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Purpose: Automated glioblastoma segmentation from magnetic resonance imaging is generally performed on a four-modality input, including T1, contrast T1, T2 and FLAIR. We hypothesize that information redundancy is present within these image combinations, which can possibly reduce a model’s performance. Moreover, for clinical applications, the risk of encountering missing data rises as the number of required input modalities increases. Therefore, this study aimed to explore the relevance and influence of the different modalities used for MRI-based glioblastoma segmentation. Methods: After the training of multiple segmentation models based on nnU-Net and SwinUNETR architectures, differing only in their amount and combinations of input modalities, each model was evaluated with regard to segmentation accuracy and epistemic uncertainty. Results: Results show that T1CE-based segmentation (for enhanced tumor and tumor core) and T1CE-FLAIR-based segmentation (for whole tumor and overall segmentation) can reach segmentation accuracies comparable to the full-input version. Notably, the highest segmentation accuracy for nnU-Net was found for a three-input configuration of T1CE-FLAIR-T1, suggesting the confounding effect of redundant input modalities. The SwinUNETR architecture appears to suffer less from this, where said three-input and the full-input model yielded statistically equal results. Conclusion: The T1CE-FLAIR-based model can therefore be considered as a minimal-input alternative to the full-input configuration. Addition of modalities beyond this does not statistically improve and can even deteriorate accuracy, but does lower the segmentation uncertainty.

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ABSTRACTDespite the low prevalence of each rare disease, the total burden is high. Patients with rare diseases encounter numerous barriers, including delayed diagnosis and limited access to high-quality treatments. In order to tackle these challenges, the European Commission launched the European Reference Networks (ERNs), cross-border networks of healthcare providers and patients representatives. In parallel, the aims and structure of these ERNs were translated at the federal and regional levels, resulting in the creation of the Flemish Network of Rare Diseases. In line with the mission of the ERNs and to ensure equal access to care, we describe as first patient pathways for systemic sclerosis (SSc), as a pilot model for other rare connective and musculoskeletal diseases. Consensus was reached on following key messages: 1. Patients with SSc should have multidisciplinary clinical and investigational evaluations in a tertiary reference expert centre at baseline, and subsequently every three to 5 years. Intermediately, a yearly clinical evaluation should be provided in the reference centre, whilst SSc technical evaluations are permissionably executed in a centre that follows SSc-specific clinical practice guidelines. In between, monitoring can take place in secondary care units, under the condition that qualitative examinations and care including interactive multidisciplinary consultations can be provided. 2. Patients with early diffuse cutaneous SSc, (progressive) interstitial lung disease and/or pulmonary arterial hypertension should undergo regular evaluations in specialised tertiary care reference institutions. 3. Monitoring of patients with progressive interstitial lung disease and/or pulmonary (arterial) hypertension will be done in agreement with experts of ERN LUNG.

ObjectiveDevelop a consensus on the content and form of safety netting advice (SNA) for parents of acutely ill children.DesignFour-round modified e-Delphi using online questionnaires and feedback among clinical and research experts.SettingAmbulatory care in high-income countries.ParticipantsForty-one experts from 13 countries: 3 emergency physicians, 15 general practitioners, 4 nurses and 19 paediatricians.ResultsThe experts defined the content of SNA as advice on the normal, expected disease course of the provisional diagnosis, diagnostic uncertainty, alarm signs that indicate the need for medical help and information on where and how to find such help. Regarding the form of the SNA, the experts agree that a reliable source should give SNA verbally with paper or digital written or video/image resources at every appropriate healthcare encounter in a short and simple empowering fashion, specific to the child’s situation and seek confirmatory feedback from parents.ConclusionsSNA needs to contain advice on the expected disease course, alarm signs and where and how to find help. It should be given verbally with written resources by a reliable healthcare professional or digital platform. Short, simple and specific, SNA needs to empower the parent whose understanding of the advice should be checked. The effectiveness of SNA resources coproduced by parents and experts should be assessed in different settings and those providing SNA require up-to-date and reliable training.

The VALHUDES protocol was established to evaluate clinical accuracy of human papillomavirus (HPV) assays to detect cervical precancer on first-void urine (FVU) and vaginal self-samples versus matched clinician-collected cervical samples (CCSs). Here we evaluated clinical performance of Alinity m HR HPV assay in a colposcopy referral population. Home-collected FVU (Colli-Pee FV 5020) 1 day before colposcopy (n= 492), at-clinic collected dry vaginal self-samples [multi-Collect Swab (mC; n= 493), followed by Evalyn Brush (EB; n= 233) or Qvintip (QT; n= 260)] and matched CCSs, were available for the study. Sensitivity to detect cervical intraepithelial neoplasia grade 2 or higher (CIN2+) of Alinity testing on FVU (ratio, 0.94; 95% CI, 0.85–1.03), mC (ratio, 1.00; 95% CI, 0.94–1.06), and EB/QT (ratio, 0.92; 95% CI, 0.85–1.00) was not different to CCSs. Specificity on FVU was similar to CCS (ratio, 1.02; 95% CI, 0.95–1.10), whereas specificity on mC was lower (ratio, 0.83; 95% CI, 0.76–0.90), but on EB/QT was higher (ratio, 1.08; 95% CI, 1.01–1.15) than on CCS. Accuracy on EB (sensitivity ratio, 0.96; 95% CI, 0.87–1.05; specificity ratio, 1.18; 95% CI, 1.06–1.31) was slightly better than on QT (sensitivity ratio, 0.88; 95% CI, 0.75–1.03; specificity ratio, 1.00; 95% CI, 0.92–1.09). In conclusion, clinical sensitivity of Alinity assay on all self-sample types was similar to cervical specimens. Adjustment of signal thresholds improved assay's accuracy to detect CIN2+in all self-sample types.

Human germline gene correction by targeted nucleases holds great promise for reducing mutation transmission. However, recent studies have reported concerning observations in CRISPR-Cas9-targeted human embryos, including mosaicism and loss of heterozygosity (LOH). The latter has been associated with either gene conversion or (partial) chromosome loss events. In this study, we aimed to correct a heterozygous basepair substitution in PLCZ1, related to infertility. In 36% of the targeted embryos that originated from mutant sperm, only wild-type alleles were observed. By performing genome-wide double-digest restriction site-associated DNA sequencing, integrity of the targeted chromosome (i.e., no deletions larger than 3 Mb or chromosome loss) was confirmed in all seven targeted GENType-analyzed embryos (mutant editing and absence of mutation), while short-range LOH events (shorter than 10 Mb) were clearly observed by single-nucleotide polymorphism assessment in two of these embryos. These results fuel the currently ongoing discussion on double-strand break repair in early human embryos, making a case for the occurrence of gene conversion events or partial template-based homology-directed repair.

ABSTRACT Hybrid composite-concrete elements are increasingly developed because of their lightweight and durable properties. This paper investigates the structural behaviour of a new hybrid composite concrete floor--based on the beam-and-block [...]

AbstractAimsThe aim of this study was to provide an up-to-date overview of gender differences or similarities in risk factor control and medical management in the Belgian CHD population.MethodsAll analyses are based on the ESC EORP EUROASPIRE IV and EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) surveys. Patients between 18 and 80 years old, hospitalised for a first or recurrent coronary event, were included in the survey.ResultsData were available for 10,519 patients, of which 23.9% were women. Women had a worse risk factor profile compared to men. Women were more physical inactive (OR = 1.31, 95% CI = 1.19–1.44), had a higher prevalence of obesity (OR = 1.37, 95% CI = 1.25–1.50) and had a worse LDL-C control (OR = 1.52, 95% CI = 1.36–1.70). Moreover, women were less likely to use ACE-I/ARBs (OR = 0.84, 95% CI = 0.76–0.94) and statins (OR = 0.79, 95% CI = 0.70–0.90). In addition, little gender differences were found in patients’ risk factor awareness, except on cholesterol awareness. Women were more aware about their total cholesterol levels (OR = 1.37, 95% CI = 1.21–1.56).ConclusionDespite little to no gender differences in the management of CHD patients, women still have a worse risk factor profile, both in Belgian and in other European high-income countries.

The article focuses on the transformation of Nieuwstraat in Brussels from a mono-functional street to a vibrant urban center by BUUR Part of Sweco, emphasizing the revival of the neighborhood by integrating housing and community spaces alongside commercial areas. It highlights the master plan's design principles that create a network of connections, squares, and streets, facilitating a shift from a shopping corridor to a diverse urban space, enhancing the neighborhood's overall quality.

The article focuses on Geurst & Schulze's collaboration with JAVA Architecten/s for the GRAB Schaarbeek project, revitalizing the former Optima factory into an educational and sports site. Topics include the architectural transformation of the site, the integration of schools and sports facilities, and the design's harmonious coexistence with the surrounding urban context.

ABSTRACT Context: Current formwork research aims towards new cost-competitive formwork systems and materials that focus on labour reduction and efficient material use. This labour cost is reduced when using Stay-in-Place [...]

ABSTRACTBackground/AimTo provide longitudinal data on the evolution of lipid levels and the intake of lipid-lowering therapies in patients with stable coronary artery disease.MethodsSingle-centre retrospective study with inclusion of 350 patients with a first coronary artery event in 2014 or earlier and outpatient cardiac clinic follow-up in 2015 and 2019. Lipid levels were collected within a time frame of 3 months of their visits.This retrospective study protocol (2020.086) was approved by the ethical committee and by the Data Privacy Officer of AZ Maria Middelares Ghent. For this type of study, formal consent is not required, following local law and regulations.ResultsAverage LDL levels were 82 (±26) mg/dl in 2015 and 70 (±24) mg/dl in 2019 (p < 0.001). Most patients included were already on statin treatment before inclusion in the trial (94%), with a significant increase in high-intensity statin use (45% vs. 58%) after a 5-year follow-up. At the same time, we observed a significant increase in ezetimibe use (in combination with statin therapy or in monotherapy) (8% vs. 22%) during follow-up. LDL ≤70 mg/dl was 34% in 2015 and 53% in 2019. LDL ≤55 mg/dl was 13% in 2015 and 28% in 2019.ConclusionThis study shows significant intensification of lipid-lowering therapy use during follow-up, and a significant lipid level lowering after 5-year follow-up, in an outpatient cardiac clinic follow-up. Further improvement in lipid control is still desirable, especially after the European Society of Cardiology recommend stricter lipid levels in the 2021 Prevention Guidelines.

AbstractObjectiveAutonomic disorders are common in chronic illness, and their symptoms may restrict the daily functioning of patients. However, in chronic heart failure, extensive knowledge about autonomic symptoms is still lacking. This study aims to explore self-perceived autonomic symptoms, associated factors, and their relationship with health-related quality of life in chronic heart failure.MethodsOne hundred and twenty-four patients with documented chronic heart failure (men and women; 50–86 years) and 124 sex and age-matched controls participated in this study. The participants filled validated questionnaires about autonomic symptom profile (COMPASS 31), fatigue (CIS, Checklist for individual strength), anxiety and depression (HADS, Hospital Anxiety and Depression), and health-related quality of life (SF36). Non-parametric statistics were performed to analyse the data.ResultsTotal score for autonomic symptoms was higher in chronic heart failure compared to controls [Median: 14.9; IQR: 6.2–25.1 vs.7.3; 0–18; p < 0.001], especially for orthostatic hypotension [Median: 8; IQR: 0–16 vs.0; 0–12; p < 0.001], vasomotor [Median: 0; IQR: 0–0 vs.0; 0–0; p < 0.001] and secretomotor function [Median: 0; IQR: 0–4.2 vs.0; 0–2.1; p = 0.013]. High scores for autonomic symptoms were moderate correlated with higher scores of fatigue, anxiety and depression (0.343 ≤ rs ≥ 0.420; p < 0.001) and with decreased health-related quality of life (−0.454; p < 0.01).ConclusionAutonomic symptoms, especially for orthostatic intolerance, vasomotor and secretomotor subdomains, are prevalent and are associated with fatigue complaints and poor health-related quality of life in CHF.

Physiologically based pharmacokinetic (PBPK) models consist of compartments representing different tissues. As most models are only verified based on plasma concentrations, it is unclear how reliable associated tissue profiles are. This study aimed to assess the accuracy of PBPK-predicted beta-lactam antibiotic concentrations in different tissues and assess the impact of using effect site concentrations for evaluation of target attainment. Adipose, bone, and muscle concentrations of five beta-lactams (piperacillin, cefazolin, cefuroxime, ceftazidime, and meropenem) in healthy adults were collected from literature and compared with PBPK predictions. Model performance was evaluated with average fold errors (AFEs) and absolute AFEs (AAFEs) between predicted and observed concentrations. In total, 26 studies were included, 14 of which reported total tissue concentrations and 12 unbound interstitial fluid (uISF) concentrations. Concurrent plasma concentrations, used as baseline verification of the models, were fairly accurate (AFE: 1.14, AAFE: 1.50). Predicted total tissue concentrations were less accurate (AFE: 0.68, AAFE: 1.89). A slight trend for underprediction was observed but none of the studies had AFE or AAFE values outside threefold. Similarly, predictions of microdialysis-derived uISF concentrations were less accurate than plasma concentration predictions (AFE: 1.52, AAFE: 2.32). uISF concentrations tended to be overpredicted and two studies had AFEs and AAFEs outside threefold. Pharmacodynamic simulations in our case showed only a limited impact of using uISF concentrations instead of unbound plasma concentrations on target attainment rates. The results of this study illustrate the limitations of current PBPK models to predict tissue concentrations and the associated need for more accurate models.SIGNIFICANCE STATEMENTClinical inaccessibility of local effect site concentrations precipitates a need for predictive methods for the estimation of tissue concentrations. This is the first study in which the accuracy of PBPK-predicted tissue concentrations of beta-lactam antibiotics in humans were assessed. Predicted tissue concentrations were found to be less accurate than concurrent predicted plasma concentrations. When using PBPK models to predict tissue concentrations, this potential relative loss of accuracy should be acknowledged when clinical tissue concentrations are unavailable to verify predictions.

AbstractBackgroundStroke is a major concern in transcatheter aortic valve replacement (TAVR). The introduction of a cerebral protection devices may counteract the evolution towards minimally invasive TAVR. At this time, there is insufficient data to support the routine use of these devices.MethodsWe aimed to evaluate the outcome of the routine use of the Sentinel Cerebral protection system®(CPS) in patients undergoing TAVR, after completing a CT-based screening process for feasibility of Sentinel implantation. We report our initial experience with the routine implementation of the Sentinel CPS in all anatomically suitable patients undergoing TAVR. We retrospectively compared the procedural characteristics and outcomes between all TAVR patients treated with (n = 78) and without (n = 79) intended Sentinel.ResultsThe Sentinel CPS could successfully be deployed in 99% of intended cases after CT feasibility screening. TAVR procedures with Sentinel CPS were not longer than procedures without Sentinel use (89 ± 20 versus 120 ± 50 min, p = 0.007). Sentinel CPS use was not associated with an increased risk of procedural complications. Stroke was observed in none (0%) of the Sentinel CPS patients, and in 6.3% of the non-Sentinel CPS patients (p = 0.05). The finding of stroke was associated with a high risk of early postprocedural mortality: 60% of stroke patients died within 3 months.ConclusionRoutine use of the Sentinel CPS in CT-screened TAVR patients is feasible with high procedural success, without significant adverse events and without counteracting the evolution towards minimally invasive TAVR. Clinically relevant stroke was observed in none of the Sentinel CPS patients.

ABSTRACTBackground and aimThe rise in long-term antidepressant use is concerning. Long-term antidepressant (AD) use, much longer than recommended by guidelines, can result in risk of adverse events and generate unnecessary costs. In order to mitigate these risks, patients views about their antidepressants and how to discontinue need to be taken into account. We aimed to explore patients’ experiences and views of discontinuing long-term AD, barriers and facilitators of discontinuation and required support.MethodsSemi-structured face to face interviews were conducted with 14 patients with long-term AD use in primary care. Interviews were analysed thematically.ResultsParticipants describe various perceptions about discontinuation. There is fear of returning to their depression, even in those who were ambivalent about the effectiveness and safety of AD continuation. Participants describe low confidence in their own coping resources, fear of stress, and previous negative experiences with stopping. This enhances their perception of AD dependence. Participants indicate the importance of the support of their GP and their social network to help them withdraw.ConclusionDiscontinuation of long-term antidepressants is a complex issue for patients. More awareness of the lack of evidence and the potential risks of long-term AD continuation is required. By raising the issue and offering support during discontinuation GPs can help their patients stop AD. A greater focus on non-pharmacological approaches of depression in primary care is needed to reduce unnecessary AD use.

* OBJECTIVE To compare the efficacy of amoxicillin vs placebo in patients with an acute upper respiratory tract infection and purulent rhinorrhea. * STUDY DESIGN Double-blind randomized placebo-controlled trial. * [...]

In vitro fertilization (IVF) results in a higher risk of premature birth and infant mortality even in single-fetus pregnancies and even after adjusting for other factors. This was the conclusion of a study that compared IVF pregnancies with spontaneously conceived pregnancies.

AbstractCombining myocardial perfusion single photon emission computed tomography (SPECT-MPI) and coronary computed tomography angiography (CCTA) is an interesting hybrid imaging option in modern cardiovascular medicine. The integrated hybrid technique has a number of advantages compared to visual side-by-side analysis of the separate modalities. CT attenuation map can correct for attenuation artefacts and thus improve the diagnostic accuracy of SPECT-MPI. Moreover, the anatomical information of the CCTA and the perfusion map of SPECT-MPI allow for vessel-based correlation and culprit vessel identification. Combining SPECT-MPI with CCTA is an appealing tool in the work-up of complex ischaemic heart disease and might help determine the optimal treatment strategy. This case series illustrates the role of SPECT-CCTA in decision-making of revascularization strategy in complex ischaemic heart disease.

ObjectiveTo determine the rate and appropriateness of antibiotic prescribing for acutely ill children in ambulatory care in high-income countries.DesignOn 10 February 2021, we systematically searched articles published since 2000 in MEDLINE, Embase, CENTRAL, Web Of Science and grey literature databases. We included cross-sectional and longitudinal studies, time-series analyses, randomised controlled trials and non-randomised studies of interventions with acutely ill children up to and including 12 years of age in ambulatory care settings in high-income countries. Pooled antibiotic prescribing and appropriateness rates were calculated using random-effects models. Meta-regression was performed to describe the relationship between the antibiotic prescribing rate and study-level covariates.ResultsWe included 86 studies comprising 11 114 863 children. We found a pooled antibiotic prescribing rate of 45.4% (95% CI 38.2% to 52.8%) for all acutely ill children, and 85.6% (95% CI 73.3% to 92.9%) for acute otitis media, 37.4% (95% CI 30.9% to 44.3%) for respiratory tract infections, and 40.4% (95% CI 29.9% to 51.9%) for other diagnoses. Considerable heterogeneity can only partly be explained by differences in diagnoses. The overall pooled appropriateness rate is 68.5% (95% CI 55.8% to 78.9%, I²=99.8%; 19 studies, 119 995 participants). 38.3% of all prescribed antibiotics were aminopenicillins.ConclusionsAntibiotic prescribing rates for acutely ill children in ambulatory care in high-income countries remain high. Large differences in prescription rates between studies can only partly be explained by differences in diagnoses. Better registration and further research are needed to investigate patient-level data on diagnosis and appropriateness.

It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies.

AbstractBackgroundThe COVID-19 pandemic has forced many cardiac rehabilitation centres to focus more on the remote delivery of cardiac rehabilitation (CR) components. This increased focus and the lessons learned from this period could enhance the implementation of telerehabilitation and increase the participation in CR in Belgium.MethodsWe conducted a survey between April and May 2020 about the implementation of telerehabilitation services during the COVID-19 pandemic. The electronic questionnaire was sent viaemail to the heads of 42 Belgian CR centres. Three reminders viaemail were sent during the study period.Results27 CR centres (64%) returned completed questionnaires after three mailings. 52% of the CR centres provided remote CR services during the lockdown due to the COVID-19 pandemic. All CR centres that provided remote CR services delivered exercise training. The most used medium to deliver the CR components were online videos (71%) followed by online information on the website (64%) and emails (64%).ConclusionIt is interesting that the COVID-19 pandemic has encouraged many CR centres to implement remote delivery of CR components. This can help to speed up the research and implementation of telerehabilitation in daily clinical practice. The COVID-19 pandemic could be the push for a large multicentre implementation study that could prove that telerehabilitation is feasible and effective in the Belgian setting.

Detection of a heartbeat in a fetus is an early indication of a viable pregnancy. Recent advances have improved the ability to detect and measure fetal heartbeats at even sooner. It has been reported that fetal heart rates normally are around 100 beats per minute at five weeks which gradually increases with time. On the other hand, abnormally slow rates have been associated with fetal death. Fetal heart rates were monitored between the fifth and 12th week of pregnancy in 170 pregnancies to establish normal development and to see if abnormally slow heart rates correlated with adverse outcomes of pregnancy. Results showed that 29 of the pregnancies ended in a miscarriage before the 12th week. Heartbeats were detected as early as five weeks three days of pregnancy and were always detected by the first day of the seventh week in normal pregnancies. In all instances where a heartbeat was not detected by six weeks one day, the pregnancy ended in miscarriage. In the normal pregnancies fetal heart rate increased from an average of 82 beats per minute during the fifth week to 156 beats per minute the ninth week. In cases where miscarriage occurred, but a heart rate was detected at some point, the rates never exceeded 100 beats per minute and a gradual decline in heart rate was detected in 10 cases. In fact, a gradual decline in heart rate was always indicative of miscarriage. A single measurement of abnormally low fetal heart rate was not a good predictor of outcome. These results suggest that fetal heart rates in normal pregnancies increase significantly between the fifth and ninth week of pregnancy and are always detectable by the beginning of the seventh week. A single observation of an abnormally slow heart rate does indicate a higher likelihood of adverse outcome, but is not a useful indicator for screening purposes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Protein-protein interactions play an important biological role in every aspect of cellular homeostasis and functioning. Proximity labeling mass spectrometry-based proteomics overcomes challenges typically associated with other methods and has quickly become the current state of the art in the field. Nevertheless, tight control of proximity-labeling enzymatic activity and expression levels is crucial to accurately identify protein interactors. Here, we leverage a T2A self-cleaving peptide and a non-cleaving mutant to accommodate the protein of interest in the experimental and control TurboID setup. To allow easy and streamlined plasmid assembly, we built a Golden Gate modular cloning system to generate plasmids for transient expression and stable integration. To highlight our T2A Split/link design, we applied it to identify protein interactions of the glucocorticoid receptor and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid and non-structural protein 7 (NSP7) proteins by TurboID proximity labeling. Our results demonstrate that our T2A split/link provides an opportune control that builds upon previously established control requirements in the field.

Little is known about rhinitis control in real-life, nor about the contribution of treatment-related and patient-related factors.

AbstractBackgroundFamilial hypercholesterolaemia (FH) is underdiagnosed in most countries. We report our first experience from a national pilot project of cascade screening in relatives of FH patients.MethodologyParticipating specialists recruited consecutive index patients (IP) with Dutch Lipid Clinic Network (DLCN) score ≥6. After informed consent, the relatives were visited by the nurses to collect relevant clinical data and perform blood sampling for lipid profile measurement. FH diagnosis in the relatives was based on the DLCN and/or MEDPED FH (Make-Early-Diagnosis-to-Prevent-Early-Deaths-in-FH) criteria.ResultsIn a period of 18 months, a total of 127 IP (90 with definite FH and 37 with probable FH) were enrolled in 15 centres. Out of the 270 relatives visited by the nurses, 105 were suspected of having FH: 31 with DCLN score >8, 33 with DLCN score 5-8 and 41 with MEDPED FH criteria. In a post-hoc analysis, another set of MEDPED FH criteria established in the Netherlands and adapted to Belgium allowed to detect FH in 51 additional relatives.ConclusionIn a country with no national FH screening program, our pilot project demonstrated that implementing a simple phenotypical FH cascade screening strategy using the collaboration of motivated specialists and two nurses, allowed to diagnose FH in 127 index patients and an additional 105 of their relatives over the two-year period. Newly developed MEDPED FH cut-offs, easily applicable by a nurse with a single blood sample, might further improve the sensitivity of detecting FH within families.

AbstractCardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients’ health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.

ABSTRACTSarcoidosis is a multisystem disease of unclear etiology with a variable clinical profile characterized by the presence of non-caseating granuloma in involved organs. The diagnosis is often challenging and based on clinical, radiological and anatomopathological data. Sarcoidosis can be benign and self-limiting, but some cases may follow a chronic, progressive course and result in severe morbidity. The disease has a predilection for the lungs and thoracic lymph nodes but can involve nearly any part of the body, possible more commonly in areas with contact to the external environment, such as the eyes and the skin. This paper is based on a case in which a recurrent uveitis led to the diagnosis of an underlying sarcoidosis.

ABSTRACTBackground: Teledermatology, the application of telemedicine in the field of dermatology, can be a valuable tool to improve the efficiency of care in general practice.Objectives: In this pilot study, we implemented a teledermatology programme in Belgian context to assess the effect on referral rate and to evaluate the acceptability of teledermatology by clinicians and patients.Material and methods: A store-and-forward teledermatology service between 12 general practitioners (GPs) and 3 academic dermatologists was evaluated for a period of 3–6 months. Clinicians and patients were questioned about satisfaction, benefits and barriers.Results: In total, 54 teledermatologic consultations were performed. The referral rate was reduced. Thirty-one teleconsulations were performed instead of physical referral, of which nine patients were actually referred. In 23 cases, performed for a second opinion, two more patients were referred on the dermatologist’s advice.All clinicians want to continue working with teledermatology. GPs highlighted the educational benefit, whereas dermatologists were interested in the triage effect and reduced referral rate. Patients indicated that teledermatology would encourage them to consult a GP sooner when experiencing dermatologic problems.Conclusion: Teledermatology proved to be a feasible and acceptable tool for both clinicians and patients. It also shows to be a valuable for triage and reducing unnecessary referrals. Considering the emergent pressure on health care in the next decades, teledermatology following GP selection could be useful for the Belgian health care system and deserves further elaboration in the search for effective tools to strengthen first line health care and streamline referral to secondary care.

Discusses techniques for post-pass compaction in computer programming. Post-pass whole-program optimization; Elimination of duplicated code; Construction of an internal program representation. INSETS: Diablo.;AiPop.;Squeeze++.

ABSTRACTIt has been well established that low-density lipoproteins (LDL) and other apolipoprotein B-containing lipoproteins are causally related to atherosclerotic cardiovascular disease (ASCVD) and that lowering these lipoproteins reduces the risk of ASCVD. By lowering LDL particles as much as possible, ASCVD can be prevented. There seems to be no LDL-cholesterol (LDL-C) threshold below which no further ASCVD prevention can be achieved. Furthermore, a low (an even very low) LDL-C appears to be safe. The new ESC/EAS guidelines based on these concepts are a step towards a benefit-based strategy by focusing on the clinical benefit that can be achieved by treating the cause of ASCVD. It is recommended to lower LDL-C as much as possible to prevent ASCVD, especially in high and very high-risk patients. With these new recommendations come recognition of the importance of combination therapies in high and very high-risk patients, first with statins and ezetimibe, and if needed with a PCSK9 inhibitor. The present paper is a review of some new concepts arising during the past 10 years in the field of lipidology and the description of what is new in the 2019 EAS/ESC guidelines.

Antivirals are infrequently prescribed in European primary care for influenza-like illness, mostly because of perceived ineffectiveness in real world primary care and because individuals who will especially benefit have not been identified in independent trials. We aimed to determine whether adding antiviral treatment to usual primary care for patients with influenza-like illness reduces time to recovery overall and in key subgroups.

This paper introduces $\Delta$ΔBreakpad. It extends the Breakpad crash reporting system to handle software diversity effectively and efficiently by replicating and patching the debug information of diversified software versions. Simple adaptations to existing open source compiler tools are presented that on the one hand introduce significant amounts of diversification in the code and stack layout of ARMv7 binaries to mitigate the widespread deployment of code injection and code reuse attacks, while on the other hand still supporting accurate crash reporting. An evaluation on SPEC2006 benchmarks demonstrates that the corresponding computational, storage, and communication overheads are small.

ObjectiveThis study aimed to assess implementation adherence (how well the patient’s actual intake matches the prescribed dosing regimen) to non-vitamin K antagonist oral anticoagulants (NOACs) and to explore experiences with and beliefs about NOACs in a real-world sample of long-term NOAC users.MethodsA cross-sectional observational study was conducted in home-dwelling adults who started taking a NOAC at least 1 year prior to inclusion. Pharmacy dispensing data were used to calculate the Medication Possession Ratio (MPR). Patients were recruited in 158 community pharmacies in Flanders, Belgium. They completed a questionnaire collecting basic characteristics and exploring self-reported adherence to NOACs (using the Medication Adherence Report Scale, MARS) and experiences with and beliefs about NOACs (using the Beliefs about Medicines Questionnaire, BMQ).ResultsA total of 766 patients (mean age 76.2±8.8 years, median CHA2DS2-VASc score 4 (IQR=3–4)) were included. The majority (93.5%) used NOAC for stroke prevention in atrial fibrillation. The median MPR was 95.2% (IQR=87.8–99.7) which corresponds with half of the study population not taking their NOAC on at least 17 cumulative days per year. Almost 21% of participants reported non-adherence on the MARS (score <25), with unintentional non-adherence (forgetfulness) most frequently reported (15.4%). Although two-thirds of NOAC users indicated to experience adverse drug reactions, the BMQ demonstrated a positive attitude towards NOAC therapy, where necessity beliefs outweigh the concerns.ConclusionsOur data indicate that long-term NOAC users have high implementation adherence and a positive attitude towards NOAC therapy. However, taking into account patients’ thromboembolic risk and NOACs’ short half-lives, further optimisation of NOAC use seems warranted in this population.

Existing compiler techniques can transform code to make its timing behavior independent of sensitive values to prevent information leakage through time side channels. Those techniques are hampered, however, by their static nature and dependence on details of the processor targeted during the compilation. This paper presents a dynamic compiler approach based on offline profiles and JIT compiler strategies. This approach reduces overhead significantly and enables a trade-off between provided protection and overhead. Furthermore, it supports adaptive policies in which the protection adapts to run-time changes in the requirements. A prototype implementation in the Jikes Research VM is evaluated on RSA encryption, HMAC key verification, and IDEA encryption.