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Ultracentral heavy ion collisions due to their exceptionally large multiplicity probe an interesting regime of quark-gluon plasma where the size is (mostly) fixed and fluctuations in the initial condition dominate. Spurred by the recent measurement of the CMS collaboration we investigate the driving factors of the increase of transverse momentum, including a complete analysis of the influence of the QCD equation of state. Particularly interesting is the influence of the centrality selection as well as the initial energy deposition.

People can have a sense of collective ownership of a particular territory, such as “our” country, “our” neighborhood, and “our” park. Collective psychological ownership is argued to go together with rights and responsibilities that have different behavioral implications. We found that collective psychological ownership leads to perceived determination right, and indirectly to the exclusion of outsiders from “our” place. Simultaneously, collective psychological ownership leads to perceived group responsibility, and indirectly to engagement in stewardship behavior. These results were found among Dutch adults, cross-sectionally in relation to their country (Study 1; N = 617) and a neighborhood (Study 2; N = 784), and experimentally in relation to an imaginary local park (Study 3; N = 384, Study 4; N = 502, both pre-registered). Our research shows that the feeling that a place is “ours” can, via perceived rights and responsibilities, result in both exclusionary and prosocial behavioral tendencies.

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.

Background: In 2013, physical therapy students demonstrated low guideline-adherent recommendations regarding chronic low back pain (CLBP) for spinal pathology, activity, and work. Objectives: To assess the differences in physical therapy students’ attitudes, beliefs, and adherence to guideline recommendations regarding CLBP and knee osteoarthritis between 2013 and 2020. Methods: In 2013 and 2020, second and fourth-year physical therapy students were recruited from 6 Belgian and 2 Dutch institutions. Attitudes and beliefs regarding CLBP and knee OA were evaluated using the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT), the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), and a questionnaire regarding therapeutic exercise and knee osteoarthritis. A clinical vignette was used to measure guideline-adherent recommendations regarding spinal pathology, activity, and work. Results: In 2013, 927 second-year and 695 fourth-year students; in 2020, 695 second-year and 489 fourth-year students; were recruited to participate in the study. Compared to 2013, students had less biomedical and stronger biopsychosocial attitudes and beliefs regarding CLBP, more guideline-adherent recommendations for activity, and more biopsychosocial beliefs regarding the benefits of exercise for patients with knee osteoarthritis in both the second and fourth year. Only fourth-year students in 2020 scored significantly better on HC-PAIRS and guideline-adherent recommendation relating to spinal pathology. No differences were found regarding work recommendations. Conclusions: Between 2013 and 2020, physical therapy students made a positive shift towards a more biopsychosocial approach to CLBP and knee osteoarthritis management. Guideline-adherent recommendations for CLBP concerning activity improved, however, concerning work and spinal pathology, it remained low.

The contemporary interaction of climate and disturbance drives vegetation composition and species distribution shifts, making their respective roles difficult to disentangle. This study describes the long-term ruderal plant species distributions along the ‘Rallarvägen' in Abisko, subarctic Sweden. This trail currently serves as a hiking trail but was initially created as a construction road for a railroad from 1898 to 1903 and is paralleled by the E10 Highway since 1982. Using vegetation and climate data from 1903, 1913, 1983, and 2021, we found that warm-adapted ruderal plant species were common along the Rallarvägen shortly after railroad construction in the early 20th century. Interestingly, many of these native and non-native ruderals with relatively high temperature affinity that were present in 1903 and 1913 have since disappeared and have not reappeared, despite the substantial increase in regional temperature in recent decades. In addition, the historical disturbances have had long-lasting effects on the current spatial distribution of the ruderal vegetation. Most ruderals still reside close to the railroad tracks and are progressively filtered out with increasing distance from anthropogenically disturbed introductory points, such as train stations, where they peak in species richness – a process we term ‘horizontal directional ecological filtering', in parallel to the established concept of ‘directional ecological filtering' along elevational gradients. The historical record of ruderal plant species in the region, influenced by a century-old railroad construction, emphasizes the importance of knowing a system's disturbance history for understanding current vegetation dynamics and anticipating its future in a changing climate.

We present an estimate of the yield of hard probes expected for collisions of the isobars 4496Ru and 4096Zr at collision energies reachable at RHIC and the LHC. These yields are proportional to the number of binary nucleon-nucleon interactions, which is characteristically different due to the presence of the large neutron skin in 4096Zr. This provides an independent opportunity to measure the difference between the neutron skin of 4496Ru and 4096Zr, which can provide an important constraint on the Equation of State of cold neutron-rich matter.

This study evaluates the technoeconomic impacts of direct and indirect electrification on the EU's net-zero emissions target by 2050. By linking the JRC-EU-TIMES long-term energy system model with PLEXOS hourly resolution power system model, this research offers a detailed analysis of the interactions between electricity, hydrogen and synthetic fuel demand, production technologies, and their effects on the power sector. It highlights the importance of high temporal resolution power system analysis to capture the synergistic effects of these components, often overlooked in isolated studies. Results indicate that direct electrification increases significantly and unimpacted by biomass, CCS, and nuclear energy assumptions. However indirect electrification in the form of hydrogen varies significantly, between 1400 and 2200 TWhH2 by 2050. Synthetic fuels are essential for sector coupling, making up 6–12% of total energy consumption by 2050, with the power sector supplying most hydrogen and CO2 for their production. Varying levels of indirect electrification impact electrolysers, renewable energy, and firm capacities. Higher indirect electrification increases electrolyser capacity factors by 8%, leading to more renewable energy curtailment but improves system reliability by reducing 11 TWh unserved energy and increasing flexibility options. These insights inform EU energy policies, stressing the need for a balanced approach to electrification, biomass use, and CCS to achieve a sustainable and reliable net-zero energy system by 2050. We also explore limitations and sensitivities.

Background: The NELSON trial demonstrated a 24% intention-to-screen reduction in lung cancer mortality from regular screening with low-dose computed tomography. Implementation efforts in Europe are ongoing, but still await country-specific and NELSON-adapted estimates of the benefits and harms of screening. Methods: We use the MISCAN-Lung microsimulation model, calibrated to individual-level outcomes from the NELSON trial, to estimate the effectiveness under 100% compliance of biennial lung cancer screening with concomitant smoking cessation support for Dutch cohorts 1942–1961. The model simulates smoking behaviour, lung cancer incidence and the effects of screening and smoking cessation on lung- and other-cause mortality. Findings: We find biennial screening with eligibility criteria equal to those of the 4-IN-THE-LUNG-RUN implementation trial to reduce lung cancer mortality by 16.9% among the eligible population, equivalent to 1076 LC deaths prevented per year in the next two decades. Eligible individuals constitute 21.5% of the cohorts studied, and stand to face 61% of the projected lung cancer mortality burden in the absence of screening. 10.3 life-years are gained per prevented LC death, for 14.9 screens per life year gained. Concomitant smoking cessation interventions may increase the expected gains in life years from screening by up to 20%. Interpretation: Policy makers should imminently consider the implementation of lung cancer screening in Europe, paired with effective smoking cessation interventions. Smoking cessation interventions on their own are not estimated to yield a gain in remaining life expectancy of the magnitude offered by even a single CT screen. Funding: European Union Horizon 2020 grant 848294: 4-IN-THE-LUNG-RUN.

Introduction: Lung cancer is a leading cause of mortality worldwide, with lung cancer treatment presenting a significant financial burden. The treatment landscape has recently shifted, seeing an increase in targeted- and immunotherapies. Such treatments are expensive, but estimates of the medical costs of the lung cancer treatment pathway largely predate their introduction. Methods: We link medical expenditures of individuals resident in the Netherlands (n = 19.2 m) for 2013–2021 to tumour-level (n = 137,129, incident 2012–2021) Netherlands Cancer Registry data. We estimate lung cancer-attributable costs by phase of care (initial, continuing and terminal), stratified by cancer stage and histology, and observe trends in medical costs over time. Results: We estimate mean costs over the lung cancer treatment pathway to be €48,443 per patient. Total medical costs are highest in the initial phase, followed by the terminal and continuing phase. Monthly treatment for stage IV lung cancer is significantly more expensive than for early-stage disease (€8293 per month of initial care relative to €3228 for stage IA). Stage IV lung cancer has become significantly more expensive to treat 2018–2021 relative to 2013–2017, with monthly expenditures rising 55 % in initial care and 148 % in continuing care. Population-wide, we find €900.6 million spent on lung cancer care in 2021, €433 million more than in 2016, of which €307.3 million is attributed to per-patient expenditure trends. Conclusions: Treatment advances are quickly inflating medical costs for late-stage lung cancer. Policy makers should carefully evaluate the cost-effectiveness of novel treatments, and incorporate stage-specific treatment costs in evaluating interventions for early detection.

Staurastrum glaronense, a rare species in Austria In July 2023, a peculiar Staurastrum (circa 20x20 um) was found in sample material from a small mountain lake (12 x 4 meters) at an altitude of 2350 meters. Initially this species could not be identified, even after consulting various experts. A few months later, and with the help of SEM photos, it became clear that it had to be Staurastrum glaronense. This species was first found in Switzerland in 1951 and described by Messikommer.

The contemporary interaction of climate and disturbance drives vegetation composition and species distribution shifts, making their respective roles difficult to disentangle. This study describes the long-term ruderal plant species distributions along the ‘Rallarvägen' in Abisko, subarctic Sweden. This trail currently serves as a hiking trail but was initially created as a construction road for a railroad from 1898 to 1903 and is paralleled by the E10 Highway since 1982. Using vegetation and climate data from 1903, 1913, 1983, and 2021, we found that warm-adapted ruderal plant species were common along the Rallarvägen shortly after railroad construction in the early 20th century. Interestingly, many of these native and non-native ruderals with relatively high temperature affinity that were present in 1903 and 1913 have since disappeared and have not reappeared, despite the substantial increase in regional temperature in recent decades. In addition, the historical disturbances have had long-lasting effects on the current spatial distribution of the ruderal vegetation. Most ruderals still reside close to the railroad tracks and are progressively filtered out with increasing distance from anthropogenically disturbed introductory points, such as train stations, where they peak in species richness – a process we term ‘horizontal directional ecological filtering', in parallel to the established concept of ‘directional ecological filtering' along elevational gradients. The historical record of ruderal plant species in the region, influenced by a century-old railroad construction, emphasizes the importance of knowing a system's disturbance history for understanding current vegetation dynamics and anticipating its future in a changing climate.

BACKGROUND: Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content. METHODS: Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be display

The contemporary interaction of climate and disturbance drives vegetation composition and species distribution shifts, making their respective roles difficult to disentangle. This study describes the long-term ruderal plant species distributions along the ‘Rallarvägen' in Abisko, subarctic Sweden. This trail currently serves as a hiking trail but was initially created as a construction road for a railroad from 1898 to 1903 and is paralleled by the E10 Highway since 1982. Using vegetation and climate data from 1903, 1913, 1983, and 2021, we found that warm-adapted ruderal plant species were common along the Rallarvägen shortly after railroad construction in the early 20th century. Interestingly, many of these native and non-native ruderals with relatively high temperature affinity that were present in 1903 and 1913 have since disappeared and have not reappeared, despite the substantial increase in regional temperature in recent decades. In addition, the historical disturbances have had long-lasting effects on the current spatial distribution of the ruderal vegetation. Most ruderals still reside close to the railroad tracks and are progressively filtered out with increasing distance from anthropogenically disturbed introductory points, such as train stations, where they peak in species richness – a process we term ‘horizontal directional ecological filtering', in parallel to the established concept of ‘directional ecological filtering' along elevational gradients. The historical record of ruderal plant species in the region, influenced by a century-old railroad construction, emphasizes the importance of knowing a system's disturbance history for understanding current vegetation dynamics and anticipating its future in a changing climate.

BACKGROUND: Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content. METHODS: Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be display

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes., De två första författarna delar förstaförfattarskapet.

Context. Modified Newtonian dynamics (MOND) is a promising alternative to dark matter. To further test the theory, there is a need for fluid- and particle-dynamics simulations. The force in MOND is not a direct particle-particle interaction, but derives from a potential for which a nonlinear partial differential equation (PDE) needs to be solved. Normally, this makes the problem of simulating dynamical evolution computationally expensive. Aims. We intend to develop a fast particle-mesh (PM) code for MOND (the AQUAL formalism). Methods. We transformed the nonlinear equation for MOND into a system of linear PDEs plus one algebraic equation. An iterative scheme with the fast Fourier transform (FFT) produces successively better numerical approximations. Results. The algorithm was tested for dynamical systems in MOND where analytical solutions are known: the two-body problem, a body with a circular ring, and a spherical distribution of particles in thermal equilibrium in the self-consistent potential. Conclusions. The PM code can accurately calculate the forces at subpixel scale and reproduces the analytical solutions. Four iterations are required for the potential, but when the spatial steps are small compared to the kernel width, one iteration is suffices. The use of a smoothing kernel for the accelerations is inevitable in order to eliminate the self-gravity of the point particles. Our PDE solver is 15 to 42 times as slow as a standard Poisson solver. However, the smoothing and particle propagation takes up most of the time above one particle per 10 3 pixels. The FFTs, the smoothing, and the propagation part in the code can all be parallelized., Mathematical Physics, RST/Fundamental Aspects of Materials and Energy

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.

In low back pain (LBP), primary care and secondary prevention of recurrent and persistent LBP are not always successful. Enhanced understanding of neural mechanisms of sensorimotor processing and pain modulation in patients with acute LBP is mandatory. This explorative fMRI study investigated sensorimotor processing due to mechanosensory stimulation of the lumbar spine. We studied 19 adult patients with acute LBP (< 4 weeks of an acute episode) and 23 healthy controls. On a numeric rating scale, patients reported moderate mean pain intensity of 4.5 out of 10, while LBP-associated disability indicated mild mean disability. The event-related fMRI analysis yielded no between-group differences. However, the computation of functional connectivity resulted in adaptive changes in networks involved in sensorimotor processing in the patient group: Connectivity strength was decreased in the salience and cerebellar networks but increased in the limbic and parahippocampal networks. Timewise, these results indicate that early connectivity changes might reflect adaptive physiological processes in an episode of acute LBP. These findings raise intriguing questions regarding their role in pain persistence and recurrences of LBP, particularly concerning the multiple consequences of acute LBP pain. Advanced understanding of neural mechanisms of processing non-painful mechanosensations in LBP may also improve therapeutic approaches.

Background In 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50–80 years who had ever smoked and had at least 20 pack-years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial. Methods The authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10, 15, 20, 25, 30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated. Outcomes included the number of screens, the percentage ever screened, screening benefits (lung cancer deaths averted, life-years gained), and harms (false-positive tests, overdiagnosed cases, radiation-induced lung cancer deaths). Sensitivity analyses were conducted to evaluate the effect of restricting screening to those who had at least 5 years of life expectancy. Results As the YSQ criterion was relaxed, the number of screens and the benefits and harms of screening increased. Raising the age at which to stop screening age resulted in additional benefits but with more overdiagnosis, as expected, because screening among those older than 80 years increased. Limiting screening to those who had at least 5 years of life expectancy would maintain most of the benefits while considerably reducing the harms. Conclusions Expanding screening to persons who formerly smoked and have greater than 15 YSQ would result in considerable increases in deaths averted and life-years gained. Although additional harms would occur, these could be moderated by ensuring that screening is restricted to only those with reasonable life expectancy.

Background: Angelman syndrome (AS) is a rare neurodevelopmental disorder characterised by severe intellectual disability, movement disorder, epilepsy, sleeping problems, and behavioural issues. Little is known on child health-related quality of life (HRQoL) in AS. AS family studies have reported elevated parenting stress and a high impact of the child's syndrome on the parent. It is unclear which factors influence child HRQoL and parenting stress/impact in AS. Methods: We collected data prospectively through standardised clinical assessments of children with AS at the ENCORE Expertise centre for Angelman Syndrome at the Erasmus MC Sophia Children's Hospital. A linear regression analysis was conducted for the following outcome variables: (1) child HRQoL (Infant and Toddler Quality of Life Questionnaire); (2) the impact of the child's syndrome on the parent (Infant and Toddler Quality of Life Questionnaire); and (3) parenting stress (Parenting Stress Index). Predictor variables were child genotype, epilepsy, sleeping problems (Sleep Disturbance Scale for Children), cognitive developmental level (Bayley Cognition Scale), autistic features (Autism Diagnostic Observation Schedule) and emotional/behavioural problems (Child Behaviour Checklist). Covariates were sex, age and socio-economic status. Results: The study sample consisted of 73 children with AS, mean age = 9.1 years, range = 2–18 years. Emotional/behavioural problems were the strongest significant predictor of lowered child HRQoL. Internalising problems were driving this effect. In addition, having the deletion genotype and higher age was related to lower child HRQoL. Sleeping problems were related to a higher impact of the child's syndrome on the parent. Finally, emotional/behavioural problems were associated with higher parenting stress. Cognitive developmental level, autistic features and epilepsy were not a significant predictor of child HRQoL and parenting stress/impact. Conclusions: These results suggest

Despite the low prevalence of each rare disease, the total burden is high. Patients with rare diseases encounter numerous barriers, including delayed diagnosis and limited access to high-quality treatments. In order to tackle these challenges, the European Commission launched the European Reference Networks (ERNs), cross-border networks of healthcare providers and patients representatives. In parallel, the aims and structure of these ERNs were translated at the federal and regional levels, resulting in the creation of the Flemish Network of Rare Diseases. In line with the mission of the ERNs and to ensure equal access to care, we describe as first patient pathways for systemic sclerosis (SSc), as a pilot model for other rare connective and musculoskeletal diseases. Consensus was reached on following key messages: 1. Patients with SSc should have multidisciplinary clinical and investigational evaluations in a tertiary reference expert centre at baseline, and subsequently every three to 5 years. Intermediately, a yearly clinical evaluation should be provided in the reference centre, whilst SSc technical evaluations are permissionably executed in a centre that follows SSc-specific clinical practice guidelines. In between, monitoring can take place in secondary care units, under the condition that qualitative examinations and care including interactive multidisciplinary consultations can be provided. 2. Patients with early diffuse cutaneous SSc, (progressive) interstitial lung disease and/or pulmonary arterial hypertension should undergo regular evaluations in specialised tertiary care reference institutions. 3. Monitoring of patients with progressive interstitial lung disease and/or pulmonary (arterial) hypertension will be done in agreement with experts of ERN LUNG.

INTRODUCTION: Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS: The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION: This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATIO

Throughout Europe, computed tomography (CT) screening for lung cancer is in a phase of clinical implementation or reimbursement evaluation. To efficiently select individuals for screening, the use of lung cancer risk models has been suggested, but their incremental (cost-)effectiveness relative to eligibility based on pack-year criteria has not been thoroughly evaluated for a European setting. We evaluate the cost-effectiveness of pack-year and risk-based screening (PLCOm2012 model-based) strategies for Switzerland, which aided in informing the recommendations of the Swiss Cancer Screening Committee (CSC). We use the MISCAN (MIcrosimulation SCreening ANalysis)-Lung model to estimate benefits and harms of screening among individuals born 1940 to 1979 in Switzerland. We evaluate 1512 strategies, differing in the age ranges employed for screening, the screening interval and the strictness of the smoking requirements. We estimate risk-based strategies to be more cost-effective than pack-year-based screening strategies. The most efficient strategy compliant with CSC recommendations is biennial screening for ever-smokers aged 55 to 80 with a 1.6% PLCOm2012 risk. Relative to no screening this strategy is estimated to reduce lung cancer mortality by 11.0%, with estimated costs per Quality-Adjusted Life-Year (QALY) gained of €19 341, and a €1.990 billion 15-year budget impact. Biennial screening ages 55 to 80 for those with 20 pack-years shows a lower mortality reduction (10.5%) and higher cost per QALY gained (€20 869). Despite model uncertainties, our estimates suggest there may be cost-effective screening policies for Switzerland. Risk-based biennial screening ages 55 to 80 for those with ≥1.6% PLCOm2012 risk conforms to CSC recommendations and is estimated to be more efficient than pack-year-based alternatives.

BACKGROUND: Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content. METHODS: Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be display

BACKGROUND: Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content. METHODS: Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be display

Insectenmeel en biologisch melkweipoeder zijn potentieel veelbelovende grondstoffen voor pluimveevoeders door onder meer hun nutritionele waarde, regionale oorsprong en bijdrage binnen het concept van circulaire landbouw. Zowel insectenmeel als melkweipoeder bevatten hoge gehaltes aan methionine en vitamine B2, twee componenten die zeer belangrijk zijn in het rantsoen van leghennen. Binnen de biologische veeteelt is het niet toegestaan om synthetische aminozuren of vitamines in het voeder toe te voegen, waardoor de gehaltes ervan vaak moeilijk op peil te houden zijn.

BACKGROUND: Spinal stenosis is the most common reason for elective spine surgery, and the cardinal symptom is leg pain and discomfort when walking. Patients with spinal stenosis have a decreased level of physical activity and thereby an increased risk of poor health. Get Back is a person-centred digital programme that strives to support patients being physically active after surgery. The aim is to explore if Get Back, in its present format (referred to as Get Backfeasibility), is feasible and contributes to detectable change in variables related to intervention content. METHODS: Thirty patients planned for decompression surgery due to central lumbar spinal stenosis who present with low physical activity, pain catastrophizing or fear of movement, will be included in a randomized feasibility study. All patients will be randomly allocated to either Get Backfeasibility or usual physical therapy. Get Backfeasibility aims to increase the patient's physical activity level by combining a person-centred and cognitive behavioural approach. It comprises 10 video and telephone sessions led by a physical therapist over 12 weeks (pre/postoperatively). Outcomes are treatment fidelity (treatment dose, adherence, and content), process feasibility (recruitment, intervention use, and acceptability of measurements and intervention), and variables related to the intervention content (steps per day, physical activity level, pain catastrophizing, fear of movement, and general self-efficacy). Treatment fidelity and feasibility data will be assessed during the full study period (12 weeks). Physical activity, physical capacity, and patient-reported outcomes will be assessed digitally at baseline (2 weeks preoperatively) and 11-12 weeks postoperatively. Variables related to the intervention content will be monitored weekly through a digital application. Feasibility data will be analysed descriptively and inferentially using a nonparametric approach, data from repeated measures will be display

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.

In november 2023 heeft Wageningen Food Safety Research (WFSR), onderdeel van Wageningen University & Research, de hier beschreven ringtest, “Ringtest nutriënten in meststoffen” (WSRPT-MS01) uitgevoerd in opdracht van het Ministerie van Landbouw, Natuur en Voedselkwaliteit. Deze ringtest is uitgevoerd volgens de ISO/IEC 17043:2023 norm, voor de organisatie van interlaboratoriumonderzoeken, maar valt niet onder de accreditatie omdat de matrix vaste dierlijke mest buiten de huidige scope valt. Voor deze ringtest zijn twee batches vaste dierlijke mest verzameld, gemengd en uitgevuld in potten met minimaal 500 g. De homogeniteit van elk van de twee monsters is bepaald voor zowel totaal stikstof als totaal fosfor. Vervolgens heeft elk deelnemend laboratorium twee monsterpotten ontvangen, namelijk één monster dikke fractie rundveedrijfmest en één monster dikke fractie varkensdrijfmest. Aan de deelnemende laboratoria is gevraagd om in beide monsters de gehaltes totaal stikstof en totaal fosfor te bepalen met de eigen methode(s). Er zijn vijf laboratoria die zich hebben geregistreerd voor deze ringtest. De resultaten van WFSR uit de homogeniteitsstudie zijn in de berekening als deelnemend laboratorium voor de berekening van de z’-scores meegenomen. Alle laboratoria hebben voor de sluitingsdatum hun resultaten ingediend. Voor elk deelnemend laboratorium zijn vier z’-scores berekend. Vier van de 5 deelnemende laboratoria lieten een optimale prestatie zien, namelijk 4 van de 4 z’-scores als voldoende. Eén van de deelnemende laboratoria had drie z’-scores als voldoende één z’-score als twijfelachtige.

PURPOSE Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. METHODS This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. RESULTS A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7-42.5 h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). CONCLUSION The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.

(1) Background: This exploratory study aims to explore the relationship between nonspecific chronic spinal pain (nCSP) and insomnia symptoms, by examining the interconnections, strengths, and directional dependence of the symptoms. In addition, we aim to identify the key symptoms of the nCSP–insomnia relationship and shed light on the bidirectional nature of this relationship. (2) Methods: This study is a secondary analysis of the baseline data (cross-sectional) from a randomized controlled trial, which examined the added value of Cognitive Behavioral Therapy for Insomnia (CBT-I) combined with cognition-targeted exercise therapy, conducted in collaboration with the Universiteit Gent and Vrije Universiteit Brussel (Belgium). One hundred and twenty-three nCSP patients with comorbid insomnia were recruited through the participating hospitals, advertisements, announcements in local newspapers, pharmacies, publications from support groups, and primary care. To explore the interconnections and directionality between symptoms and the strengths of the relationships, we estimated a regularized Gaussian graphical model and a directed acyclic graph. (3) Results: We found only one direct, but weak, link between sleep and pain, namely, between average pain and difficulties maintaining sleep. (4) Conclusions: Despite the lack of strong direct links between sleep and pain, pain and sleep seem to be indirectly linked via anxiety and depression symptoms, acting as presumable mediators in the network of nCSP and comorbid insomnia. Furthermore, feeling slowed down and fatigue emerged as terminal nodes, implying their role as consequences of the network., SCOPUS: ar.j, info:eu-repo/semantics/published

At a time of radical uncertainty, with our future under threat, a small constellation of Brussels-based associations and activists have set out to explore otherwise possible futures. Against powerlessness, against the ineluctable – but through what is at the core of their struggles for technological, environmental, and social justice – they have com- posed worlds, cultivated dissenting futures and crafted stories that they share here like a bottle to the sea, as an invitation to join this makeshift vessel of imagination., info:eu-repo/semantics/inPress, 1

En ces temps d’incertitude radicale, où notre futur est menacé de toutes parts, une petite constellation d’associations et d’activistes bruxelloises a entrepris d’explorer des ave- nirs autrement possibles. Contre l’impuis- sance, contre l’inéluctable – mais à travers ce qui est au cœur de leurs luttes pour la justice technologique, environnementale et sociale – iels ont composé des mondes, cultivé des futurs dissidents et élaboré des histoires qu’iels partagent ici telle une bouteille à la mer, une invitation à rejoindre ce vaisseau de fortune de l’imagination., info:eu-repo/semantics/inPress, 1

Brief introduction: What are microclimates and why are they important?: Microclimate science has developed into a global discipline. Microclimate science is increasingly used to understand and mitigate climate and biodiversity shifts. Here, we provide an overview of the current status of microclimate ecology and biogeography in terrestrial ecosystems, and where this field is heading next. Microclimate investigations in ecology and biogeography: We highlight the latest research on interactions between microclimates and organisms, including how microclimates influence individuals, and through them populations, communities and entire ecosystems and their processes. We also briefly discuss recent research on how organisms shape microclimates from the tropics to the poles. Microclimate applications in ecosystem management: Microclimates are also important in ecosystem management under climate change. We showcase new research in microclimate management with examples from biodiversity conservation, forestry and urban ecology. We discuss the importance of microrefugia in conservation and how to promote microclimate heterogeneity. Methods for microclimate science: We showcase the recent advances in data acquisition, such as novel field sensors and remote sensing methods. We discuss microclimate modelling, mapping and data processing, including accessibility of modelling tools, advantages of mechanistic and statistical modelling and solutions for computational challenges that have pushed the state-of-the-art of the field. What's next?: We identify major knowledge gaps that need to be filled for further advancing microclimate investigations, applications and methods. These gaps include spatiotemporal scaling of microclimate data, mismatches between macroclimate and microclimate in predicting responses of organisms to climate change, and the need for more evidence on the outcomes of microclimate management.

Purpose: Ventilation Perfusion SPECT is important in the diagnostics of e.g. pulmonary embolism and chronic obstructive pulmonary disease. Classical and reverse mismatched defects can be identified by utilizing the ventilation-perfusion ratio. Unfortunately, this ratio is only linear in the ventilation, the scale is not symmetrical regarding classical and reversed mismatches and small perfusion values give rise to artifacts. The ventilation-perfusion (VQ) difference is developed as an alternative. Methods: For both VQ-ratio and VQ-difference a scaling factor for the perfusion is computed, so that voxels with matched ventilation and perfusion (on average) yield zero signal. The relative VQ-difference is calculated by scaling with the summed VQ-signal in each voxel. The scaled VQ-difference is calculated by scaling with the global maximum of this sum. Results: The relative and scaled differences have a scale from −1 (perfusion only) to + 1 (ventilation only). Image quality of relative VQ-difference and VQ-ratio images is hampered by artifacts from areas with both low perfusion and low ventilation. Ratio and differences have been investigated in ten patients and are shown for three patients (one without defects). Clinical thresholds for the difference images are derived resulting in color maps of relevant (reversed) mismatches with a (reciprocal) ratio larger than two. Conclusions: The relative ventilation-perfusion difference is a methodological improvement on the ventilation-perfusion ratio, because it has a symmetrical scale and is bound on a closed domain. A better diagnostic value is expected by utilizing the scaled difference, which represents functional difference instead of relative difference.

Background: Recommendations regarding personalized lung cancer screening are being informed by natural-history modeling. Therefore, understanding how differences in model assumptions affect model-based personalized screening recommendations is essential. Design: Five Cancer Intervention and Surveillance Modeling Network (CISNET) models were evaluated. Lung cancer incidence, mortality, and stage distributions were compared across 4 theoretical scenarios to assess model assumptions regarding 1) sojourn times, 2) stage-specific sensitivities, and 3) screening-induced lung cancer mortality reductions. Analyses were stratified by sex and smoking behavior. Results: Most cancers had sojourn times <5 y (model range [MR]; lowest to highest value across models: 83.5%–98.7% of cancers). However, cancer aggressiveness still varied across models, as demonstrated by differences in proportions of cancers with sojourn times <2 y (MR: 42.5%–64.6%) and 2 to 4 y (MR: 28.8%–43.6%). Stage-specific sensitivity varied, particularly for stage I (MR: 31.3%–91.5%). Screening reduced stage IV incidence in most models for 1 y postscreening; increased sensitivity prolonged this period to 2 to 5 y. Screening-induced lung cancer mortality reductions among lung cancers detected at screening ranged widely (MR: 14.6%–48.9%), demonstrating variations in modeled treatment effectiveness of screen-detected cases. All models assumed longer sojourn times and greater screening-induced lung cancer mortality reductions for women. Models assuming differences in cancer epidemiology by smoking behaviors assumed shorter sojourn times and lower screening-induced lung cancer mortality reductions for heavy smokers. Conclusions: Model-based personalized screening recommendations are primarily driven by assumptions regarding sojourn times (favoring longer intervals for groups more likely to develop less aggressive cancers), sensitivity (higher sensitivities favoring longer intervals), and screening-induced m

PurposeTo examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN).MethodIn total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology.ResultsPeri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group.ConclusionOverall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic.Level of evidenceLevel III: Evidence obtained from well-designed cohort or case-control analytic studies.

Brief introduction: What are microclimates and why are they important?: Microclimate science has developed into a global discipline. Microclimate science is increasingly used to understand and mitigate climate and biodiversity shifts. Here, we provide an overview of the current status of microclimate ecology and biogeography in terrestrial ecosystems, and where this field is heading next. Microclimate investigations in ecology and biogeography: We highlight the latest research on interactions between microclimates and organisms, including how microclimates influence individuals, and through them populations, communities and entire ecosystems and their processes. We also briefly discuss recent research on how organisms shape microclimates from the tropics to the poles. Microclimate applications in ecosystem management: Microclimates are also important in ecosystem management under climate change. We showcase new research in microclimate management with examples from biodiversity conservation, forestry and urban ecology. We discuss the importance of microrefugia in conservation and how to promote microclimate heterogeneity. Methods for microclimate science: We showcase the recent advances in data acquisition, such as novel field sensors and remote sensing methods. We discuss microclimate modelling, mapping and data processing, including accessibility of modelling tools, advantages of mechanistic and statistical modelling and solutions for computational challenges that have pushed the state-of-the-art of the field. What's next?: We identify major knowledge gaps that need to be filled for further advancing microclimate investigations, applications and methods. These gaps include spatiotemporal scaling of microclimate data, mismatches between macroclimate and microclimate in predicting responses of organisms to climate change, and the need for more evidence on the outcomes of microclimate management.

Purpose: Ventilation Perfusion SPECT is important in the diagnostics of e.g. pulmonary embolism and chronic obstructive pulmonary disease. Classical and reverse mismatched defects can be identified by utilizing the ventilation-perfusion ratio. Unfortunately, this ratio is only linear in the ventilation, the scale is not symmetrical regarding classical and reversed mismatches and small perfusion values give rise to artifacts. The ventilation-perfusion (VQ) difference is developed as an alternative. Methods: For both VQ-ratio and VQ-difference a scaling factor for the perfusion is computed, so that voxels with matched ventilation and perfusion (on average) yield zero signal. The relative VQ-difference is calculated by scaling with the summed VQ-signal in each voxel. The scaled VQ-difference is calculated by scaling with the global maximum of this sum. Results: The relative and scaled differences have a scale from −1 (perfusion only) to + 1 (ventilation only). Image quality of relative VQ-difference and VQ-ratio images is hampered by artifacts from areas with both low perfusion and low ventilation. Ratio and differences have been investigated in ten patients and are shown for three patients (one without defects). Clinical thresholds for the difference images are derived resulting in color maps of relevant (reversed) mismatches with a (reciprocal) ratio larger than two. Conclusions: The relative ventilation-perfusion difference is a methodological improvement on the ventilation-perfusion ratio, because it has a symmetrical scale and is bound on a closed domain. A better diagnostic value is expected by utilizing the scaled difference, which represents functional difference instead of relative difference.

Energy companies are considering producing renewable fuels such as hydrogen/ammonia. Setting up a production network means deciding where to build production plants, and how to operate them at minimum electricity and transport costs. These decisions are complicated by many factors including the difficulty in obtaining accurate current data (e.g., electricity price and transport costs) for potential supply locations, the accuracy of data predictions (e.g., for demand and costs), and the need for some decisions to be made due to external (not modelled) factors. Thus, decision-makers need access to a user-centric decision system that helps them visualise, explore, interact and compare the many possible solutions of many different scenarios. This paper describes the system we have built to support our energy partner in making such decisions, and shows the advantages of having a graphical user-focused interactive tool, and of using a high-level constraint modelling language (MiniZinc) to implement the underlying model.

Our Community Series introduces a comprehensive and dynamic perspective within the evolving field of instrumental music education. The first volume of this series, entitled Towards a meaningful instrumental music education: methods, perspectives, and challenges, examined a range of pivotal topics including technology, meaning, and expression. Likewise, the 11 contributions to this second volume are collaborative and draw upon a diverse spectrum of perspectives—they integrate empirical insights, engage robust theoretical frameworks, and develop reflective insights from pedagogical practice. In doing so, they enrich our comprehension of music's role within broader pedagogical contexts and showcase possibilities for catalyzing transformative shifts within music education itself. Like the first volume, this Research Topic provides insights that resonate with educators, researchers, and students alike.

The present contribution introduces a theoretical framework to explore music performance from a perspective inspired by the conceptual resources of two orientations known as Dynamical System Theory and Embodied Cognitive Science. We discursively elaborate on how music performance might be conceived of as a complex, multi-component system that deals with evolving patterns of stability and instability, and examine how a combination of cognitive, motor, and affective skills stands at the heart of the performer’s capacity to optimize their performance. In doing so, we consider how musicians often generate different interpretative “hypotheses” with little or no pre-planning and use their body to selectively navigate the range of possibilities such hypotheses entail. In conclusion, the relevance of this perspective is discussed in relation to current research in music performance and music education to outline continuities and differences between the two domains.