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Smell and taste changes are frequently reported bothersome treatment symptoms during treatment for childhood cancer and assumed to influence outcomes such as food intake. Since nutritional status of children with cancer is already vulnerable, any detrimental effects on food intake should be prevented. Therefore, understanding the exact relationship between chemosensory changes and dietary intake, eating behavior, and other domains such as health-related quality of life (HRQoL), is important for improving outcomes. In this longitudinal study, we followed 87 childhood cancer patients treated for hematological, solid, or brain malignancies. Smell (odor threshold and odor identification) and taste function (total taste score) were objectively investigated using commercial Sniffin' Sticks and Taste Strips respectively, and by self-report. Dietary intake was measured using a 3-day food dairy. For nutritional status, BMI expressed as standard deviation scores was derived from medical records. Eating behavior and HRQoL were assessed by the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and PedsQL 4.0 Generic Core Scales, respectively. Measurements were taken approximately 6 weeks (T0), 3 months (T1), 6 months after starting chemotherapy (T2), and 3 months after termination of chemotherapy or maintenance phase for children with acute lymphoblastic leukemia (ALL) (T3). Dietary intake, eating behavior, nutritional status, and HRQoL were modelled over time using mixed model analysis. Associations between smell and taste (objective and self-report), as well as patient characteries were studied. Energy intake significantly increased during the study period, with a higher age, BMI, and total taste scores associated to this increase. Boys had higher energy intake compared to girls. Eating behavior scores significantly declined, indicating less eating problems. Age, pre-diagnosis eating behavior, self-reported smell changes, and tube feeding were associated to eating behavior. BMI significantly increased, with a higher BMI at diagnosis to be related to a higher BMI during the study period. A lower BMI was found in children receiving tube feeding and self-reported taste changes. HRQoL improved during the study period, with lower HRQoL in children receiving tube feeding and self-reported taste changes. Both objective and subjective measures of taste and smell influence dietary intake, eating behavior, nutritional status, and HRQoL. Individual dietary advice and coping strategies are warranted to prevent detrimental effects of chemosensory changes on food intake and clinical outcomes in children with cancer. [ABSTRACT FROM AUTHOR]

A dysfunctional hypothalamus may result in decreased feelings of satiety (hyperphagia), decreased energy expenditure, and increased fat storage as a consequence of hyperinsulinemia. Hypothalamic dysfunction may thus lead to morbid obesity and can be encountered in childhood as a consequence of congenital, genetic, or acquired disorders. There is currently no effective treatment for hypothalamic obesity (HO). However, comparable to alimentary obesity, dietary and lifestyle interventions may be considered the cornerstones of obesity treatment. We questioned the effect of dietary or lifestyle interventions for HO and systematically searched the literature for evidence on feasibility, safety, or efficacy of dietary or lifestyle interventions for childhood hypothalamic overweight or obesity. A systematic search was conducted in MEDLINE (including Cochrane Library), EMBASE, and CINAHL (May 2023). Studies assessing feasibility, safety, or efficacy of any dietary or lifestyle intervention in children with hypothalamic overweight or obesity, were included. Animal studies, studies on non-diet interventions, and studies with no full text available were excluded. Because the number of studies to be included was low, the search was repeated for adults with hypothalamic overweight or obesity. Risk of bias was assessed with an adapted Cochrane Risk of Bias Tool. Level of evidence was assessed using the GRADE system. Descriptive data were described, as pooled-data analysis was not possible due to heterogeneity of included studies. In total, twelve studies were included, with a total number of 118 patients (age 1–19 years) of whom one with craniopharyngioma, one with ROHHAD-NET syndrome, 50 with monogenic obesity, and 66 with Prader–Willi syndrome (PWS). Four studies reported a dietary intervention as feasible. However, parents did experience difficulties with children still stealing food, and especially lowering carbohydrates was considered to be challenging. Seven studies reported on efficacy of a dietary intervention: a well-balanced restrictive caloric diet (30% fat, 45% carbohydrates, and 25% protein) and various hypocaloric diets (8–10 kcal/cm/day) were considered effective in terms of weight stabilization or decrease. No negative effect on linear growth was reported. Four studies reported on specific lifestyle interventions, of which three also included a dietary intervention. Combined dietary and lifestyle intervention resulted in decreased BMI, although BMI returned to baseline values on long-term. One additional study was identified in adults after brain trauma and showed a significant reduction in BMI in one out of eight patients after a combined dietary and lifestyle intervention. Hypocaloric diet or restrictive macronutrient diet with lower percentage of carbohydrates seems feasible and effective for childhood HO, although most of the studies had a high risk of bias, small cohorts without control groups, and were conducted in children with PWS only, compromising the generalizability. Lifestyle interventions only resulted in BMI decrease in short-term, indicating that additional guidance is needed to sustain its effect in the long-term. Literature on feasibility and efficacy of a dietary or lifestyle intervention for hypothalamic overweight or obesity is scarce, especially in children with acquired HO (following treatment for a suprasellar tumor). There is need for prospective (controlled) studies to determine which dietary and lifestyle intervention are most helpful for this specific patient group. [ABSTRACT FROM AUTHOR]

This paper provides a Christian philosophical and theological response to the moral imperative of human advancement through multiplanetarism as emerging from the Great Filter theory. First, it explains the Fermi paradox that underlies the Great Filter theory. Next, it explores this theory itself and its motivational power in driving advancement toward multiplanetarism. In particular, we explore two motives behind the multiplanetary efforts that are (in part) guided by the Great Filter theory, analyzing the relevant statements of SpaceX founder and chief engineer Elon Musk. Finally, we assess these motivations (and the accompanying normative assumptions) behind space exploration and multiplanetarism from the perspective of Reformational philosophy, using Herman Dooyeweerd's theory of ground motives as a lens. Thus, the paper's leading research question is this: How can we assess the current attempts at securing a multiplanetary existence for humankind in the light of Dooyeweerd's theory of ground motives? [ABSTRACT FROM AUTHOR]

BACKGROUND: Cortical microinfarcts (CMI) were attributed to cerebrovascular disease and cerebral amyloid angiopathy (CAA). CAA is frequent in Down syndrome (DS) while hypertension is rare, yet no studies have assessed CMI in DS. METHODS: We included 195 adults with DS, 63 with symptomatic sporadic Alzheimer's disease (AD), and 106 controls with 3T magnetic resonance imaging. We assessed CMI prevalence in each group and CMI association with age, AD clinical continuum, vascular risk factors, vascular neuroimaging findings, amyloid/tau/neurodegeneration biomarkers, and cognition in DS. RESULTS: CMI prevalence was 11.8% in DS, 4.7% in controls, and 17.5% in sporadic AD. In DS, CMI increased in prevalence with age and the AD clinical continuum, was clustered in the parietal lobes, and was associated with lacunes and cortico‐subcortical infarcts, but not hemorrhagic lesions. DISCUSSION: In DS, CMI are posteriorly distributed and related to ischemic but not hemorrhagic findings suggesting they might be associated with a specific ischemic CAA phenotype. Highlights: This is the first study to assess cortical microinfarcts (assessed with 3T magnetic resonance imaging) in adults with Down syndrome (DS).We studied the prevalence of cortical microinfarcts in DS and its relationship with age, the Alzheimer's disease (AD) clinical continuum, vascular risk factors, vascular neuroimaging findings, amyloid/tau/neurodegeneration biomarkers, and cognition.The prevalence of cortical microinfarcts was 11.8% in DS and increased with age and along the AD clinical continuum. Cortical microinfarcts were clustered in the parietal lobes, and were associated with lacunes and cortico‐subcortical infarcts, but not hemorrhagic lesions.In DS, cortical microinfarcts are posteriorly distributed and related to ischemic but not hemorrhagic findings suggesting they might be associated with a specific ischemic phenotype of cerebral amyloid angiopathy. [ABSTRACT FROM AUTHOR]

The international growth of the physician assistant/associate (PA) profession provides opportunities for global exchange that PA faculty and clinicians should seek out and cultivate. Physician assistant/associate programs can benefit from the experiences and expertise of faculty educators from different backgrounds and countries. The Fulbright International Scholars Program is a well-established and recognized organization dedicated to supporting international exchange in higher education. This study describes the experience of an American PA who received a Fulbright Specialist Program award that provided the opportunity to collaborate with a Dutch PA program on improvement of their geriatric medicine didactic curriculum. [ABSTRACT FROM AUTHOR]

Background: Cortical microinfarcts (CMI) are emerging biomarkers of vascular damage associated with cognitive decline and are frequent in sporadic AD (sAD) patients. However, no study assessed CMI in Down syndrome (DS), a genetically determined form of AD. Therefore, we aimed to assess CMI's frequency in adults with DS, sAD, and cognitively unimpaired euploid controls and its relationship with age, sex, clinical status, and APOE ε4 carriership. Method: Cross‐sectional study. We included 175 participants with 3T‐MRI: 64 with DS (39 asymptomatic [aDS], 11 prodromal AD [pDS], and 14 AD‐dementia [dDS]), 62 with sAD (41 prodromal AD, 21 AD dementia), and 49 controls. A neuroradiologist blind to participants' data visually analyzed the 3T‐MRI images following a validated protocol to detect CMI (Figure 1). We compared CMI's prevalence in the different clinical groups along the AD continuum in DS and sAD, in APOE ε4 carriers vs. non‐carriers, and males vs. females using Chi‐square, Mann‐Whitney, or Kruskal‐Wallis tests when appropriate. Result: CMI's prevalence was 7.8% in DS (5.1% in aDS, 21.4% in pDS, and 0% in dDS [p = 0.085]), 17.7% in sAD (22.0% in prodromal AD and 9.5% in AD dementia [p = 0.389]), and 10.2% in controls (p = 0.207). CMI frequency increased with age in DS, sAD, and controls (Table 1). Regarding sex, CMI's frequency was 10% in men and 5.9% in women with DS (p = 0.884), and 27.3% in men and 12.5% in women with sAD (p = 0.267). In controls, CMIs' frequency was 10% in men and 10.3% in women (p = 1.000). Regarding APOEε4 carriership, CMI's prevalence was 21.4% in APOEε4 carriers and 9.1% in non‐carriers in sAD (p = 0.428), 8.7% in carriers and 6.0% in non‐carriers in DS (p = 1.000), and 8.3% in carriers and 8.6% in non‐carriers controls (p = 1.000) (Table 2). Conclusion: CMI's prevalence increased with age, but was not different in DS, sporadic AD, and controls. Also, sex and APOEε4 carriership did not impact the prevalence of CMI in the three study groups. [ABSTRACT FROM AUTHOR]

Demographic inequalities in law enforcement practices and subsequent youth justice decisions are well-documented in many youth justice systems worldwide. Informed by the concept of 'cumulative disadvantage' and empirical evidence from England & Wales and the Netherlands, this paper explores how inequalities in youth justice decisions are produced, how they might move and accumulate across different stages of the youth justice process and interact with inequalities in interlocking systems, specifically the educational system and the child protection system. Subsequently, this paper presents the first contours of an overarching analytical framework which can be used to unpack the complex web of dynamics, interactions and mechanisms that produce and reinforce inequalities in youth justice decisions. The analytical framework distinguishes seven spheres of influence – from the micro to the macro – that shape youth justice decision-making, out of which inequalities might develop and accumulate. These spheres of influence illustrate that interactions between individuals, agencies and systems as well as the wider societal context are all implicated in the mechanisms of creating, sustaining or amplifying children's inequalities and disadvantages in youth justice. Overall, by illuminating the complexity and the multidimensional nature of mechanisms of inequality and cumulative disadvantage in youth justice decision-making, the presented analytical framework offers researchers, policymakers and practitioners much-needed guidance to identify avenues for further inquiry and potential areas for reform, with the aim of effectively addressing unwarranted inequalities in youth justice in England & Wales, the Netherlands and internationally. [ABSTRACT FROM AUTHOR]

Increased pharmaceutical usage has led to their widespread presence in aquatic environments, resulting in concerns regarding their potential environmental impacts. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like citalopram, are frequently detected in European surface waters. Acute laboratory studies have demonstrated that citalopram can inhibit algal growth, immobilise Daphnia magna, and may result in foot detachment (i.e. the inability to adhere to a substrate) in snails. However, research on long-term citalopram exposure is scarce, and our understanding of its effects on aquatic community- and ecosystem-level is limited. Therefore, we investigated the impact of 13-week exposure to 0.01, 0.1, 1, 10 and 100 μg/L citalopram in outdoor freshwater mesocosms, focusing on water quality variables (i.e. pH, dissolved oxygen, electrical conductivity, temperature, algal chlorophyll-a, turbidity) and the structure of aquatic communities, with a special focus on mollusc foot detachment (Lymnaea stagnalis, Planorbis sp. and the total snail population). We found that environmentally relevant citalopram concentrations did not affect water quality variables, bacterial composition, zooplankton and macroinvertebrate communities. In contrast to expectations based on literature, snail foot detachment was not observed while the tested concentrations overlapped with the reported effect concentrations. This is in line with the absence of indirect adverse effects of foot detachment, such as population changes that could be the result of an increased vulnerability to predation or the inability to feed or reproduce. Reported sublethal effects in the literature, as found in laboratory studies, do not appear to lead to population- or community-level impacts in a semi-field experiment within the concentration range tested in this study. The experimental outcomes suggest that environmentally relevant concentrations of citalopram might not pose a threat to water quality variables, bacterial composition, zooplankton and macroinvertebrate communities, and snail foot detachment. [Display omitted] • Environmental citalopram concentrations do not affect aquatic communities. • Snail plates are efficient monitoring tools for snail populations. • No persisting snail foot detachment was observed after citalopram exposure. [ABSTRACT FROM AUTHOR]

Objective: To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients. Background: Postoperative complications are the leading cause of perioperative morbidity and mortality. Although modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration. Methods: In a prospective, multicenter, stepped-wedge cluster randomized interventional study in 9 academic and nonacademic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day 1 and 3 to routine use of MEWS in 5473 patients undergoing elective noncardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay, and intensive care unit admission. Results: Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0.56% (n = 14) in the control and 0.44% (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34–1.62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1.7% (n = 41) vs 1.0% (n = 27), P = 0.014). Median length of hospital stay did not differ significantly between groups. During the postanesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day 1 and 3, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up. Conclusions: The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined. Trial Registration: Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249. [ABSTRACT FROM AUTHOR]

To meet surge capacity and to prevent hospitals from being overwhelmed with COVID-19 patients, a regional crisis task force was established during the first pandemic wave to coordinate the even distribution of COVID-19 patients in the Amsterdam region. Based on a preexisting regional management framework for acute care, this task force was led by physicians experienced in managing mass casualty incidents. A collaborative framework consisting of the regional task force, the national task force, and the region's hospital crisis coordinators facilitated intraregional and interregional patient transfers. After hospital admission rates declined following the first COVID-19 wave, a window of opportunity enabled the task forces to create, standardize, and optimize their patient transfer processes before a potential second wave commenced. Improvement was prioritized according to 3 crucial pillars: process standardization, implementation of new strategies, and continuous evaluation of the decision tree. Implementing the novel "fair share" model as a straightforward patient distribution directive supported the regional task force's decisionmaking. Standardization of the digital patient transfer registration process contributed to a uniform, structured system in which every patient transfer was verifiable on intraregional and interregional levels. Furthermore, the regional task force team was optimized and evaluation meetings were standardized. Lines of communication were enhanced, resulting in increased situational awareness among all stakeholders that indirectly provided a safety net and an improved integral framework for managing COVID-19 care capacities. In this article, we describe enhancements to a patient transfer framework that can serve as an exemplary system to meet surge capacity demands during current and future pandemics. [ABSTRACT FROM AUTHOR]

Background: This paper describes an online survey of men who have sex with men (MSM) and use drugs before or during sex ('chemsex') via injection ('slamming' or 'practising slamsex'). Approximately 15–30% of the MSM population in The Netherlands have practiced chemsex at some point, and 0.5–3.1% of them ever had 'slamsex'. This study investigates which substances are used in The Netherlands during slamsex, the motives for slamming and the health risks involved. Method: In total, 175 MSM from The Netherlands, who had used substances before or during sex via injection completed an ad hoc online questionnaire designed for this study. Results: Mean age of respondents was 47.8 years. During chemsex, almost every substance was used; the most common substances that were injected (slammed) were 3-methylmethcathinone (3-MMC), methamphetamine, ketamine, 4-methylethcathinone (4-MEC) and mephedrone (4-MMC). Reasons for slamming were mainly to experience a more intense rush and longer sex. Virtually none of the respondents used a condom during slamsex, but needles were almost never shared or used only once. Slammers reported health problems associated with injecting drugs (skin problems, collapsed veins and infections). Of most concern were the psychological symptoms reported by about three-quarters of respondents (e.g. insomnia, sadness, depressed mood, anxiety, suicidal tendencies). About half of respondents reported some degree of loss of control or concerns about their slamming behaviour. Conclusion: Results show that slamsex is associated with consciously chosen sexual risk behaviours and risk-avoidance slam behaviours. This study may contribute to the reinforcement of accessible, non-judgmental and well informed prevention and harm reduction activities to support MSM practising slamsex. About 0.5–3.1% of men who have sex with men (MSM) self inject drugs before or during sex ('slamming'). Our survey among 175 Dutch MSM, who had practised slamsex, reported various adverse health effects associated with slamsex (skin problems, collapsed veins, infections, and psychological symptoms, like insomnia, sadness, depressed mood, anxiety, suicidal tendencies and loss of control). The current information of slamsex by MSM may contribute to the reinforcement of accessible, non-judgmental and well informed prevention and harm reduction activities. [ABSTRACT FROM AUTHOR]

Since 1992, Dutch volunteers have monitored the breeding attempts of Barn Swallows on a systematic basis. For two regions – Noord-Veluwe and Twente – a dataset of 27 years (1992–2018) was available. This paper examines the timing of breeding and the number of fledglings per successful breeding attempt. As spring and summer weather in Western Europe became on average warmer during this period, we analysed whether Barn Swallows adapted to this shift. The laying date of first broods advanced on average 2.3 days per ten years. The average advancement of laying date of second broods was 2.9 days per decade. The average number of fledglings per successful breeding attempt was constant over time, but showed large inter-year-variation. First broods consistently produced 0.6 fledglings more than second broods. These results are in line with results from similar studies in Western Europe. Contrary to our expectations, neither large scale nor local weather parameters were found to explain the advancement of laying and the number of fledged young. It is essential to study key species like Barn Swallows during all stages of their life cycle over a long time span and large spatial scale to be able to unravel potential effects of climate change. Our study demonstrates that volunteers can contribute essential demographic data. Ideally, these demographic parameters would be monitored with individually marked (colour-ringed) birds. Frequent quality checks and feedback to volunteers are key to maximize the quality of the data collected through long-term volunteer surveys. [ABSTRACT FROM AUTHOR]