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In the current age, digital advancements have shaped the educational landscape by providing numerous possibilities for a fast and on-demand influx of information for students. This brings an additional difficulty for course designers in how to incorporate such technologies in teaching in an optimal way. Key examples are educational videos, which are especially relevant now due to the increase in accessibility of pre-made videos and recording technology since the pandemic. This puts post-pandemic teaching in the new but revolutionary position to complement in-person teaching with videos. In this study, we examine the effect of videos combined with in-person teaching in a mathematics master course in motivation and grades. This experiment is specifically insightful due to our course consisting of three different topics (A,B,C). In Year 1 (control group), the course was taught traditionally. In Year 2 (experimental group), we provided additional video lectures on (A), while keeping (B) and (C) as before. We compare assessment and survey results between and within years. Videos did not increase the students' motivation for the topic (Fisher exact test pp = 0.06182). The intervention did not improve the midterm or final exam grades on (A) between years. Students who watched videos did not score significantly better on their assignments (2MWUt pp = 0.275) nor on their exams (2MWUt pp = 0.745) than students who did not watch the videos. However, a positive effect size was observed between years, while the intervention led to a negative effect size within the same year.

The optimal cut-off value of the optical density index of the galactomannan antigen assays (GM) for diagnosing invasive pulmonary aspergillosis in hematological patients is a disputed topic. This article conducts a systematic review with a meta-analysis to establish which optical density index (ODI) cut-off value should be implemented into clinical practice. Pubmed, Embase and Cochrane databases were searched (N = 27). The pooled data, using a generalized linear mixed model with binomial distribution, resulted in an overall serum sensitivity of 0.76 and a specificity of 0.92. For serum ODI 0.5 there was a pooled sensitivity of 0.92 and a specificity of 0.84. The pooled data of all broncho-alveolar lavage (BAL) studies resulted in an overall sensitivity of 0.80 and a specificity of 0.95. For BAL ODI 0.5, there was a pooled sensitivity of 0.75 and a specificity of 0.88. For the BAL ODI 1.0 pooling, the studies resulted in a sensitivity of 0.75 and a specificity of 0.96. Serum ODI of 0.5 and BAL ODI of 1.0 are the most suitable cut-offs for clinical practice. However, our study affirms that the evidence for the use of GM in clinical practice for the hematological malignancy patient is currently insufficient and more research is needed to determine the diagnostic value of GM.

OBJECTIVES: Two-dimensional speckle tracking echocardiography has been considered an angle-independent modality. However, current literature is limited and inconclusive on the actual impact of angle of insonation on strain values. Therefore, the primary objective of this study was to assess the impact of angles of insonation on the estimation of fetal left ventricular and right ventricular global longitudinal strain. Secondarily, the impact of different definitions for angles of insonation was investigated in a sensitivity analysis.METHODS: This is a retrospective analysis of a prospective longitudinal cohort study with 124 healthy subjects. The analyses were based on the four-chamber view ultrasound clips taken between 18+0 and 21+6 weeks of gestation. Angles of insonation were categorized into three groups: up/down, oblique and perpendicular. The mean fetal left and right ventricular and global longitudinal strain values corresponding to these three groups were compared by an ANOVA test corrected for heteroscedasticity.RESULTS: Fetal left and right ventricular global longitudinal strain values were not statistically different between the three angles of insonation (p-value >0.062 and >0.149, respectively). When applying another definition for angles of insonation in the sensitivity analysis, the mean left ventricular global longitudinal strain value was significantly decreased for the oblique compared to the up/down angle of insonation (p-value 0.041).CONCLUSIONS: There is no evidence of a difference in fetal left and right ventricular global longitudinal strain between the different angles of insonation in fetal two-dimensional speckle tracking echocardiography.

Progression of atrial fibrillation (AF) and outcomes of ablation therapy are strongly affected by modifiable risk factors. Although previous studies show beneficial effects of modifying single risk factors, there is lack of evidence from randomized controlled trials on the effects of integrated AF lifestyle programmes. The POP trial is designed to evaluate the clinical outcomes of a dedicated nurse-led AF lifestyle outpatient clinic in patients with symptomatic AF. This study is a prospective, 1:1 randomized, single centre, investigator-initiated clinical trial in 150 patients with paroxysmal or persistent AF referred for a first pulmonary vein isolation (PVI). Prior to the ablation, patients in the intervention group receive a personalized risk factor treatment programme in a specialized, protocolized, nurse-led outpatient clinic. Patient education and durable lifestyle management is promoted with an e-health platform. Patients in the control group receive standard care by cardiologists before ablation. The primary endpoint is the number of hospitalizations for re-ablation and cardioversion, with a follow-up of 12 months after ablation. Secondary endpoints include mortality, number of acute ischemic events, stroke or hospitalizations for heart failure, quality of life, number of ablations cancelled because of symptom reduction, and ablation success rate at 12 months. Determinants of patient and staff experience are explored and a cost-effectiveness analysis is included. The POP trial will help ascertain the efficacy and cost-effectiveness of an integrated technology-supported lifestyle therapy in patients with symptomatic AF. The trial is funded by the Netherlands Organisation for Health Research and Development [10070012010001]. Home sleep apnoea testing devices were provided by Itamar Medical, Ltd. ClinicalTrials.gov Identifier NCT05148338. Graphical abstract: [Figure not available: see fulltext.] AF atrial fibrillation, OSA obstructive sleep apnoea, PFA pulse

Importance: Colorectal surgery is associated with substantial morbidity rates and a lowered functional capacity. Optimization of the patient's condition in the weeks prior to surgery may attenuate these unfavorable sequelae. Objective: To determine whether multimodal prehabilitation before colorectal cancer surgery can reduce postoperative complications and enhance functional recovery. Design, Setting, and Participants: The PREHAB randomized clinical trial was an international, multicenter trial conducted in teaching hospitals with implemented enhanced recovery after surgery programs. Adult patients with nonmetastasized colorectal cancer were assessed for eligibility and randomized to either prehabilitation or standard care. Both arms received standard perioperative care. Patients were enrolled from June 2017 to December 2020, and follow-up was completed in December 2021. However, this trial was prematurely stopped due to the COVID-19 pandemic. Interventions: The 4-week in-hospital supervised multimodal prehabilitation program consisted of a high-intensity exercise program 3 times per week, a nutritional intervention, psychological support, and a smoking cessation program when needed. Main Outcomes and Measures: Comprehensive Complication Index (CCI) score, number of patients with CCI score more than 20, and improved walking capacity expressed as the 6-minute walking distance 4 weeks postoperatively. Results: In the intention-to-treat population of 251 participants (median [IQR] age, 69 [60-76] years; 138 [55%] male), 206 (82%) had tumors located in the colon and 234 (93%) underwent laparoscopic- or robotic-assisted surgery. The number of severe complications (CCI score >20) was significantly lower favoring prehabilitation compared with standard care (21 of 123 [17.1%] vs 38 of 128 [29.7%]; odds ratio, 0.47 [95% CI, 0.26-0.87]; P =.02). Participants in prehabilitation encountered fewer medical complications (eg, respiratory) compared with participants receivin

Importance: Colorectal surgery is associated with substantial morbidity rates and a lowered functional capacity. Optimization of the patient's condition in the weeks prior to surgery may attenuate these unfavorable sequelae. Objective: To determine whether multimodal prehabilitation before colorectal cancer surgery can reduce postoperative complications and enhance functional recovery. Design, Setting, and Participants: The PREHAB randomized clinical trial was an international, multicenter trial conducted in teaching hospitals with implemented enhanced recovery after surgery programs. Adult patients with nonmetastasized colorectal cancer were assessed for eligibility and randomized to either prehabilitation or standard care. Both arms received standard perioperative care. Patients were enrolled from June 2017 to December 2020, and follow-up was completed in December 2021. However, this trial was prematurely stopped due to the COVID-19 pandemic. Interventions: The 4-week in-hospital supervised multimodal prehabilitation program consisted of a high-intensity exercise program 3 times per week, a nutritional intervention, psychological support, and a smoking cessation program when needed. Main Outcomes and Measures: Comprehensive Complication Index (CCI) score, number of patients with CCI score more than 20, and improved walking capacity expressed as the 6-minute walking distance 4 weeks postoperatively. Results: In the intention-to-treat population of 251 participants (median [IQR] age, 69 [60-76] years; 138 [55%] male), 206 (82%) had tumors located in the colon and 234 (93%) underwent laparoscopic- or robotic-assisted surgery. The number of severe complications (CCI score >20) was significantly lower favoring prehabilitation compared with standard care (21 of 123 [17.1%] vs 38 of 128 [29.7%]; odds ratio, 0.47 [95% CI, 0.26-0.87]; P =.02). Participants in prehabilitation encountered fewer medical complications (eg, respiratory) compared with participants receivin

The detection of arrhythmias from wearable devices is still an open challenge, while the availability of screening tools for the large population would allow reduced complications and costs. We propose a model-based approach to the detection and classification of premature contractions into atrial and ventricular. The extracted signal morphology and the deviations from the expected stationarity are used to detect and classify premature contractions. Our approach is self-contained, patient-specific and robust to mis-segmentation. Both model fit, and detection and classification accuracy of the proposed methods are evaluated on two real cases and a simulated dataset, and show promising results.

The robustness of the t linear mixed model (tLMM) has been proved and exploited in many applications. Various publications emerged with the aim of proving superiority with respect to traditional linear mixed models, extending to more general settings and proposing more efficient estimation methods. However, little attention has been paid to the mathematical properties of the model itself and to the evaluation of the proposed estimation methods. In this paper we perform an in-depth analysis of the tLMM, evaluating a direct maximum likelihood estimation method via an intensive simulation study and investigating some identifiability properties. The theoretical findings are illustrated through an application to a dataset collected from a sleep trial.

Models characterized by autoregressive structure and random coefficients are powerful tools for the analysis of high-frequency, high-dimensional and volatile time series. The available literature on such models is broad, but also sector-specific, overlapping, and confusing. Most models focus on one property of the data, while much can be gained by combining the strength of various models and their sources of heterogeneity. We present a structured overview of the literature on autoregressive models with random coefficients. We describe hierarchy and analogies among models, and for each we systematically list properties, estimation methods, tests, software packages and typical applications.

Purpose: Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF.

Background: A flow limitation in the iliac arteries (FLIA) in endurance athletes is notoriously difficult to diagnose with the currently available diagnostic tools. At present, a commonly used diagnostic measure is a decrease in ankle brachial index with flex hips (ABIFlexed) following a maximal effort exercise test. Near-infrared spectroscopy (NIRS) is a non-invasive technique that measures skeletal muscle oxygenation as reflected by the balance of O2 delivery from microvascular blood flow and O2 uptake by metabolic activity. Therefore, NIRS potentially serves as a novel technique for diagnosing FLIA. The purpose of this study is to compare the diagnostic accuracy of NIRS-derived absolute, amplitude, and kinetic variables in legs during and after a maximal exercise test with ABIFlexed. Methods: ABIFlexed and NIRS were studied in 33 healthy subjects and 201 patients with FLIA diagnosed with echo-Doppler. Results: After maximal exercise, NIRS kinetic variables, such as the half value time and mean response time, resulted in a range of 0.921 to 0.939 AUC for the diagnosis of FLIA when combined with ABIFlexed. Conversely, ABIFlexed measurements alone conferred significantly worse test characteristics (AUC 0.717, p < 0.001). Conclusions: NIRS may serve as a diagnostic adjunct in patients with possible FLIA.

Models characterized by autoregressive structure and random coefficients are powerful tools for the analysis of high-frequency, high-dimensional and volatile time series. The available literature on such models is broad, but also sector-specific, overlapping, and confusing. Most models focus on one property of the data, while much can be gained by combining the strength of various models and their sources of heterogeneity. We present a structured overview of the literature on autoregressive models with random coefficients. We describe hierarchy and analogies among models, and for each we systematically list properties, estimation methods, tests, software packages and typical applications.

The robustness of the t linear mixed model (tLMM) has been proved and exploited in many applications. Various publications emerged with the aim of proving superiority with respect to traditional linear mixed models, extending to more general settings and proposing more efficient estimation methods. However, little attention has been paid to the mathematical properties of the model itself and to the evaluation of the proposed estimation methods. In this paper we perform an in-depth analysis of the tLMM, evaluating a direct maximum likelihood estimation method via an intensive simulation study and investigating some identifiability properties. The theoretical findings are illustrated through an application to a dataset collected from a sleep trial.

Renske Meijer,1,2 Martijn van Hooff,1,2 Nicole E Papen-Botterhuis,3 Charlotte JL Molenaar,4 Marta Regis,3,5 Thomas Timmers,6 Lonneke V van de Poll-Franse,7– 9 Hans HCM Savelberg,2 Goof Schep1 1Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands; 2Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; 3Academy, Máxima Medical Center, Veldhoven, the Netherlands; 4Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands; 5Department of Mathematics and Computer Science, University of Technology, Eindhoven, the Netherlands; 6Department of Research & Development, Interactive Studios, Rosmalen, the Netherlands; 7Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; 8Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; 9Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the NetherlandsCorrespondence: Renske Meijer, Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands, Tel +31 40 8888 000, Email fitmax@mmc.nl; renske.meijer@mmc.nl; rc.meijer@student.maastrichtuniversity.nlPurpose: Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF.Materials and Methods: The FitMáx©-questionnaire, consisting of only three questions assessing walking, stair climbing, and cycling capacity, was compared with the commonly used Duke Activity

Lieke WA Hermans,1 Marta Regis,2 Pedro Fonseca,1,3 Bertram Hoondert,4 Tim RM Leufkens,3 Sebastiaan Overeem,1,4 Merel M van Gilst1,4 1Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; 2Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands; 3Philips Research, Eindhoven, the Netherlands; 4Sleep Medicine Center Kempenhaeghe, Heeze, the NetherlandsCorrespondence: Lieke WA HermansDepartment of Electrical Engineering, Eindhoven University of Technology, De Zaale, 5600, MB Eindhoven, the NetherlandsEmail l.w.a.hermans@tue.nlIntroduction: Assessing objective measures of sleep fragmentation could yield important features reflecting impaired sleep quality in people with insomnia. Survival analysis allows the specific examination of the stability of NREM sleep, REM sleep and wake. The objective of this study was to assess the differences between survival dynamics of NREM sleep, REM sleep and wake between people with insomnia and healthy controls.Methods: We analyzed retrospective polysomnography recordings from 86 people with insomnia and 94 healthy controls. For each participant, survival dynamics of REM sleep, NREM sleep and wake were represented using Weibull distributions. We used lasso penalized parameter selection in combination with linear regression to analyze the difference between participant groups with respect to the Weibull scale and shape parameters, while correcting for age, sex, total sleep time and relevant interaction effects.Results: Significant effects of group were found for the NREM scale parameter, and for the wake scale and shape parameters. Results indicated that people with insomnia had less stable NREM sleep and more stable wake after sleep onset compared to healthy controls. Additionally, the altered distribution of wake segment lengths indicated an increased difficulty to fall asleep after longer awakenings in the insomnia group. However, the

The Dutch government compensates health insurance companies when insuringindividuals who are estimated to have high health care costs. This is necessaryto avoid insurers not offering services to certain groups or not providing themwith a high quality of service. It is, however, unknown to what extent thedifferences in health care expenses by different groups of people are truly due toa poorer or better health status. We explore several statistical approaches thatfacilitate explaining the cause of these differences.

The Dutch government compensates health insurance companies when insuringindividuals who are estimated to have high health care costs. This is necessaryto avoid insurers not offering services to certain groups or not providing themwith a high quality of service. It is, however, unknown to what extent thedifferences in health care expenses by different groups of people are truly due toa poorer or better health status. We explore several statistical approaches thatfacilitate explaining the cause of these differences.

The Dutch government compensates health insurance companies when insuringindividuals who are estimated to have high health care costs. This is necessaryto avoid insurers not offering services to certain groups or not providing themwith a high quality of service. It is, however, unknown to what extent thedifferences in health care expenses by different groups of people are truly due toa poorer or better health status. We explore several statistical approaches thatfacilitate explaining the cause of these differences.

The Dutch government compensates health insurance companies when insuringindividuals who are estimated to have high health care costs. This is necessaryto avoid insurers not offering services to certain groups or not providing themwith a high quality of service. It is, however, unknown to what extent thedifferences in health care expenses by different groups of people are truly due toa poorer or better health status. We explore several statistical approaches thatfacilitate explaining the cause of these differences.

The Dutch government compensates health insurance companies when insuringindividuals who are estimated to have high health care costs. This is necessaryto avoid insurers not offering services to certain groups or not providing themwith a high quality of service. It is, however, unknown to what extent thedifferences in health care expenses by different groups of people are truly due toa poorer or better health status. We explore several statistical approaches thatfacilitate explaining the cause of these differences.