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Item does not contain fulltext, Treatment with tyrosine kinase inhibitors (TKIs), especially nilotinib, often results in hyperglycemia, which may further increase cardiovascular disease risk in patients with chronic myeloid leukemia (CML). The mechanism underlying the TKI-induced glucose dysregulation is not clear. TKIs are suggested to affect insulin secretion but also insulin sensitivity of peripheral tissue has been proposed to play a role in the pathogenesis of TKI-induced hyperglycemia. Here, we aimed to assess whether skeletal muscle glucose uptake and insulin responses are altered in nondiabetic patients with CML receiving TKI treatment. After a glycogen-depleted exercise bout, an intravenous glucose bolus (0.3 g/kg body weight) was administered to monitor 2-h glucose tolerance and insulin response in 14 patients with CML receiving nilotinib, 14 patients with CML receiving imatinib, and 14 non-CML age- and gender-matched controls. A dynamic [(18)F]-FDG PET scan during a hyperinsulinemic-euglycemic clamp was performed in a subgroup of 12 male patients with CML to assess m. quadriceps glucose uptake. We showed that patients with CML treated with nilotinib have an increased insulin response to intravenous glucose administration after muscle glycogen-depleted exercise. Despite the increased insulin response to glucose administration in patients with CML receiving nilotinib, glucose disappearance rates were significantly slower in nilotinib-treated patients when compared with controls in the first 15 min after glucose administration. Although [(18)F]-FDG uptake in m. quadriceps was not different, patients receiving nilotinib showed a trend toward decreased glucose infusion rates during euglycemic clamping when compared with patients receiving imatinib. Together, these findings indicate disturbed skeletal muscle glucose handling in patients with CML receiving nilotinib therapy.NEW & NOTEWORTHY In this study, we have shown that non-diabetic patients with CML receiving nilotinib therapy show early

Contains fulltext : 293292.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext, BACKGROUND: Statin use may exacerbate exercise-induced skeletal muscle injury caused by reduced coenzyme Q10 (CoQ10) levels, which are postulated to produce mitochondrial dysfunction. OBJECTIVES: We determined the effect of prolonged moderate-intensity exercise on markers of muscle injury in statin users with and without statin-associated muscle symptoms. We also examined the association between leukocyte CoQ10 levels and muscle markers, muscle performance, and reported muscle symptoms. METHODS: Symptomatic (n = 35; age 62 ± 7 years) and asymptomatic statin users (n = 34; age 66 ± 7 years) and control subjects (n = 31; age 66 ± 5 years) walked 30, 40, or 50 km/d for 4 consecutive days. Muscle injury markers (lactate dehydrogenase, creatine kinase, myoglobin, cardiac troponin I, and N-terminal pro-brain natriuretic peptide), muscle performance, and reported muscle symptoms were assessed at baseline and after exercise. Leukocyte CoQ10 was measured at baseline. RESULTS: All muscle injury markers were comparable at baseline (P > 0.05) and increased following exercise (P < 0.001), with no differences in the magnitude of exercise-induced elevations among groups (P > 0.05). Muscle pain scores were higher at baseline in symptomatic statin users (P < 0.001) and increased similarly in all groups following exercise (P < 0.001). Muscle relaxation time increased more in symptomatic statin users than in control subjects following exercise (P = 0.035). CoQ10 levels did not differ among symptomatic (2.3 nmol/U; IQR: 1.8-2.9 nmol/U), asymptomatic statin users (2.1 nmol/U; IQR: 1.8-2.5 nmol/U), and control subjects (2.1 nmol/U; IQR: 1.8-2.3 nmol/U; P = 0.20), and did not relate to muscle injury markers, fatigue resistance, or reported muscle symptoms. CONCLUSIONS: Statin use and the presence of statin-associated muscle symptoms does not exacerbate exercise-induced muscle injury after moderate exercise. Muscle injury markers were not related to leukocyte CoQ10 levels. (Exercise-induce

Item does not contain fulltext, Treatment with tyrosine kinase inhibitors (TKIs), especially nilotinib, often results in hyperglycemia, which may further increase cardiovascular disease risk in patients with chronic myeloid leukemia (CML). The mechanism underlying the TKI-induced glucose dysregulation is not clear. TKIs are suggested to affect insulin secretion but also insulin sensitivity of peripheral tissue has been proposed to play a role in the pathogenesis of TKI-induced hyperglycemia. Here, we aimed to assess whether skeletal muscle glucose uptake and insulin responses are altered in nondiabetic patients with CML receiving TKI treatment. After a glycogen-depleted exercise bout, an intravenous glucose bolus (0.3 g/kg body weight) was administered to monitor 2-h glucose tolerance and insulin response in 14 patients with CML receiving nilotinib, 14 patients with CML receiving imatinib, and 14 non-CML age- and gender-matched controls. A dynamic [(18)F]-FDG PET scan during a hyperinsulinemic-euglycemic clamp was performed in a subgroup of 12 male patients with CML to assess m. quadriceps glucose uptake. We showed that patients with CML treated with nilotinib have an increased insulin response to intravenous glucose administration after muscle glycogen-depleted exercise. Despite the increased insulin response to glucose administration in patients with CML receiving nilotinib, glucose disappearance rates were significantly slower in nilotinib-treated patients when compared with controls in the first 15 min after glucose administration. Although [(18)F]-FDG uptake in m. quadriceps was not different, patients receiving nilotinib showed a trend toward decreased glucose infusion rates during euglycemic clamping when compared with patients receiving imatinib. Together, these findings indicate disturbed skeletal muscle glucose handling in patients with CML receiving nilotinib therapy.NEW & NOTEWORTHY In this study, we have shown that non-diabetic patients with CML receiving nilotinib therapy show early

Item does not contain fulltext, BACKGROUND: Statin use may exacerbate exercise-induced skeletal muscle injury caused by reduced coenzyme Q10 (CoQ10) levels, which are postulated to produce mitochondrial dysfunction. OBJECTIVES: We determined the effect of prolonged moderate-intensity exercise on markers of muscle injury in statin users with and without statin-associated muscle symptoms. We also examined the association between leukocyte CoQ10 levels and muscle markers, muscle performance, and reported muscle symptoms. METHODS: Symptomatic (n = 35; age 62 ± 7 years) and asymptomatic statin users (n = 34; age 66 ± 7 years) and control subjects (n = 31; age 66 ± 5 years) walked 30, 40, or 50 km/d for 4 consecutive days. Muscle injury markers (lactate dehydrogenase, creatine kinase, myoglobin, cardiac troponin I, and N-terminal pro-brain natriuretic peptide), muscle performance, and reported muscle symptoms were assessed at baseline and after exercise. Leukocyte CoQ10 was measured at baseline. RESULTS: All muscle injury markers were comparable at baseline (P > 0.05) and increased following exercise (P < 0.001), with no differences in the magnitude of exercise-induced elevations among groups (P > 0.05). Muscle pain scores were higher at baseline in symptomatic statin users (P < 0.001) and increased similarly in all groups following exercise (P < 0.001). Muscle relaxation time increased more in symptomatic statin users than in control subjects following exercise (P = 0.035). CoQ10 levels did not differ among symptomatic (2.3 nmol/U; IQR: 1.8-2.9 nmol/U), asymptomatic statin users (2.1 nmol/U; IQR: 1.8-2.5 nmol/U), and control subjects (2.1 nmol/U; IQR: 1.8-2.3 nmol/U; P = 0.20), and did not relate to muscle injury markers, fatigue resistance, or reported muscle symptoms. CONCLUSIONS: Statin use and the presence of statin-associated muscle symptoms does not exacerbate exercise-induced muscle injury after moderate exercise. Muscle injury markers were not related to leukocyte CoQ10 levels. (Exercise-induce

The Netherlands is facing an increased risk of pluvial flooding, mainly due to the expected rise in the frequency and intensity of extreme rainfall events caused by climate change. Recent events have highlighted the importance of accurate flood forecasting to minimize damage. Hydrological inundation models are crucial in flood mitigation as they support water managers in an operational setting by predicting the size and timing of a flooding event, such that they can make informed decisions and implement appropriate measures (e.g. adjusting weir levels, alerting relevant parties). To ensure the operational usability of hydrological inundation models, they must meet certain criteria. Detailed hydrological inundation models provide accurate results but have long computational times, making them impractical for the operational context. Surrogate models have a shorter computational time by approximating the detailed hydrological inundation model. Surrogate models may offer a solution, but their quality and added value in an operational setting compared to existing hydrological models are yet to be determined. In this study, the added value of surrogate models in an operational setting compared to the W2O model is researched. Three cases studies are selected to evaluate the hydrological inundation models’ compliance with the end-users’ requirements. These case studies include: the municipality of Amersfoort who would like to have an accurate forecast of the locations where inundation is expected within the city, the municipality of Tilburg who would like to have an accurate forecast of urban surface inundation, and Hoogheemraadschap van Rijnland who would like to know probability of flooding when the interaction between open waters (surface waters) and inundation on surface level is included.

The first JWST observations of hot Jupiters showed an unexpected detection of SO2 in their hydrogen-rich atmospheres. We investigate how much sulphur can be expected in the atmospheres of rocky exoplanets and which sulphur molecules can be expected to be most abundant and detectable by transmission spectroscopy. We run thermo-chemical equilibrium models at the crust-atmosphere interface, considering surface temperatures 500 to 5000 K, surface pressures 1 to 100 bar, and various sets of element abundances based on common rock compositions. Between 1000 K and 2000 K, we find gaseous sulphur concentrations of up to 25 percent above the rock in our models. SO2, SO, H2S and S2 are by far the most abundant sulphur molecules. SO2 shows potentially detectable features in transmission spectra at about 4 micron, between 7 and 8 micron, and beyond 15 micron. In contrast, the sometimes abundant H2S molecule is difficult to detect in these spectra, which are mostly dominated by H2O and CO2. Although the molecule PS only occurs with concentrations below 300 ppm, it can cause a strong absorption feature between 0.3 and 0.65 micron in some of our models for high surface pressures. The detection of sulphur molecules would enable a better characterisation of the planetary surface., Comment: Typos have been corrected compared to version 1

Background When improving the health of local and regional populations, cross-sector collaboration between different policy domains, non-governmental organisations and citizens themselves is needed. Previously, enabling factors and strategies have been identified to improve cross-sector collaboration for health. However, few longitudinal studies have been conducted to understand how the implementation of strategies for cross-sector collaboration changes throughout the collaboration process. The aim of this study is therefore to learn more about the different strategies that were implemented throughout three cross-sector collaboration projects for a healthy living environment. Methods The realist evaluation approach was used to understand how the implemented strategies worked, in which context, why and with what outcomes. Project partners were asked to reflect on their implemented strategies at two different moments in the project timelines, and quarterly updates with project leaders were held. In addition two reference panels were organised for data triangulation. Results Three key insights for successful cross-sector collaboration throughout projects for a healthy living environment were identified, namely 1. Investing in trust among the partners and faith in the project has a positive influence on continuing the collaboration throughout the project; 2. Making stakeholders actively participate throughout the project requires additional strategies after the onset of the project, and 3. Defining roles, tasks, and other prerequisites at the start of the project helps in pursuing the project over time, but needs re-examination throughout the project. These key insights were based on multiple examples of implemented strategies, linked to context, mechanisms and outcomes. Conclusions This study shows the different strategies that can be employed as the collaboration in projects for a healthy living environment progresses. We fou

Aim Health economic evaluations conducted from a societal perspective currently do not consider inter-sectoral unit costs (UC) of the German Criminal Justice Sector.Methods UCwere calculated according to the pre-defined measurement parameters from the PECUNIA questionnaire by means of literature and internet research, or direct correspondence with the institution. If UC could not be identified, proxies were used.Results UC were calculated for police, fire brigade, vandalism, prison, police custody, simple and serious theft, minor and serious vandalism of real estate, and legal fees in court.Conclusion The lack of UC for services in the criminal justice sector in Germany makes this work important for health economic evaluations from a societal perspective. The usability of the developed UC outside of health economics, such as forensic psychiatry, emphasizes the relevance of this work.

RIVM rapport:In Nederland gaan mensen gewoonlijk eerst naar de huisarts als ze een vraag hebben over hun gezondheid. In het begin van de coronapandemie stonden er berichten in de media dat mensen niet naar de huisarts durfden. Het RIVM en het Nivel onderzochten hoe vaak dat gebeurde en wat de redenen hiervoor waren. Tussen maart en juni 2020 (de eerste golf) lag het totaal aantal bezoeken aan huisartsen in totaal 11 procent lager dan in dezelfde periode in 2019. Het aandeel huisartsbezoeken naar aanleiding van symptomen die mogelijk duiden op ernstige klachten, zoals kanker of hartziekten, was 21 procent lager. Het aandeel korte consulten was tijdens de eerste golf hoger. Waarschijnlijk gaat het daarbij om telefonische afspraken of mailcontact. Tijdens de zomer en de tweede golf (tussen half september en eind december 2020) was het aantal consulten weer vergelijkbaar met 2019. Het lijkt er dus op dat de gemiste consulten niet na de eerste golf zijn ingehaald. Het kan ook zijn dat een verschuiving heeft plaatsgevonden in type consulten en ze in een andere vorm hebben plaatsgevonden, zoals korte consulten. Het percentage korte consulten lijkt sinds de eerste golf hoger te blijven dan voor de coronapandemie. Overigens was het tijdens de eerste golf voor sommige klachten ook minder vaak nodig om naar de huisarts te gaan. Door de lockdown en de coronamaatregelen waren er bijvoorbeeld minder sportblessures en andere infectieziekten. Mensen meden de zorg om verschillende redenen. Een deel van hen vond zijn klacht niet ernstig genoeg om een afspraak te maken met de huisarts. Een ander deel zei dat hun klacht volgens de assistenten van de huisarts niet ernstig genoeg was voor een bezoek. Ook is de keuze van mensen beïnvloed door berichten in de media over de drukte in de zorg, de angst om daar besmet te raken of een ander te besmetten. Anderen dachten dat het niet mogelijk was om een afspraak met de huisarts te maken.

Background: Approximately 25% of patients after bariatric surgery either do not lose enough weight or regain a considerable amount of weight, both are referred to as nonresponse. This study aimed to describe the added value of a multidisciplinary approach on treatment strategies in patients with nonresponse.Materials and Methods: The primary outcome of this retrospective cohort study was the initiated treatment by the multidisciplinary team (MDT). Outcomes were described separately for patients with primary (i.e., <50% excess weight loss [EWL]) and secondary nonresponse (i.e., >= 50% EWL followed by >5% regain).Results: Of the 83 included patients, 10 patients underwent revisional surgery. A total of 73 patients received a conservative treatment as they either had not been able to change their lifestyle or due to certain behavioral factors. Conservatively treated patients stabilized in weight after 2 years (-0.9 kg +/- 5.8, n = 27), while surgically treated patients did lose weight (-12.1 kg +/- 16.9, n = 7). One patient suffered from an ulcerative stenosis at the gastroenterostomy after limb length alteration.Conclusions: a conservative treatment was the most frequently advocated treatment by the MDT. A surgical treatment resulted in successful weight loss, although only a few patients were selected for this by the MDT. A multidisciplinary approach can be beneficial for the identification of lifestyle and behavioral factors.

Background: Protein intake and physical activity have a substantial impact on body composition and weight loss outcomes after bariatric surgery. The 24-h dietary recall and 6-min walk test (6mWT) are frequently used to monitor protein intake and physical activity, respectively. Despite its frequent use, it is unknown whether these tests can predict long-term weight loss. Methods: This retrospective study included 85 patients who underwent laparoscopic Roux-en-Y gastric bypass. Protein intake was recorded using the 24-h dietary recall and physical function was measured using the 6mWT. Data about total weight loss (TWL) and nonresponse (i.e., insufficient weight loss and weight regain) were collected up to 5 years. Multiple regression analyses were performed to examine the predictive value of the 24-h dietary recall and 6mWT on weight loss outcomes. Results: The mean protein intake 1 year postoperatively was 68.1 +/- 15.0 g/day and the mean distance covered during the 6mWT was 591.7 +/- 67.9 m. Both the 24-h dietary recall and 6mWT were not significantly associated with TWL and neither with nonresponse. Conclusions: The 24-h dietary recall and 6mWT are poor predictors for long-term weight loss outcomes after gastric bypass. Despite the well-known advantages of these clinical tests, other monitoring tests are suggested for future research.

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C.T. McMahon The Coffin Ship. Life and Death at Sea during the Great Irish Famine New York:New York University Press ,2021 9781479808762, Item does not contain fulltext

Contains fulltext : 252594.pdf (Publisher’s version ) (Open Access), Background: Control over the tendency to make or withhold responses guided by contextual Pavlovian information plays a key role in understanding impulsivity and hyperactivity. Here we set out to assess (1) the understudied relation between contextual Pavlovian inhibitory control and hyperactivity/impulsivity in adults with ADHD and (2) whether this inhibition can be enhanced by mindfulness based cognitive therapy (MBCT). Methods: Within the framework of a randomized controlled trial 50 Adult ADHD patients were assessed before and after 8 weeks of treatment as usual (TAU) with (n = 24) or without (n = 26) MBCT. We employed a well-established behavioral Pavlovian-to-instrumental transfer task that quantifies Pavlovian inhibitory control over instrumental behavior. Results: Task results revealed (1) less aversive Pavlovian inhibition in ADHD patients with clinically relevant hyperactivity/impulsivity than in those without; and (2) enhanced Pavlovian inhibition across all ADHD patients after TAU+MBCT compared with TAU. Conclusion: These findings offer new insights in the neurocognitive mechanisms of hyperactivity/impulsivity in ADHD and its treatment: We reveal a role for Pavlovian inhibitory mechanisms in understanding hyperactive/impulsive behaviors in ADHD and point toward MBCT as an intervention that might influence these mechanisms.

Contains fulltext : 252753.pdf (Publisher’s version ) (Open Access)

C.T. McMahon The Coffin Ship. Life and Death at Sea during the Great Irish Famine New York:New York University Press ,2021 9781479808762, Item does not contain fulltext

C.T. McMahon The Coffin Ship. Life and Death at Sea during the Great Irish Famine New York:New York University Press ,2021 9781479808762, Item does not contain fulltext

C.T. McMahon The Coffin Ship. Life and Death at Sea during the Great Irish Famine New York:New York University Press ,2021 9781479808762, Item does not contain fulltext

Contains fulltext : 252753.pdf (Publisher’s version ) (Open Access)

C.T. McMahon The Coffin Ship. Life and Death at Sea during the Great Irish Famine New York:New York University Press ,2021 9781479808762, Item does not contain fulltext

Contains fulltext : 252594.pdf (Publisher’s version ) (Open Access), Background: Control over the tendency to make or withhold responses guided by contextual Pavlovian information plays a key role in understanding impulsivity and hyperactivity. Here we set out to assess (1) the understudied relation between contextual Pavlovian inhibitory control and hyperactivity/impulsivity in adults with ADHD and (2) whether this inhibition can be enhanced by mindfulness based cognitive therapy (MBCT). Methods: Within the framework of a randomized controlled trial 50 Adult ADHD patients were assessed before and after 8 weeks of treatment as usual (TAU) with (n = 24) or without (n = 26) MBCT. We employed a well-established behavioral Pavlovian-to-instrumental transfer task that quantifies Pavlovian inhibitory control over instrumental behavior. Results: Task results revealed (1) less aversive Pavlovian inhibition in ADHD patients with clinically relevant hyperactivity/impulsivity than in those without; and (2) enhanced Pavlovian inhibition across all ADHD patients after TAU+MBCT compared with TAU. Conclusion: These findings offer new insights in the neurocognitive mechanisms of hyperactivity/impulsivity in ADHD and its treatment: We reveal a role for Pavlovian inhibitory mechanisms in understanding hyperactive/impulsive behaviors in ADHD and point toward MBCT as an intervention that might influence these mechanisms.

Injectable scaffolds are a promising strategy to restore and regenerate damaged and diseased tissues. They require minimally invasive procedure and allow the formation of an in-situ structure of any shape. However, the formation of 3D in-situ structure with aligned morphologies using a method which could be easily transferred to clinical settings remains a challenge. Herein, the rational design of an aligned injectable hydrogel-based scaffold via remote-induced alignment is reported. Carboxylated multi-walled carbon nanotubes (cMWCNT) are aligned into hydrogel via low magnetic field. The uniform dispersion and alignment of cMWCNT into the hydrogel are clearly demonstrated by small angle neutron scattering. The obtained aligned cMWCNT-embodied hydrogel is stable over 7 days at room temperature and as well at body temperature (i.e. 37 °C). As unique approach, the formation of MWCNT-hydrogel composite is investigated combining rheology with molecular dynamic and quantum mechanical calculations. The increase of MWCNT concentration into the hydrogel decreases the total energy promoting structural stabilization and increase of stiffness. The remote aligning of injectable hydrogel-based scaffold opens up horizons in the engineering of functional tissues which requires specific cell orientation.

Background The most commonly performed bariatric procedures worldwide are Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), yet outcomes following these procedures in young adults are limited. Therefore, the objective of this study was to compare weight loss outcomes between RYGB and SG in young adults.Methods This is a nationwide retrospective cohort study of young adults, aged 18-25 years, who underwent RYGB or SG between 2015 and 2019, with data from the Dutch Audit Treatment of Obesity (DATO). The primary outcome was weight loss expressed as percentage total weight loss (%TWL) in a period of 3 years after surgery. Secondary outcomes were the incidence of complications (<30 days) and progression of obesity-related comorbidities.Results In total, 2313 patients were included, 1246 in the RYGB group and 1067 in the SG group. Percentage TWL was significantly higher in the RYGB group compared to the SG group at 1, 2, and 3 years after surgery (respectively 2.4%, 2.9%, and 3.3% higher, p < 0.001). RYGB was associated with an on-average 2.75 higher %TWL compared to SG in females (p < 0.001), although this was not seen in males (beta= 0.63, p =0.514). No differences were found in the incidence of complications, nor the progression of obesity-related comorbidities except for gastroesophageal reflux disease (GERD). There was more improvement or resolution of GERD in the RYGB group (95.2% vs. 56.3%, p < 0.001).Conclusion Similar numbers of RYGB and SG were performed in young adults, whereas RYGB was associated with greater weight loss in the short- and midterm, particularly in females.

RIVM rapport:In Nederland gaan mensen gewoonlijk eerst naar de huisarts als ze een vraag hebben over hun gezondheid. In het begin van de coronapandemie stonden er berichten in de media dat mensen niet naar de huisarts durfden. Het RIVM en het Nivel onderzochten hoe vaak dat gebeurde en wat de redenen hiervoor waren. Tussen maart en juni 2020 (de eerste golf) lag het totaal aantal bezoeken aan huisartsen in totaal 11 procent lager dan in dezelfde periode in 2019. Het aandeel huisartsbezoeken naar aanleiding van symptomen die mogelijk duiden op ernstige klachten, zoals kanker of hartziekten, was 21 procent lager. Het aandeel korte consulten was tijdens de eerste golf hoger. Waarschijnlijk gaat het daarbij om telefonische afspraken of mailcontact. Tijdens de zomer en de tweede golf (tussen half september en eind december 2020) was het aantal consulten weer vergelijkbaar met 2019. Het lijkt er dus op dat de gemiste consulten niet na de eerste golf zijn ingehaald. Het kan ook zijn dat een verschuiving heeft plaatsgevonden in type consulten en ze in een andere vorm hebben plaatsgevonden, zoals korte consulten. Het percentage korte consulten lijkt sinds de eerste golf hoger te blijven dan voor de coronapandemie. Overigens was het tijdens de eerste golf voor sommige klachten ook minder vaak nodig om naar de huisarts te gaan. Door de lockdown en de coronamaatregelen waren er bijvoorbeeld minder sportblessures en andere infectieziekten. Mensen meden de zorg om verschillende redenen. Een deel van hen vond zijn klacht niet ernstig genoeg om een afspraak te maken met de huisarts. Een ander deel zei dat hun klacht volgens de assistenten van de huisarts niet ernstig genoeg was voor een bezoek. Ook is de keuze van mensen beïnvloed door berichten in de media over de drukte in de zorg, de angst om daar besmet te raken of een ander te besmetten. Anderen dachten dat het niet mogelijk was om een afspraak met de huisarts te maken.

Background: Approximately 25% of patients after bariatric surgery either do not lose enough weight or regain a considerable amount of weight, both are referred to as nonresponse. This study aimed to describe the added value of a multidisciplinary approach on treatment strategies in patients with nonresponse.Materials and Methods: The primary outcome of this retrospective cohort study was the initiated treatment by the multidisciplinary team (MDT). Outcomes were described separately for patients with primary (i.e., <50% excess weight loss [EWL]) and secondary nonresponse (i.e., >= 50% EWL followed by >5% regain).Results: Of the 83 included patients, 10 patients underwent revisional surgery. A total of 73 patients received a conservative treatment as they either had not been able to change their lifestyle or due to certain behavioral factors. Conservatively treated patients stabilized in weight after 2 years (-0.9 kg +/- 5.8, n = 27), while surgically treated patients did lose weight (-12.1 kg +/- 16.9, n = 7). One patient suffered from an ulcerative stenosis at the gastroenterostomy after limb length alteration.Conclusions: a conservative treatment was the most frequently advocated treatment by the MDT. A surgical treatment resulted in successful weight loss, although only a few patients were selected for this by the MDT. A multidisciplinary approach can be beneficial for the identification of lifestyle and behavioral factors.

Background: Protein intake and physical activity have a substantial impact on body composition and weight loss outcomes after bariatric surgery. The 24-h dietary recall and 6-min walk test (6mWT) are frequently used to monitor protein intake and physical activity, respectively. Despite its frequent use, it is unknown whether these tests can predict long-term weight loss. Methods: This retrospective study included 85 patients who underwent laparoscopic Roux-en-Y gastric bypass. Protein intake was recorded using the 24-h dietary recall and physical function was measured using the 6mWT. Data about total weight loss (TWL) and nonresponse (i.e., insufficient weight loss and weight regain) were collected up to 5 years. Multiple regression analyses were performed to examine the predictive value of the 24-h dietary recall and 6mWT on weight loss outcomes. Results: The mean protein intake 1 year postoperatively was 68.1 +/- 15.0 g/day and the mean distance covered during the 6mWT was 591.7 +/- 67.9 m. Both the 24-h dietary recall and 6mWT were not significantly associated with TWL and neither with nonresponse. Conclusions: The 24-h dietary recall and 6mWT are poor predictors for long-term weight loss outcomes after gastric bypass. Despite the well-known advantages of these clinical tests, other monitoring tests are suggested for future research.

Background and Objectives Surgery for colorectal cancer (CRC) negatively affects health-related quality of life (HRQoL). Addressing shortcomings in literature, the purpose of this study was to evaluate the impact of surgery for CRC on the course of HRQoL from baseline up to 2 years after diagnosis. Methods In this prospective, population-based study patients with newly diagnosed CRC were included between 2016 and 2019. HRQoL was assessed by the EORTC QLQ-C30 questionnaire over time both between and within subgroups of patients that underwent right-sided colonic, left-sided colonic, and rectal resection using linear mixed model analyses. Results The study included 415 patients of whom 148 patients underwent right-sided colonic (36%), 147 left-sided colonic (35%), and 120 rectal resection (29%). Overall, HRQoL scores restored to baseline level 1 year after diagnosis. Impact of surgery seems to be more prominent in patients who underwent rectal resection, as they experienced more pain and had worse role and social functioning scores 4 weeks after surgery. Finally, among patients who underwent left-sided and rectal resection, physical functioning did not return to baseline level during follow-up. Conclusion This study shows several differences (between-group and within-group) in HRQoL according to surgery type and offers perspective which patients may need additional support in the care pathway.

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Radboud University, 01 oktober 2021, Promotor : Kremer, J.A.M. Co-promotores : Kool, R.B., Janssen, L., Item does not contain fulltext

Contains fulltext : 237194.pdf (Publisher’s version ) (Open Access)

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Contains fulltext : 245055.pdf (Publisher’s version ) (Open Access), Fatigue is a common side effect of tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia (CML) patients. However, the prevalence of TKI-induced fatigue remains uncertain and little is known about predictors of fatigue and its relationship with physical activity. In this study, 220 CML patients receiving TKI therapy and 110 gender- and age-matched controls completed an online questionnaire to assess fatigue severity and fatigue predictors (Part 1). In addition, physical activity levels were objectively assessed for 7 consecutive days in 138 severely fatigued and non-fatigued CML patients using an activity monitor (Part 2). We demonstrated that the prevalence of severe fatigue was 55.5% in CML patients and 10.9% in controls (P<0.001). We identified five predictors of fatigue in our CML population: age (OR 0.96, 95% CI 0.93-0.99), female gender (OR 1.76, 95% CI 0.92-3.34), Charlson Comorbidity Index (OR 1.91, 95% CI 1.16-3.13), the use of comedication known to cause fatigue (OR 3.43, 95% CI 1.58-7.44), and physical inactivity (OR of moderately active, vigorously active and very vigorously active compared to inactivity 0.43 (95% CI 0.12-1.52), 0.22 (95% CI 0.06-0.74), and 0.08 (95% CI 0.02-0.26), respectively). Objective monitoring of activity patterns confirmed that fatigued CML patients performed less physical activity on both light (P=0.017) and moderate to vigorous intensity (P=0.009). In fact, compared to the non-fatigued patients, fatigued CML patients performed 1 hour less of physical activity per day and took 2000 fewer steps per day. Our findings facilitate the identification of patients at risk of severe fatigue and highlight the importance to set the reduction of fatigue as a treatment goal in CML care. This study was registered at The Netherlands Trial Registry, NTR7308 (Part 1) and NTR7309 (Part 2).

Learners often have difficulty with regulating their learning processes before, during, and after task performance. Learning environments need to offer support to help them with this. In immersive learning environments (ILEs), learning analytics are available that could provide such support by means of learning analytic dashboards (LADs). With LADs, learning analytics (LA) can be visualized and support SRL skills before, during, and after task performance. However, this will only happen if learners appreciate the LA visualizations on their dashboards. Therefore this study focuses on the preferences learners have for LADs used before, during, and after task performance that use a specific means to present LA, namely reference frames. Reference frames provide an anchor point for comparing learning analytics that could help learners evaluate their learning. Three different types of reference frames were used: the social reference frame, the progress reference frame, and the achievement reference frame. This research showed that regardless of timing (i.e., before, during, or after task performance), learners have a preference for LADs with a progress reference frame. This insight can contribute to the design of LADs in ILEs that learners appreciate and potentially support them in regulating their learning.

Due to computerization, many jobs are automated by computers and complex tasks become increasingly important. When designing training for mastering complex tasks, the Four-Component Instructional Design (4C/ID) model claims that four components are needed. One of these components is supportive information. The inductive-expository principle aligns with supportive information and states that learners with little prior knowledge should first get a concrete example before the general information is presented. However, previous studies examining the influence of prior knowledge on presentation strategies are hard to find. Therefore, this study investigates the effect of presentation strategies of supportive information on students’ learning performance and how this relation is influenced by prior knowledge. A total of 129 university students participated in 2 sessions where they were exposed to the inductive or the deductive presentation strategy. Results show no significant differences between the deductive and inductive groups with respect to learning performance. Additionally, results indicate that the effect of inductive and deductive information presentation strategies in participants’ learning performance is not influenced by the participants’ prior knowledge. It is therefore concluded that teaching with an inductive or deductive strategy has no difference on the learning performance of low prior knowledge and high prior knowledge.

This study investigates one of the design principles provided by the 4C/ID by Van Merriënboer and Kirschner. In this model, it is recommended to present supportive information with an inductive-expository strategy (presenting an example prior to abstract information) to domain novices and to use a deductive-expository strategy (presenting an example after abstract information) for learners with high prior knowledge. The present study investigates whether an inductive-expository strategy is indeed of significant influence on domain novices’ learning performance. In addition, this study looks at the effects of this strategy on domain novices’ mental effort and self-efficacy. This study has a randomized two-group design, consisting of two experimental sessions in which participants were either exposed to the deductive-expository information presentation strategy or the inductive-expository information presentation strategy. A total of 107 bachelor students from Utrecht University participated in this study. The present study shows that there are no significant differences on learning performance, mental effort and self-efficacy between the two information presentation strategies for domain novices.

Radboud University, 01 oktober 2021, Promotor : Kremer, J.A.M. Co-promotores : Kool, R.B., Janssen, L., Item does not contain fulltext

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Contains fulltext : 237194.pdf (Publisher’s version ) (Open Access)