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Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. [ABSTRACT FROM AUTHOR]

The reconstruction of clonal families (CFs) in B-cell receptor (BCR) repertoire analysis is a crucial step to understand the adaptive immune system and how it responds to antigens. The BCR repertoire of an individual is formed throughout life and is diverse due to several factors such as gene recombination and somatic hypermutation. The use of Adaptive Immune Receptor Repertoire sequencing (AIRR-seq) using next generation sequencing enabled the generation of full BCR repertoires that also include rare CFs. The reconstruction of CFs from AIRR-seq data is challenging and several approaches have been developed to solve this problem. Currently, most methods use the heavy chain (HC) only, as it is more variable than the light chain (LC). CF reconstruction options include the definition of appropriate sequence similarity measures, the use of shared mutations among sequences, and the possibility of reconstruction without preliminary clustering based on V- and J-gene annotation. In this study, we aimed to systematically evaluate different approaches for CF reconstruction and to determine their impact on various outcome measures such as the number of CFs derived, the size of the CFs, and the accuracy of the reconstruction. The methods were compared to each other and to a method that groups sequences based on identical junction sequences and another method that only determines subclones. We found that after accounting for data set variability, in particular sequencing depth and mutation load, the reconstruction approach has an impact on part of the outcome measures, including the number of CFs. Simulations indicate that unique junctions and subclones should not be used as substitutes for CF and that more complex methods do not outperform simpler methods. Also, we conclude that different approaches differ in their ability to correctly reconstruct CFs when not considering the LC and to identify shared CFs. The results showed the effect of different approaches on the reconstruction of CFs and highlighted the importance of choosing an appropriate method. [ABSTRACT FROM AUTHOR]

Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist. This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle. Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p =.886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = −7.217; p =.046; Cohens d = 0.33), but not depressive symptoms (B = −1.041; p =.607) than TAU. The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low. Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy. • Online emotion regulation training improved emotion regulation in depressed patients. • iERT did not reduce revictimization rates or depressive symptoms compared to TAU. • Violent victimization rates decreased substantially during psychotherapy. [ABSTRACT FROM AUTHOR]

Religious symbols in public schools – A European and international legal analysis: The pluralistic society poses challenges for public educational institutions. This article analyses UN rulings and ECtHR case law regarding the wearing of religious symbols by pupils and students in public education. The aim is to provide a frame of reference for national policy and practice in the field of public education. [ABSTRACT FROM AUTHOR]

Starting December 2019, a novel coronavirus (SARS-CoV-2) spread among humans across the world. From 2020 onward, farmed mink were found susceptible to the virus. In this paper, we describe the Dutch surveillance system and the added surveillance components for early detection of SARS-CoV-2 outbreaks and their results in Dutch mink farms. In the Netherlands, a surveillance system was in place in which mink farmers could submit carcasses for postmortem evaluation and could contact a telephone helpdesk for veterinary advise. Through this system, the first SARS-CoV-2 outbreak in two mink farms was detected in April 2020. Immediately, the Dutch Ministry of Agriculture commissioned a consortium of statutory and research institutes to intensify the surveillance system. The program consisted of both passive surveillance, i.e., mandatory notifications and active surveillance components, i.e., serological screenings and weekly risk-based sampling of dead mink for early detection of new SARS-CoV-2 infections. When one of the surveillance components indicated a suspicion of a possible SARS-CoV-2 infection, follow-up samplings were conducted and at confirmation, all mink were culled. During 2020, 67 out of 124 mink farms that were under surveillance became infected with SARS-CoV-2 (54%). Of these, 31 were detected based on clinical signs (passive surveillance of clinical signs) and 36 were detected through active surveillance. From the mink farms with a new SARS-CoV-2 outbreak that was detected through the surveillance, in 19% of the farms (n = 7), the mink never showed any clinical signs of SARS-CoV-2 and might have been missed by the passive notification system. This study underlines the added value of a surveillance system that can quickly be intensified. The subsequent combination of both passive and active surveillance has shown to be effective in the early detection of emerging pathogens, which is important to minimize the risk of zoonotic spill-over. [ABSTRACT FROM AUTHOR]

The reconstruction of clonal families (CFs) in B-cell receptor (BCR) repertoire analysis is a crucial step to understand the adaptive immune system and how it responds to antigens. The BCR repertoire of an individual is formed throughout life and is diverse due to several factors such as gene recombination and somatic hypermutation. The use of Adaptive Immune Receptor Repertoire sequencing (AIRR-seq) using next generation sequencing enabled the generation of full BCR repertoires that also include rare CFs. The reconstruction of CFs from AIRR-seq data is challenging and several approaches have been developed to solve this problem. Currently, most methods use the heavy chain (HC) only, as it is more variable than the light chain (LC). CF reconstruction options include the definition of appropriate sequence similarity measures, the use of shared mutations among sequences, and the possibility of reconstruction without preliminary clustering based on V- and J-gene annotation. In this study, we aimed to systematically evaluate different approaches for CF reconstruction and to determine their impact on various outcome measures such as the number of CFs derived, the size of the CFs, and the accuracy of the reconstruction. The methods were compared to each other and to a method that groups sequences based on identical junction sequences and another method that only determines subclones. We found that after accounting for data set variability, in particular sequencing depth and mutation load, the reconstruction approach has an impact on part of the outcome measures, including the number of CFs. Simulations indicate that unique junctions and subclones should not be used as substitutes for CF and that more complex methods do not outperform simpler methods. Also, we conclude that different approaches differ in their ability to correctly reconstruct CFs when not considering the LC and to identify shared CFs. The results showed the effect of different approaches on the reconstruction of CFs and highlighted the importance of choosing an appropriate method. [ABSTRACT FROM AUTHOR]

Mimicking another individual functions as a social glue: it smoothens the interaction and fosters affiliation. Here, we investigated whether the intrinsic motivation to affiliate with others, stemming from attachment relationships, modulates individuals' engagement in facial mimicry (FM). Participants (N = 100; MAge = 24.54 years, SDAge = 3.90 years) observed faces with happy, sad, and neutral expressions, while their facial muscle activity was recorded with electromyography. Attachment was measured with the Attachment Styles Questionnaire, which provides a multidimensional profile for preoccupied and dismissing styles. It was proposed that the preoccupied and dismissing styles are characterized by high and low intrinsic affiliation motivation, respectively, and these were hypothesized to manifest in enhanced and diminished FM. Participants showed happy and sad FM, yet attachment styles did not significantly predict FM. Bayes Factor analyses lend evidence favoring the null hypothesis, suggesting that adult attachment do not contribute to FM. [ABSTRACT FROM AUTHOR]

Uncertainty complicates the issue of climate change. Climate change education should therefore help students to address uncertainty. The question, then, is how to educate students about that which is 'in the dark'. Here, we might find a role for games as a resource for climate change education. This study explores which climate change-related uncertainties were represented in three games. A qualitative content analysis was conducted using a framework that distinguishes between different types of uncertainty. Most uncertainties in the games concerned questions such as, 'What will happen?' and 'What should I do?' Five main topics of uncertainty were represented in the games: (a) climate change measures, action and cooperation; (b) climate change consequences; (c) resource availability and management, and survival; (d) events; and (e) perspectives on the climate crisis, on measures and on the treatment of others. The games approached these uncertainties differently. The study forms a starting point for research on the potential of games for addressing climate change-related uncertainty in education. [ABSTRACT FROM AUTHOR]

Background: This study explores what pre-service teachers identify as uncertainties within two climate board games and to what aspects of reality they relate these uncertainties, if at all. Should games be suitable resources for teaching topics related to climate change uncertainty, I expect pre-service teachers to (a) identify uncertainties within climate board games, and (b) relate these uncertainties to reality. Intervention: To explore whether and how pre-service teachers identify and relate in-game uncertainties to reality, pre-service teachers played and discussed two climate board games (Another Future and CATAN: Oil Springs Scenario). Methods: A content analysis of pre-service teachers' audio-recorded discussions about the games was conducted. First, a conventional content analysis indicated the uncertainties that they identified. Second, further analysis showed how the pre-service teachers related these uncertainties to reality. Results: This study indicates that pre-service teachers identify various uncertainties from two different board games, including the occurrence/impact of catastrophes and the behaviour of players, who can ruin the game. In most cases, the pre-service teachers link these uncertainties to reality. Pre-service teachers discuss, for example, political dilemmas and interests, climate justice issues, challenges of and adaptation to possible catastrophes, and the significance of environmental activism. Discussion: The research findings are discussed in relation to existing literature on uncertainty in climate change games. Teacher educators and teachers using games for education about climate change uncertainties are recommended to encourage dialogues about these uncertainties, use or take into account context, and consider games as tools for learning to live with climate change uncertainty. [ABSTRACT FROM AUTHOR]

This article discusses a scientific study of a mummified child from Zagreb Cathedral in Croatia. The study aimed to gain a deeper understanding of the child's life and human physiology through medical and scientific assessment of the remains. The remains were imaged using various techniques, including digital radiographs and CT scans, and isotope analysis was conducted. The findings revealed that the child was between three and five years old at the time of death and that the mummification process likely occurred in the tenth century CE. The study raises questions about why the child was mummified using an old Egyptian technique despite the practice being discontinued in Egypt by the seventh century CE. Further molecular analysis is hoped to provide more insights into these questions. [Extracted from the article]

Background: Healthcare professionals in palliative care are found to be confronted with moral challenges on a frequent basis. CURA is a low-threshold instrument for dialogical ethical reflection that was developed to deal with these challenges. A previous study identified the need of healthcare professionals to be trained to introduce CURA in their organization, initiate and facilitate reflections with CURA, and contribute to the implementation of CURA. The aim of this study was to develop and evaluate a training for professionals to become 'CURA-ambassadors'. Methods: The training was developed in a participatory way in two cycles. We trained 72 healthcare professionals. The training was evaluated by means of a questionnaire and six semi-structured interviews. Results: The study resulted in a blended learning training combining training sessions with an e-module and with practicing with organizing and facilitating CURA in daily healthcare practice. The main objectives of the training are to enable CURA-ambassadors to introduce CURA within their organization, initiate and facilitate ethical reflections using CURA, and contribute to the implementation of CURA. Participants were generally positive about the training program and the trainers. Technical difficulties related to the e-module were mentioned as main point of improvement. Discussion: The training program can generate ownership, responsibility, and competency among CURA-ambassadors, which are essential foundations for implementing complex interventions in healthcare practice. The training program received positive evaluations shortly after completing the program. This study adds to our understanding of what is needed for healthcare professionals to use CURA, in order to support them in dealing with moral challenges and to foster their moral resilience. Further research is needed to assess whether participants experience the training as sufficient and effective when using and implementing CURA structurally in their organizations over a longer period of time. [ABSTRACT FROM AUTHOR]

Introduction: Survival of childhood-onset craniopharyngioma (cCP) is excellent; however, many survivors suffer from hypothalamic-pituitary dysfunction. Growth hormone replacement therapy (GHRT) is of high importance for linear growth and metabolic outcome. Optimal timing for initiation of GHRT in cCP is on debate because of concerns regarding tumor progression or recurrence. Methods: A systematic review and cohort studys were performed for the effect and timing of GHRT on overall mortality, tumor progression/recurrence, and secondary tumors in cCP. Within the cohort, cCP receiving GHRT ≤1 year after diagnosis were compared to those receiving GHRT >1 year after diagnosis. Results: Evidence of 18 included studies, reporting on 6,603 cCP with GHRT, suggests that GHRT does not increase the risk for overall mortality, progression, or recurrent disease. One study evaluated timing of GHRT and progression/recurrence-free survival and found no increased risk with earlier initiation. One study reported a higher than expected prevalence of secondary intracranial tumors compared to a healthy population, possibly confounded by radiotherapy. In our cohort, 75 of 87 cCP (86.2%) received GHRT for median of 4.9 years [0.0–17.1]. No effect of timing of GHRT was found on mortality, progression/recurrence-free survival, or secondary tumors. Conclusion: Although the quality of the evidence is low, the available evidence suggests no effect of GHRT or its timing on mortality, tumor progression/recurrence, or secondary neoplasms in cCP. These results support early initiation of GHRT in cCP aiming to optimize linear growth and metabolic outcome. Prospective studies are needed to increase the level of evidence upon the optimal timing to start GHRT in cCP patients. [ABSTRACT FROM AUTHOR]

Background : Perioperative preventive measures are important to further reduce the rate of periprosthetic joint infections (PJI) in patients undergoing total hip arthroplasty (THA). During THA surgery, joint capsule sutures are commonly placed to optimize exposure and reinsertion of the capsule. Bacterial contamination of these sutures during the procedure poses a potential risk for postoperative infection. In this exploratory study, we assessed the contamination rate of capsule sutures compared to the contamination of the remains of exchanged control sutures at the time of closure. Methods : In 100 consecutive patients undergoing primary THA capsule sutures were exchanged by sterile sutures at the time of capsule closure. Both the original sutures and the remainder of the newly placed (control) sutures were retrieved, collected and cultured for ten days. Types of bacterial growth and contamination rates of both sutures were assessed. Results : Sutures from 98 patients were successfully collected and analyzed. Bacterial growth was observed in 7/98 (7.1%) of the capsule sutures versus 6/98 (6.1%) of the control sutures, with a difference of 1% [CI -6–8]. There was no clear pattern in differences in subtypes of bacteria between groups. Conclusions : This study showed that around 7% of capsule sutures used in primary THA were contaminated with bacteria and as such exchange by new sutures at the time of capsule closure could be an appealing PJI preventive measure. However, since similar contamination rates were encountered with mainly non-virulent bacteria for both suture groups, the PJI preventive effect of this measure appears to be minimal. [ABSTRACT FROM AUTHOR]

How well populations can cope with global warming will often depend on the evolutionary potential and plasticity of their temperature‐sensitive, fitness‐relevant traits. In Bechstein's bats (Myotis bechsteinii), body size has increased over the last decades in response to warmer summers. If this trend continues it may threaten populations as larger females exhibit higher mortality. To assess the evolutionary potential of body size, we applied a Bayesian 'animal model' to estimate additive genetic variance, heritability and evolvability of body size, based on a 25‐year pedigree of 332 wild females. Both heritability and additive genetic variance were reduced in hot summers compared to average and cold summers, while evolvability of body size was generally low. This suggests that the observed increase in body size was mostly driven by phenotypic plasticity. Thus, if warm summers continue to become more frequent, body size likely increases further and the resulting fitness loss could threaten populations. [ABSTRACT FROM AUTHOR]

Death is accompanied by rituals in every culture. It seems universal that we symbolically approach this life transition. This study focuses on experiences of bereaved who could not physically attend a funeral during COVID-19. Ten Dutch bereaved were interviewed. Disembodiment in terms of (1) not participating in ritual time and place, (2) experiencing live-stream funerals as lonely, and (3) feeling a disruption of one's grief, were revealed as main themes by thematic analysis. Without physical participation the respondents felt (partially) disconnected from the ritual and isolated from the community. The physical absence impacted ritual transformation and meaning making after a loss. [ABSTRACT FROM AUTHOR]

This research uniquely examines time perspective (TP) predictors of online security behaviour. Participants (N = 121) completed questionnaires assessing computer security use, security behaviour intentions, and time perspective. Stepwise multiple regression analysis revealed computer security use was positively by predicted by Future TP. Device Securement was positively predicted from Carpe Diem TP. Updating was positively predicted from a Carpe Diem TP and a Past Negative TP. Proactive Awareness was negatively predicted from Present Hedonism. As time perspective is malleable, an ability to switch effectively between the TPs may enhance aspects of online security. [ABSTRACT FROM AUTHOR]

Children with low grade glioma (LGG) may present with, or develop, elevated concentrations of insulin‐like growth factor 1 (IGF‐1). The prevalence, pathophysiology, or its possible clinical effects are poorly understood. Our aim was to evaluate the prevalence of such elevated IGF‐1 concentrations and to describe its association with linear growth, body mass index (BMI), pituitary outcome, and tumor behavior in a large retrospective national cohort. From a nationwide retrospective cohort of pediatric brain tumor survivors diagnosed between 2002 and 2012, tumor, treatment, endocrine, and auxological data of children with LGG were collected (n = 358). Prevalence and risk factors for elevated IGF‐1 concentrations, as well as the association between having elevated IGF‐1 concentrations and receiving tumor treatment, were explored. IGF‐1 concentrations had only been measured in 45.5% of cases (n = 163/358). In 18.4% of 163 children with available IGF‐1 measurements, IGF‐1 concentrations were found elevated. No association was described between having an elevated IGF‐1 concentration and tumor behavior or height SDS at last moment of follow‐up. Multivariate logistic regression identified posterior pituitary disorder (OR 6.14 95% CI: 2.21–17.09) and BMI SDS at follow‐up (OR 1.56 95% CI: 1.09–2.20) to be significantly associated with elevated IGF‐1 concentrations. In this retrospective cohort of children with LGG, IGF‐1 was found elevated in 18.4% of children with available IGF‐1 measurements. Elevated IGF‐1 seems to be related to hypothalamic dysfunction worsening over time. Larger prospective cohort studies are needed. [ABSTRACT FROM AUTHOR]

Imaging of the lymphatic system has always encountered difficulties, such as high costs, timeconsuming procedures, and low-resolution images. Each method of imaging provides its own challenges. The use of high-resolution ultrasonography (HR-US) and microvascular flow imaging (MVFI) may prove to be the most effective method for visualizing the superficial lymphatic vessels. This study investigated the utilization of HR-US and MVFI in imaging inguinal lymph nodes and vessels, as well as the innovative use of an intranodal saline injection that acted as a contrast agent. This technical note aims to demonstrate that HR-US and MVFI, in combination with an intranodal saline injection, are applicable to the dynamic imaging of superficial inguinal lymph nodes and vessels. [ABSTRACT FROM AUTHOR]

In the early modern Low Countries, narrative cartography was a thriving new medium aimed at disseminating information about events concerning the Dutch Revolt. News maps combined spatial and narrative information in order to tell the story of a recent event to a large audience, representing actions, moments, and (spatial) change. They were in essence temporal products. To keep the maps topical, map publishers released new map states by modifying their copperplates and adding the latest news, sometimes multiple times. This article analyses the 'updated' map series by the Amsterdam publisher Claes Jansz Visscher that reported on events in the Scheldt river area between Bergen op Zoom and Antwerp (such as the 1631 Battle of the Slaak). The central question is how and why Visscher incorporated temporal information into his news maps. First, it shows the tools and strategies how Visscher, in comparison to other Northern and Southern Netherlandish news map publishers, added temporal information to his maps. Then, the rhythm of mapping and the map narratives are put in the context of real-time events and news culture, and the circulation and use of the maps are interpreted in the context of memory culture and historical consciousness. The article shows how news maps imply specific narratives of events and invite contemporary and later users to engage with and 'navigate' the past, present, and future in ways that transcend the limiting idea of time as a linear progress. [ABSTRACT FROM AUTHOR]

Background: The general aim of this study was to investigate the effectiveness of blended Cognitive Behavioral Therapy (bCBT) as compared to Treatment as Usual (TAU) for depression in specialized routine mental healthcare in the Netherlands. We further explored a range of secondary outcome variables, including quality of life, clinical response, remission and reliable improvement, as well as clinical deterioration and potential negative effects of treatment. Methods: n = 103 patients with Major Depressive Disorder were recruited as part of the E-COMPARED project, and randomly allocated to bCBT (n = 53) or TAU (n = 50). Measurements took place at baseline, 3-, 6- and 12-months follow-up. Treatment effects were analyzed using linear mixed-effects models for repeated measures. Results: Depressive symptoms significantly declined and quality of life significantly improved over time in both bCBT and TAU during 12-months follow-up. No significant interaction effects between treatment group and assessment point were found. Likewise, there were no significant differences between the two treatment groups on secondary outcomes. Patients following bCBT went from severe to mild symptom severity, along with large within-group effects. Conclusion: Applying bCBT in routine specialized mental health care seems promising, but is a relatively new form of treatment that is still under development and more research is needed. Clinical Trial Registration: Netherlands Trials Register NTR4962. Registered on 5 January 2015. [ABSTRACT FROM AUTHOR]

The freedom of religion or belief is internationally recognized. However, studies demonstrate that the implementation of the right to apostasy, an essential aspect of this freedom, encounters difficulties in state practices. Doctrinal and historical research is conducted regarding the UN legal documents and the drafting history in order to demonstrate that the phrasing of the freedom to change religion in the provisions has been gradually altered since the legal establishment in 1948. Within the UN, member states have succeeded in changing the provisions, resulting in conceptual ambiguity regarding the right to apostasy. It is a matter of concern that there is little recognition, within the UN and in academia, of the fact that the explicit right to apostasy has been disregarded, resulting in diminishing the normative force of the religious freedom provision. [ABSTRACT FROM AUTHOR]

Background: Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making. The aim of this study was to develop a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke.Methods: A convergent mixed methods design was used, starting with needs assessments among patients with stroke and health care professionals (HCPs). Results of these assessments were used to develop the PtDA with integrated outcome information in several co-creation sessions. Subsequently, acceptability and usability were tested to optimize the PtDA. Development was guided by the International Patient Decision Aids Standards (IPDAS) criteria.Results: In total, 74 patients and 111 HCPs participated in this study. A three-component PtDA was developed, consisting of: 1) a printed consultation sheet to introduce the options for discharge destinations, containing information that can be specified for each individual patient; 2) an online information and deliberation tool to support patient education and clarification of patient values, containing an integrated "patients-like-me" model with outcome information about discharge destinations; 3) a summary sheet to support actual decision-making during consultation, containing the patient's values and preferences concerning discharge planning. In the acceptability test, all qualifying and certifying IPDAS criteria were fulfilled. The usability test showed that patients and HCPs highly appreciated the PtDA with integrated outcome information.Conclusions: The developed PtDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness. [ABSTRACT FROM AUTHOR]

Large brains provide adaptive cognitive benefits but require unusually high, near-constant energy inputs and become fully functional well after their growth is completed. Consequently, young of most larger-brained endotherms should not be able to independently support the growth and development of their own brains. This paradox is solved if the evolution of extended parental provisioning facilitated brain size evolution. Comparative studies indeed show that extended parental provisioning coevolved with brain size and that it may improve immature survival. The major role of extended parental provisioning supports the idea that the ability to sustain the costs of brains limited brain size evolution. How do large-brained species account for the high energy requirements of their growing brains when they cannot yet produce the cognitive benefits needed to provide the energy? In this Essay, the authors suggest that extended parental provisioning could solve this energy dilemma. [ABSTRACT FROM AUTHOR]

Objective: Hypothalamic syndrome (HS) in childhood is a rare condition. Its epidemiology is not well known because incidence and prevalence are related to very rare underlying diseases. In addition, different criteria for the syndrome are used across studies. Recognizing the HS may be difficult, due to its rareness and variety of symptoms. Having diagnostic criteria for signs and symptoms of hypothalamic dysfunction may aid in early recognition and diagnosis, in the reporting and understanding of its etiology, in predicting its course and its management. We aimed to define diagnostic criteria for hypothalamic dysfunction and a score for the presence of HS in childhood. Methods: Diagnostic criteria for hypothalamic dysfunction were developed and subdivided into hyperphagia, hypophagia, body mass index, behavioral problems, sleep disorders, temperature regulation disorders, pituitary dysfunction, radiological hypothalamic assessment, and presence/suspicion of a hypothalamic genetic syndrome. Subsequently, the scoring system was tested in a retrospective cohort of 120 patients at risk for hypothalamic dysfunction. Results: A score for presence of HS was developed. Using this new hypothalamic score, in total 52.5% were scored as having HS. Of these patients, 76.7% were diagnosed with pituitary dysfunction, 32.5% with hyperphagia, 40% with sleep disorders, and 14.2% with temperature dysregulation. For several criteria, clinical data was missing in more than 50% of cases. Conclusions: The here proposed diagnostic criteria for hypothalamic dysfunction and score for presence of HS may be used for care purposes and to aid in early recognition. Also it will be useful for research or registration purposes. [ABSTRACT FROM AUTHOR]

This paper aggregates and summarizes studies that use paleoradiology techniques in the analysis of pediatric remains. Building on these findings, we offer evidence‐based, best‐practice protocols for the use of radiographic techniques in the assessment of pediatric remains from archaeological contexts. We also provide a recommended reporting worksheet for recording findings in a standardized way. After reviewing studies of pediatric remains that used radiographic techniques, with a focus on three major bioarchaeological journals, PubMed, and the Yearbook of Mummy Studies, we identified areas for improvement in the acquisition and reporting of paleoradiographic findings in pediatric remains. Although radiological techniques are used with increasing frequency in the assessment of pediatric remains, no standardized pediatric imaging protocols presently exist. We combine insights gained from existing literature with current clinical imaging protocols in order to provide best‐practice protocols for the acquisition and reporting of radiographic findings from archeological contexts, specific to pediatric remains. This is, as far as we know, the first proposal of imaging protocols specifically tailored for the assessment of pediatric remains from bioarchaeological contexts. Recognizing the limitations faced by archaeologists around the use of imaging technologies in their fieldwork (including lack of funding, equipment access, and permit acquisition, among others), this review is offered not to criticize previous work, but in the hope that the need for appropriate radiographic study can be incorporated into research plans and funding applications from the beginning, and that granting agencies will encourage and support these types of analyses in skeletal studies. It holds implications for how paleoradiology techniques might be systematically used and applied to pediatric remains from multiple time periods, across the world. Our proposed imaging acquisition and reporting protocols are primarily based on English‐language sources. Further assessment of the proposed protocols, following systematic application in multiple contexts, is recommended. [ABSTRACT FROM AUTHOR]

Summary: Background: Tofacitinib is an oral Janus kinase (JAK) inhibitor and is registered for the treatment of ulcerative colitis (UC). The effectiveness of tofacitinib has been evaluated up to 12 months of treatment. Aim: The aim of this study was to assess the effectiveness and safety of 24 months of tofacitinib use in UC patients in the Netherlands. Methods: Patients initiating tofacitinib treatment were included in the ICC Registry, a nationwide, observational registry. Patients were prospectively evaluated for up to 24 months. The primary outcome was corticosteroid‐free clinical remission (CSFR, Simple Clinical Colitis Activity Index [SCCAI] ≤2) at week 104. Secondary outcomes included biochemical remission (C‐reactive protein (CRP) ≤5 mg/L and faecal calprotectin (FC) ≤250 μg/g), safety, and discontinuation rate. Results: We included 110 patients of whom 104 (94.5%) were anti‐TNF experienced. After 104 weeks of tofacitinib, 31.8% (34/107) were in CSFR, 23.4% (25/107) in biochemical remission and 18.7% (20/107) in combined clinical and biochemical remission. Of the patients in CSFR at week 52, 76.5% (26/34) remained so after 104 weeks of treatment. Sixty‐one patients (55.5%) discontinued tofacitinib after a median duration of 13 weeks (IQR 7–34). The main reasons for discontinuation were non‐response (59%), loss of response (14.8%), and adverse events (18%). There were 33.9 possible tofacitinib‐related adverse events per 100 patient‐years during follow‐up. Adverse events most probably related to tofacitinib were skin reactions and headaches. There were 6.4 herpes zoster infections per 100 patient‐years. Conclusion: Tofacitinib was effective in 31.8% of patients after 24 months of treatment. [ABSTRACT FROM AUTHOR]

When teaching infants new actions, parents tend to modify their movements. Infants prefer these infant‐directed actions (IDAs) over adult‐directed actions and learn well from them. Yet, it remains unclear how parents' action modulations capture infants' attention. Typically, making movements larger than usual is thought to draw attention. Recent findings, however, suggest that parents might exploit movement variability to highlight actions. We hypothesized that variability in movement amplitude rather than higher amplitude is capturing infants' attention during IDAs. Using EEG, we measured 15‐month‐olds' brain activity while they were observing action demonstrations with normal, high, or variable amplitude movements. Infants' theta power (4–5 Hz) in fronto‐central channels was compared between conditions. Frontal theta was significantly higher, indicating stronger attentional engagement, in the variable compared to the other conditions. Computational modelling showed that infants' frontal theta power was predicted best by how surprising each movement was. Thus, surprise induced by variability in movements rather than large movements alone engages infants' attention during IDAs. Infants with higher theta power for variable movements were more likely to perform actions successfully and to explore objects novel in the context of the given goal. This highlights the brain mechanisms by which IDAs enhance infants' attention, learning, and exploration. [ABSTRACT FROM AUTHOR]

Simple Summary: To protect animal and human health, it is important to detect disease early and prevent spreading. Other common aims of animal health surveillance are disease monitoring and proving freedom of disease. In a good surveillance system, representative information of farmers and veterinarians from the entire country should be collected. Our study focused on the validity of the Dutch passive surveillance components based on veterinary helpdesk and postmortem data. We examined whether data was received from the entire country and represented the swine and cattle sector in the Netherlands. The difference between the region with the highest and lowest contact rate was 12.8 and 6.1 fold for cattle and pigs, respectively; for postmortem, this was 4.0 and 38.3. Part of the differences could be explained by the distance to the postmortem facility and farm density. We found that veterinary practices serving few farms and veterinary practices serving many cattle farms had fewer contacts compared to other practices. Although this study found regions and practices with lower-than-expected contacts and postmortems, information was obtained from all regions and most veterinarians. The results can be used to improve the coverage and representativeness by an increased focus on specific regions, farms or veterinary practices. Common aims of animal health surveillance systems are the timely detection of emerging diseases and health status monitoring. This study aimed to evaluate the coverage and representativeness of passive surveillance components for cattle and swine in the Netherlands from 2015–2019. The passive surveillance components consisted of a telephone helpdesk for veterinary advice and diagnostic and postmortem facilities. Spatial analysis showed heterogeneity (range in RR = 0.26–5.37) of participation across the Netherlands. Generalized linear mixed models showed that distance to the diagnostic facility and farm density were associated with the number of contacts of farmers with the helpdesk and postmortem examination. The contact rate of veterinary practices was associated with their number of clients, ranging in RR from 0.39 to 1.59. We concluded that the evaluation indicated differences in coverage of the passive surveillance components across regions, farms and veterinary practices. Due to the absence of emerging infections in the study period, we were unable to estimate the consequences of the observed differences for the early detection of disease. Nevertheless, regions and veterinary practices with low participation in passive surveillance might be a risk for early detection, and consequently, further understanding of the motivation to participate in passive surveillance components is needed. [ABSTRACT FROM AUTHOR]

Comprehensive Genomic Profiling (CGP) allows for the identification of many targets. Reimbursement decision-making is, however, challenging because besides the health benefits of on-label treatments and costs, other factors related to diagnostic and treatment pathways may also play a role. The aim of this study was to identify which other factors are relevant for the technology assessment of CGP and to summarize the available evidence for these factors. After a scoping search and two expert sessions, five factors were identified: feasibility, test journey, wider implications of diagnostic results, organisation of laboratories, and "scientific spillover". Subsequently, a systematic search identified 83 studies collecting mainly evidence for the factors "test journey" and "wider implications of diagnostic results". Its nature was, however, of limited value for decision-making. We recommend the use of comparative strategies, uniformity in outcome definitions, and the inclusion of a comprehensive set of factors in future evidence generation. [Display omitted] • Comprehensive genomic profiling (GCP) is increasingly used in oncology. • Alongside clinical benefit and costs, five factors influence the choice for CGP. • Limited evidence exists for a technology assessment involving the five factors. • No or suboptimal comparative strategies were used in studies examining CGP. • Heterogeneous definitions of outcomes relating to the five factors were observed. [ABSTRACT FROM AUTHOR]

Background: Belimumab, an anti-B-cell activating factor antibody, is approved for the treatment of auto-antibody positive systemic lupus erythematosus with a high degree of disease activity. Anti-CD20 B cell depletion with rituximab is used in refractory SLE as well, although with variable responses. We hypothesized that incomplete B cell depletion, related to a surge in BAFF levels following rituximab treatment, can cause ongoing disease activity and flares. The Synbiose 1 study primarily focused on immunological effects and shows the preliminary clinical benefit of combined rituximab and belimumab in SLE. The Synbiose 2 study will evaluate the clinical efficacy of combining belimumab with rituximab in patients with severe SLE, allowing the tapering of prednisolone and mycophenolate.Methods: Synbiose 2 is a phase 3, multicenter, randomized, controlled, open-label 2-year clinical trial. Seventy adults with severe SLE including lupus nephritis will be randomized 1:1 to receive either standard of care consisting of prednisolone and mycophenolate as induction and maintenance treatment, or belimumab and rituximab combined with standard of care as induction treatment, followed by prednisolone and belimumab as maintenance treatment. The primary objective is to assess whether combined B cell therapy will lead to a reduction of treatment failure. Secondary endpoints are complete and partial clinical and renal response and the improvement of SLE-specific autoimmune phenomena. Safety endpoints include the incidence of adverse events, with a special interest in infections.Discussion: The Synbiose 2 trial is the first multicenter phase 3 clinical trial investigating combined B cell targeted therapy in SLE, including lupus nephritis. The outcome of this study will provide further evidence for the clinical efficacy of this new treatment strategy in severe SLE.Trial Registration: ClinicalTrials.gov NCT03747159 . Registered on 20 November 2018. [ABSTRACT FROM AUTHOR]

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. [ABSTRACT FROM AUTHOR]

Communicative repair is a fundamental and universal element of interactive language use. It has been suggested that the persistence and elaboration after communicative breakdown in nonhuman primates constitute two evolutionary building blocks of this capacity, but the conditions favouring it are poorly understood. Because zoo-housed individuals of some species are more social and more terrestrial than in the wild, they should be more likely to show gestural redoings (i.e. both repetition and elaboration) after communicative failure in the coordination of their joint activities. Using a large comparative sample of wild and zoo-housed orang-utans of two different species, we could confirm this prediction for elaboration, the more flexible form of redoings. Specifically, results showed that gestural redoings in general were best predicted by the specific social action context (i.e. social play) and interaction dyad (i.e. beyond mother–offspring), although they were least frequent in captive Bornean orang-utans. For gestural elaboration, we found the expected differences between captive and wild research settings in Borneans, but not in Sumatrans (the more socially tolerant species). Moreover, we found that the effectiveness of elaboration in eliciting responses was higher in Sumatrans, especially the captive ones, whereas effectiveness of mere repetition was influenced by neither species nor setting. We conclude that the socio-ecological environment plays a central role in the emergence of communicative repair strategies in great apes. This article is part of the theme issue 'Revisiting the human 'interaction engine': comparative approaches to social action coordination'. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease with unknown etiology that can be characterized by the presence of demyelinated lesions. Prevailing treatment protocols in MS rely on the modulation of the inflammatory process but do not impact disease progression. Remyelination is an essential factor for both axonal survival and functional neurological recovery but is often insufficient. The extracellular matrix protein fibronectin contributes to the inhibitory environment created in MS lesions and likely plays a causative role in remyelination failure. The presence of the blood–brain barrier (BBB) hinders the delivery of remyelination therapeutics to lesions. Therefore, therapeutic interventions to normalize the pathogenic MS lesion environment need to be able to cross the BBB. In this review, we outline the multifaceted roles of fibronectin in MS pathogenesis and discuss promising therapeutic targets and agents to overcome fibronectin-mediated inhibition of remyelination. In addition, to pave the way for clinical use, we reflect on opportunities to deliver MS therapeutics to lesions through the utilization of nanomedicine and discuss strategies to deliver fibronectin-directed therapeutics across the BBB. The use of well-designed nanocarriers with appropriate surface functionalization to cross the BBB and target the lesion sites is recommended. [ABSTRACT FROM AUTHOR]

Countries survey wildlife for bovine tuberculosis (bTB) to ensure case detection or to ascertain a high probability of freedom from bTB in wildlife. The Eurasian badger (Meles meles) is a potential bTB reservoir host. Between 2008 and 2019, 282 badgers were examined post‐mortem in the context of general wildlife disease and targeted bTB surveillance programmes in the Netherlands, and no bTB cases were detected. However, it was unclear how effective this surveillance effort was to demonstrate freedom from Mycobacterium bovis infection in the badger population of ±6000 or to detect cases if present. Therefore, surveillance effectiveness was assessed using scenario tree modelling. For lack of standards for wildlife, the models were run against three assumed levels of disease in the population called design prevalence P*: 0.1%, 0.5%, and 3%. A small risk of introduction (0.015/year) was applied, because the Netherlands are officially free from bTB in cattle, with rare import of bTB‐infected cattle and no bTB‐infected wildlife reported along the Belgian and German borders with the Netherlands. Surveillance more readily picks up bTB presence in badgers when case detection sensitivity tends towards 100% and demonstrates freedom best when the probability of freedom tends towards 100%. For P* 0.1%, 0.5% and 3%, respectively, maximum case detection sensitivity during 2008–2019 was 8%, 35% and 94% and the probability of freedom in 2019 was 46%, 67%, and 95%. At P* = 3%, performing targeted surveillance on 300 badgers in a year would make it extremely unlikely to miss a case (case detection sensitivity > 99.9%); and if no cases are detected, the adjusted probability of freedom would then reach nearly 98.5%. Stakeholders should be made aware that at P* = 3%, one case detected implies around 3% infected badgers. Additional surveillance system components to assess bTB in wildlife and its economics are to be explored further. [ABSTRACT FROM AUTHOR]

Central to this article are two maps by Floris Balthasarsz van Berckenrode, both on the siege of Grave (1602) by Maurice of Orange during the Dutch Revolt. The first map was in 1602 produced as a news map about the events, the second was a re-edition, published eight years later as a book illustration for Jan Jansz Orlers, Den Nassauschen Lauren-Crans (Leiden 1610). In this article, principles for a new method are introduced to analyse and compare these 'story maps' with particular attention to the narrative impact of the map. Using this method in combi-nation with (book) historical research, it argues that the 1610 map should be considered as a 'memorial map' that reframes the collective memory of the Dutch Revolt. It emphasizes the dynamic relationship between news, map and book publishing and pleads for a more prominent position of story maps and book illustrations in Early Modern memory landscapes. [ABSTRACT FROM AUTHOR]

Purpose: Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up.Methods: The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts.Results: Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty.Conclusion: Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment. [ABSTRACT FROM AUTHOR]

Clinical trials in chronic inflammatory demyelinating polyneuropathy (CIDP) often assess efficacy using the ordinal Inflammatory Neuropathy Cause and Treatment (INCAT) disability score. Here, data from the PATH study was reanalyzed using change in Inflammatory Rasch‐built Overall Disability Scale (I‐RODS) to define CIDP relapse instead of INCAT. The PATH study comprised an intravenous immunoglobulin (IVIG) dependency period and an IVIG (IgPro10 [Privigen]) restabilization period; subjects were then randomized to weekly maintenance subcutaneous immunoglobulin (SCIG; IgPro20 [Hizentra]) 0.2 g/kg or 0.4 g/kg or placebo for 24 weeks. CIDP relapse was defined as ≥1‐point deterioration in adjusted INCAT, with a primary endpoint of relapse or withdrawal rates. This retrospective exploratory analysis redefined relapse using I‐RODS via three different cut‐off methods: an individual variability method, fixed cut‐off of ≥8‐point deterioration on I‐RODS centile score or ≥4‐point deterioration on I‐RODS raw score. Relapse or withdrawal rates were 47% for placebo, 34% for 0.2 g/kg IgPro20 and 19% for 0.4 g/kg IgPro20 using the raw score; 40%, 28% and 15%, respectively using the centile score, and 49%, 40% and 27%, respectively using the individual variability method. IgPro20 was shown to be efficacious as a maintenance therapy for CIDP when relapse was defined using I‐RODS. A stable response pattern was shown for I‐RODS across various applied cut‐offs, which could be applied in future clinical trials. [ABSTRACT FROM AUTHOR]

Dysregulation of the Ras/Mitogen-activated protein kinase (MAPK) signaling pathway is suggested to play a pivotal role in the development of the lymphatic system in patients with Noonan Syndrome (NS). Pathogenic gene variants in the Ras/MAPK pathway can therefore lead to various lymphatic diseases such as lymphedema, chylo-thorax and protein losing enteropathy. Diagnosis and treatment of the lymphatic phenotype in patients with NS remain difficult due to the variability of clinical presentation, severity and, probably, underlying unknown pathophysiologic mechanism. The objective of this article is to give an overview of the clinical presentation of lymphatic disease in relation to central conducting lymphatic anomalies (CCLA) in NS, including new diagnostic and therapeutic options. We visualized the central conducting lymphatic system using heavily T2-weighted MR imaging (T2 imaging) and Dynamic Contrast-enhanced MR Lymphangiography (DCMRL) and compared these results with the lymphatic clinical presentation in seven patients with NS. Our results show that most patients with NS and lymphatic disease have CCLA. Therefore, it is probable that CCLA is present in all patient with NS, presenting merely with lymphedema, or without sensing lymphatic symptoms at all. T2 imaging and DCMRL can be indicated when CCLA is suspected and this can help to adjust therapeutic interventions. [ABSTRACT FROM AUTHOR]

Between-individual variation in behavioural expression, such as social responsiveness, has been shown to have important eco-evolutionary consequences. However, most comparative research on non-human primate communication has focused on species- or population-level variation, while among- and within-individual variation has been largely ignored or considered as noise. Here, we apply a behavioural reaction norm framework to repeated observations of mother–offspring interactions in wild and zoo-housed orang-utans (Pongo abelii, P. pygmaeus) to tease apart variation on the individual level from population-level and species-level differences. Our results showed that mothers not only differed in the composition of their infant-directed gestural repertoires, but also in communicative tactics, such as gestural redoings (i.e. persistence) and responsiveness to infants' requests. These differences remained after controlling for essential moderators, including species, setting, parity and infant age. Importantly, mothers differed in how they adjusted their behaviour across social contexts, making a strong case for investigating within-individual variation. Our findings highlight that partitioning behavioural variation into its within-individual, between-individual and environmental sources allows us to estimate the extent of plastic responses to the immediate environment in great ape communication. [ABSTRACT FROM AUTHOR]

The STOC free project constructed a generic framework that allows a standardised and harmonised description of different control programmes (CP) for cattle diseases. The STOC free model can be used to determine the confidence of freedom from infection that has been achieved in disease CPs, in support of an ongoing assessment of progress towards output‐based standards as outlined in the EU Animal Health Law. With this information, and as required, further CP actions can be taken to mitigate the risks of persistence and (re‐)introduction on the probability of freedom from infection. Bovine viral diarrhoea virus (BVDV) was chosen as the case disease because of the diversity in CPs in the six participating countries. A Bayesian hidden Markov model was considered the best modelling method. Detailed BVDV CP information was collected in the participating countries and the key aspects for inclusion in the STOC free model were identified. A first version of STOC free model was developed and tested on simulated data. The risk factors for BVDV infection that needed to be included in the model were defined and default values for these risk factors were quantified. A data collection tool was finalised with which the data for the STOC free model was collected. Subsequently, the developed model was tested and validated using real BVDV CP data from partner countries. Based on the feedback, the model was finalised and the report and corresponding computer code were made publicly available. There were roughly three different BVDV situations that occurred in the partner countries: 1. Endemic situation with a CP operating at herd level, 2. Endemic situation with a CP operating at animal level and 3. BVD free situation. The STOC free model is able to include herd level data only and animal level data has to be aggregated to herd level before the model can be applied. The STOC free model is not applicable for a country that is completely BVDV free given that it needs some infections to estimate its parameters and converge. In the latter situation, a scenario tree model could be a better suited tool, and this was evaluated in the Swedish case study. Further work is needed for generalisation of the method to other diseases and expansion of the method to include socioeconomic aspects of CPs. [ABSTRACT FROM AUTHOR]

In species in which adults of the two sexes show long‐term association, males often engage in acts of assistance ("services") aimed at females and/or their young in various behavioural contexts that are not reciprocated. We conducted a quantitative review of the primate literature on sex differences in involvement in protection against predation. We found that males were more likely to be at the front of group progressions, especially in contexts of increased risk, were more vigilant, sometimes to the point of becoming sentinels, were more active in mobbing, and were far more likely to counter‐attack felids and monkey‐eating raptors than females did. Our evaluation showed that these services may be an expression of male parental care or aimed at bonded partners, but we also encountered many cases in which non‐sires, unrelated to either females or immatures, provide them. We hence investigate explanations invoking group augmentation or costly signalling. Currently, available data on male anti‐predation services in nonhuman primates do not allow us to distinguish among them, although costly signalling better explains data on birds and humans. We develop predictions that will allow more detailed tests of the various hypotheses for this understudied phenomenon. [ABSTRACT FROM AUTHOR]

Orthobiologics, including platelet-rich plasma, prolotherapy, and mesenchymal stem cells, are seeing increasing use in the treatment of osteoarthritis (OA), muscle injury, and tendinopathy. This article reviews the biology and applications of orthobiologics in tendons, muscles, and joints, and focuses on platelet-rich plasma (PRP). Clinical evidence-based literature related to the use of PRP in the treatment of rotator cuff injury, lateral epicondylosis, Achilles tendinopathy, plantar fasciitis, knee OA, and acute muscle injury are discussed. [ABSTRACT FROM AUTHOR]

[Display omitted] • Estimating the expansion of granular activated carbon (GAC) in water is complex. • The incipient porosity of GAC is much higher compared to rigid particles. • Combining fluidisation and characterisation experiments enables fluidisation modelling. • GAC fluidisation modelling is complex but possible. Granular activated carbon (GAC) filtration is an important unit operation in drinking water treatment. GAC filtration is widely used for its filtration and adsorption capabilities as a barrier for undesired organic macro- and micro-pollutants. GAC filtration consists of two successive phases: adsorption and filtration, capturing the impurities from the water in conjunction with a backwash procedure in which the suspended particles are flushed out of the system. Available literature predominantly focusses on adsorption. A less frequently discussed but nevertheless equally crucial aspect of this operation is the backwash procedure of GAC beds. To prevent accumulation of suspended particles and to avoid additional operation costs, optimal backwashing is required. Another factor is sustainability: water utilities are showing increasing interest in exploring new sustainable GAC media. As these have different bed expansion tendencies due to different GAC characteristics with varying geometries, operational developments are needed for prediction models to estimate the expansion degree during backwashing. The prediction of the bed expansion of GAC is complex as the particles are non-spherical, porous and polydisperse. Through a combination of advanced particle laboratory and fluidisation experiments, we demonstrate a new approach which leads to an improved expansion prediction model for the backwashing of GAC filters. [ABSTRACT FROM AUTHOR]

Contemporary quality control methods are often insufficient in predicting clinical outcomes after revascularization in lower extremity arterial disease (LEAD) patients. This study evaluates the potential of near-infrared fluorescence imaging with indocyanine green to predict the clinical outcome following revascularization. Near-infrared fluorescence imaging was performed before and within 5 days following the revascularization procedure. Clinical improvement was defined as substantial improvement of pain free walking distance, reduction of rest- and/or nocturnal pain, or tendency toward wound healing. Time-intensity curves and 8 perfusion parameters were extracted from the dorsum of the treated foot. The quantified postinterventional perfusion improvement was compared within the clinical outcome groups. Successful near-infrared fluorescence imaging was performed in 72 patients (76 limbs, 52.6% claudication, 47.4% chronic limb-threatening ischemia) including 40 endovascular- and 36 surgical/hybrid revascularizations. Clinical improvement was observed in 61 patients. All perfusion parameters showed a significant postinterventional difference in the clinical improvement group (P -values <.001), while no significant differences were seen in the group without clinical improvement (P -values.168–.929). Four parameters demonstrated significant differences in percentage improvement comparing the outcome groups (P -values within.002–.006). Near-infrared fluorescence imaging has promising additional value besides clinical parameters for predicting the clinical outcome of revascularized LEAD patients. [ABSTRACT FROM AUTHOR]

Theoretical and empirical scholars of cultural evolution have traditionally studied social learning strategies, such as conformity, as adaptive strategies to obtain accurate information about the environment, whereas within social psychology there has been a greater focus upon the social consequences of such strategies. Although these two approaches are often used in concert when studying human social learning, we believe the potential social benefits of conformity, and of social learning more broadly, have been overlooked in studies of non‐humans. We review evidence from studies of homophily, imitation, and rapid facial mimicry that suggests that behaving like others affords social benefits to non‐human animals and that behaviour matching may be deployed strategically to increase affiliation. Furthermore, we review studies of conformity in dispersers, and suggest that forgoing personal information or preferences in favour of those of the new group during immigration may be a strategy to facilitate social integration. We therefore propose that the informational and social functions of conformity apply to humans and animals alike. We use this perspective to generate several interesting research questions to inspire work in this field. For example, under what conditions do animals use informational or social conformity and what role does uncertainty play in social learning in immigrant individuals? [ABSTRACT FROM AUTHOR]