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Despite increasing sequencing efforts, numerous fish families still lack a reference genome, which complicates genetic research. One such understudied family is the sand lances (Ammodytidae, literally: “sand burrower”), a globally distributed clade of over 30 fish species that tend to avoid tidal currents by burrowing into the sand. Here, we present the first annotated chromosome-level genome assembly of the great sand eel (Hyperoplus lanceolatus). The genome assembly was generated using Oxford Nanopore Technologies long sequencing reads and Illumina short reads for polishing. The final assembly has a total length of 808.5 Mbp, of which 97.1% were anchored into 24 chromosome-scale scaffolds using proximity-ligation scaffolding. It is highly contiguous with a scaffold and contig N50 of 33.7 and 31.3 Mbp, respectively, and has a BUSCO completeness score of 96.9%. The presented genome assembly is a valuable resource for future studies of sand lances, as this family is of great ecological and commercial importance and may also contribute to studies aiming to resolve the suprafamiliar taxonomy of bony fishes.

Aims and objectives: The purpose of this exploratory case study is to contribute to the set of studies that center children’s perspectives on their bilingual development, with a specific focus on their emotional connection within their linguistic family landscape. Methodology: This was a case study of a Korean transnational family in the United States and included both parents and their daughter. Data and analysis: Due to COVID-19 restrictions, semi-structured in-depth interviews and a language-mapping activity were conducted via ZOOM, recorded, and transcribed. DeDoose, a qualitative collaborative research tool, was used to conduct a thematic analysis. Findings and conclusion: Findings suggest that parents positioning bilingualism as a resource for communication and expression impacts a bilingual child’s positive linguistic and socioemotional well-being. A strong sense of belonging was shaped through strong relationships with parents and family, engagement in diverse and inclusive spaces that valued multilingualism and multiculturalism, and by being given agency in one’s own language choices. Originality: This study focuses on a Korean immigrant family and centers on the child’s experiences. It provides a counter-narrative to the negative emotions parents and their children often express in extant family language policy (FLP) research. The study calls for FLP research to include a “multilingualism as a resource” orientation. Significance/implications: This case study provides the lens of multilingualism as a resource through FLP that has a different impact on the emotional dimensions of heritage language learning and maintenance.

Increasing evidence indicates that disgust might compromise sexual functioning and can contribute to sexual problems. Although the stimuli and conditions that elicit disgust vary greatly across individuals, they cluster in three categories of disgust elicitors: Stimuli that are associated with an increased risk of the transmission of infectious diseases (pathogen disgust), stimuli that signal poor mating quality and may jeopardize reproductive success (sexual disgust), and behaviors that violate social norms (moral disgust). It has been argued that each of these categories of disgust may interfere with sexual responses. Thus far, research on the role of disgust in sexual contexts focused on external stimuli (e.g., sperm). Yet, recently it has been proposed that disgust can also become directed to features of the self. Such self-directed disgust may also apply to sexual contexts and contribute to sexual problems. As a first step to explore the relevance of self-disgust in sexual functioning, we tested if indeed particular sexual experiences have the ability to elicit self-disgust. Using a within subject design, participants (N = 124; all women) imagined themselves as well as others experiencing a series of sex-related scenarios, each relevant for one of the three categories of disgust, and subsequently rated their self-disgust. For all types of disgust, the scenarios evoked self-disgust, and the "self-perspective" elicited significantly more self-disgust than the "other-perspective." These findings support theoretical models pointing to the relevance of taking self-disgust into consideration as a factor that may compromise sexual functioning. Future research should test whether this also holds for men.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation grant to dr. P.G. Postema, MD PhD Background Stereotactic arrhythmia radiotherapy (STAR) has evolved as promising bail-out treatment in patients with therapy-refractory ventricular tachycardia (VT). The mechanism of action of STAR in preventing VT has yet to be elucidated and further understanding could improve this technique in the future. Preclinical studies reported an increase in conduction velocity and consequently a decrease in conduction intervals on electrocardiograms (ECGs) within the first months after STAR, although this has not yet been evaluated in detail in prospective studies. Purpose To evaluate the early effects of STAR on ventricular conduction as electrocardiographically assessed. Methods The STARNL-1 was a prospective, monocenter, pre-post intervention study. Six patients with VT recurrences despite optimal doses of anti-arrhythmic drugs (AADs), after one or more unsuccessful catheter ablation(s), were considered therapy-refractory. Patients were treated with a single fraction of 25 Gy. ECG evaluation included ECGs recorded pre-therapy, at 3 hours, 12 hours, 24 hours, 1 month, and 3 months after therapy. For an additional assessment, only patients in whom AADs remained unchanged up to 3 months after STAR were selected. QRS duration and QT interval were measured by a single observer using digital callipers. Four consecutive beats were used to measure and calculate a mean QRS duration and QT interval per ECG. This study was not powered to evaluate for significant changes in ECG parameters. Results All patients were male, all suffered from ischaemic cardiomyopathy, and all completed 3-month follow-up. One patient presented with atrial fibrillation on ECG recordings, and three patients with a paced rhythm. Four patients (66.7%) were selected for an additional assessment, two patients (P1 and P2, 33.3%) underwent changes in AAD dose and were therefore excluded. Figure 1 shows a line graph of the QRS duration and QTc interval of all STARNL-1 patients during 3-month follow-up. As can be appreciated from Figure 1, QRS duration and QTc interval did not appear to be altered between pre-therapy and 3 months after therapy. When excluding P1 and P2, QRS duration and QTc interval also did not appear to be altered between pre-therapy and 3 months after therapy. Conclusion(s) STAR for VT does not appear to alter QRS duration and QTc interval within the first 3 months after therapy.

Integration is a defining feature of two-way bilingual education (TWBE), yet the integrative dimension of TWBE has received relatively little attention. Over time, scholars have raised concerns that the integration of English speakers and speakers of other languages may not effectively support minority students in the program and in fact, reinforce the inequalities that exist outside of the program or school. This paper discusses the rationale for integration and critical issues of integration and equity as they have emerged at the classroom and program level. The authors provide a conclusion proposing ways forward and what is needed to realize the potential of integration as a transformative third space within TWBE.

Nursing has a long and celebrated history of providing life-saving care during crises and periods of great need. Following the government collapse in Afghanistan and the withdrawal of US troops, a severe humanitarian and human rights crisis emerged. The US military participated in one of the largest and most complex humanitarian missions in history to aid Afghan relief efforts. US and coalition forces evacuated more than 130,000 people in the chaotic Allied airlift from the Kabul Airport. The overarching missions, Operation Allies Refuge and Operation Allies Welcome, provided humanitarian support to at-risk Afghan nationals who contributed to the Global War on Terrorism efforts, as well as US citizens living in Afghanistan. Landstuhl Regional Medical Center (LRMC), an overseas military treatment facility located in Germany, supported the healthcare needs of Afghan evacuees and injured US service members during the humanitarian crisis. LRMC clinicians provided emergent, urgent, and specialty care while advocating for evacuee health, wellness, and living conditions. Perioperative and perianesthesia nurses were essential to the humanitarian response, as many evacuees and injured US service members arrived in Germany requiring immediate surgical interventions. In this article, we describe the vital contributions of military perioperative and perianesthesia nurses to the Operation Allies Refuge and Operation Allies Welcome missions, and share our experiences providing humanitarian relief. Military and civilian healthcare planners can learn from our humanitarian relief contributions, experiences, and lessons to strategically prepare their health systems to respond to future crises.

Item does not contain fulltext Premenstrual Syndrome (PMS) comprises psychological, somatic, and behavioral symptoms during the luteal phase of almost every menstrual cycle. PMS and premenstrual dysphoric disorder (PMDD) may be associated with substance use. Between 2018 and 2020 we studied the relationship between PMS and substance use within a prospective case-control design comparing a consecutive series of women having a substance use disorder and being treated in an addiction treatment center (ATC group, n = 151)) and one with community dwelling women attending their general practitioner (GP group, n = 101). The psychoactive substance use disorder women in the ATC were most frequently treated for was alcohol (39.7 percent), cannabis (20.5) and cocaine 7.9 percent) respectively. The relationship between PMS, problematic alcohol use, and craving for alcohol was explored with the Alcohol Use Disorders Identification Test (AUDIT), Premenstrual Screening Symptoms Tool (PSST), and Penn Alcohol Craving Scale (PACS). Descriptive analyses were used to report demographic variables, and the prevalence and nature of SUD according to DSM-5 and PMS in the two study populations and a two-step multiple hierarchical linear regression to assess the contribution of the variance of the AUDIT and PSST to craving, as measured with PACS. The frequency of PMS and PMDD is significantly higher in the ATC group than in the GP group (48.3 versus 26.7 percent and 16.6 versus 5.9 percent). Craving in the ATC group is better predicted (50 percent) by alcohol-related problems as measured by the AUDIT than in the GP group (25 percent). PMS complaints do contribute to craving in ATC group and not in GP group. There is a high prevalence of PMS/PMDD in the population with a substance use disorder. If these patients with PMS symptoms experience higher levels of craving, it may increase the risk of substance use relapse. 9 p.

Attentional bias towards rewards has been extensively studied in both healthy and clinical populations. Several studies have shown an association between reward value-modulated attentional capture (VMAC) and greater substance use. However, less is known about the association between these VMAC effects and internalizing symptoms. Moreover, while VMAC effects have also been found in punishment contexts, the association between punishment VMAC and psychopathology has not been studied so far. In the present two-part preregistered study, we adapted a novel VMAC task to also include a punishment context and examined associations with internalizing symptoms and substance use. Our results showed consistent VMAC effects in reward contexts across two separate studies. Attentional capture was stronger for distractors associated with high rewards than for low rewards. We replicated and extended previous findings by showing such VMAC effects in a substantially shorter task that also included alternating punishment blocks. Contrary to our expectations, we found no VMAC effects in punishment contexts and no direct associations between VMAC and symptom measures. Our results speak to the feasibility of assessing VMAC effects using a scalable and short behavioral online task, but the relationship with the development of internalizing and externalizing psychopathology remains uncertain.

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Disgust-based body image concerns can bias autobiographical memory towards the recall and avoidant processing of disgust-related memories of the own body. Repeated exposure to such memories may help breaking avoidance and promote the habituation of disgust, thereby lowering body concerns. Using a within-participant experimental design, we tested if repeatedly exposing women with high self-disgust (N = 61) to disgust-focused body-related memories vs. neutral memories led to changes in disgust, body acceptance, and reactive avoidance. Disgust towards the body itself only decreased following neutral exposure. Disgust elicited by the body-related memories also decreased following repeated disgust exposure trials. In the disgust exposure session, stronger habitual prevention of body-related disgust was associated with higher disgust elicited by the memories, whereas reactive avoidance increased from pre to post exposure. Pre-post decreases in state disgust in the disgust exposure session were associated with increases in acceptance. Results regarding the disgust exposure session point to the potency of repeated exposure to disgust-eliciting memories as a means to promote the habituation of disgust and formation of positive body appraisals. The tenacity of disgust-driven avoidance highlights the importance of effective response prevention.

Dose reduction of biologics for psoriasis could contribute to more efficient use of these expensive medicines. Evidence on opinions of patients with psoriasis regarding dose reduction is sparse. The objective of this study was therefore to explore patients’ perspectives towards dose reduction of biologics for psoriasis. A qualitative study was conducted, comprising semi-structured interviews with 15 patients with psoriasis with different characteristics and treatment experiences. Interviews were analyzed by inductive thematic analysis. Perceived benefits of biologic dose reduction according to patients were minimizing medication use, lowering risks of adverse effects and lowering societal healthcare costs. Patients reported to have experienced a large impact of their psoriasis, and expressed concerns about loss of disease control due to dose reduction. Fast access to flare treatment and adequate monitoring of disease activity were among reported preconditions. According to patients, they should have confidence in dose reduction effects and should be willing to change their effective treatment. Moreover, addressing information needs and involvement in decision-making were deemed important among patients. In conclusion, addressing patients’ concerns, fulfilling information needs, providing the possibility of resuming standard dose, and involving patients in decision-making are important according to patients with psoriasis when considering biologic dose reduction.

Population-genomic studies can shed new light on the effect of past demographic processes on contemporary population structure. We reassessed phylogeographical patterns of a classic model species of postglacial recolonisation, the brown bear (Ursus arctos), using a range-wide resequencing dataset of 128 nuclear genomes. In sharp contrast to the erratic geographical distribution of mtDNA and Y-chromosomal haplotypes, autosomal and X-chromosomal multi-locus datasets indicate that brown bear population structure is largely explained by recent population connectivity. Multispecies coalescent based analyses reveal cases where mtDNA haplotype sharing between distant populations, such as between Iberian and southern Scandinavian bears, likely results from incomplete lineage sorting, not from ancestral population structure (i.e., postglacial recolonisation). However, we also argue, using forward-in-time simulations, that gene flow and recombination can rapidly erase genomic evidence of former population structure (such as an ancestral population in Beringia), while this signal is retained by Y-chromosomal and mtDNA, albeit likely distorted. We further suggest that if gene flow is male-mediated, the information loss proceeds faster in autosomes than in X chromosomes. Our findings emphasise that contemporary autosomal genetic structure may reflect recent population dynamics rather than postglacial recolonisation routes, which could contribute to mtDNA and Y-chromosomal discordances.

Frontotemporal dementia (FTD) is an early-onset neurodegenerative disorder with a heterogeneous clinical presentation. Verbal fluency is regularly used as a sensitive measure of language ability, semantic memory, and executive functioning, but qualitative changes in verbal fluency in FTD are currently overlooked. This retrospective study examined qualitative, linguistic features of verbal fluency in 137 patients with behavioral variant (bv)FTD (n = 50), or primary progressive aphasia (PPA) [25 non-fluent variant (nfvPPA), 27 semantic variant (svPPA), and 34 logopenic variant (lvPPA)] and 25 control participants. Between-group differences in clustering, switching, lexical frequency (LF), age of acquisition (AoA), neighborhood density (ND), and word length (WL) were examined in the category and letter fluency with analysis of variance adjusted for age, sex, and the total number of words. Associations with other cognitive functions were explored with linear regression analysis. The results showed that the verbal fluency performance of patients with svPPA could be distinguished from controls and other patient groups by fewer and smaller clusters, more switches, higher LF, and lower AoA (all p < 0.05). Patients with lvPPA specifically produced words with higher ND than the other patient groups (p < 0.05). Patients with bvFTD produced longer words than the PPA groups (p < 0.05). Clustering, switching, LF, AoA, and ND-but not WL-were differentially predicted by measures of language, memory, and executive functioning (range standardized regression coefficient 0.25-0.41). In addition to the total number of words, qualitative linguistic features differ between subtypes of FTD. These features provide additional information on lexical processing and semantic memory that may aid the differential diagnosis of FTD.

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Contains fulltext : 232053.pdf (Publisher’s version ) (Open Access) The Social Norms Questionnaire-Dutch version (SNQ-NL) measures the ability to understand and identify social boundaries. We examined the psychometric characteristics of the SNQ-NL and its ability to differentiate between patients with behavioral variant frontotemporal dementia (bvFTD; n = 23), Alzheimer's dementia (AD; n = 26), chronic psychiatric disorders (n = 27), and control participants (n = 92). Between-group differences in the Total score, Break errors, and Overadhere errors were examined and associations with demographic variables and other cognitive functions were explored. Results showed that the SNQ-NL Total Score and Break errors differed between patients with AD and bvFTD, but not between patients with bvFTD and psychiatric disorders. Modest correlations with age, sex, and education were observed. The SNQ-NL Total score and Break errors correlated significantly with emotion recognition and verbal fluency but not with processing speed or mental flexibility. In conclusion, the SNQ-NL has sufficient construct validity and can be used to investigate knowledge of social norms in clinical populations. 12 p.

Early adolescence is an important transition period during which many mental disorders emerge. The interplay between different internalizing and externalizing mental health problems in adolescence is poorly understood at the within-person level. Executive functioning (EF) in early adolescence has been shown to constitute a transdiagnostic risk factor, but the specificity of the associations between different domains of EF and internalizing/externalizing mental health problems remains unclear. Leveraging data from a large longitudinal panel study of adolescents (TRAILS, n > 1641) assessed at ages 11, 13, and 15, we investigated the network dynamics of different internalizing and externalizing symptoms. We showcase the use of two novel methodological panel network approaches: cross-lagged panel network models (CLPN) and graphical vector autoregressive (GVAR) models. Moreover, we used hierarchical regression models to investigate prospective associations between different measures of EF (working memory, sustained attention, shifting attention) and broadband transdiagnostic dimensions (internalizing/externalizing symptoms). Depressive symptoms emerged as an important bridge connecting clusters of internalizing and externalizing mental health problems in the cross-sectional networks. Importantly, depressive symptoms predicted a range of other internalizing symptoms (i.e., panic, somatic problems, separation anxiety, general anxiety, social phobia) over time, in particular during early adolescence. In contrast, social phobia symptoms were most strongly predicted by other symptoms. Externalizing symptoms, such as oppositional-defiant problems and inattention/hyperactivity predicted depressive and OCD symptoms at the within-person level respectively. We identified important feedback loops with reciprocal associations between different anxiety symptoms (e.g., separation anxiety – general anxiety, and panic symptoms – somatic problems). Different facets of EF assessed at age 11, in particular sustained attention, showed weak but significant prospective associations with internalizing and externalizing symptoms at age 13 and 15. Our findings speak to the importance of attending to depressive symptoms in early adolescence to prevent a spiral of different internalizing symptoms from arising later on.

Item does not contain fulltext BACKGROUND: Despite its effectiveness in treating Crohn's disease, adalimumab is associated with an increased risk of infections and high health-care costs. We aimed to assess clinical outcomes of increased adalimumab dose intervals versus conventional dosing in patients with Crohn's disease in stable remission. METHODS: The LADI study was a pragmatic, open-label, multicentre, non-inferiority, parallel, randomised controlled trial, done in six academic hospitals and 14 general hospitals in the Netherlands. Adults (aged ≥18 years) diagnosed with luminal Crohn's disease (with or without concomitant perianal disease) were eligible when in steroid-free clinical and biochemical remission (defined as Harvey-Bradshaw Index [HBI] score

The risk of SARS-CoV-2 infection does not appear to be increased for psoriasis patients using biologics compared to those on other treatments, but evidence is still limited. (1) to estimate the prevalence of SARS-CoV-2 infection in patients with psoriasis, (2) to compare SARS-CoV-2 infection rates for different psoriasis treatments groups (biologic vs. systemic conventional vs. topical therapy) corrected for confounders and (3) to describe patients with severe COVID-19 for all treatment groups. In this cross-sectional cohort study all patients received a questionnaire to gather data on psoriasis treatment, SARS-CoV-2 infections and related risk factors. Simultaneously, they underwent a blood test to screen for antibodies to SARS-CoV-2 N-antigen. Prevalence of SARS-CoV-2 infections was calculated and logistic regression and Cox proportional-hazards models were performed to determine the association between treatment group and SARS-CoV-2 infection risk, corrected for confounders. Patients with severe COVID-19 disease were described and the mortality rate per treatment group was calculated for the target population. Patients were included between April 12 2021 and October 31 2021. Of 551 patients, 59 (10.7% (CI95% 8.3–13.6)) had experienced a SARS-CoV-2 infection, based on questionnaire data combined with serological data. In our study cohort, corrected for confounders, biologic or non-biologic systemic therapy users did not appear to have increased SARS-CoV-2 infection risk compared to patients using other treatment. Only 4 hospitalizations (0.7% (CI95% 0.2–1.0) were reported in our study population and no ICU admissions were reported. The rough mortality rate in the target cohort was 0.32% (CI95% 0.13–0.66) in all treatment groups. Corrected for risk-mitigating behavior and vaccination status, a higher SARS-CoV-2 incidence for biologics or non-biologics systemics compared to other treatments could not be proven. Severe cases were infrequent in all treatment groups. This finding further strengthens treatment recommendations that systemic therapies for patients with psoriasis do not require preventive cessation for reduction of SARS-CoV-2 infection risk.

In the PURE-01 study, patients with muscle-invasive bladder cancer (MIBC) who achieved a pathological complete response (CR; ypT0N0) had tumor features suggesting that pre-existing immunity may promote response. We focused on fibroblast growth factor receptor-3 (FGFR3) genomic alterations (GAs) as potential tumor resistance features. The primary endpoint of our study was CR. FGFR3 GAs were assessed via comprehensive genomic profiling of sequenced DNA (N = 112), a transcriptome-based FGFR3 activity signature, an FGFR3 subtyping model based on long noncoding RNA (lncRNA), and gene expression profiling (N = 84 for all three). We used Wilcoxon rank-sum tests, Fisher's exact test, and logistic regression analyses to analyze the associations between the various FGFR3 alterations and CR. High FGFR3 activity was defined as a signature score that was higher than the median value. Cases that were positive for lncRNA-FGFR3 subtype (lncRNA-FGFR3 active, N = 11) had consistent biology with published data: low epithelial-mesenchymal transition and immune-signature scores, high p53 activity, FGFR3 activity, and sonic hedgehog activity. In total, 17 (15.2%), 42 (50%), and 11 patients (13%) showed FGFR3 GAs or high FGFR3 signature scores, or had lncRNA-FGFR3–active tumors. Despite an association of high FGFR3 gene expression with a lower CR rate (p = 0.01), we did not find a correlation between FGFR3 activity or mutation/fusion and CR (p = 0.2 and p = 0.8). We conclude that the association of FGFR3 expression with pathological response is balanced by multiple factors. Overall, FGFR3-altered tumors should not be excluded from neoadjuvant immunotherapy studies at this time. Patient summary In patients with muscle-invasive bladder cancer treated within the PURE-01 trial, we analyzed the role of fibroblast growth factor receptor-3 (FGFR3) alterations, at the DNA and RNA levels, in association with the pathological response. We did not find any robust association, mainly when analyzing the landscape of alterations defining tumors with higher biological FGFR activity. Overall, FGFR3 activity and gene alterations did not provide sufficiently robust data to exclude patients whose tumors harbor these alterations from neoadjuvant immunotherapy trials.

The term Repulsive Body Image (RBI) refers to a schematic construct combining body-directed self-disgust and other negative body image features. As a self-schema, the RBI is assumed to bias information processing, including autobiographical memory retrieval. When specific memories about the own body are retrieved in a direct (automatic) fashion, intense self-disgust may arise. This may trigger attempts to escape from those memories which, in turn, might further strengthen the RBI. We asked 133 women with high (H-RBI; n = 63) and low (L-RBI; n = 70) levels of habitual body-directed self-disgust to recall autobiographical memories in response to 11 concrete body-related cue words in a minimal instructions Autobiographical Memory Test (AMT). Despite an overall low level of memory specificity, we found that RBI levels were associated with stronger disgust reactions and stronger tendencies to escape from body-related memories. In addition, increased disgust reactions to body-related memories accounted for the association between habitual levels of self-disgust and increased tendencies to escape from these memories. Thus, the findings indicated that women with body image concerns showed disgust-based escape from body-related memories. This disgust-based inclination to avert from body-related autobiographical memories might counteract the correction of an RBI, thereby contributing to the persistence of body image concerns and associated psychopathology.

Environments, particularly developmental environments, can generate a considerable amount of phenotypic variation through phenotypic plasticity. Plasticity in response to incubation temperature is well characterised in egg-laying reptiles. However, traits do not always vary independently of one another, and studies encompassing a broad range of traits spanning multiple categories are relatively rare but crucial to better understand whole-organism responses to environmental change, particularly if covariation among traits may constrain plasticity. In this study, we investigated multivariate plasticity in response to incubation across three temperatures in the delicate skink, Lampropholis delicata, and whether this was affected by covariation among traits. At approximately 1 month of age, a suite of growth, locomotor performance, thermal physiology and behavioural traits were measured. Plasticity in the multivariate phenotype of delicate skinks was distinct for different incubation temperatures. Cool temperatures drove shifts in growth, locomotor performance and thermal physiology, while hot temperatures primarily caused changes in locomotor performance and behaviour. These differences are likely due to variation in thermal reaction norms, as there was little evidence that covariation among traits or phenotypic integration influenced plasticity, and there was no effect of incubation temperature on the direction or strength of covariation. While there were broad themes in terms of which trait categories were affected by different incubation treatments, traits appeared to be affected independently by developmental temperature. Comparing reaction norms of a greater range of traits and temperatures will enable better insight into these patterns among trait categories, as well as the impacts of environmental change.

The COVID-19 pandemic overwhelmed health care systems and exposed major gaps in preparedness and response plans. The crisis challenged nurse leaders to develop and implement novel care delivery plans while preventing disease transmission to patients and staff. COVID-19 required nurse leaders to make decisions in an environment of conflicting data and directives. The authors share essential nurse leader competencies vital to the development and support of thriving nurse leaders. As crises persist and future challenges arise, nurse leaders can leverage these essential competencies to successfully drive engagement, lead ahead of consensus, and define the shadows of limited, incomplete, and conflicting data.

The coronavirus disease 2019 pandemic stressed healthcare systems worldwide and exposed major flaws in military and civilian healthcare systems. Landstuhl Regional Medical Center (LRMC) serves as the only military medical center for over 205,000 U.S. service members, beneficiaries, and coalition partners stationed throughout Europe, Africa, and the Middle East. The pandemic response required LRMC leaders to reconfigure services to meet pandemic concerns while providing lifesaving care to injured service members from combatant commands. The quickly evolving pandemic challenged leaders to ensure healthcare delivery amid constant change and imperfect information. While LRMC senior leaders developed a strategic pandemic response plan, a multidisciplinary team of nurses, doctors, and technicians collaborated to create an inpatient team to support the dual mission of coronavirus disease 2019 response and casualty care for the warfighter. In this manuscript, we discuss how a multidisciplinary clinical working group at a regional medical center prepared and responded to the pandemic, strategically planned patient care, and ensured support to combatant commands for ongoing forward military operations. Additionally, we share our experiences and lessons learned to inform other military facilities across the medical community and global healthcare systems.

OBJECTIVES The aim of this study was to investigate the interscanner and interscoring platform variability of calcium quantification in peripheral arteries of the lower extremities. MATERIALS AND METHODS Twenty human fresh-frozen legs were scanned using 3 different computed tomography (CT) scanners. The radiation dose (CTDIvol) was kept similar for all scanners. The calcium scores (Agatston and volume scores) were quantified using 4 semiautomatic scoring platforms. Comparative analysis of the calcium scores between scanners and scoring platforms was performed by using the Friedman test; post hoc analysis was performed by using the Wilcoxon signed rank test with Bonferroni correction. RESULTS Sixteen legs had calcifications and were used for data analysis. Agatston and volume scores ranged from 12.1 to 6580 Agatston units and 18.2 to 5579 mm3. Calcium scores differed significantly between Philips IQon and Philips Brilliance 64 (Agatston: 19.5% [P = 0.001]; volume: 14.5% [P = 0.001]) and Siemens Somatom Force (Agatston: 18.1% [P = 0.001]; volume: 17.5% [P = 0.001]). The difference between Brilliance 64 and Somatom Force was smaller (Agatston: 5.6% [P = 0.778]; volume: 7.7% [P = 0.003]). With respect to the interscoring platform variability, OsiriX produced significantly different Agatston scores compared with the other 3 scoring platforms (OsiriX vs IntelliSpace: 14.8% [P = 0.001] vs Syngo CaScore: 13.9% [P = 0.001] vs iX viewer: 13.2% [P < 0.001]). For the volume score, the differences between all scoring platforms were small ranging from 2.9% to 4.0%. Post hoc analysis showed a significant difference between OsiriX and IntelliSpace (3.8% [P = 0.001]). CONCLUSIONS The use of different CT scanners resulted in notably different Agatston and volume scores, whereas the use of different scoring platforms resulted in limited variability especially for the volume score. In conclusion, the variability in calcium quantification was most evident between different CT scanners and for the Agatston score.

Background Many nations are faced with challenges regarding the sustainability of their healthcare systems. Rising costs and limited financial and human resources mean that difficult decisions regarding the provision of healthcare are imminent. Which care should be provided, when and where? These decisions will affect all current and future users of healthcare. This has given rise to calls from policy makers and others to include citizens in the decision making process. The question is how this can be done. What are viable ways of citizen participation in healthcare? What are critical issues to take into account? And how do citizens themselves want to participate? Methods We use results from a literature review, six interviews with organizations in the field and the results of two citizen platforms to map the challenges and opportunities for citizen participation in healthcare. We study the case of the Netherlands, a country with a long and singular tradition of participatory policies. Results Preliminary findings indicate there are six key decision variables that are instrumental in shaping citizen participation in the field of healthcare. Among those are the kinds of knowledge that participants possess and the valuation of these kinds of knowledge by agents in the field of healthcare. Conclusions We interpret the results using a Bourdieusian conceptual framework, which emphasizes the contextual framing of participation. Citizen participation can be understood as an intervention in the field of healthcare. Participation is structured by the different forms of knowledge of participants as capitals. This highlights power differences that must be understood in order to design fruitful participatory processes. Key messages • Citizen participation in healthcare understood as an intervention in the field of healthcare. • Understanding power differences is crucial for designing and implementing this intervention.

Background Cardiac radioablation for ventricular tachycardia (VT) appears to be highly effective and safe in patients with recurrent VT despite anti-arrhythmic therapy and catheter ablation(s), although global experience is currently very limited. Detailed echocardiographic strain analysis could provide important insights in (subclinical) functional safety. Importantly, current stereotactic cardiac radioablation techniques includes irradiation of the VT substrate but, inherently, also includes irradiation of the VT border zone and some healthy cardiac tissue. The latter particularly may result in detoriation of cardiac function after cardiac radioablation. Purpose To evaluate functional echocardiographic safety of cardiac radioablation. Methods The STARNL-1 trial is a prospective, monocenter, single-arm, pre-post intervention study. Six patients with recurrent VT despite high dose anti-arrhythmic drugs, after (single or multiple) conventional catheter ablation and deemed unsuited for repeat catheter ablation, were treated with a single fraction 25 Gy radiotherapy dose. Per protocol, patients underwent echocardiograms at baseline, 24 hours after treatment, and 3 months after treatment. Echocardiograms were analysed using 2D-speckle tracking. Mean radiotherapy dose per segment was calculated according to the AHA 17-segment model. Echocardiographic parameters were compared between baseline, 24 hours and 3 months, and correlated to radiotherapy dose. Results Patients were all male (age 55–83 years), all suffered from ischaemic cardiomyopathy, and all completed 3 month follow-up. At baseline, median left ventricle ejection fraction (LVEF) was 38% [30; 47] and median global longitudinal strain (GLS) −8% [−12; −5]. Interestingly, LVEF significantly improved 24 hours after treatment (42% [36; 49], p=0.046) but GLS did not change (−7% [−12; −5], p=0.833). At 3 months, both LVEF and GLS were unchanged compared to baseline (LVEF 39% [33; 49%], p=0.463; GLS −6% [−12; −5], p=0.893). The difference in longitudinal strain per segment before and after treatment did not correlate with the mean radiotherapy dose per segment, both 24 hours after treatment (Pearson coefficient −0.082, p=0.410) and 3 months after treatment (Pearson coefficient −0.005, p=0.957). In Figure 1 an illustrative case is presented. Conclusion(s) Cardiac radioablation for VT does not worsen (subclinical) cardiac function within the first 3 months after treatment. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation

Background Height, weight, and body mass index (BMI) are well established risk factors for atrial fibrillation (AF) but whether they are also predictors of successful pharmacological cardioversion of AF is unknown. Data from the open-label INSTANT study of flecainide acetate oral inhalation solution (FlecIH) for acute cardioversion of recent-onset symptomatic AF were examined to determine if these anthropometric measures are predictors of successful cardioversion of AF to sinus rhythm (SR) with FlecIH. Methods Logistic regression was performed on a broad array of patient and disease characteristics to identify predictors of cardioversion success at 90 minutes post-dose, and potential interactions were examined by boundary restriction analysis. Data are presented for patients receiving 120 mg FlecIH. Results Data from 81 patients (32.1% female) with a mean age of 59.8 years (range: 26.0, 84.0) were included in the analysis. This cohort had a mean weight of 87 kg (range: 57, 150), a mean height of 180 cm (range: 156, 199), and a mean BMI of 26.8 kg/m2 (range: 17.2, 37.9). A logistic regression model identified height, weight, and BMI as significant predictors of cardioversion success (p Conclusions Successful cardioversion of recent onset AF with 120 mg FlecIH was observed in normal, overweight, and obese patients with BMI values Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): InCarda Therapeutics

PURPOSE OF REVIEW: To provide an overview of the recent literature on RNA-based molecular urine assays for the diagnosis and surveillance of non-muscle invasive bladder cancer (NMIBC). RECENT FINDINGS: Articles were eligible for inclusion if performance metrics sensitivity, specificity, and negative-predictive value (NPV) were reported or could be calculated. Only prospective studies published between 2020-2022 were included. Five out of fourteen studies addressed the primary diagnostic setting; the proportion of gross hematuria patients in all study populations was >50%. Only one study reported performance metrics within a microscopic hematuria subgroup. This study evaluated Xpert Bladder and reported a sensitivity: 73%, specificity: 84%, NPV: 99%, and PPV: 12%. Ten studies assessed test performance during surveillance for NMIBC. For the detection of high-grade (HG) and high-risk (HR) NMIBC, sensitivity, specificity, NPV, and PPV varied between 78-100%, 64-89%, 97.0-99.7%, and 9.2-39%. SUMMARY: Multiple RNA-based urine assays have been investigated for the detection of urothelial cancer in the primary or surveillance setting. However, studies included within this review have important limitations, hampering the interpretation of study results. As such, performance metrics should be interpreted with caution and further research is required to evaluate the clinical impact of RNA-based urine assays in daily practice.

Wood decomposition in tropical forests is strongly linked to the terrestrial carbon cycle. Our understanding of the successional changes in wood decomposition in diverse tropical forests is still limited. In this study, we tested the hypothesis that fine wood decomposition rates decline with the increasing age of successional forests due to the interspecific variation in wood density and changes in species composition. We studied fine wood decomposition in a chronosequence of tropical forests representing four successional phases in southern Mexico. Wood segments (1–7.5 cm diameter) from 30 dominant species (wood density range 0.34–0.83 g cm−3) were left on the ground for decomposition, and samples were recollected at different time intervals for three years. We used a modified negative exponential model by introducing the power parameter (p) that allowed for a time-dependent decomposition rate (k). Average k within a successional phase ranged from 0.22 to 0.39 yr−1 and declined gradually with the increase in forest age. We found a significant negative correlation between wood density and decomposition rate constants. The kspecies ranged from 0.07 to 1.11 yr−1, whereas p-parameters varied between 0.65 and 1.42. Trees such as Bursera simaruba, and Cascabela gaumeri decomposed faster, while Eugenia ibarrae, and Pouteria reticulata decomposed slower. Average fine woody debris inputs ranged from 1.2 to 3.7 Mg ha−1 yr−1 which increased with forest age. Increasing production and declining decomposition rates during succession contribute to the higher accumulation of deadwood in primary forests. The results on generalized, age- and species-specific wood decay parameters have important implications in simulating carbon dynamics of the changing tropical forests.

Objectives To determine the potential impact of the presence of secondary variant histology on the gene expression profiles of muscle-invasive bladder cancer (MIBC) tumors. Methods For six tumors, revised samples were collected from urothelial and secondary variant components (cohort A). The commercial cohort (cohort B) consisted of the anonymized gene expression profiles of 173 patients with MIBC. Samples were obtained from the clinical use of the Decipher Bladder test that were available as part of the Decipher GRID prospective registry (NCT02609269). Secondary variant presence in cohort B was abstracted from institutional pathology reports. For the commercial cohort, only the urothelial carcinoma component was profiled. Results Molecular subtyping of both urothelial and variant components found micropapillary and nested cases were classified as a luminal subtype. Conversely, the sarcomatoid and small cell cases were classified as basal/squamous or neuroendocrine-like, respectively. For cohort B, 50 (29%) of 173 cases had reported secondary variant histology. Cases with squamous variant had basal profiles, small cell cases expressed neuronal markers, and micropapillary cases were classified as luminal. Sarcomatoid tumors had robust epithelial-mesenchymal transition marker expression. Conclusions Our data suggest that in MIBC with secondary variant, the urothelial component can demonstrate an expression profile that closely resembles the variant component.

Microhematuria is a prevalent condition and the American Urological Association has developed a new risk-stratified approach for the evaluation of patients with microhematuria. Our objective was to provide the first evaluation of this important guideline.This multinational cohort study combines contemporary patients from 5 clinical trials and 2 prospective registries who underwent urological evaluation for hematuria. Patients were stratified into American Urological Association risk strata (low, intermediate or high risk) based on sex, age, degree of hematuria, and smoking history. The primary end point was the incidence of bladder cancer within each risk stratum.A total of 15,779 patients were included in the analysis. Overall, 727 patients (4.6%) were classified as low risk, 1,863 patients (11.8%) were classified as intermediate risk, and 13,189 patients (83.6%) were classified as high risk. The predominance of high risk patients was consistent across all cohorts. A total of 857 bladder cancers were diagnosed with a bladder cancer incidence of 5.4%. Bladder cancer was more prevalent in men, smokers, older patients and patients with gross hematuria. The cancer incidence for low, intermediate and high risk groups was 0.4% (3 patients), 1.0% (18 patients) and 6.3% (836 patients), respectively.The new risk stratification system separates hematuria patients into clinically meaningful categories with differing likelihoods of bladder cancer that would justify evaluating the low, intermediate and high risk groups with incremental intensity. Furthermore, it provides the relative incidence of bladder cancer in each risk group which should facilitate patient counseling regarding the risks and benefits of evaluation for bladder cancer.

In the last decade, cellular forces in three-dimensional hydrogels that mimic the extracellular matrix have been calculated by means of Traction Force Microscopy (TFM). However, characterizing the accuracy limits of a traction recovery method is critical to avoid obscuring physiological information due to traction recovery errors. So far, 3D TFM algorithms have only been validated using simplified cell geometries, bypassing image processing steps or arbitrarily simulating focal adhesions. Moreover, it is still uncertain which of the two common traction recovery methods, i.e., forward and inverse, is more robust against the inherent challenges of 3D TFM. In this work, we established an advanced in silico validation framework that is applicable to any 3D TFM experimental setup and that can be used to correctly couple the experimental and computational aspects of 3D TFM. Advancements relate to the simultaneous incorporation of complex cell geometries, simulation of microscopy images of varying bead densities and different focal adhesion sizes and distributions. By measuring the traction recovery error with respect to ground truth solutions, we found that while highest traction recovery errors occur for cases with sparse and small focal adhesions, our implementation of the inverse method improves two-fold the accuracy with respect to the forward method (average error of 23% vs. 50%). This advantage was further supported by recovering cellular tractions around angiogenic sprouts in an in vitro model of angiogenesis. The inverse method recovered higher traction peaks and a clearer pulling pattern at the sprout protrusion tips than the forward method. STATEMENT OF SIGNIFICANCE: Biomaterial performance is often studied by quantifying cell-matrix mechanical interactions by means of Traction Force Microscopy (TFM). However, 3D TFM algorithms are often validated in simplified scenarios, which do not allow to fully assess errors that could obscure physiological information. Here, we established an advanced in silico validation framework that mimics real TFM experimental conditions and that characterizes the expected errors of a 3D TFM workflow. We apply this framework to demonstrate the enhanced accuracy of a novel inverse traction recovery method that is illustrated in the context of an in vitro model of sprouting angiogenesis. Together, our study shows the importance of a proper traction recovery method to minimise errors and the need for an advanced framework to assess those errors.

Founder populations are of special interest to both evolutionary and conservation biologists, but the detection of genetic signals of selection in these populations is challenging due to their demographic history. Geographically separated founder populations likely to have been subjected to similar selection pressures provide an ideal but rare opportunity to overcome these challenges. Here we take advantage of such a situation generated when small, isolated founder populations of reindeer were established on the island of South Georgia, and using this system we look for empirical evidence of selection overcoming strong genetic drift. We generated a 70 k ddRADseq single nucleotide polymorphism database for the two parallel reindeer founder populations and screened for signatures of soft sweeps. We find evidence for a genomic region under selection shared among the two populations, and support our findings with Wright–Fisher model simulations to assess the power and specificity of interpopulation selection scans—namely Bayescan, OutFLANK, PCadapt and a newly developed scan called Genome Wide Differentiation Scan (GWDS)—in the context of pairwise source–founder comparisons. Our simulations indicate that loci under selection in small founder populations are most probably detected by GWDS, and strengthen the hypothesis that the outlier region represents a true locus under selection. We explore possible, relevant functional roles for genes in linkage with the detected outlier loci.

Aim: To examine how the spatial topology of the operating room (OR) within the medical center impacts surgical team communication. Background: Understanding the complex association between surgical team communication and the OR’s spatial network location is critical to patient safety. Effective surgical communication is associated with fewer adverse events and medical errors. Methods: We employed a cross-sectional, quantitative, case study, and network-centric study design. We studied the population of 204 clinicians in a large military medical center (36 perioperative nurses, 34 surgical technicians, 62 anesthesia providers, and 72 surgeons), focusing on surgical teams with cases completed within duty hours. Data were collected from December 2020 to June 2021 using an electronic survey. Spatial network analysis was done using electronic floor plans. Statistical analysis was done with descriptive statistics and linear regressions. The outcomes were general and task-specific communication, and team-level variables were aggregated from scores for all team members. Spatial effects were assessed with network centrality (degree, Laplacian, and betweenness). Results: The individual-level survey response rate was 77% (157 of 204). Data were collected on 137 surgical teams. On a 5-point scale, general and task-specific communication ranged from 3.4 to 5.0 and 3.5 to 5.0, respectively (for both, median = 4.7). Team size ranged from 4 to 6 individuals (median = 4). Surgical suites with higher network centralities were associated with significantly lower communication scores. Conclusions: The OR’s spatial network location has important impacts on surgical team communication. Our findings have design and workflow implications for ORs and even surgical care in combat zones.

Research on speech production in the P-center paradigm (Rapp, 1972) explores how speakers produce various items with temporal regularity, as guided by a metronome. Studies find a regular pattern in which, with small offsets created by different types of onset consonants, and by material appearing after the vowel, the acoustic onsets of stressed vowels are aligned with the metronome. The current paper examines the extent to which language structure, in the form of syllabic constituency, affects speech in metronome alignment. Previous work (Lin, 2020) finds strong evidence that Mandarin speakers associate approximants with neighboring vowels, contra English wherein labial approximants (as in quick) appear to associate with the previous onset consonants. In the current work, 6 speakers of Mandarin produced syllabic forms in time to a metronome. Stimuli included items with and without vowel-like approximants before the vowel. Mandarin productions show strong evidence for metronome alignment with the onset of these approximants, as would be the case if a vowel complex forms the main unit of alignment and approximants are part of this vowel complex. Analysis of the parallel English productions is currently underway, and will be reported.

During the 1980s–1990s, 4600 hectares of the seagrass Zostera marina were permanently lost from Lake Grevelingen (the Netherlands), and restoration is planned. In 1971, the lake was fully marine (salinity 30), and seagrass covered 1300 hectares. After closure in that year, the lake gradually became brackish (salinity of 23 by 1978), and the meadows expanded to 4600 hectares. However, with the creation of a sluice connection to the sea in 1978, the lake returned to marine conditions and a fatal decline initiated. We revisit traditionally suggested causes of the disappearance of the seagrass, finding them unsatisfactory. We hypothesize that during the lower salinity conditions from 1971 to 1978, selection of low-salinity genotypes occurred, and these genotypes were not adapted to returning marine conditions. This hypothesis is no longer testable through genetic analysis in Lake Grevelingen but is supported by previously unpublished experiments that found a lack of seed germination at even moderately high salinity for the now extinct population. Such processes could be relevant for, and tested in, environmentally modified water systems worldwide, particularly when isolated. Based on our assessment, the abiotic environment of Lake Grevelingen seems suitable for Z. marina restoration using a donor from a high salinity environment.

Introduction: Transdermal analysis patches (TAPs) noninvasively measure soluble proteins in the stratum corneum. Ultimately, such local protein profiles could benefit the search for biomarkers to improve personalized treatment in psoriasis. This study aimed to explore the patient friendliness and protein detection by TAP in pediatric psoriasis in daily clinical practice. Methods: In this observational study, TAPs measuring CXC chemokine ligand (CXCL)-1/2, CC chemokine ligand (CCL)-27, interleukin (IL)-1RA, IL-23, IL-1α, IL-8, IL-4, IL-22, IL-17A, vascular endothelial growth factor (VEGF), human beta-defensin (hBD)-2, hBD-1, and kallikrein-related peptidase (KLK)-5 were applied on lesional, peri-lesional, and non-lesional skin sites of psoriasis patients aged >5 to Results: Thirty-two patients (median age 14.0 years) were included, of which 19 were treated with solely topical agents and 13 with systemic treatment. The median VAS of discomfort during TAP removal was 1.0 (interquartile range 1.0). Significantly higher levels in lesional versus non-lesional skin were found for IL-1RA, VEGF, CXCL-1/2, hBD-2, and IL-8, whereas lower levels were found for IL-1α. Skin surface proteins were measured in both treatment groups, with significant higher lesional levels of KLK-5, IL-1RA, hBD-2, IL-1α, IL-23, and CCL-27 in the systemic treatment group. Conclusion: The TAP platform holds the potential for patient-friendly and noninvasive monitoring of skin-derived proteins in pediatric psoriasis patients in daily clinical practice.

Contains fulltext : 235374.pdf (Publisher’s version ) (Open Access) BACKGROUND: Stratum corneum hydration (SCH) and transepidermal water loss (TEWL) provide useful information about skin barrier function. This study aimed to determine the value of GPSkin Pro, a new handheld device determining both SCH and TEWL, to measure skin barrier impairment and to monitor barrier function in rosacea in daily practice. MATERIALS AND METHODS: Two pilots were performed. Pilot 1: in 27 healthy participants, GPSkin SCH and TEWL were compared to Aquaflux(®) and Epsilon(®) values at the forearm before and after skin barrier perturbation via tapestripping. Moreover, GPSkin values were measured at both cheeks without intervention. Pilot 2: in 16 rosacea patients, GPSkin measurements were performed at the forearm, and at both cheeks before and during anti-inflammatory treatment. They were compared to clinical symptoms and to GPSkin values from pilot 1. RESULTS: Pilot 1: after merging data from before and after tapestripping, a strong correlation was observed between GPSkin TEWL and Aquaflux(®) (R(s) = 0.9256), and GPSkin SCH and Epsilon(®) (R(s) = 0.8798). Pilot 2: SCH was significantly lower at the cheeks of rosacea patients compared to controls, with a normalizing trend during successful treatment. TEWL was comparable among patients and controls and did not change during treatment at all locations. CONCLUSION: The GPSkin determines TEWL and SCH accurately in healthy and impaired skin barrier state and can monitor skin barrier function in rosacea during treatment. The GPSkin device is much more practical compared to previous skin barrier tools when used in clinical practice. Its further validation in other inflammatory skin diseases is recommended.

Using a unique dataset of FINRA-licenced individuals in Florida in 2015 that was enriched to include job classification information generally not contained in publicly-available regulatory data, a ...

Reward and punishment sensitivity seem important traits in understanding behavior in general and psychopathology in particular. Though the definitions used for reward and punishment sensitivity differentiate between responsivity and motivation, the measures thus far used to assess these constructs do not. Further, specificity of the type of reward (e.g., drugs) and punishment (e.g., spiders) in questionnaires might result in measurement bias especially when examining the relationship with psychopathology. Therefore, we developed a stimulus-independent multidimensional questionnaire of reward and punishment sensitivity that differentiates between responsivity and motivation. This study addresses the psychometric qualities of this newly developed reward and punishment responsivity and motivation questionnaire (RPRM-Q). On the basis of exploratory ordinal factor analysis (N = 273) that was used to examine the quality of the initial pool of 39 items, the number of items was reduced to 18. Confirmatory ordinal factor analysis on the remaining items in an independent sample (N = 328) supported a 18-item four-factor model, and showed acceptable to good internal reliability. The relationship between the subscales of the RPRM-Q and often used questionnaires was examined in the combined sample (N = 601), which showed some first support for the ability of the new questionnaire to differentiate between responsivity and motivation to approach/avoid. The findings indicate that the RPRM-Q might be a helpful instrument to further test the relevance of punishment and reward sensitivity in psychopathology.

Background Salvage external beam radiotherapy (sEBRT) for patients with a biochemical recurrence (BCR) after radical prostatectomy provides a 5-year biochemical progression-free survival up to 60%. Multiple studies have shown that dose escalation to the primary prostate tumour improves treatment outcome. However, data is lacking on the role of dose escalation in the recurrent salvage setting. The main objective of the PERYTON-trial is to investigate whether treatment outcome of sEBRT for patients with a BCR after prostatectomy can be improved by increasing the biological effective radiation dose using hypofractionation. Moreover, patients will be staged using the PSMA PET/CT scan, which is superior to conventional imaging modalities in detecting oligometastases. Methods The PERYTON-study is a prospective multicentre open phase III randomised controlled trial. We aim to include 538 participants (269 participants per treatment arm) with a BCR after prostatectomy, a PSA-value of Discussion Firstly, the high rate of BCR after sEBRT may be due to the presence of oligometastases, for which local sEBRT is inappropriate. With the use of the PSMA PET/CT before sEBRT, patients with oligometastases will be excluded from intensive local treatment to avoid unnecessary toxicity. Secondly, the currently applied radiation dose for sEBRT may be too low to achieve adequate local control, which may offer opportunity to enhance treatment outcome of sEBRT by increasing the biologically effective radiotherapy dose to the prostate bed. Trial registration This study is registered at ClinicalTrials.gov (Identifier: NCT04642027). Registered on 24 November 2020 – Retrospectively registered. The study protocol was approved by the accredited Medical Ethical Committee (METc) of all participating hospitals (date METc review: 23-06-2020, METc registration number: 202000239). Written informed consent will be obtained from all participants.

Autobiographical memories involving the own body are likely an important factor in defining people’s body images. People with a negative body image may not only be more likely to recall negative/repulsive memories of their body, but also be motivated to avoid retrieving specific memories to prevent triggering aversive emotions (e.g., disgust). Such inclination to retain at a global level of memory recall may hamper the correction of their negative body image, thereby contributing to the persistence of body image concerns. In previous research using Autobiographical Memory Tests (AMTs) with minimal instructions we failed to find evidence for such an overgeneral memory bias specific to individuals with a negative body image, but observed an overall low memory specificity in response to body cue words. Therefore, the present study (N = 153) included a traditional AMT with extensive instructions next to a minimal instructions AMT condition. In addition, we explored the idea that episodic quality may be a memory characteristic that is relevant to avoidance and included episodic quality ratings next to memory specificity. Women with a relatively negative body image recalled relatively negative body-memories. Yet, in both conditions the findings failed to support our prediction that a more negative body image would also be associated with relatively low specificity or episodic quality ratings. Thus, the findings are consistent with the view that autobiographical memories might be an important factor in defining one’s body image, yet, cast doubt on the relevance of avoidant retrieval of body-related memories, at least in non-clinical samples.