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The past decade has seen efforts to develop new forms of autonomous systems with varying applications in different domains, from underwater search and rescue to clinical diagnosis. All of these applications require risk analyses, but such analyses often focus on technical sources of risk without acknowledging its wider systemic and organizational dimensions. In this article, we illustrate this deficit and a way of redressing it by offering a more systematic analysis of the sociotechnical sources of risk in an autonomous system. To this end, the article explores the development, deployment, and operation of an autonomous robot swarm for use in a public cloakroom in light of Macrae's structural, organizational, technological, epistemic, and cultural framework of sociotechnical risk. We argue that this framework provides a useful tool for capturing the complex "nontechnical" dimensions of risk in this domain that might otherwise be overlooked in the more conventional risk analyses that inform regulation and policymaking., (© 2024 The Author(s). Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

Background: Multiple factors can fuel nurses' intention to leave their employing hospital or their profession. Job dissatisfaction and burnout are contributors to this decision. Sociodemographic and work context factors can also play a role in explaining nurses' intention to leave., Objective: To investigate the role of sociodemographic and work context factors, including job resources, job demands, job dissatisfaction, depersonalization, and emotional exhaustion, on nurses' intention to leave their hospital or their profession., Design: Multicentre cross-sectional study., Settings: Eight European hospitals, two per each country, including Belgium, the Netherlands, Italy, and Poland., Participants: From May 16 to September 30, 2022, we collected 1,350 complete responses from nurses working at the selected hospitals (13 % response rate)., Methods: The intention to leave was assessed through two 5-Likert scale outcomes, agreeing with the intention to leave the profession and the intention to leave the hospital. Logistic regression models were used for statistical analysis., Results: At the multivariable analysis, a higher intention to leave the hospital was observed for: younger age, having served on the frontline against COVID-19, lack of quipment, living in the Netherlands, emotional exhaustion, dissatisfaction with work prospects, and dissatisfaction with the use of professional abilities. There was a higher intention to leave the profession for: younger age, living in the Netherlands, having work-related health problems, depersonalization, emotional exhaustion, low possibilities of professional development, dissatisfaction with work prospects, lack of use of professional abilities, overall ob issatisfaction, and dissatisfaction with salary. Nurses living in Italy expressed the lowest intention to leave., Conclusion: While confirming the role of job dissatisfaction and burnout, we found higher intention to leave for young nurses, nurses with work-related health problems, and caregivers during the COVID-19 pandemic. Dissatisfaction with work prospects, professional development, and salary also increased the intention to leave. We call for educators, managers, and policymakers to address these factors to retain at-risk nursing categories, implementing strategies to mitigate intentions to leave., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

When hospitalized, infants, particularly preterm, are often subjected to multiple painful needle procedures to collect sufficient blood for metabolic screening or diagnostic purposes using standard clinical tests. For example, at least 100 µL of whole blood is required to perform one creatinine plasma measurement with enzymatic colorimetric assays. As capillary electrophoresis-mass spectrometry (CE-MS) utilizing a sheathless porous tip interface only requires limited amounts of sample for in-depth metabolic profiling studies, the aim of this work was to assess the utility of this method for the determination of creatinine in low amounts of plasma using residual blood samples from adults and infants. By using a starting amount of 5 µL of plasma and an injection volume of only 6.7 nL, a detection limit (S/N = 3) of 30 nM could be obtained for creatinine, and intra- and interday precisions (for peak area ratios) were below 3.2%. To shorten the electrophoretic separation time, a multi-segment injection (MSI) strategy was employed to analyze up to seven samples in one electrophoretic run. The findings obtained by CE-MS for creatinine in pretreated plasma were compared with the values acquired by an enzymatic colorimetric assay typically used in clinical laboratories for this purpose. The comparison revealed that CE-MS could be used in a reliable way for the determination of creatinine in residual plasma samples from infants and adults. Nevertheless, to underscore the clinical efficacy of this method, a subsequent investigation employing an expanded pool of plasma samples is imperative. This will not only enhance the method's diagnostic utility but also contribute to minimizing both the amount and frequency of blood collection required for diagnostic purposes., (© 2024 The Authors. ELECTROPHORESIS published by Wiley‐VCH GmbH.)

4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive measurement technique capable of quantifying blood flow across the cardiovascular system. While practical use is limited by spatial resolution and image noise, incorporation of trained super-resolution (SR) networks has potential to enhance image quality post-scan. However, these efforts have predominantly been restricted to narrowly defined cardiovascular domains, with limited exploration of how SR performance extends across the cardiovascular system; a task aggravated by contrasting hemodynamic conditions apparent across the cardiovasculature. The aim of our study was therefore to explore the generalizability of SR 4D Flow MRI using a combination of existing super-resolution base models, novel heterogeneous training sets, and dedicated ensemble learning techniques; the latter-most being effectively used for improved domain adaption in other domains or modalities, however, with no previous exploration in the setting of 4D Flow MRI. With synthetic training data generated across three disparate domains (cardiac, aortic, cerebrovascular), varying convolutional base and ensemble learners were evaluated as a function of domain and architecture, quantifying performance on both in-silico and acquired in-vivo data from the same three domains. Results show that both bagging and stacking ensembling enhance SR performance across domains, accurately predicting high-resolution velocities from low-resolution input data in-silico. Likewise, optimized networks successfully recover native resolution velocities from downsampled in-vivo data, as well as show qualitative potential in generating denoised SR-images from clinicallevel input data. In conclusion, our work presents a viable approach for generalized SR 4D Flow MRI, with the novel use of ensemble learning in the setting of advanced fullfield flow imaging extending utility across various clinical areas of interest.

Background: Infants born moderate-to-late preterm (i.e., 32 wk-35 wk 6 d gestation) are, analogous to those born very preterm, at risk of later obesity, hypertension, and diabetes. Appropriate early life nutrition is key for ensuring optimal growth and body composition, thereby mitigating potential cardiometabolic risks., Objectives: We aimed to compare growth and body composition between infants born moderate-to-late preterm fed isocaloric but protein- and mineral-enriched postdischarge formula (PDF) or standard term formula (STF) until 6 mo corrected age (CA; i.e., after term equivalent age [TEA])., Methods: After enrollment (≤7 d postpartum), infants received PDF if (fortified) mother's own milk (MOM) was insufficient. At TEA, those receiving >25% of intake as formula were randomized to either continue the same PDF (n = 47) or switch to STF (n = 50); those receiving ≥75% of intake as MOM (n = 60) served as references. At TEA and 6 mo CA, we assessed anthropometry and body composition using both dual-energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP)., Results: Feeding groups had similar gestational age (median [25th percentile;75th percentile]: 34.3 [33.5; 35.1] wk), birthweight (mean ± standard deviation [SD]: 2175 ± 412 g), anthropometry, and body composition at TEA. At 6 mo CA, infants fed PDF had slightly, but significantly, greater length (67.6 ± 2.5 and 66.9 ± 2.6 cm, P < 0.05) and larger head circumference (43.9 ± 1.3 and 43.4 ± 1.5 cm, P < 0.05) compared to infants fed STF. Also, infants fed PDF had higher lean mass (LM) and bone mineral content estimated by DXA (4772 ± 675 and 4502 ± 741 g; 140 ± 20 and 131 ± 23 g, respectively; P < 0.05). ADP estimates, however, were not statistically different between feeding groups., Conclusions: Infants born moderate-to-late preterm demonstrated modest increases in length, head circumference, LM, and bone mineral content when fed PDF compared to STF for 6 mo after TEA. This trial was registered at the International Clinical Trial Registry Platform as NTR5117 and NTR NL4979., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Aseptic loosening is the most common mode of failure after total knee arthroplasty. Despite this, the diagnosis often remains challenging and mainly relies on imaging modalities. Until today, no biomarker exists to aid in diagnosing loosening of the implants. As zirconium (Zr) is often found in bone cement, where it serves as radiopacifier, this study aimed to establish Zr as a synovial biomarker for loosened cemented knee prostheses., Methods: A total of 31 patients scheduled for revision of a cemented knee prostheses were included. In all patients, the initial used cement contained Zr. After arthrotomy, specimens of synovial fluid were taken and levels of Zr were measured by inductively coupled plasma mass spectrometry. Depending on the necessary amount of force for explantation, the implants were graded "loose" or "well-fixed". Preoperative radiographs were evaluated by 2 independent physicians., Results: The concentration of Zr in the synovial fluid differed significantly (P < .001) between the "loose" (mean 170.9 μg/L, range 0 to 1941 μg/L) and the "well-fixed" (mean 0.6 μg/L, range 0 to 6 μg/L) implants. The receiver operating characteristic analysis revealed 0.25 μg/l as an optimal cutoff value leading to a sensitivity of 0.84, a specificity of 0.92, a positive predictive value of 0.94, and a negative predictive value of 0.79. There was no significant difference in the diagnostic performance compared to radiographs (P = .66)., Conclusions: Zirconium proved to be a reliable novel synovial biomarker for diagnosing aseptic loosening of knee prothesis fixed with cement containing Zr. This biomarker should not be interpreted in isolation, but in combination with existing diagnostic tools., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Uncover the pivotal link between lymphocyte-specific protein tyrosine kinase (Lck)-related genes and clinical risk stratification in pancreatic cancer. Methods: This study identifies shared genes between differentially expressed genes (DEGs) and Lck-related genes in pancreatic cancer using a methodological framework rooted in The Cancer Genome Atlas database. Feature gene selection is accomplished and a signature model is constructed. Statistical significant clinical endpoints such as overall survival (OS), disease-specific survival (DSS), and progression-free interval (PFI) were defined. Results: After performing random survival forest, Lasso regression, and multivariate Cox regression model, 7 trait genes out of 272 Lck-associated DEGs are selected to create a signature model that is independent of other clinical factors and can predict OS and DSS. It appears that high-risk patients have activated the TP53 signaling pathway and the cell cycle signaling pathway. LAMA3 turned out to be the hub gene of the signature with high expression in pancreatic cancer. Patients with increased expression of LAMA3 had a short OS, DSS, and PFI in comparison. The candidate competing endogenous RNA network of LAMA3 turned out to be OPI5-AS1/hsa-miR-186-5p/ LAMA3 axis. Conclusions: A characteristic signature of seven Lck-related genes, especially LAMA3 , has been shown to be a key factor in clinical risk stratification for pancreatic cancer.

Introduction: Intracranial 4D flow MRI enables quantitative assessment of hemodynamics in patients with intracranial atherosclerotic disease (ICAD). However, quantitative assessments are still challenging due to the time-consuming vessel segmentation, especially in the presence of stenoses, which can often result in user variability. To improve the reproducibility and robustness as well as to accelerate data analysis, we developed an accurate, fully automated segmentation for stenosed intracranial vessels using deep learning., Methods: 154 dual-VENC 4D flow MRI scans (68 ICAD patients with stenosis, 86 healthy controls) were retrospectively selected. Manual segmentations were used as ground truth for training. For automated segmentation, deep learning was performed using a 3D U-Net. 20 randomly selected cases (10 controls, 10 patients) were separated and solely used for testing. Cross-sectional areas and flow parameters were determined in the Circle of Willis (CoW) and the sinuses. Furthermore, the flow conservation error was calculated. For statistical comparisons, Dice scores (DS), Hausdorff distance (HD), average symmetrical surface distance (ASSD), Bland-Altman analyses, and interclass correlations were computed using the manual segmentations from two independent observers as reference. Finally, three stenosis cases were analyzed in more detail by comparing the 4D flow-based segmentations with segmentations from black blood vessel wall imaging (VWI)., Results: Training of the network took approximately 10 h and the average automated segmentation time was 2.2 ± 1.0 s. No significant differences in segmentation performance relative to two independent observers were observed. For the controls, mean DS was 0.85 ± 0.03 for the CoW and 0.86 ± 0.06 for the sinuses. Mean HD was 7.2 ± 1.5 mm (CoW) and 6.6 ± 3.7 mm (sinuses). Mean ASSD was 0.15 ± 0.04 mm (CoW) and 0.22 ± 0.17 mm (sinuses). For the patients, the mean DS was 0.85 ± 0.04 (CoW) and 0.82 ± 0.07 (sinuses), the HD was 8.4 ± 3.1 mm (CoW) and 5.7 ± 1.9 mm (sinuses) and the mean ASSD was 0.22 ± 0.10 mm (CoW) and 0.22 ± 0.11 mm (sinuses). Small bias and limits of agreement were observed in both cohorts for the flow parameters. The assessment of the cross-sectional lumen areas in stenosed vessels revealed very good agreement (ICC: 0.93) with the VWI segmentation but a consistent overestimation (bias ± LOA: 28.1 ± 13.9%)., Discussion: Deep learning was successfully applied for fully automated segmentation of stenosed intracranial vasculatures using 4D flow MRI data. The statistical analysis of segmentation and flow metrics demonstrated very good agreement between the CNN and manual segmentation and good performance in stenosed vessels. To further improve the performance and generalization, more ICAD segmentations as well as other intracranial vascular pathologies will be considered in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Winter, Berhane, Moore, Aristova, Reichl, Wollenberg, Richter, Jarvis, Patel, Caprio, Abdalla, Ansari, Markl and Schnell.)

Background: The aim of this study was to investigate the link between parenting and parents' perspectives on health-related decision making for adolescents. During adolescence, there is a gradual increase in responsibility and autonomy, which influences parenting behavior and child development. Understanding how parenting is associated with parents' views on medical decision making is crucial in the context of the parent-child-physician triad. This study was the first to explore parenting and parents' views on adolescent health care decision making. We compare Belgian and Dutch parents-two countries selected for their different legal frameworks on medical adolescent decision making., Method: An online questionnaire surveyed 984 Belgian and 992 Dutch parents (ages 35-55) with at least one child. Analytical methods included t tests, structural equation modeling, and latent profile analysis., Results: Parents considered adolescents to be competent decision makers at 16.7 years old. Dutch parents granted autonomy at younger ages than Belgian parents. Parents with high behavioral expectations granted autonomy to adolescents at higher ages, while those high in autonomy support and punishment granted autonomy at lower ages. When classifying parents into profiles, we distinguished four types: highly permissive, moderately permissive, moderately restrictive, and highly restrictive groups. The majority of the sample was classified into moderately and highly restrictive profiles., Conclusion: The study highlighted the importance of providing parents with education and support on adolescent development and autonomy. Parenting practices that encourage autonomy and support open communication between parents and adolescents may contribute to a more trusting and supportive parent-child context for adolescent medical decision making. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background and Purpose: Quantification of neurofilament light chain protein in serum (sNfL) enables the neuro-axonal damage in peripheral blood to be reliably assessed and monitored. There is a long-standing debate whether essential tremor represents a 'benign' tremor syndrome or whether it is linked to neurodegeneration. This study aims to investigate sNfL concentrations in essential tremor compared to healthy controls (cross-sectionally and longitudinally) and to assess whether sNfL is associated with motor and nonmotor markers of disease progression., Methods: Data of patients with essential tremor from our prospective registry on movement disorders (PROMOVE) were retrospectively analysed. Age-, sex- and body-mass-index-matched healthy controls were recruited from an ongoing community-dwelling aging cohort. sNfL was quantified by an ultra-sensitive single molecule array (Simoa). All participants underwent detailed clinical examination at baseline and after approximately 5 years of follow-up., Results: Thirty-seven patients with clinically diagnosed essential tremor were included and 37 controls. The essential tremor group showed significantly higher sNfL levels compared to healthy controls at baseline and follow-up. sNfL levels increased over time in both groups, and the slope of sNfL increase was similar in the essential tremor and healthy control groups. Comparing patients with a disease duration under 5 years to those with a longer disease duration, the former group had a significantly greater increase of sNfL over time, which strongly correlated to worsening of tremor and cognition., Conclusion: Our findings indicate that neurodegeneration, possibly happening at an early disease stage, might play a role in the pathophysiology of essential tremor., (© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

The European healthcare sector faces a significant shortage of healthcare workers. Assessing the prevalence of this issue and understanding its direct and indirect determinants are essential for formulating effective recruitment programs and enhancing job retention strategies for physicians and nurses. A multicentric cross-sectional study was conducted, involving 381 physicians and 1351 nurses recruited from eight European hospitals in Belgium, the Netherlands, Italy, and Poland. The study focused on assessing turnover intentions among healthcare workers based on the Job Demands-Resources model, using an online questionnaire. Structural equation models were employed to test the data collection questionnaires' construct validity and internal consistency. The turnover intention was assessed by agreement with the intention to leave either the hospital or the profession. Among physicians, 17% expressed an intention to leave the hospital, while 9% intended to leave the profession. For nurses, the figures were 8.9% and 13.6%, respectively. The internal consistency of the questionnaires exceeded 0.90 for both categories of health workers. Depersonalization and job dissatisfaction were identified as direct determinants of turnover intention, with work engagement being particularly relevant for nurses. We found a higher intention to leave the hospital among physicians, while nurses were more prone to leave their profession. To mitigate turnover intentions, it is recommended to focus on improving job satisfaction, work engagement and fostering a positive working climate, thereby addressing depersonalisation and promoting job retention., (© 2024. The Author(s).)

The major focus of this research is the level of awareness among Dutch parents of general patient rights in relation to minors' patient rights. Moreover, this study is intended to highlight the most effective strategies to increase the awareness of general and minor patient rights in the Netherlands. A survey was conducted among 1010 Dutch parents aged between 35 and 55 years who had at least one child. In this study, we described the relationship between the knowledge among parents of general patient rights and their understanding of the patient rights of minors. A significant connection was found between the knowledge levels of general patient rights and the knowledge levels of the patient rights of minors ( p < 0.05 [95% CI: 0.019-0.183]). While age and sex (male/female) did not appear to be significant confounders in this association, the educational background of the participants may have played a role. This study provides comprehensive insights into the association between the knowledge of general patient rights and the patient rights of minors among Dutch parents. Furthermore, this study points out that there is a need for focused educational interventions to address specific areas of misunderstanding or uncertainty.

Background: Scientific progress in the field of knee and hip arthroplasty has enabled the preservation of mobility and quality of life in the case of patients with many primary degenerative and (post-) traumatic joint diseases. This comparative study aims to investigate differences in scientific performance between the leading continents in the field of hip and knee arthroplasty., Methods: Using specific search terms all studies published by the scientific leading continents Europe, North America, Asia and Oceania listed in the Web of Science databases were included. All identified publications were analysed and comparative conclusions were drawn regarding the qualitative and quantitative scientific merit of each continent., Results: Europe, followed by North America, Asia, and Oceania, had the highest overall number of publications in the field of arthroplasty. Since 2000, there has been a strong increase in knee arthroplasty publication rate, particular pronounced in Asia. Studies performed and published in North America and those on knee arthroplasty received the highest number of fundings. Publications regarding hip arthroplasty achieved the highest average citation rate. In contradistinction to the others, in North America most funding was provided by private agencies., Conclusion: Although Europe showed the highest total number of publications, authors and institutions, arthroplasty research from North America received greater scientific attention and financial support. Measured by citations, publications on hip arthroplasty attained higher scientific interest and studies on knee arthroplasty received higher economic affection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Wolf, Winter, Landgraeber and Orth.)

Purpose: To search for new predictive breast cancer biomarkers. We analyzed the serum concentrations of biomarkers involved in carcinogenesis, which can also be targeted by therapy., Methods: In a single-center prospective study, the serum levels of Aurora A, thymidine kinase 1, and human epidermal growth factor receptor type 3 (HER3) were determined in 119 women with BC before neoadjuvant treatment using ELISA kits., Results: The following clinical data were analyzed: age; TNM; the expression of ER, PGR, HER2, and Ki67; histological grade (G); and the response to neoadjuvant treatment (NAT) in the residual tumor burden classification (RCB). A complete pathological response (pCR) was achieved after NAT in 41 patients (34%). The highest proportion of the patients with a confirmed pCR was found for triple negative breast cancer (TNBC) (62.5%); non-luminal HER2-positive (52.6%) cancer subtypes ( p = 0.0003); and in the G3 group (50%; p = 0.0078). The patients with higher levels of Aurora A were more likely to achieve pCR ( p = 0.039). In the multivariate analysis, the serum Aurora A levels ≥ 4.75 ng/mL correlated with a higher rate of pCR (OR: 3.5; 95% CI: 1.2-10.1; p = 0.023)., Conclusions: We showed that in a biologically heterogeneous group of BC patients, the pretreatment serum Aurora A levels were of significant value in predicting the response to NAT.

Alternative family configurations are becoming more prevalent, yet current legislative statutory does not support stepparents in medical decisions for their stepchildren. We investigate opinions of Belgian and Dutch adults regarding inclusion of stepparents in medical decision-making in minors. We make two observations. First, participants wanted stepparents to be involved in cases when medical information had to be shared or informed consent signed. Second, when stepparents object against previously approved medical interventions by a biological parent, respondents were less likely to support stepparents. Participants with stepchildren were likely to favour inclusion of stepparents in decision-making. Overall, our findings indicate that Belgian and Dutch adults view stepparents as potential executive actors in medical decision-making for minors, but not as primary decision-makers. This study is a first step in showing to what extent stepparents could be included in medical information and decision-making regarding stepchildren. We reflect on these findings in light of implications for medical practice and legislative shortcomings., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

We present a new measurement of the positive muon magnetic anomaly, a&#95;{μ}≡(g&#95;{μ}-2)/2, from the Fermilab Muon g-2 Experiment using data collected in 2019 and 2020. We have analyzed more than 4 times the number of positrons from muon decay than in our previous result from 2018 data. The systematic error is reduced by more than a factor of 2 due to better running conditions, a more stable beam, and improved knowledge of the magnetic field weighted by the muon distribution, ω[over ˜]&#95;{p}^{'}, and of the anomalous precession frequency corrected for beam dynamics effects, ω&#95;{a}. From the ratio ω&#95;{a}/ω[over ˜]&#95;{p}^{'}, together with precisely determined external parameters, we determine a&#95;{μ}=116 592 057(25)×10^{-11} (0.21 ppm). Combining this result with our previous result from the 2018 data, we obtain a&#95;{μ}(FNAL)=116 592 055(24)×10^{-11} (0.20 ppm). The new experimental world average is a&#95;{μ}(exp)=116 592 059(22)×10^{-11} (0.19 ppm), which represents a factor of 2 improvement in precision.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become the gold standard.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become a gold standard. The purpose of the study was to analyze the complications and own experience with the use of Serasynth fully absorbable and SeragynBR partially absorbable synthetic meshes.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; In the period from December 2017 to July 2020, 118 IBR were performed in the Author's Department with the use of SeragynBR and Serasynth meshes in 93 patients operated for breast cancer. 78 Serasynth meshes (Group 1) and 40 SeragynBR meshes (Group 2) were implanted.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; The most common complication was persistent seroma collection, which was reported in 17.9% of cases in Group 1 and 25% in Group 2. Skin inflammation was reported in 7.6% and 17.5%, while infections in 2.5% and 5% of the operated breasts in Group 1 and Group 2. Reoperation was required in 5.1% and 5% of the patients in Group 1 and Group 2. The percentage of complications was lower when Serasynth rather than Seragyn BR meshes were implanted. The frequent incidence of the seroma collection did not contribute in any significant way to serious complications such as removal of mesh/implant or infection. The complications, which developed following the implantation of both mesh types, were similar to those presented in other publications concerning mastectomy with IBR with the use of synthetic meshes. The percentage of implant losses/explanations in the discussed groups was lower than that reported in the literature.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; Despite the complications, both types of meshes can be considered as safe additions to reconstructive breast surgeries.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Level of Evidence:&lt;/b&gt; Level III.&lt;/br&gt.

Trichophyton quinckeanum , the causative agent of mouse favus, has been responsible for several infections of animal owners in recent years and showed an infection peak around 2020 in Jena, Thuringia. The isolated T. quinckeanum strains from Thuringia differ in some positions of the ITS region compared to strains from the IHEM collection as well as to Trichophyton schoenleinii . All T. quinckeanum strains of the new genotype show up to a 100-fold increased itraconazole resistance as measured by microplate laser nephelometry (MLN) assays. Analysis of genes involved in Trichophyton indotineae azole resistance, such as Erg1 , which encodes squalene epoxidase, and Erg11B , one of two copies of the sterol 14-α demethylase gene, show a 100% identity between the two T. quinckeanum genotypes. In contrast, Erg11A fragments differ in 15-nucleotide positions between both T. quinckeanum genotypes, resulting in the unique amino acid substitution Ala256Ser in resistant strains. The new T. quinckeanum genotype may have evolved through interspecies mating. Mating type analysis showed a nearly 100% identity of the minus type MAT1-1-1 fragment for all T. quinckeanum isolates. The closely related Trichophyton schoenleinii belongs to the plus mating type and has 100% identical fragments of Erg1 and Erg11B . Erg11A protein sequences of T. schoenleinii and T. quinckeanum showed increased diversity.

Background: The tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens., Methods: The study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification., Results: Irritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients., Conclusions: TMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations., Level of Evidence: Level V, Expert Opinion includes Case Reports and Technique Tips., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Objectives: Healthcare systems in European countries, including METEOR partner countries, are faced with the aging population, an increase in costs for innovative technologies and medication, a shortage of health professionals, and inequality in access to healthcare. Presented paper aimed to recognize and compare the functioning of healthcare systems between METEOR partner countries and simultaneously check if the current epidemiological situation of COVID-19 has some relationship with the number of medical staff, yearly gross domestic product, or documented percentage of fully vaccinated people., Material and Methods: In the model of descriptive epidemiological study, available demographic, socioeconomic, and healthcare organizational data in the Netherlands, Belgium, Italy, and Poland were compared to the epidemiological situation of the COVID-19 pandemic (percentage of fully vaccinated people, incidence, and mortality) in all mentioned countries., Results: Obtained data confirmed that the lowest number of physicians, as well as the life expectancy and gross domestic product per capita, is in Poland. Simultaneously, the lower number of medical staff and lower gross domestic product (GDP) correspond to higher mortality due to COVID-19. The percentage of fully vaccinated with the last dose of the primary series was also the lowest in Poland., Conclusions: Obtained results confirmed that higher mortality due to COVID-19 in METEOR participants' countries is related to a lower number of medical staff and weaker GDP. The worse situation was noted in Poland, a country with problems in the functioning healthcare system, including hospital care and a serious shortage of practicing medical staff. Int J Occup Med Environ Health. 2023;36(3):417-27., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background : Revision hip arthroplasty presents a surgical challenge, necessitating meticulous preoperative planning to avert complications like periprosthetic fractures and aseptic loosening. Historically, assessment of the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has focused exclusively on primary hip arthroplasty. Materials and Methods : In this retrospective study, we examined the accuracy of 3D templating for acetabular revision cups in 30 patients who underwent revision hip arthroplasty. Utilizing computed tomography scans of the patients' pelvis and 3D templates of the implants (Aesculap Plasmafit, B. Braun; Aesculap Plasmafit Revision, B. Braun; Avantage Acetabular System, Zimmerbiomet, EcoFit 2M, Implantcast; Tritanium Revision, Stryker), we performed 3D templating and positioned the acetabular cup implants accordingly. To evaluate accuracy, we compared the planned sizes of the acetabular cups in 2D and 3D with the sizes implanted during surgery. Results : An analysis was performed to examine potential influences on templating accuracy, specifically considering factors such as gender and body mass index (BMI). Significant statistical differences ( p < 0.001) in the accuracy of size prediction were observed between 3D and 2D templating. Personalized 3D templating exhibited an accuracy rate of 66.7% for the correct prediction of the size of the acetabular cup, while 2D templating achieved an exact size prediction in only 26.7% of cases. There were no statistically significant differences between the 2D and 3D templating methods regarding gender or BMI. Conclusion : This study demonstrates that 3D templating improves the accuracy of predicting acetabular cup sizes in revision arthroplasty when compared to 2D templating. However, it should be noted that the predicted implant size generated through 3D templating tended to overestimate the implanted implant size by an average of 1.3 sizes.

Background: Flexor hallucis longus (FHL) transfer is a well-established method for treating chronic Achilles tendon ruptures and tendinopathy. Harvesting of the FHL tendon in zone 2 results in greater length but is also associated with an increased risk of injury to the medial plantar nerve and requires an additional plantar incision. Because of the anatomic proximity of the FHL tendon to the tibial neurovascular bundle in zone 2, the purpose of this study was to investigate the risk of vascular or nerve injury with arthroscopic assisted percutaneous tenotomy in zone 2 of the FHL tendon., Methods: Endoscopically assisted percutaneous FHL transfer was performed on 10 right lower extremities from 10 cadaveric human specimens. The FHL tendon lengths and the relationship between FHL tendon and the tibial neurovascular bundle at zone 2 was analyzed., Results: We observed a complete transection of the medial plantar nerve in 1 case (10%). The mean length of the FHL tendon was 54.7 ± 9.5 mm and the mean distance from the distal stump of the FHL tendon to local neurovascular structures was 1.3 ± 0.7 mm., Conclusion: There is a risk of neurovascular injury after endoscopic FHL tenotomy in zone 2. The tenotomy site is within 2 mm of the local neurovascular structures in the majority of cases. The additional length gained from this technique is unlikely to be required for the majority of FHL tendon transfer procedures. If additional length is needed, we would recommend the use of intraoperative ultrasonography or a mini-open approach to minimize injury risk., Level of Evidence: Level V, expert opinion.

Background: In many situations, the therapeutic efficacy of CAR T cells is limited due to immune suppression and poor persistence. Immunostimulatory fusion protein (IFP) constructs have been advanced as a tool to convert suppressive signals into stimulation and thus promote the persistence of T cells, but no universal IFP design has been established so far. We now took advantage of a PD-1-CD28 IFP as a clinically relevant structure to define key determinants of IFP activity., Methods: We compared different PD-1-CD28 IFP variants in a human leukemia model to assess the impact of distinctive design choices on CAR T cell performance in vitro and a xenograft mouse model., Results: We observed that IFP constructs that putatively exceed the extracellular length of PD-1 induce T-cell response without CAR target recognition, rendering them unsuitable for tumour-specific therapy. IFP variants with physiological PD-1 length ameliorated CAR T cell effector function and proliferation in response to PD-L1 + tumour cells in vitro and prolonged survival in vivo. Transmembrane or extracellular CD28 domains were found to be replaceable by corresponding PD-1 domains for in vivo efficacy., Conclusion: PD-1-CD28 IFP constructs must mimic the physiological interaction of PD-1 with PD-L1 to retain selectivity and mediate CAR-conditional therapeutic activity., (© 2023. The Author(s).)

Background: Parents are often confronted with a difficult decision when their child falls ill: should they go to the general practitioner (GP) or not? This study aims to describe this process comprehensively in order to allow clinicians to assess the extent to which parents can recognise clinical warning signs and act accordingly. The purpose of this study is to describe parents' decision-making processes when deciding whether or not to consult a GP for their sick child., Methods: We used a qualitative study design based on semistructured interviews to investigate the decision-making process of 25 parents. Four case scenarios describing a developing illness in a child were presented., Results: Parents' reasons for seeking medical attention could be divided into two main categories. First, non-specific fears lead parents to consult a doctor. Parents were alarmed by the persistence and progression of symptoms, the combination of symptoms or changes in their child's behaviour or they needed reassurance. Second, several specific fears were identified. Sometimes, parents fear a specific disease, while at other times, they are concerned about warning signs. Some parents, however, would not seek medical attention at any decision point even though their child could be in a potentially life-threatening situation., Conclusions: Although parents make carefully considered decisions on whether or not to consult a doctor, many appear to miss red flags, including more experienced parents. Conversely, some become overly concerned with certain specific symptoms such as fever, and few parents are familiar with self-management strategies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: For the preparation of surgical procedures in orthopedics and trauma surgery, precise knowledge of imaging and the three-dimensional imagination of the surgeon are of outstanding importance. Image-based, preoperative two-dimensional planning is the gold standard in arthroplasty today. In complex cases, further imaging such as computed tomography (CT) or magnetic resonance imaging is also performed, generating a three-dimensional model of the body region and helping the surgeon in the planning of the surgical treatment. Four-dimensional, dynamic CT studies have also been reported and are available as a complementary tool., Digital Aids: Furthermore, digital aids should generate an improved representation of the pathology to be treated and optimize the surgeon's imagination. The finite element method allows patient-specific and implant-specific parameters to be taken into account in preoperative surgical planning. Intraoperatively, relevant information can be provided by augmented reality without significantly influencing the surgical workflow., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital's mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.

Introduction: Arthroplasty is the final treatment option for maintaining mobility and quality of life in many primary degenerative and (post-) traumatic joint diseases. Identification of research output and potential deficits for specific subspecialties may be an important measure to achieve long-term improvement of patient care in this field., Methods: Using specific search terms and Boolean operators, all studies published since 1945 to the subgroups of arthroplasty listed in the Web of Science Core Collection were included. All identified publications were analysed according to bibliometric standards, and comparative conclusions were drawn regarding the scientific merit of each subgroup., Results: Most publications investigated the subgroups of septic surgery and materials followed by approach, navigation, aseptic loosening, robotic and enhanced recovery after surgery (ERAS). In the last 5 years, research in the fields of robotic and ERAS achieved the highest relative increase in publications In contrast, research on aseptic loosening has continued to lose interest over the last 5 years. Publications on robotics and materials received the most funding on average while those on aseptic loosening received the least. Most publications originated from USA, Germany, and England, except for research on ERAS in which Denmark stood out. Relatively, publications on aseptic loosening received the most citations, whereas the absolute scientific interest was highest for the topic infection., Discussion: In this bibliometric subgroup analysis, the primary scientific outputs focused on septic complications and materials research in the field of arthroplasty. With decreasing publication output and the least financial support, intensification of research on aseptic loosening is urgently recommended., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Wolf, Goebel, Winter, Landgraeber and Orth.)

Background: Advanced core decompression (ACD) is a relative new technique for treatment of early stages of avascular femoral head necrosis. Although it is a promising treatment option, there is a need to modify this technique for achieving higher hip survival rates. An idea was to combine this technique with the lightbulb procedure in order to get a complete removal of the necrosis. This study aimed at evaluating the fracture risk of the femora treated by the combined Lightbulb-ACD technique as the basis for clinical application., Methods: Subject-specific models were generated from CT scan data of five intact femora. Several treated models were then created from each intact bone and simulated during normal walking activity. Biomechanical testing was additionally performed on 12 pairs of cadaver femora to confirm the simulation results., Findings: The finite element results revealed that the risk factor of the treated models with a 8 mm-drill increased, but was not significantly greater than that of their corresponding intact models. However, for the femur treated with a 10 mm-drill, the risk factor increased significantly. Fracture always initiated on the femoral neck, i.e. it was either subcapital or transcervical fracture. Our biomechanical testing results correlated well with the simulation data which confirmed the usefulness and effectiveness of the bone models., Interpretation: The combined Lightbulb-ACD technique using a 10 mm drill increased the fracture risk of femur postoperatively. A drill of up to 8 mm at the anterior head-neck junction did not however lead to the weakening of the femur so that full load bearing may be possible., Competing Interests: Declaration of Competing Interest Stefan Landgraeber received honoraria for lectures by Wright Medical., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Introduction: Revision hip arthroplasty is a challenging surgical procedure, especially in cases of advanced acetabular bone loss. Accurate preoperative planning can prevent complications such as periprosthetic fractures or aseptic loosening. To date, the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has been evaluated only in primary hip and knee arthroplasty., Methods: We retrospectively investigated the accuracy of 3D personalized planning of reinforcement cages (Burch Schneider) in 27 patients who underwent revision hip arthroplasty. Personalized 3D modeling and positioning of the reinforcement cages were performed using computed tomography (CT) of the pelvis of each patient and 3D templates of the implant. To evaluate accuracy, the sizes of the reinforcement cages planned in 2D and 3D were compared with the sizes of the finally implanted cages. Factors that may potentially influence planning accuracy such as gender and body mass index (BMI) were analyzed., Results: There was a significant difference ( p = 0.003) in the accuracy of correct size prediction between personalized 3D templating and 2D templating. Personalized 3D templating predicted the exact size of the reinforcement cage in 96.3% of the patients, while the exact size was predicted in only 55.6% by 2D templating. Regarding gender and BMI, no statistically significant differences in planning accuracy either for 2D or 3D templating were observed., Conclusion: Personalized 3D planning of revision hip arthroplasty using Burch Schneider reinforcement cages leads to greater accuracy in the prediction of the required size of implants than conventional 2D templating.

The clinical use of cellular immunotherapies is gaining momentum and the number of approved indications is steadily increasing. One class of cellular therapies-chimeric antigen receptor (CAR)-modified T cells-has achieved impressive results in distinct blood cancer indications. These existing cellular therapies treating blood cancers face significant relapse rates, and their application beyond hematology has been underwhelming, especially in solid oncology. Major reasons for resistance source largely in the tumor microenvironment (TME). The TME in fact functionally suppresses, restricts, and excludes adoptive immune cells, which limits the efficacy of cellular immunotherapies from the onset. Many promising efforts are ongoing to adapt cellular immunotherapies to address these obstacles, with the aim of reshaping the tumor microenvironment to ameliorate function and to achieve superior efficacy against both hematological and solid malignancies., (© 2022. The Author(s).)

Purpose: As children progress through adolescence, they become more independent and more responsible regarding their health. This shift in responsibility from the parents to the adolescent poses a challenge for healthcare professionals who must consider both parties. Pediatricians and other healthcare professionals may encounter problems regarding consent and confidentiality. This study aimed to investigate the opinions of Belgian parents of adolescents concerning cases about confidentiality in adolescent health problems., Methods: A qualitative methodology with semi-structured interviews and a case-based approach was chosen to answer our study aim. Belgian parents of adolescents were recruited voluntarily; 20 parents were interviewed. Parents' opinions on four different cases regarding confidentiality were obtained. Interviews were audio- and video-recorded and transcribed verbatim. Independent coding of the transcripts was conducted., Results: Parents' opinions differ considerably when asked if a physician has to maintain confidentiality toward the adolescent, depending on the content of the case. Opinions appear underpinned by three factors: trust, responsibility of the different parties, and the etiology of the problem., Discussion: This study shows that the nature, severity, and frequency of the medical issue at hand shape the opinions of parents toward patient confidentiality, on top of the trust and responsibility factors also highlighted in previous work. This is in contrast to the Belgian legislation, which focuses on maturity regardless of context., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

The total uptake of prenatal aneuploidy screening for Down syndrome (DS) is increasing worldwide. As a result of increasing prenatal diagnosis of DS and subsequent termination of pregnancy, livebirth prevalence of DS is decreasing. The aim of this study is to explore the impact of an increasing uptake of prenatal aneuploidy screening on the neonatal mortality and morbidity in DS. This is a retrospective cohort study of 253 neonates with DS born between 2012 and 2018 that were seen at the outpatient clinic of five hospitals in the Netherlands. The medical files were reviewed for maternal and neonatal characteristics and neonatal morbidities. The Dutch national birth registry (Perined) provided mortality numbers of neonates with DS. The results were interpreted in the context of other published studies. Neonatal mortality in DS remained stable, ranging from 1.4 to 3.6%. A congenital heart defect (CHD) was found in 138 of the 251 neonates (55.0%) with atrial septal defect, atrioventricular septal defect, and ventricular septal defect being the most common. The type of CHD in DS did not change over time. Gastro-intestinal defects were present in 22 of the 252 neonates with DS (8.7%), with duodenal atresia as the most reported anomaly. Persistent pulmonary hypertension of the neonate (PPHN) was found in 31 of the 251 infants (12.4%).  Conclusions: Although uptake of prenatal aneuploidy screening increased, neonatal mortality and morbidity in DS appears to be stable. An increased incidence of PPHN was found. What is Known: • The total uptake of prenatal aneuploidy screening for Down syndrome is increasing worldwide. • As a result of increasing prenatal diagnosis of Down syndrome and subsequent termination of pregnancy, the livebirth prevalence of Down syndrome is decreasing. What is New: • Although uptake of prenatal aneuploidy screening increased, neonatal mortality and morbidity in Down syndrome appears to be stable. • An increased incidence of persistent pulmonary hypertension of the neonate was found., (© 2022. The Author(s).)

PURPOSE OF THE STUDY A global bibliometric comparison of the level of scientific interest and output in the two research areas hip and knee arthroscopy (H-ASC and K-ASC) was carried out. In addition, the different degrees of publication activity in the countries and institutes performing this research were investigated. MATERIAL AND METHODS Publications from 1945-2020 listed in the Web of Science Core Collection were included in the study. Using the web application Science Performance Evaluation (SciPE), quantitative and qualitative aspects were evaluated. Subsequently, the date of publication, author information, and other metadata were analysed. RESULTS Since 1945, 3,924 studies have been published on K-ASC and 2,163 on H-ASC. The majority of the publications which have appeared since 2016 dealt with the topic of H-ASC (H-ASC: 241.2 publications/year; K-ASC: 217.4 publications/year). The USA published the most on both topics (H-ASC: 1,123 publications; K-ASC: 1,078 publications). More countries and institutes participated in K-ASC (3,008 institutes, 82 countries) than in H-ASC (103 institutes, 57 countries). The ten institutes with the most publications accounted for 36.71% and 12.34% of all publications on H-ASC and K-ASC, respectively. H-ASC received 78.12% of its funding from private sponsors while K-ASC was supported mainly by governmental/nonprofit sponsors (70.92%). CONCLUSIONS This study provides the first scientific comparison between H-ASC and K-ASC. Measured by qualitative and quantitative aspects, K-ASC was the most flourishing research area overall. In the last ten to five years, interest has shifted towards HASC with an increasing number of publications and a higher rate of citations. Key words: knee arthroscopy, hip arthroscopy, bibliometric comparison.

The expectations of professionals working on the development of healthcare Artificial Intelligence (AI) technologies and the patients who will be affected by them have received limited attention. This paper reports on a Foresight Workshop with professionals involved with pulmonary hypertension (PH) and a Focus Group with members of a PH patient group, to discuss expectations of AI development and implementation. We show that while professionals and patients had similar expectations of AI, with respect to the priority of early diagnosis; data risks of privacy and reuse; and responsibility, other expectations differed. One important point of difference was in the attitude toward using AI to point up other potential health problems (in addition to PH). A second difference was in the expectations regarding how much clinical professionals should know about the role of AI in diagnosis. These findings allow us to better prepare for the future by providing a frank appraisal of the complexities of AI development with foresight, and the anxieties of key stakeholders., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Peyronellaea pinodes is a devastating pathogen of pea crop. Quantitative trait loci (QTL) associated with resistance have been identified, as well as genes differentially expressed between resistant and susceptible pea lines. The key question is which of these many genes located into these QTLs, or differentially expressed, are the key genes that distinguish resistant from susceptible plants and could be used as markers. To identify these key genes, in the present study we applied MACE (Massive Analysis of cDNA Ends) -Seq to a whole Recombinant Inbred Line population segregating for resistance to this disease and their parental lines and identified those genes which expression was more correlated with the level of resistance. We also compared gene expression profiles between the most resistant and the most susceptible families of the RIL population. A total of 6780 transcripts were differentially expressed between the parental lines after inoculation. Of them, 803 showed the same expression pattern in the bulks formed by the most resistant and most susceptible RIL families. These genes, showing a consistent expression pattern, could be used as expression markers to distinguish resistant from susceptible plants. The analysis of these genes also discovered the crucial mechanisms acting against P. pinodes., (© 2022. The Author(s).)

Atraumatic femoral head necrosis (aFHN) in adults is estimated to be the leading cause of approximately 10% of all hip prosthesis implantations. Due to the relatively frequent occurrence of aFHN at a young age, the possibility of a joint-preserving intervention should be examined. This includes the classic "core decompression" and modifications based on it. There are different data on the success rates of this method. Reasons for treatment failure could include a lack of clearance of the necrosis zone. The clearance of the necrosis zone is taken into account by alternative surgical procedures for the treatment of aFHN. These are the "trap-door procedure", the "light-bulb procedure" and "advanced core decompression". The current state of knowledge on these procedures is reviewed in this keynote article. It is shown that the extensive excision of femoral head necrosis is of particular importance. None of the procedures mentioned can currently be recommended in preference over the others., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Whenever a child falls ill, parents need to decide whether there is a need to contact medical professionals. Parental and physician perspectives on the severity of a child's illness differ. We aimed to determine triggers for help-seeking among parents., Design and Setting: We conducted a survey study among 200 parents. In four hypothetical case scenarios, an acutely ill child was described with a baseline symptom (abdominal pain, rhinitis, headache, limping), with deterioration over time. Parents had to answer when they would contact the general practitioner. Fifty-four physicians received the same case scenarios., Main Outcome Measures: Parents and physicians did not differ significantly in help-seeking in the abdominal pain case. In the non-urgent rhinitis case, parents sought help earlier than physicians wished them to, while in the urgent illness cases of headache and limping parents tend to seek help later than physicians wished. Rising body temperature was more alarming to parents than physicians, while loss of appetite did not concern either group. Parents did not recognise several red flags, for example, drowsiness and refusal to stand. Low educated parents and parents with a history of more frequent healthcare use were inclined to seek help earlier., Implication of Results: In urgent cases, parents do not seem to recognise red flags, while some non-urgent symptoms trigger them to seek help. This reveals a need for mutual education. Physician awareness of a perception gap could help them adjust their communication and empower parents., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Disabled people are often involved in robotics research as potential users of technologies which address specific needs. However, their more generalised lived expertise is not usually included when planning the overall design trajectory of robots for health and social care purposes. This risks losing valuable insight into the lived experience of disabled people, and impinges on their right to be involved in the shaping of their future care. This project draws upon the expertise of an interdisciplinary team to explore methodologies for involving people with disabilities in the early design of care robots in a way that enables incorporation of their broader values, experiences and expectations. We developed a comparative set of focus group workshops using Community Philosophy, LEGO® Serious Play® and Design Thinking to explore how people with a range of different physical impairments used these techniques to envision a "useful robot". The outputs were then workshopped with a group of roboticists and designers to explore how they interacted with the thematic map produced. Through this process, we aimed to understand how people living with disability think robots might improve their lives and consider new ways of bringing the fullness of lived experience into earlier stages of robot design. Secondary aims were to assess whether and how co-creative methodologies might produce actionable information for designers (or why not), and to deepen the exchange of social scientific and technical knowledge about feasible trajectories for robotics in health-social care. Our analysis indicated that using these methods in a sequential process of workshops with disabled people and incorporating engineers and other stakeholders at the Design Thinking stage could potentially produce technologically actionable results to inform follow-on proposals., Competing Interests: Author JM was employed by company IBM Global. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 de Saille, Kipnis, Potter, Cameron, Webb, Winter, O’Neill, Gold, Halliwell, Alboul, Bell, Stratton and McNamara.)

The data presented in this article provide one of the first large-scale insights on adult preferences for confidentiality and consent with regards to medical decision-making for minors. We collected data on these preferences through 12 hypothetical scenario's that were presented, for which each participant had to indicate if they would (not) follow the minor's preferences. Data regarding family communication, relationship quality, and sociodemographic characteristics were also collected. The data were collected through an online survey in September and October 2020, which yielded responses from 1000 Belgian and 1000 Dutch participants between 35 and 55 years of age. We selected this age range because it increased the chances that they had a child near the age of the fictional minor in the hypothetical cases. These data can be of interest for family researchers and/or health workers who want to explore adults' perceptions regarding confidentiality and consent among minors., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Heterozygous pathogenic variants in the STIP1 homologous and U-box containing protein 1 ( STUB1 ) gene have been identified as causes of autosomal dominant inherited spinocerebellar ataxia type 48 (SCA48). SCA48 is characterized by an ataxic movement disorder that is often, but not always, accompanied by a cognitive affective syndrome. We report a severe early onset dementia syndrome that mimics frontotemporal dementia and is caused by the intronic splice donor variant c.524+1G>A in STUB1 . Impaired splicing was demonstrated by RNA analysis and in minigene assays of mutated and wild-type constructs of STUB1 . The most striking consequence of this splicing impairment was retention of intron 3 in STUB1 , which led to an in-frame insertion of 63 amino acids (aa) (p.Arg175&#95;Glu176ins63) into the highly conserved coiled-coil domain of its encoded protein, C-terminus of HSP70-interacting protein (CHIP). To a lesser extent, activation of two cryptic splice sites in intron 3 was observed. The almost exclusively used one, c.524+86, was not predicted by in silico programs. Variant c.524+86 caused a frameshift (p.Arg175fs*93) that resulted in a truncated protein and presumably impairs the C-terminal U-box of CHIP, which normally functions as an E3 ubiquitin ligase. The cryptic splice site c.524+99 was rarely used and led to an in-frame insertion of 33 aa (p.Arg175&#95;Glu176ins33) that resulted in disruption of the coiled-coil domain, as has been previously postulated for complete intron 3 retention. We additionally detected repeat expansions in the range of reduced penetrance in the TATA box-binding protein ( TBP ) gene by excluding other genes associated with dementia syndromes. The repeat expansion was heterozygous in one patient but compound heterozygous in the more severely affected patient. Therefore, we concluded that the observed severe dementia syndrome has a digenic background, making STUB1 and TBP important candidate genes responsible for early onset dementia syndromes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Reis, Patrun, Ackl, Winter, Scheifele, Danek and Nolte.)

Background: Osteonecrosis of the femoral head is a serious disease which, if left untreated, leads to destruction of the affected hip joint. For treatment of early stages of this disease, core decompression is the most common procedure. This study investigated the influence of the necrotic lesion and core decompression on the stress pattern in the hip joint using finite element analysis., Methods: Subject-specific models were generated from CT scan data of 5 intact hips. For each intact hip, twelve affected hip models were created by imposing a necrotic lesion in the femoral head, and four treated models were then created from four affected ones with central lesion, respectively. Treated models were created by supposing that the defect zone and the drill canal were filled with a bone substitute. Totally 105 hip models from three groups (intact, affected and treated) were simulated during normal walking activity., Findings: Necrotic lesion modified the stress distribution within the femoral head. Peak stress increased significantly up to 186% in mean in hips with a large lesion indicating an increased risk of femoral head collapse. Additionally, the presence of a medium to large necrosis altered significantly stress values (P < 0.05) and pattern in the articular cartilage. Our study revealed that advanced core decompression can recover normal cartilage stress values and pattern in treated joint., Interpretation: The presence of a large lesion increased the risk of femoral head collapse. Advanced core decompression with bone grafts can restore normal cartilage mechanics in hip postoperatively., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: T 1ρ dispersion quantification can potentially be used as a cardiac magnetic resonance index for sensitive detection of myocardial fibrosis without the need of contrast agents. However, dispersion quantification is still a major challenge, because T 1ρ mapping for different spin lock amplitudes is a very time consuming process. This study aims to develop a fast and accurate T 1ρ mapping sequence, which paves the way to cardiac T 1ρ dispersion quantification within the limited measurement time of an in vivo study in small animals., Methods: A radial spin lock sequence was developed using a Bloch simulation-optimized sampling pattern and a view-sharing method for image reconstruction. For validation, phantom measurements with a conventional sampling pattern and a gold standard sequence were compared to examine T 1ρ quantification accuracy. The in vivo validation of T 1ρ mapping was performed in N = 10 mice and in a reproduction study in a single animal, in which ten maps were acquired in direct succession. Finally, the feasibility of myocardial dispersion quantification was tested in one animal., Results: The Bloch simulation-based sampling shows considerably higher image quality as well as improved T 1ρ quantification accuracy (+ 56%) and precision (+ 49%) compared to conventional sampling. Compared to the gold standard sequence, a mean deviation of - 0.46 ± 1.84% was observed. The in vivo measurements proved high reproducibility of myocardial T 1ρ mapping. The mean T 1ρ in the left ventricle was 39.5 ± 1.2 ms for different animals and the maximum deviation was 2.1% in the successive measurements. The myocardial T 1ρ dispersion slope, which was measured for the first time in one animal, could be determined to be 4.76 ± 0.23 ms/kHz., Conclusion: This new and fast T 1ρ quantification technique enables high-resolution myocardial T 1ρ mapping and even dispersion quantification within the limited time of an in vivo study and could, therefore, be a reliable tool for improved tissue characterization., (© 2021. The Author(s).)