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To facilitate Safe and Sustainable by Design (SSbD) strategies during the development of nanomaterials (NMs), quick and easy in vitro assays to test for hazard potential at an early stage of NM development are essential. The formation of reactive oxygen species (ROS) and the induction of oxidative stress are considered important mechanisms that can lead to NM toxicity. In vitro assays measuring oxidative stress are therefore commonly included in NM hazard assessment strategies. The fluorescence-based dichloro-dihydro-fluorescein (DCFH) assay for cellular oxidative stress is a simple and cost-effective assay, making it a good candidate assay for SSbD hazard testing strategies. It is however subject to several pitfalls and caveats. Here, we provide further optimizations to the assay using 5-(6)-Chloromethyl-2′,7′-dichlorodihydrofluorescein diacetate acetyl ester (CM-H2DCFDA-AE, referred to as DCFH probe), known for its improved cell retention. We measured the release of metabolic products of the DCFH probe from cells to supernatant, direct reactions of CM-H2DCFDA-AE with positive controls, and compared the commonly used plate reader-based DCFH assay protocol with fluorescence microscopy and flow cytometry-based protocols. After loading cells with DCFH probe, translocation of several metabolic products of the DCFH probe to the supernatant was observed in multiple cell types. Translocated DCFH products are then able to react with test substances including positive controls. Our results also indicate that intracellularly oxidized fluorescent DCF is able to translocate from cells to the supernatant. In either way, this will lead to a fluorescent supernatant, making it difficult to discriminate between intra- and extra-cellular ROS production, risking misinterpretation of possible oxidative stress when measuring fluorescence on a plate reader. The use of flow cytometry instead of plate reader-based measurements resolved these issues, and also impro

Background: While some long-term effects of COVID-19 are respiratory in nature, a non-respiratory effect gaining attention has been a decline in hemoglobin, potentially mediated by inflammatory processes. In this study, we examined the correlations between hemoglobin levels and inflammatory biomarkers and evaluated the association between hemoglobin and fatigue in a cohort of Long-COVID patients. Methods: This prospective cohort study in the Netherlands evaluated 95 (mostly hospitalized) patients, aged 40-65 years, 3-6 months post SARS-CoV-2 infection, examining their venous hemoglobin concentration, anemia (hemoglobin < 7.5 mmol/L in women and <8.5 mmol/L in men), inflammatory blood biomarkers, average FSS (Fatigue Severity Score), demographics, and clinical features. Follow-up hemoglobin was compared against hemoglobin during acute infection. Spearman correlation was used for assessing the relationship between hemoglobin concentrations and inflammatory biomarkers, and the association between hemoglobin and fatigue was examined using logistic regression. Results: In total, 11 (16.4%) participants were suffering from anemia 3-6 months after SARS-CoV-2 infection. The mean hemoglobin value increased by 0.3 mmol/L 3-6 months after infection compared to the hemoglobin during the acute phase ( p-value = 0.003). Whilst logistic regression showed that a 1 mmol/L greater increase in hemoglobin is related to a decrease in experiencing fatigue in Long-COVID patients (adjusted OR 0.38 [95%CI 0.13-1.09]), we observed no correlations between hemoglobin and any of the inflammatory biomarkers examined. Conclusion: Our results indicate that hemoglobin impairment might play a role in developing Long-COVID fatigue. Further investigation is necessary to identify the precise mechanism causing hemoglobin alteration in these patients.

Aviation has been shown to cause high particle number concentrations (PNC) in areas surrounding major airports. Particle size distribution and composition differ from motorized traffic. The objective was to study short-term effects of aviation-related UFP on respiratory health in children. In 2017–2018 a study was conducted in a school panel of 7–11 year old children (n = 161) living North and South of Schiphol Airport. Weekly supervised spirometry and exhaled nitric oxide (eNO) measurements were executed. The school panel, and an additional group of asthmatic children (n = 19), performed daily spirometry tests at home and recorded respiratory symptoms. Hourly concentrations of various size fractions of PNC and black carbon (BC) were measured at three school yards. Concentrations of aviation-related particles were estimated at the residential addresses using a dispersion model. Linear and logistic mixed models were used to investigate associations between daily air pollutant concentrations and respiratory health. PNC20, a proxy for aviation-related UFP, was virtually uncorrelated with BC and PNC50-100 (reflecting primarily motorized traffic), supporting the feasibility of separating PNC from aviation and other combustion sources. No consistent associations were found between various pollutants and supervised spirometry and eNO. Major air pollutants were significantly associated with an increase in various respiratory symptoms. Odds Ratios for previous day PNC20 per 3,598pt/cm3 were 1.13 (95%CI 1.02; 1.24) for bronchodilator use and 1.14 (95%CI 1.03; 1.26) for wheeze. Modelled aviation-related UFP at the residential addresses was also positively associated with these symptoms, corroborating the PNC20 findings. PNC20 was not associated with daily lung function, but PNC50-100 and BC were negatively associated with FEV1. PNC of different sizes indicative of aviation and other combustion sources were independently associated with an increase of respiratory

Background Four months after SARS-CoV-2 infection, 22%–50% of COVID-19 patients still experience complaints. Long COVID is a heterogeneous disease and finding subtypes could aid in optimising and developing treatment for the individual patient. Methods Data were collected from 95 patients in the P4O2 COVID-19 cohort at 3–6 months after infection. Unsupervised hierarchical clustering was performed on patient characteristics, characteristics from acute SARSCoV-2 infection, long COVID symptom data, lung function and questionnaires describing the impact and severity of long COVID. To assess robustness, partitioning around medoids was used as alternative clustering. Results Three distinct clusters of patients with long COVID were revealed. Cluster 1 (44%) represented predominantly female patients (93%) with pre-existing asthma and suffered from a median of four symptom categories, including fatigue and respiratory and neurological symptoms. They showed a milder SARS-CoV-2 infection. Cluster 2 (38%) consisted of predominantly male patients (83%) with cardiovascular disease (CVD) and suffered from a median of three symptom categories, most commonly respiratory and neurological symptoms. This cluster also showed a significantly lower forced expiratory volume within 1 s and diffusion capacity of the lung for carbon monoxide. Cluster 3 (18%) was predominantly male (88%) with pre-existing CVD and diabetes. This cluster showed the mildest long COVID, and suffered from symptoms in a median of one symptom category. Conclusions Long COVID patients can be clustered into three distinct phenotypes based on their clinical presentation and easily obtainable information. These clusters show distinction in patient characteristics, lung function, long COVID severity and acute SARS-CoV-2 infection severity. This clustering can help in selecting the most beneficial monitoring and/or treatment strategies for patients suffering from long COVID. Follow-up research is needed to reveal the un

A significant body of research has investigated potential correlates of deception and bodily behavior. The vast majority of these studies consider discrete, subjectively coded bodily movements such as specific hand or head gestures. Such studies fail to consider quantitative aspects of body movement such as the precise movement direction, magnitude and timing. In this paper, we employ an innovative data mining approach to systematically study bodily correlates of deception. We re-analyze motion capture data from a previously published deception study, and experiment with different data coding options. We report how deception detection rates are affected by variables such as body part, the coding of the pose and movement, the length of the observation, and the amount of measurement noise. Our results demonstrate the feasibility of a data mining approach, with detection rates above 65%, significantly outperforming human judgement (52.80%). Owing to the systematic analysis, our analyses allow for an understanding of the importance of various coding factor. Moreover, we can reconcile seemingly discrepant findings in previous research. Our approach highlights the merits of data-driven research to support the validation and development of deception theory.

Early identification of hearing loss through newborn hearing screening followed by an early start of intervention has proven to be effective in promoting speech and language development in children with hearing loss. During the COVID-19 pandemic, newborn hearing screening was postponed for a group of newborns in the Netherlands. Therefore, meeting the guidelines for early identification was at risk. In this study, we examine parental attitudes, beliefs, and experiences concerning the hearing screening during the COVID-19 pandemic. Our results indicated that parents (n = 1053) were very positive about newborn hearing screening and their experiences with the screening, even during the COVID-19 pandemic. Parents’ beliefs on the information provision around newborn hearing screening were more inconsistent. The results showed that parents with a postponed hearing screening felt less informed about the hearing screening than parents without a postponed screening. Furthermore, child and family characteristics affected how parents experienced newborn hearing screening. Parents with a premature child were more worried about the hearing abilities of their child before the screening took place. The results also indicate that deafness in the family might lead to parental worries around newborn hearing screening.

Background: In the Netherlands, the prevalence of post COVID-19 condition is estimated at 12.7% at 90–150 days after SARS-CoV-2 infection. This study aimed to determine the occurrence of fatigue and other symptoms, to assess how many patients meet the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) criteria, to identify symptom-based clusters within the P4O2 COVID-19 cohort and to compare these clusters with clusters in a ME/CFS cohort. Methods: In this multicentre, prospective, observational cohort in the Netherlands, 95 post COVID-19 patients aged 40–65 years were included. Data collection at 3–6 months after infection included demographics, medical history, questionnaires, and a medical examination. Follow-up assessments occurred 9–12 months later, where the same data were collected. Fatigue was determined with the Fatigue Severity Scale (FSS), a score of ≥ 4 means moderate to high fatigue. The frequency and severity of other symptoms and the percentage of patients that meet the ME/CFS criteria were assessed using the DePaul Symptom Questionnaire-2 (DSQ-2). A self-organizing map was used to visualize the clustering of patients based on severity and frequency of 79 symptoms. In a previous study, 337 Dutch ME/CFS patients were clustered based on their symptom scores. The symptom scores of post COVID-19 patients were applied to these clusters to examine whether the same or different clusters were found. Results: According to the FSS, fatigue was reported by 75.9% of the patients at 3–6 months after infection and by 57.1% of the patients 9–12 months later. Post-exertional malaise, sleep disturbances, pain, and neurocognitive symptoms were also frequently reported, according to the DSQ-2. Over half of the patients (52.7%) met the Fukuda criteria for ME/CFS, while fewer patients met other ME/CFS definitions. Clustering revealed specific symptom patterns and showed that post COVID-19 patients occurred in 11 of the clusters that have been observed in the M

BACKGROUND: The incidence of severe asthma exacerbations (SAE) requiring a pediatric intensive care unit (PICU) admission during the coronavirus disease 2019 (COVID-19) pandemic (and its association with public restrictions) is largely unknown. We examined the trend of SAE requiring PICU admission before, during, and after COVID-19 restrictions in Amsterdam, the Netherlands, and its relationship with features such as environmental triggers and changes in COVID-19 restriction measures.METHODS: In this single-center, retrospective cohort study, all PICU admissions of children aged ≥2 years for severe asthma at the Amsterdam UMC between 2018 and 2022 were included. The concentrations of ambient fine particulate matter (PM 2.5 ) and pollen were obtained from official monitoring stations. RESULTS: Between January 2018 and December 2022, 228 children were admitted to the PICU of the Amsterdam UMC for SAE. While we observed a decrease in admissions during periods of more stringent restriction, there was an increase in the PICU admission rate for SAE in some periods following the lifting of restrictions. In particular, following the COVID-19 restrictions in 2021, we observed a peak incidence of admissions from August to November, which was higher than any other peak during the indicated years. No association with air pollution or pollen was observed.CONCLUSION: We hypothesize that an increase in clinically diagnosed viral infections after lockdown periods was the reason for the altered incidence of SAE at the PICU in late 2021, rather than air pollution and pollen concentrations.

Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia after Alzheimer disease (AD). Efforts in the field mainly focus on familial forms of disease (fFTDs), while studies of the genetic etiology of sporadic FTD (sFTD) have been less common. In the current work, we analyzed 4,685 sFTD cases and 15,308 controls looking for common genetic determinants for sFTD. We found a cluster of variants at the MAPT (rs199443; p = 2.5 × 10−12, OR = 1.27) and APOE (rs6857; p = 1.31 × 10−12, OR = 1.27) loci and a candidate locus on chromosome 3 (rs1009966; p = 2.41 × 10−8, OR = 1.16) in the intergenic region between RPSA and MOBP, contributing to increased risk for sFTD through effects on expression and/or splicing in brain cortex of functionally relevant in-cis genes at the MAPT and RPSA-MOBP loci. The association with the MAPT (H1c clade) and RPSA-MOBP loci may suggest common genetic pleiotropy across FTD and progressive supranuclear palsy (PSP) (MAPT and RPSA-MOBP loci) and across FTD, AD, Parkinson disease (PD), and cortico-basal degeneration (CBD) (MAPT locus). Our data also suggest population specificity of the risk signals, with MAPT and APOE loci associations mainly driven by Central/Nordic and Mediterranean Europeans, respectively. This study lays the foundations for future work aimed at further characterizing population-specific features of potential FTD-discriminant APOE haplotype(s) and the functional involvement and contribution of the MAPT H1c haplotype and RPSA-MOBP loci to pathogenesis of sporadic forms of FTD in brain cortex.

Rubinstein-Taybi syndrome (RTS) is an archetypical genetic syndrome that is characterised by intellectual disability, well-defined facial features, distal limb anomalies and atypical growth, among numerous other signs and symptoms. It is caused by variants in either of two genes (CREBBP, EP300) which encode for the proteins CBP and p300, which both have a function in transcription regulation and histone acetylation. As a group of international experts and national support groups dedicated to the syndrome, we realised that marked heterogeneity currently exists in clinical and molecular diagnostic approaches and care practices in various parts of the world. Here, we outline a series of recommendations that document the consensus of a group of international experts on clinical diagnostic criteria for types of RTS (RTS1: CREBBP; RTS2: EP300), molecular investigations, long-term management of various particular physical and behavioural issues and care planning. The recommendations as presented here will need to be evaluated for improvements to allow for continued optimisation of diagnostics and care.

Background: Shallow whole genome sequencing (Shallow-seq) is used to determine the copy number aberrations (CNA) in tissue samples and circulating tumor DNA. However, costs of NGS and challenges of small biopsies ask for an alternative to the untargeted NGS approaches. The mFAST-SeqS approach, relying on LINE-1 repeat amplification, showed a good correlation with Shallow-seq to detect CNA in blood samples. In the present study, we evaluated whether mFAST-SeqS is suitable to assess CNA in small formalin-fixed paraffin-embedded (FFPE) tissue specimens, using vulva and anal HPV-related lesions. Methods: Seventy-two FFPE samples, including 36 control samples (19 vulva;17 anal) for threshold setting and 36 samples (24 vulva; 12 anal) for clinical evaluation, were analyzed by mFAST-SeqS. CNA in vulva and anal lesions were determined by calculating genome-wide and chromosome arm-specific z-scores in comparison with the respective control samples. Sixteen samples were also analyzed with the conventional Shallow-seq approach. Results: Genome-wide z-scores increased with the severity of disease, with highest values being found in cancers. In vulva samples median and inter quartile ranges [IQR] were 1[0–2] in normal tissues (n = 4), 3[1–7] in premalignant lesions (n = 9) and 21[13–48] in cancers (n = 10). In anal samples, median [IQR] were 0[0–1] in normal tissues (n = 4), 14[6–38] in premalignant lesions (n = 4) and 18[9–31] in cancers (n = 4). At threshold 4, all controls were CNA negative, while 8/13 premalignant lesions and 12/14 cancers were CNA positive. CNA captured by mFAST-SeqS were mostly also found by Shallow-seq. Conclusion: mFAST-SeqS is easy to perform, requires less DNA and less sequencing reads reducing costs, thereby providing a good alternative for Shallow-seq to determine CNA in small FFPE samples.

Introduction: Demands for myopia management are rising. A web-based tool that allows home-performed self-assessments of visual acuity (VA) and refractive error may enable hybrid care pathways and aid in identifying those with deteriorating visual performance. The tool has been validated in adult populations, but has yet to be evaluated in children. This study compared home-performed VA and refraction self-assessments to conventional measurements obtained at the clinic in a population of myopic children. Methods: Myopic children aged >= 6 years old were invited to perform web-based eye tests at home, assisted by a parent. At two myopia control clinics, they also underwent measurements of VA using a Snellen chart and refractive error using cycloplegic autorefraction. Agreement between the tests, repeatability of the web-based test and associations between clinical characteristics and web-based test accuracy were evaluated. Results: A total of 147 children were enrolled, of whom 116 (51% male; mean age 13 +/- 3 years; mean spherical equivalent refraction (SEQ) -5.58 +/- 3.05) performed the web-based tests at home. Overall, the home-performed VA self-assessment and the Snellen chart assessment at the clinic agreed well (mean difference 0.03 +/- 0.11 logMAR). A significant proportional bias was identified (beta 0.65, p < 0.001), indicating underestimated web-based VA scores when the child's vision declined. The sensitivity to detect VA poorer than 0.10 logMAR was 94%; the specificity was 71%. The web-based refractive error algorithm measured more myopia progression compared to clinic observations (mean difference SEQ 0.40 +/- 0.51 dioptres). Age, sex or use of atropine drops were not significantly associated with test accuracy. Conclusions: The web-based test for self-assessing vision, performed at home by children with assistance from their parents, yielded VA scores with a precision similar to Snellen chart testing conducted in a clinical setting. However, the we

Analyzing exhaled breath for volatile organic compounds (VOCs) using thermal desorption–gas chromatography–mass spectrometry (TD-GC-MS) offers a non-invasive diagnostic approach for various diseases. Despite its promise, the method faces challenges like sampling heterogeneity and high costs. Following the European Respiratory Society’s advocacy for methodological standardization, we developed the SPIRITAS (Standardized Product for Inexpensive Respiratory InvesTigation: A breath Sampler), a low-cost, disposable breath sampler. This study evaluates the SPIRITAS’s effectiveness in detecting targeted VOCs. We tested the SPIRITAS using the Peppermint Experiment, a standardized protocol that allows for comparison between different breath sampling and analytical practices by assessing the ability to detect five peppermint-specific VOCs after ingestion of a 200-milligram peppermint oil capsule. We included ten subjects and performed six breath samples per participant, including a baseline measurement taken before ingestion. We used the Wilcoxon signed-rank test to evaluate whether baseline values were significantly lower than the peak values of the targeted VOCs. Additionally, we conducted an experiment utilizing humidified medical-grade air to identify any VOCs attributable to the SPIRITAS setup itself. Results showed successful detection of four out of five targeted “peppermint-associated” VOCs: alpha-pinene (p ≤ 0.01), beta-pinene (p ≤ 0.01), menthone (p = 0.01), and menthol (p = 0.02), indicating significant differences between the baseline and peak values in the volunteers’ breath. However, detection of eucalyptol was inconsistent. In addition, we identified 16 VOCs that were released by the SPIRITAS, one of which remains unidentified. Our findings underscore the SPIRITAS’s potential for clinical applications, paving the way for broader biomarker research. The combination of ease of use, low cost, reduced risk of contamination, and standardization makes SPIRITAS ver

Introduction: A peculiar spongy appearance of the perianal skin was observed in a patient who underwent wide excision surgery for inguinal and gluteal hidradenitis suppurativa (HS). Case Presentation:This peculiar appearance was observed in a 62-year-old male patient. It included multiple orifices and cavities forming the spongy aspect of the perianal skin with multiple cysts and giant comedones. The perianal lesions were asymptomatic and the patient had never received any perianal treatment for the comedones or cysts. Histopathology was performed and demonstrated dilated hair follicles with flaky keratin and loose hair shafts in the center. The spongy appearance was most likely the result of spontaneous shedding of the cystic contents. Conclusion: We suspect that the "cystic sponge anus"might be associated with HS, smoking, the male gender, and may yet be another expression of an occlusive follicular disease. Future studies will be needed to clarify the prevalence and comorbidities of the "cystic sponge anus."

Biodegradation is an important mechanism of contaminant removal from soils. We use numerical simulations to study the contaminant transport in heterogeneous soils subject to transient flow conditions and anaerobic multicomponent biodegradation. These processes and their interactions affect contaminant travel times, the extent of reactant mixing, solute and microbial biomass distributions in the soil, and biodegradation outcomes. Especially when flux variations are large, the combination of soil heterogeneity and transient flow gives rise to dynamic preferential flow zones, which affects reactant mixing and biodegradation outcomes. Results show that soil heterogeneity may reduce contaminant leaching due to enhanced reactant mixing, especially when biodegradation is more limited by reactant mixing. Furthermore, unlike under steady-state flow, under transient flow soil heterogeneity does not substantially reduce contaminant residence times. As preferential flow zones change dynamically, the spatio-temporally averaged transport, mixing, and biodegradation experienced by various parts of contaminant plumes become homogenized. Therefore, knowing the initial biodegradation rate of a contaminant upon infiltration, and its mean residence time in the soil, enables a relative sensitivity analysis. This allows biodegradation outcomes of various scenarios to be approximately ranked, even under soil heterogeneity and transient flow, using information that is straightforward to measure or estimate in the field.

Developmental time is a key life-history trait with large effects on Darwinian fitness. In many insects, developmental time is currently under strong selection to minimize ecological mismatches in seasonal timing induced by climate change. The genetic basis of responses to such selection, however, is poorly understood. To address this problem, we set up a long-term evolve-and-resequence experiment in the beetle Tribolium castaneum and selected replicate, outbred populations for fast or slow embryonic development. The response to this selection was substantial and embryonic developmental timing of the selection lines started to diverge during dorsal closure. Pooled whole-genome resequencing, gene expression analysis and an RNAi screen pinpoint a 222 bp deletion containing binding sites for Broad and Tramtrack upstream of the ecdysone degrading enzyme Cyp18a1 as a main target of selection. Using CRISPR/Cas9 to reconstruct this allele in the homogenous genetic background of a laboratory strain, we unravel how this single deletion advances the embryonic ecdysone peak inducing dorsal closure and show that this allele accelerates larval development but causes a trade-off with fecundity. Our study uncovers a life-history allele of large effect and reveals the evolvability of developmental time in a natural insect population.

Background: Microbiota alterations are common in patients hospitalised for severe infections, and preclinical models have shown that anaerobic butyrate-producing gut bacteria protect against systemic infections. However, the relationship between microbiota disruptions and increased susceptibility to severe infections in humans remains unclear. We investigated the relationship between gut microbiota and the risk of future infection-related hospitalisation in two large population-based cohorts. Methods: In this observational microbiome study, gut microbiota were characterised using 16S rRNA gene sequencing in independent population-based cohorts from the Netherlands (HELIUS study; derivation cohort) and Finland (FINRISK 2002 study; validation cohort). HELIUS was conducted in Amsterdam, Netherlands, and included adults (aged 18–70 years at inclusion) who were randomly sampled from the municipality register of Amsterdam. FINRISK 2002 was conducted in six regions in Finland and is a population survey that included a random sample of adults (aged 25–74 years). In both cohorts, participants completed questionnaires, underwent a physical examination, and provided a faecal sample at inclusion (Jan 3, 2013, to Nov 27, 2015, for HELIUS participants and Jan 21 to April 19, 2002, for FINRISK participants. For inclusion in our study, a faecal sample needed to be provided and successfully sequenced, and national registry data needed to be available. Primary predictor variables were microbiota composition, diversity, and relative abundance of butyrate-producing bacteria. Our primary outcome was hospitalisation or mortality due to any infectious disease during 5–7-year follow-up after faecal sample collection, based on national registry data. We examined associations between microbiota and infection risk using microbial ecology and Cox proportional hazards. Findings: We profiled gut microbiota from 10 699 participants (4248 [39·7%] from the derivation cohort and 6451 [60·3%] from th

Background: Healthcare is responsible for 4% to 10% of carbon emissions worldwide, of which 22% is related to transport. Telemedicine emerged as a potential solution to reduce the footprint, for example, by reducing travel. However, a need to understand which variables to include in carbon footprint estimations in telemedicine limits our understanding of the beneficial impact telemedicine might have on our environment. This paper aims to systematically assess the reported carbon footprint and include variables assessed by the literature, comparing telemedicine with usual care. Methods: The systematic review followed the PRISMA guidelines in PubMed, Medline, Embase and Scopus. A quality assessment was performed using a transparency checklist for carbon footprint calculators. Carbon emissions were evaluated based on four categories, including patient travel, and streamlined life cycle assessment (LCA) for assessing included variables relevant to telemedicine. Results: We included 33 articles from 1117 records for analysis. The average transparency score was 38% (range 18%-68%). The median roundtrip travel distance for each patient was 131 km (interquartile range [IQR]: 60.8-351), or 25.6 kgCO2 (IQR: 10.6-105.6) emissions. There is high variance among included variables. Saved emissions are structurally underestimated by not including external factors such as a streamlined LCA.Conclusions: Telemedicine aids in reducing emissions, with travel distance being the most significant contributor. Additionally, we recommend accounting for the LCA since it highlights important nuances. This review furthers the debate on assessing carbon footprint savings due to telemedicine.

Hypercholesterolemia is characterized by elevated low-density lipoprotein (LDL)-cholesterol levels and an increased risk of cardiovascular disease. The adipokine chemerin is an additional risk factor. Here we investigated whether cholesterol-lowering with statins or proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i) affects chemerin. Both statins and PCKS9i lowered plasma LDL-cholesterol, triglycerides and total cholesterol in hypercholesterolemic patients, and increased high-density lipoprotein (HDL)-cholesterol. Yet, only statins additionally reduced chemerin and high-sensitivity C-reactive protein (hsCRP). Applying PCSK9i on top of statins did not further reduce chemerin. Around 20% of chemerin occurred in the HDL2/HDL3 fractions, while >75% was free. Statins lowered both HDL-bound and free chemerin. Pull-down assays revealed that chemerin binds to the HDL-component Apolipoprotein A-I (ApoA-I). The statins, but not PCSK9i, diminished chemerin secretion from HepG2 cells by upregulating LDL receptor mRNA. Furthermore, chemerin inhibited HDL-mediated cholesterol efflux via its chemerin chemokine-like receptor 1 in differentiated macrophages. In conclusion, statins, but not PCSK9i, lower circulating chemerin by directly affecting its release from hepatocytes. Chemerin binds to ApoA-I and inhibits HDL-mediated cholesterol efflux. Statins prevent this by lowering HDL-bound chemerin. Combined with their anti-inflammatory effect evidenced by hsCRP suppression, this represents a novel cardiovascular protective function of statins that distinguishes them from PCSK9i.

A significant body of research has investigated potential correlates of deception and bodily behavior. The vast majority of these studies consider discrete, subjectively coded bodily movements such as specific hand or head gestures. Such studies fail to consider quantitative aspects of body movement such as the precise movement direction, magnitude and timing. In this paper, we employ an innovative data mining approach to systematically study bodily correlates of deception. We re-analyze motion capture data from a previously published deception study, and experiment with different data coding options. We report how deception detection rates are affected by variables such as body part, the coding of the pose and movement, the length of the observation, and the amount of measurement noise. Our results demonstrate the feasibility of a data mining approach, with detection rates above 65%, significantly outperforming human judgement (52.80%). Owing to the systematic analysis, our analyses allow for an understanding of the importance of various coding factor. Moreover, we can reconcile seemingly discrepant findings in previous research. Our approach highlights the merits of data-driven research to support the validation and development of deception theory.

Epileptic seizures are an established comorbidity of Alzheimer's disease (AD). Subclinical epileptiform activity (SEA) as detected by 24-h electroencephalography (EEG) or magneto-encephalography (MEG) has been reported in temporal regions of clinically diagnosed AD patients. Although epileptic activity in AD probably arises in the mesial temporal lobe, electrical activity within this region might not propagate to EEG scalp electrodes and could remain undetected by standard EEG. However, SEA might lead to faster cognitive decline in AD., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Hidradenitis suppurativa (HS) is a chronic, devastating, multifactorial skin disease. Patients generally develop HS after puberty and the prevalence of the disease is assumed to decrease with higher age. Data outside the usual age range are limited, especially for elderly patients. Objectives To investigate the prevalence, clinical characteristics and associated comorbidities among the elderly HS population. Methods Data were collected through a population-wide survey-based study within the Lifelines Cohort Study in the Netherlands. The clinical characteristics of elderly patients with HS (≥ 60 years) were compared with an adult population (< 60 years) with HS. The comorbidities in elderly patients with HS were compared with those of a non-HS sex- and age-matched elderly population in a 1: 4 ratio. HS in the elderly was defined as active HS in patients aged 60 years and older. Within the HS elderly group, two subgroups were defined, late-onset HS (HS developed after 60 years of age) and persistent HS (HS developed from a younger age but continuing after 60 years of age). Results Within the Lifelines cohort 209 elderly patients with HS were identified as well as an adult (< 60 years) group with HS (n=793) and a non-HS sex- and age-matched control elderly group (n=810). The prevalence of HS among the elderly bootstrap analysis population was 0.8% [95% confidence interval (CI) 0.4–1.2]. A significantly higher age of HS symptom onset was found compared with the adult HS group: respectively, 40 vs. 23 years (odds ratio 1.056, 95% CI 1.05–1.07). Among the elderly HS cohort (in the Discussion, the HS tarda cohort) a female: male ratio of 1.7: 1.0 and a higher family history for HS were found. Moreover, elderly patients with HS had a significantly higher risk of having HS-associated comorbidities compared with the sex- and age-matched controls. Conclusions

Background: Adalimumab monotherapy for hidradenitis suppurativa (HS) is often insufficient with a maximum clinical efficacy of 60% in Hidradenitis Suppurativa Clinical Response (HiSCR) and limited effect on draining tunnels. Data suggest that adalimumab therapy could be improved by concomitant antibiotics. Objective: To compare the clinical effectiveness of adalimumab with clindamycin and rifampicin versus adalimumab monotherapy after 12 weeks. Methods: This retrospective study included patients who started adalimumab with additional clindamycin and rifampicin and patients treated with adalimumab monotherapy, matched on sex and refined Hurley score. The primary outcome measure was the difference in change in the International Hidradenitis Suppurativa Severity Score System (IHS4) at 12 weeks. Results: In total, 62 patients were included in the combination therapy group (n = 31) and adalimumab monotherapy group (n = 31), showing comparable IHS4 scores; 32.5 versus 29, p = 0.87 at baseline respectively. The combination therapy demonstrated greater clinical effectiveness expressed in median IHS4 improvement (−20 vs. −9, p < 0.001), IHS4-55 (74% vs. 36%, p = 0.002), median draining tunnel reduction (−4 vs. −2, p < 0.001) and pain response (47% vs. 27%, p = 0.02). Conclusion: Adalimumab initiated with clindamycin and rifampicin shows greater clinical effectiveness than adalimumab monotherapy. An important difference in effect was observed in the decrease of draining tunnels, addressing a serious limitation of adalimumab monotherapy.

RIVM rapport:Luchtverontreiniging is schadelijk voor de gezondheid. Het RIVM heeft onderzocht of blootstelling aan luchtvervuiling door fijnstof en stikstofdioxide invloed heeft op de kans om besmet te raken met het coronavirus en op de kans om daar ernstig ziek van te worden. Onder ernstig ziek verstaan we dat iemand in het ziekenhuis moet worden opgenomen of aan de ziekte overlijdt. Mensen die aan hoge concentraties luchtverontreiniging blootstonden, blijken een grotere kans te hebben om besmet te raken. Ook was hierdoor de kans groter dat mensen door corona in het ziekenhuis moesten worden opgenomen omdat ze erg ziek werden. Ten slotte was de kans dat ze aan corona stierven groter. Deze effecten zijn te zien kort (een tot twee weken) na een periode van meer luchtverontreiniging. Dat is ook zo wanneer mensen jaren wonen op een plek met meer luchtverontreiniging. Deze resultaten bevestigen eerdere conclusies uit internationaal onderzoek. Ook blijkt dat bij een langdurige blootstelling aan luchtverontreiniging de kans op een corona-infectie hetzelfde is als die op andere luchtwegaandoeningen. Denk aan andere luchtweginfecties met klachten die lijken op corona. Dat luchtverontreiniging in het algemeen een grotere kans geeft op luchtwegaandoeningen was al bekend. In het onderzoek is gekeken naar drie belangrijke bronnen van fijnstof in Nederland: landbouw, wegverkeer en industrie. Deze bronnen hebben invloed op de luchtkwaliteit. Ook verschilt per bron de samenstelling van fijnstof, en daarmee de schadelijkheid. Fijnstof van de veehouderij draagt bij aan zowel de kans op besmetting als de ernst van de ziekte. Fijnstof van wegverkeer lijkt meer invloed te hebben op de ernst van de ziekte en minder op de kans om met het virus besmet te raken. Fijnstof van industrie lijkt niet bij te dragen. De resultaten van het onderzoek ondersteunen het beleid van de Nederlandse overheid om de luchtkwaliteit te verbeteren. Het RIVM heeft dit onderzoek gedaan met de Universiteit Utrecht, Wageningen, Air pollution is harmful to health. RIVM has examined whether exposure to air pollution from particulate matter and nitrogen dioxide increases the risks of getting infected with SARS-CoV-2 and falling severely ill. Severe illness was defined as a person requiring hospitalisation or dying as a result of COVID-19. This study found that people who were exposed to high concentrations of air pollution had an increased risk of getting infected with SARS-CoV-2. This exposure also increased the risk of hospital admission or death due to COVID-19. These effects were observed shortly (within one to two weeks) after exposure to elevated concentrations of air pollution. This was also the case for people who had been living for years in locations with elevated concentrations of air pollution. These results confirm the findings of previous international studies. It was also found that, among people under long-term exposure to air pollution, the risk of getting infected with SARS-CoV-2 was not different from that of developing other respiratory diseases, such as those causing symptoms similar to those of SARS-CoV-2 infection. It was already known that exposure to air pollution increases the risk of developing respiratory diseases in general. This study also looked at three major sources of particulate matter emissions in the Netherlands: agriculture, road traffic and industry. These sources have an impact on air quality. In addition, the composition of particle matter emissions and therefore their harmfulness differ per source. Exposure to particular matter emissions from agriculture increases both the risk of getting infected and the severity of the illness. It was found that particular matter emissions from road traffic have a larger effect on the severity of COVID-19 but less of an effect on the risk of getting infected with SARS-CoV-2. Particular matter emissions from industry did not appear to contribute significantly to either. The results of this study support the policy of

RIVM rapport:In 2022 zijn in Nederland in totaal 7,6 procent minder broeikasgassen naar de lucht uitgestoten dan in 2021. Deze daling komt vooral doordat industrie, huishoudens en landbouw minder aardgas hebben verbruikt vanwege de hogere aardgasprijzen. In 2022 steeg ook het aandeel ‘onuitputtelijke’ energiebronnen, zoals zonne- en windenergie. In totaal is dit 15 procent van het energieverbruik in Nederland. In 2021 was dit 13 procent. De totale hoeveelheid uitgestoten broeikasgassen wordt uitgedrukt in CO2(carbon dioxide)-equivalenten en bedroeg in 2022 158,4 miljard kilogram. De uitstoot wordt vergeleken met het basisjaar 1990. Ten opzichte van het basisjaar is de uitstoot gedaald met 30,5 procent. In 1990 was de uitstoot 228,1 miljard kilogram CO2-equivalenten. Hiermee is het zogeheten Urgenda-doel (een minimale afname van 25 procent ten opzichte van 1990) ruim gehaald. De uitstoot van het broeikasgas CO2 is 21,6 procent lager dan die in het basisjaar. De uitstoot van de andere broeikasgassen (methaan, distikstofoxide en gefluoreerde gassen) is sinds 1990 met 55,8 procent gedaald. Dit blijkt uit de definitieve inventarisatie van broeikasgasemissies in 2022 die het RIVM elk jaar op verzoek van het ministerie van Economische Zaken en Klimaat (EZK(Economische Zaken en Klimaat)) maakt. Hiermee voldoet Nederland aan de nationale rapportageverplichtingen voor 2024 van het Klimaatverdrag van de Verenigde Naties (UNFCCC), van het Akkoord van Parijs en van het Bewakingsmechanisme Broeikasgassen van de Europese Unie. De voorlopige emissiecijfers over 2022 zijn in het najaar van 2023 gepubliceerd. In de inventarisatie staan ook analyses van ontwikkelingen in de uitstoot van broeikasgassen tussen 1990 en 2022. Ook bevat het een analyse van de belangrijkste bronnen die broeikasgassen uitstoten (‘sleutelbronnen’), net als de onzekerheid in de berekening van deze uitstoot. Daarnaast zijn de gebruikte berekeningsmethoden en databronnen beschreven. Ten slotte bevat het een overzicht van het, Total greenhouse gas (GHG) emissions in the Netherlands decreased by 7.6 per cent in 2022, compared to the 2021 emissions. This decrease was mainly the result of lower natural gas consumption by industry, households, and agriculture due to higher natural gas prices. In 2022, the share of renewable energy was 15 per cent of total final energy consumption. In 2021, this share was 13 per cent. In 2022, total GHG emissions (including indirect CO2 emissions and including emissions from the Land use, land use change and forestry sector (LULUCF)) in the Netherlands amounted to 158.4 Tg CO2-eq. This is approximately 30.5 per cent below the emissions in the base year 1990 (228.1 Tg CO2-eq). Thanks to this emission reduction, the Netherlands met the Urgenda target (by which national GHG emissions must be reduced by at least 25 per cent relative to 1990). CO2 emissions in 2022 were 21.6 per cent below the level in the base year. The total of the emissions of methane, nitrous oxide and fluorinated gases (CH4, N2O and F-gases) was reduced by 55.8 per cent over this period. This report documents the Netherlands’ annual submission for 2024 of its GHG emissions inventory 1990-2022 in accordance with the 2006 IPCC Guidelines for National Greenhouse Gas Inventories (IPCC, 2006) prescribed by the United Nations Framework Convention on Climate Change (UNFCCC) and the Paris Agreement (PA). The report contributes to fulfilling the reporting requirements under the Governance Regulation of the Energy Union (EU 2018/1999) and implementing regulations. This report includes explanations of observed trends in emissions, an assessment of the sources with the highest contribution to total national emissions (key sources) and a description of the uncertainty in the emissions estimates. Estimation methods, data sources and emission factors (EFs) are described for each source category, and there is also a description of the quality assurance system and the verification activities performed on the d

RIVM rapport:Nederland rapporteert elk jaar nationaal en internationaal hoeveel stoffen de landbouw uitstoot naar de lucht. Het gaat om alle stoffen die in de Emissieregistratie voorkomen en voor deze sector moeten worden gerapporteerd. Denk aan broeikasgassen en stoffen die luchtverontreiniging veroorzaken, zoals ammoniak en fijnstof. De emissieberekeningen worden uitgevoerd op basis van internationale richtlijnen. De uitstoot wordt berekend met het National Emission Model for Agriculture (NEMA), dat in Nederland is ontwikkeld. Het NEMA berekent de uitstoot van stoffen voor bijvoorbeeld stallen, mestopslag, en het gebruik van mest. Het NEMA wordt ook gebruikt om emissies zoals methaan uit verschillende dieren en mest te berekenen. Dit model wordt elk jaar aangepast aan de nieuwste wetenschappelijke inzichten. De methoden die voor verschillende stoffen worden gebruikt zijn beschreven, plus de wijzigingen die in het model zijn doorgevoerd. De gegevens over de uitstoot zijn openbaar via de website emissieregistratie.nl. Ze worden gebruikt voor rapportages die vanwege internationale verdragen verplicht zijn, zoals het verdrag van Parijs, de Europese Emissieplafonds (NEC-Directive) en de Convention on Long-range Transboundary Air Pollution (CLRTAP). Dit rapport is ook de basis voor de reviewers die de Nederlandse rapportages aan de Europese Unie en Verenigde Naties valideren., Every year, the Netherlands reports, both nationally and internationally, the quantities of substances that are emitted into the air by its agricultural sector. This entails all the substances originating from agricultural activities that are listed in the Pollutant Release and Transfer Register, e.g. greenhouse gases and substances that cause air pollution, such as ammonia and fine particles. The methods used to calculate the emissions are in accordance with international guidelines. The emissions are calculated using the National Emission Model for Agriculture (NEMA), which is developed in the Netherlands. For example, the NEMA is used to calculate the emissions from stables, manure storages and the application of manure. It is also used to calculate emissions, such as methane, from various animals and manure. The model is updated annually to reflect the latest scientific insights. This time around, the methods used for different substances as well as the implemented adjustments have been described. The emission data is available to the public via the website emissieregistratie.nl. It is used for reports that are mandatory under international treaties such as the Paris Agreement, the EU Emission Ceilings (NEC Directive) and the Convention on Long-range Transboundary Air Pollution (CLRTAP). This report also forms the basis for the reviewers who validate the Dutch reports to the European Union and the United Nations.

RIVM rapport:Deze Informative Inventory Report rapportage (IIR) beschrijft de uitstoot van luchtverontreinigende stoffen in 2022 ten opzichte van 2021. Verder geeft het aan in hoeverre Nederland de Europese verplichtingen heeft gehaald om de uitstoot te laten dalen ten opzichte van 2005, het zogeheten basisjaar. Uit deze inventarisatie blijkt dat in 2022, net als in 2020 en 2021, alle doelen (EU NEC-Directive) zijn gehaald. In 2022 is 121,2 kiloton ammoniak uitgestoten, 2,3 kiloton minder dan in 2021. Daarmee is de uitstoot 22 procent minder dan in het basisjaar (het NEC-doel is 13 procent minder). Dit komt vooral doordat er in de landbouw minder dieren (rund- en pluimvee en varkens) zijn gehouden en het voer van melkvee minder eiwit bevatte. De uitstoot van fijnstof PM2.5 is verder gedaald tot 14,3 kiloton in 2022, een daling van 50 procent ten opzichte van het basisjaar (het NEC-doel is 37 procent minder). De uitstoot van stikstofoxiden is in 2022 met 11,0 kiloton afgenomen en is 59 procent minder dan in het basisjaar (het NEC-doel is 45 procent minder). De daling komt doordat auto’s steeds schoner worden. Wel zijn door vliegverkeer meer stikstofoxiden uitgestoten, 1,2 kiloton dan in 2021. Personenauto’s reden 5 procent meer kilometers dan in 2021, wat nog steeds 6 procent minder is dan voor de coronapandemie. De uitstoot van zwaveloxiden is in 2022 1,3 kiloton lager dan in 2021. Dat komt vooral omdat de industrie er minder van uitstoot. Raffinaderijen hebben wel meer procesgassen gestookt waardoor zij meer zwaveloxiden uitstootten. Ten opzichte van het basisjaar is de uitstoot ervan met 71 procent gedaald (het NEC-doel is 28 procent minder). De uitstoot van vluchtige organische stoffen is in 2022 met 2,4 kiloton gedaald ten opzichte van 2021. Deze uitstoot is in alle sectoren gedaald, met uitzondering van de sector Handel, Diensten en Overheid. Ten opzichte van het basisjaar is de uitstoot met 24 procent gedaald (het NEC-doel is 8 procent minder). De Nederlandse overheid gebr, Compared to 2021 the emissions of ammonia decreased in 2022 by 2.3 Gg to a total of 121.2 Gg. This is mainly the result of a lower protein content in roughages of cattle, a lower animal numbers for swine and poultry (-1.2% and -1.3% respectively), an increase in non dairy cattle numbers (1.6%) and less use of inorganic fertilisers. With a reduction of 22% compared to 2005 the ammonia emissions comply with the reduction target of 13% as set by the EU National Emission Ceilings Directive (NECD) and the Gothenburg Protocol under the Convention of Long-range Transboundary Air Pollution (CLRTAP). Compared to 2021 the emissions of non-methane volatile organic compounds decreased by 2.4 Gg. All sectors contribute to this decrease. With a reduction of 10% in 2022 under the NECD the emission reduction is in compliance with the reduction target of 8% as set by the European Union (EU). However, unlike for the EU-inventory, under the Gothenburg Protocol the emissions of non-methane volatile organic compounds from manure management and agricultural soils are included in the inventory. This leads to a higher emission total with the result that the 8% reduction target under the Gothenburg Protocol is not met in 2020. Despite a 5% increase in total passenger car mileage in 2022 (passenger car mileage is still 6% lower than before de Covid19 pandemic), total nitrogen oxides emissions decreased by 11 Gg mainly as result of increasingly cleaner road traffic vehicles. However, Aviation emissions from Landing and Take Off (LTO) increased with 1.2 Gg. Under both the NECD and the Gothenburg Protocol a reduction target of 45% compared to 2005 was set. With a reduction of respectively 59% and 55% compared to 2005 the nitrogen oxide emissions comply with the reduction targets. The emissions sulphur oxides decreased with 1.3 Gg compared to 2021, mainly in the sector Industry. Under both the NECD and the Gothenburg Protocol a reduction target was set of 28% compared to 2005. With a reduction o

Rubinstein-Taybi syndrome (RTS) is an archetypical genetic syndrome that is characterised by intellectual disability, well-defined facial features, distal limb anomalies and atypical growth, among numerous other signs and symptoms. It is caused by variants in either of two genes (CREBBP, EP300) which encode for the proteins CBP and p300, which both have a function in transcription regulation and histone acetylation. As a group of international experts and national support groups dedicated to the syndrome, we realised that marked heterogeneity currently exists in clinical and molecular diagnostic approaches and care practices in various parts of the world. Here, we outline a series of recommendations that document the consensus of a group of international experts on clinical diagnostic criteria for types of RTS (RTS1: CREBBP; RTS2: EP300), molecular investigations, long-term management of various particular physical and behavioural issues and care planning. The recommendations as presented here will need to be evaluated for improvements to allow for continued optimisation of diagnostics and care.

In 2017, an experiment was set up at two locations along the dike of the Amsterdam-Rhine Canal. The aim of the trial was to investigate whether grasslands along the Amsterdam-Rhine Canal can be made more flowery and thereby continue to guarantee or even improve water safety (erosion resistance). To make the grassland more flowery, an existing dike vegetation has been sown with herbs. The effect of carefully removing the clippings was also investigated by having part of the route managed by another contractor. Developments were monitored over the next six years., In 2017 is een experiment ingericht op twee locaties langs de dijk van het Amsterdam-Rijnkanaal. Doel van de proef was om te onderzoeken of graslanden langs het Amsterdam-Rijnkanaal bloemrijker te maken zijn en daarbij de waterveiligheid (erosiebestendigheid) te blijven waarborgen of zelfs te verbeteren. Om het grasland bloemrijker te maken, is een bestaande dijkvegetatie doorgezaaid met kruiden. Tevens is het effect van het zorgvuldig afvoeren van het maaisel onderzocht door een deel van het traject door een andere aannemer te laten beheren. Gedurende de daaropvolgende zes jaar zijn de ontwikkelingen gevolgd.

Study region: Bakhtegan Lake, southern Iran, is a “Wetland of International Importance” (Ramsar Site). Study focus: This study focuses on analyzing the time series of the lake's inundation area, identifying factors contributing to its shrinkage, and studying its hydrochemical characteristics. To map the inundation area, Landsat images from 1972 to 2019 were used and 64 water samples were collected from the lake during 2017–2019 for geochemical modeling. New hydrological insights for the region: The study reveals that the Bakhtegan Lake has become a seasonal lake with a long-term dry state since 2007. The lake's inundation area shows a significant correlation with the Kor River discharge, and the main reason for the lake's shrinkage is a decrease in river inflow due to over-exploitation in the basin and construction of two new dams since 2007. The lake water and brine below the lake bed have TDS concentrations varying between 70000 and 451000 mg/L and 118000–373000 mg/L, respectively. The Gibbs, Na-normalized ratio end-member diagrams show that the lake water chemistry is mainly controlled by evaporation. The saturation index indicates that brine samples were in an equilibrium state with gypsum, halite, and glauberite. The Spencer diagram and evolutionary pathway model suggest that water samples shifted toward natural sulfate-rich minerals during evaporation. The lake water evolution model predicts precipitation of halite, kieserite, and carnallite minerals during progressive evaporation.

INTRODUCTION: Data concerning the global burden of Hidradenitis Suppurativa (HS) are limited. Reported prevalence estimates vary between 0.0003% and 4.1%, and data from various geographical regions are still to be collected. Previously reported prevalence rates have been limited by the methodological approach and source of data. This has resulted in great heterogeneity as prevalence data from physician-diagnosed cases poorly match those of self-reported apparent HS disease.METHODS: The Global Hidradenitis Suppurativa Atlas (GHiSA) introduces an innovative approach to determine the global prevalence of HS. This approach involves using a previously validated questionnaire to screen apparently healthy adults accompanying a patient to a non-dermatological outpatient clinic visit in a hospital. The screening questionnaire (i.e., the index test) is combined with a subsequent physician-based in-person validation (i.e., the reference standard) of the participants who screen positive. Ten percent of the screen-negative participants are also clinically assessed to verify the diagnostic precision of the test. The local prevalence (pi) will be estimated from each country that submits the number of patients who are HS positive according to the index test and clinical examination (n), and the corresponding total number of observations (N).CONCLUSION: The GHiSA Global Prevalence studies are currently running simultaneously in 58 countries across six continents (Africa, Europe, Australia, North America, South America, and Asia). The goal of the combined global proportion is the generation of a single summary (i.e., proportional meta-analysis), which will be done after a logit transformation, and synthesized using a random-effects model. The novel standardization of the Global Prevalence studies conducted through GHiSA enables direct international comparisons, which were previously not possible due to substantial heterogeneity in past HS prevalence studies.

Daily problems of children with Cerebral Visual Impairment (CVI) are often misinterpreted as symptoms of behavioural disorders or learning disabilities instead of higher order visual function (HOVF) deficits. It is difficult to differentiate between various paediatric clinical groups based on daily manifestations. We used two CVI inventories (V-CVI-I, HVFQI) and an ADHD questionnaire (AVL) to compare parent-reported visual and behavioural problems of children with CVI, ADHD, dyslexia and neurotypical children (Age 6–15, Verbal Intelligence > 70). Our results show a higher percentage of parent-reported visual problems in children with CVI compared to all other groups, which was not affected by their visual acuity levels. On most HOVF categories, a higher percentage of parent-reported visual problems was also found in children with ADHD or dyslexia compared to neurotypical children. Children with ADHD had significantly more parent-reported behavioural problems, but more behavioural problems were reported by the parents of children with CVI compared to neurotypical children as well. Our findings complicate using the existing inventories for initial screening and referral of children with potential CVI. We propose a shortened screening list to improve the potential differentiation between CVI and ADHD or dyslexia based on parent-reported visual problems in everyday life.

Background: The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. Aims: Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU). Study Design: We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented. Results: Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage. Conclusions: While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment. Relevance to Clinical Practice: The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context al