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Purpose Surgical fluorescence guidance has gained popularity in various settings, e.g., minimally invasive robot-assisted laparoscopic surgery. In pursuit of novel receptor-targeted tracers, the field of fluorescence-guided surgery is currently moving toward increasingly lower signal intensities. This highlights the importance of understanding the impact of low fluorescence intensities on clinical decision making. This study uses kinematics to investigate the impact of signal-to-background ratios (SBR) on surgical performance. Methods Using a custom grid exercise containing hidden fluorescent targets, a da Vinci Xi robot with Firefly fluorescence endoscope and ProGrasp and Maryland forceps instruments, we studied how the participants’ (N = 16) actions were influenced by the fluorescent SBR. To monitor the surgeon’s actions, the surgical instrument tip was tracked using a custom video-based tracking framework. The digitized instrument tracks were then subjected to multi-parametric kinematic analysis, allowing for the isolation of various metrics (e.g., velocity, jerkiness, tortuosity). These were incorporated in scores for dexterity (Dx), decision making (DM), overall performance (PS) and proficiency. All were related to the SBR values. Results Multi-parametric analysis showed that task completion time, time spent in fluorescence-imaging mode and total pathlength are metrics that are directly related to the SBR. Below SBR 1.5, these values substantially increased, and handling errors became more frequent. The difference in Dx and DM between the targets that gave SBR 1.50, indicates that the latter group generally yields a 2.5-fold higher Dx value and a threefold higher DM value. As these values provide the basis for the PS score, proficiency could only be achieved at SBR > 1.55. Conclusion By tracking the surgical instruments we were able to, for the first time, quantitatively and objectively assess how the instrument positioning is impacted by fluorescent SBR. Our findings suggest that in ideal situations a minimum SBR of 1.5 is required to discriminate fluorescent lesions, a substantially lower value than the SBR 2 often reported in literature.

Item does not contain fulltext OBJECTIVE: Parents and health professionals believe that recurrent respiratory tract infections (RRTI) have a large impact on children with Down syndrome (DS). We studied the relation between parent-reported RRTI and development, behaviour and health-related quality of life (HRQoL) in 8-year-old children with DS. METHOD: During a 3-year period, 325 children with DS were recruited for inclusion in this observational study. Parents were asked to fill in the Child Behavior Checklist and TNO-AZL Children's Quality of Life Parent Form. A psychological assistant administrated the McCarthy Scales of Children's Abilities. The children were divided into a group with presence of RRTI (RRTI (+) ) and a group without RRTI (RRTI (-) ), on the basis of parental report. Linear regression analyses were performed to assess the effect of RRTI, while correcting for the influence of confounders. RESULTS: Compared with RRTI (-) children (n = 176), RRTI (+) children (n = 149, 46%) showed decreased mental and motor development (mean developmental age 3.67 vs. 4.08 years), more behavioural problems and lower scores on most HRQoL scales (P < 0.05). Moreover, school enrolment is less favourable in RRTI (+) children. CONCLUSION: In 8-year-olds with DS, the children with parent-reported RRTI show more delayed development, more behavioural problems and lower HRQoL compared with the children without RRTI. Although this association does not prove a causal relationship, further studies should focus on this, because RRTI are potentially preventable. 01 november 2013

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In this thesis, four studies on children and adolescents with Down syndrome are described. The first study showed that the number of live births of children with Down syndrome in the Netherlands remained stable over the period 1997-2007 on 14.6 per 10,000 births. Of these, 85% were live born. In the second study is observed that growth retardation in children with Down syndrome meanly occurs in three critical periods of growth, resulting in shorter final stature and smaller head circumference than the general Dutch population shows. Furthermore, Dutch children with Down syndrome have alarmingly high prevalence rates of overweight and obesity during childhood and adolescence. The third study showed that eight-year-old children with Down syndrome have an average developmental delay of four years, more often have emotional and behavioral problems, and have a less favorable health-related quality of life (HRQoL) compared with children from the general population. Children with Down syndrome and recurrent respiratory tract infections showed relatively more delayed development. In the fourth study, results showed that adolescents with Down syndrome remain dependent to a large degree and have serious difficulties in functioning socially. Additionally, results showed that serious problem behavior is highly prevalent in adolescents with Down syndrome.

Jongeren met downsyndroom zijn sterk afhankelijk en hebben veel moeite om goed sociaal te functioneren. Een deel van hen kan tot op zekere hoogte voor zichzelf zorgen, bijvoorbeeld zelfstandig opstaan, eten met mes en vork en een computer of televisie bedienen. Een op de drie heeft echter 24 uur per dag begeleiding nodig. Dat blijkt uit onderzoek van TNO naar de groei, de ontwikkeling en het functioneren van kinderen en jongeren met downsyndroom.

Doel van deze richtlijn is het bieden van handvatten voor: 1) advisering over houding, hantering en positionering ter preventie van voorkeurshouding en plagiocefalie, 2) tijdige en correcte signalering, diagnose en/of eventuele verwijzing naar huisarts en/of kinderfysiotherapeut, 3) verzorgingsadviezen na signalering, 4) monitoring van het vervolg na verwijzing.

De JGZ speelt een belangrijke rol bij een goede signalering, registratie en diagnostiek bij niet-scrotale testis (NST). Waar nodig wordt verwezen naar de kinderchirurg/-uroloog voor nader onderzoek en eventuele operatieve behandeling.

Contains fulltext : 52959.pdf (Publisher’s version ) (Closed access) PURPOSE: Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. METHODS: The functional recovery of patients suffering severe hand trauma was evaluated using AMA impairment rating tests and DASH disability questionnaire scores. RESULTS: Seventy-eight patients with 228 phalangeal fractures were available for testing, with a mean follow-up period of 7.5 years. No statistically significant correlation existed between the AMA impairment ratings for the hand and the DASH module scores. There were weak correlations between the AMA impairment ratings for the arm and total body and the DASH module function scores. CONCLUSIONS: The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.

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Contains fulltext : 74933.pdf (Publisher’s version ) (Open Access) This thesis describes the application of the shortest path algorithm in the simulation of cardiac activation. This method is both used in the forward simulation of an electrocardiogram (ECG) as well as in the non-invasive imaging of cardiac activation and recovery. Due to the immense number of cardiac cells a source model is required to simulate the electrical cardiac generator. The source model used in this thesis is the equivalent double layer source model. One of the major advantages of this model is the close relation with electrophysiological characteristics of the cardiac cells. This enables the introduction of electrophysiological knowledge in the require initial estimate on behalf of the non-invasive imaging method. Knowledge on the propagation of activation within the myocardial tissue was introduced to generate realistic activation patterns, both for the atria and the ventricles. The inverse procedure described in this thesis proves to be robust, both in respect to the number of leads used and to the waveform parameterization used in the source model. The robustness is mainly attributed to the high quality of the initial activation estimate based on the dedicated implementation of the shortest path algorithm, the fastest route algorithm. This results in an initial estimate that is close to the actual activation and recovery times, which minimize the risk that the subsequently applied inverse procedure ends up in an unrealistic local minimum in the parameter space. The clinical application of this inverse procedure is now coming within reach. Selecting the optimal lead system might enable the inverse procedure to be executed by using a limited number of leads (15-30). For specific cases and research applications, like shown for the Brugada patient, the proposed non-invasive imaging method seems to have reached maturity. RU Radboud Universiteit Nijmegen, 05 februari 2010 Promotor : Oosterom, A. van Co-promotor : Oostendorp, T.F. 119 p.

Contains fulltext : 19301_impreesoa.pdf (Publisher’s version ) (Open Access) The research described in this thesis covers different aspects of EEG and ERP source modeling. Both basic research in volume conduction and source modeling, as well as application of inverse source modeling techniques to experimental data are described. This thesis demonstrates how prior information can be applied in physical models that are used for source analysis of the EEG. It shows that realistic volume conduction models can be used that incorporate holes in the skull. The accurate placement of electrodes for high-density EEG measurements is described. It discusses how information on symmetry of sources in the brain can be used, and what the influence of incorrectly assumed symmetry in the sources is. The application of prior information on source locations is demonstrated in a forward modeling approach. A high-resolution EEG experiment is described to which source analysis was applied, making use of the prior information available in this experiment. In general, this thesis demonstrates that the application of source modeling can provide valuable information in EEG analysis 168 p.

Item does not contain fulltext KU Nijmegen, 20 november 2000 Promotores : Barentsz, J.O., Verheugt, F.W.A. Co-promotores : Brouwer, M.H.J., Heijstraten, F.M.J., Oosterom, A. van, Rossum, A.C. van, Roos, A.D.G. de 129 p.

Item does not contain fulltext KU Nijmegen, 20 november 2000 Promotores : Barentsz, J.O., Ruijs, J.H.J., Verheugt, F.W.A. Co-promotores : Russ, P.D., Skotnicki, S.H., Heerschap, A., Heijstraten, F.M.J., Blickman, J.G., Oosterom, A. van, Roos, A.D.G. de, Rossum, A.C. van 149 p.

Item does not contain fulltext TU Twente, 11 november 1999 Promotores : Rogalla, H., Oosterom, A. van Co-promotor : Peters, M.J. 145 p.

Item does not contain fulltext KUN, 15 juni 1999 Promotores : Oosterom, A. van, Werf, T. van der Co-promotor : Uijen, G.J.H. 231 p.

Contains fulltext : 122226.pdf (Publisher’s version ) (Open Access) Katholieke Universiteit Nijmegen, 19 februari 1998 Promotor : Oosterom, A. van Co-promotor : Thijssen, J.M. 120 p.

Contains fulltext : mmubn000001_247460370.pdf (Publisher’s version ) (Open Access) Promotores : D. Stegeman, A. van Oosterom en S. Notermans 128 p.

Item does not contain fulltext Urologie, 23 september 1996 Promotores : Debruyne, F.M.J., Oosterom, A. van, Wijkstra, H., Kerrebroeck, P.E.V.A. van 132 p.