions of its opposite edges. However, human sensory processing for perceiving positions differs from that for perceiving size. Which of these two information sources is used to control grip aperture? In this paper, we answer this question by prism adaptation of single-digit movements of the index finger and thumb. We previously showed that it is possible to adapt the index finger and thumb in opposite directions and that this adaptation induces an aftereffect in grip aperture in grasping. This finding suggests that grasping is based on the perceived positions of the contact points. However, it might be compatible with grasping being controlled based on size provided that the opposing prism adaptation leads to changes in visually perceived size or proprioception of hand opening. In that case, one would predict a similar aftereffect in manually indicating the perceived size. In contrast, if grasping is controlled based on information about the positions of the edges, the aftereffect in grasping is due to altered position information, so one would predict no aftereffect in manually indicating the perceived size. Our present experiment shows that there was no aftereffect in manually indicating perceived size. We conclude that grip aperture during grasping is based on perceived positions rather than on perceived size. [ABSTRACT FROM AUTHOR]

Accurate determination of glomerular filtration rate (GFR) is important. Several endogenous biomarkers exist for estimating GFR, yet, they have limited accuracy, especially in the paediatric population. Proenkephalin A 119–159 (PENK) is a novel and promising GFR marker, but its relation with age in children remains unknown. Also, the value of PENK has never been validated against measured GFR (mGFR) in children when compared to traditional GFR markers including serum creatinine (SCr), SCr-based estimated GFR (eGFR) and cystatin C (cysC). Critically ill children and term-born neonates were included in this single-centre, prospective study. Iohexol-based mGFR, SCr, and cysC were determined in each patient. eGFR was calculated using the bedside Schwartz equation, incorporating SCr and height. Spearman correlation coefficients were calculated to determine the correlation between mGFR and PENK, SCr, cysC and eGFR. For 97 patients (56 children and 41 neonates), mGFR, SCr, cysC and PENK levels were available. PENK levels were higher in young children and decreased to adult PENK reference values around two years of age. PENK levels were highly correlated with mGFR (ρ=−0.88, p<0.001), and similar to mGFR–eGFR correlation (ρ=−0.87, p<0.001). For cysC and SCr the correlation with mGFR was lower (ρ=−0.77 and ρ=−0.46, respectively. Both p<0.001). The correlation of PENK with mGFR was as good as SCr-based eGFR-mGFR correlation. To determine the added value of PENK in paediatric clinical care and prior to implementation, PENK reference values are needed and the development and validation of a paediatric PENK-based eGFR equation is necessary. [ABSTRACT FROM AUTHOR]

Background. Regarding sustainability in the intensive care unit (ICU), there is increasing interest in reducing material waste and avoiding unnecessary procedures. Therapeutic drug monitoring (TDM) of vancomycin, using a dedicated tube, is standard clinical care during treatment with vancomycin. Furthermore, in the ICU, on a daily basis, arterial blood gas (ABG) tests are frequently performed throughout the day. After analysis, a variable volume of blood is discarded. Lithium heparin (LiHep) syringes for ABG tests differ from normally used dipotassium ethylenediaminetetraacetic acid (K2EDTA) tubes. The primary objective was to compare both containers and validate the use of LiHep syringes. Secondary objectives were to evaluate the potential impact on saving materials, nursing time, and costs when implementing vancomycin TDM via LiHep syringes. Methods. Vancomycin analysis from sampling in lithium heparin (LiHep) syringes for ABG tests was validated and compared with the concentrations from conventional sampling in K2EDTA tubes. For method comparison, a Bland–Altman plot and Deming regression analysis were performed. The method was validated for inter- and intra-day precision and accuracy. Vancomycin was analyzed by means of the validated method using a particle-enhanced turbidimetric inhibition immunoassay (PETINIA) autoanalyzer. Furthermore, an analysis was conducted to evaluate the potential impact of implementing vancomycin sampling via ABG tests on savings in materials, nursing time, and costs. Results. From 18 patients, 24 plasma samples in both K2EDTA tubes and LiHep syringes were obtained and compared. The mean relative difference between the two containers was −2.0% (−3.0 to −0.93%). Both the Deming regression analysis and the Bland–Altman plot met the acceptance criteria. Potentially, over 1000 blood draws and accompanying materials and packaging can be saved when vancomycin samples are obtained by means of scavenged LiHep syringes. The vancomycin analysis for LiHep syringes showed a total interday precision of 1.95% and an accuracy of 99.7%. The total intraday precision was 2.22%, and the accuracy was 99.2%. Accuracy and precision values were within the acceptance criteria of recovery 85 to 115% and ≤15%, respectively. Conclusion. No significant differences were found in vancomycin concentration between the two analyses, and the LiHep analysis was validated for further implementation in clinical care. Residual blood from ABG test samples can be used for TDM of vancomycin, resulting in a potential reduction of materials used and the number of blood draws. These results will contribute to a more sustainable TDM process with benefits for the patient. [ABSTRACT FROM AUTHOR]

Why do smart policy makers who try to learn from policy failure end up overgeneralizing these lessons when facing new crises? This article focuses on the policy learning that can come in the wake of perceived policy failure, and the consequences that lesson learning has for diagnosing and tackling subsequent crises. We argue, in contrast to much of the existing literature, that failure can result in policy learning when the policy area is highly complex and there are recognized experts that have epistemic authority in the issue. At the same time, lessons tend to become overgeneralized in which policy makers facing a new crisis extrapolate the lessons learned from the past failure with little consideration of whether the circumstances are similar enough to be applicable. Our argument is assessed empirically using a process‐tracing analysis of how the EU responded to the Spanish banking crisis in 2012. Related Articles: Butz, Adam M., Michael P. Fix, and Joshua L. Mitchell. 2015. "Policy Learning and the Diffusion of Stand‐Your‐Ground Laws." Politics & Policy 43(3): 347–77. https://doi.org/10.1111/polp.12116. Considine, Mark. 2012. "Applying Design Theory to Public Policy." Politics & Policy 40(4): 704–24. http://onlinelibrary.wiley.com/doi/10.1111/j.1747‐1346.2012.00372.x. Raile, Eric D., Amber N. Raile, Charles T. Salmon, and Lori Ann Post. 2014. "Defining Public Will." Politics & Policy 42(1): 103–30. http://onlinelibrary.wiley.com/doi/10.1111/polp.12063. [ABSTRACT FROM AUTHOR]

When intercepting moving targets, people perform slightly better if they follow their natural tendency to pursue the target with their eyes. Is this because the velocity is judged more precisely when pursuing the target? To find out, we compared how well people could determine which of two sequentially presented moving bars was moving faster. There was always also a static bar on the screen. People judged the moving bar's velocity about 10% more precisely when pursuing it than when fixating the static bar. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare systems require healthcare professionals and students educated in an interprofessional (IP) context. Well-designed assessments are needed to evaluate whether students have developed IP competencies, but we currently lack evidence-informed guidelines to create them. This study aims to provide guidelines for the assessment of IP competencies in healthcare education. Methods: A qualitative consensus study was conducted to establish guidelines for the design of IP assessments using the nominal group technique. First, five expert groups (IP experts, patients, educational scientists, teachers, and students) were asked to discuss design guidelines for IP assessment and reach intra-group consensus. Second, one heterogeneous inter-group meeting was organized to reach a consensus among the expert groups on IP assessment guidelines. Results: This study yielded a comprehensive set of 26 guidelines to help design performance assessments for IP education: ten guidelines for both the IP assessment tasks and the IP assessors and six guidelines for the IP assessment procedures. Discussion: The results showed that IP assessment is complex and, compared to mono-professional assessment, high-quality IP assessments require additional elements such as multiple IP products and processes to be assessed, an IP pool of assessors, and assessment procedures in which standards are included for the IP collaboration process as well as individual contributions. The guidelines are based on expert knowledge and experience, but an important next step is to test these design guidelines in educational practice. [ABSTRACT FROM AUTHOR]

Most research papers in psychology study the behaviour of a sample of participants. To characterise this sample, authors report various characteristics, frequently including the mean age and the associated standard deviation. However, based on reports from authors who publish in Acta Psychologica and from respondents on X/Twitter, the present paper shows that some authors use rounded-down ages whereas others don't, which lead to an uncertainty of 0.5 year in the average age. The results furthermore show that the authors tend to report the average age with two decimals precision, irrespective of the uncertainty of this average. I recommend that publications should explicitly mention how the average age is determined and report its value using a number of decimals that reflects its uncertainty. • Authors report mean age without disclosing whether it is based on rounded-down age. • This causes a potential bias of half a year in the reported value. • The number of decimals generally suggests more certainty than the data provide. • Two recommendations are made to ensure reliable age-reporting. [ABSTRACT FROM AUTHOR]