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Despite their differences, local parties in the Netherlands share a strong degree of localism: they focus more than national parties on specific problems in their municipality. However, less is known about the representatives of local parties in the municipal council. The fact that their parties as well as their voters have different views could mean that council members of local parties fulfil their functions in a different way. This article examines the extent to which this is the case. The data from the Dutch Basic Monitor for Political Office Holders (BPA) was used to answer this question. Council members of local parties appear to be less strongly oriented towards their administrative role and to focus more on their representative activities. Compared to council members of national parties, representatives of local parties are generally more critical of the various aspects of local democracy and of the problem-solving capacity of local government. Their more centre-right position in the political spectrum is also reflected in the left-right positioning of their councillors.

Het gemeentelijke bestuursmodel in Nederland is (net als in het jaar 2000) nog steeds gebaseerd op het primaat van een door de ingezetenen direct gekozen vertegenwoordigend orgaan. Te midden van hun andere taken hechten raadsleden in 2019 het grootste belang aan de vertegenwoordiging van inwoners. Dit artikel richt zich op de vraag of ‘lokale’ raadsleden en ‘niet-lokale’ raadsleden verschillen in hun ideeën over deze belangrijke vertegenwoordigende rol van de gemeenteraad. Bij de bespreking van opvattingen over stijl en focus van de vertegenwoordiging wordt eerst ingegaan op de (on)tevredenheid van raadsleden met het functioneren van de gemeenteraad. Daarna wordt ook bezien hoeveel belang lokale en niet-lokale raadsleden hechten aan een bepaalde stijl of focus. Dit geeft inzicht in de rolopvattingen van raadsleden: welke stijl en focus zijn van belang voor het goed vervullen van hun vertegenwoordigende rol? In het algemeen moet worden geconcludeerd dat gemiddeld genomen de hier besproken verschillen tussen lokale en niet-lokale raadsleden relatief bescheiden zijn. Niettemin zijn er in bepaalde opzichten toch enige verschillen in de accenten tussen de twee groepen raadsleden. Zo is onder meer vastgesteld dat de vertegenwoordigers van lokale partijen iets meer dan andere raadsleden belang hechten aan hun vertegenwoordigende taak.

Tarsal coalition (TC) is a congenital abnormal connection (fibrous, cartilaginous, or osseous) between two or more bones in the hind and midfoot, mostly consisting of calcaneonavicular or talocalcaneal coalition, and is often asymptomatic. However, TCs may result in foot motion limitation and pain with or without flatfoot (pes planus), arising in adolescents and young adults. Appropriate imaging is needed to pinpoint foot pain in the (suspected) TC, starting with plain radiographs. Still, normal radiographs do not exclude TCs. Computed tomography (CT) and MRI are frequently used advanced imaging techniques. CT alone has known limited sensitivity in cartilaginous and fibrous TCs and correlation between CT abnormalities and pain may be challenging, as solely anatomical changes in TCs are often asymptomatic. MRI can depict soft tissue abnormalities in TC with high accuracy. Nonetheless, after the implantation of metallic osteosynthesis material, MRI is often limited due to image distortion, signal loss, and misregistration. Bone scintigraphy with [99mTc]Tc-diphosphonate single photon emission computed tomography/CT (bone-SPECT/CT) is a known sensitive tool to detect osteoblastic bone pathology. However, the literature concerning bone-SPECT/CT in TC patients is limited. This article reviews bone-SPECT/CT patterns in TCs, how it complements other imaging techniques and their relation to clinical complaints. Bone-SPECT/CT excels in accurate bone pathology characterization in TC, confidently excluding synchronous lesions elsewhere, and offering optimal insight into osseous structures and 3D-localization of bone metabolism for surgery planning. Furthermore, even with implanted osteosynthesis material, bone-SPECT/CT can pinpoint the culprit pain generator, where MRI is either contra-indicated or considerably hampered.

Strategies to sustainably transform road transformation often focus on electrification and environmental benefits. However, transportation is also intricately linked to socio-economic aspects of sustainable development and electrification poses its own challenges.

Background: No adequately powered studies exist to compare major clinical outcomes after endovascular therapy (EVT) with stent implantation vs bypass surgery (BSx) for symptomatic femoropopliteal peripheral artery disease. Objectives: This study sought to perform a pooled analysis of individual patient data from all randomized controlled trials comparing EVT vs BSx. Methods: Principal investigators of 5 of 6 available randomized controlled trials agreed to pool individual patient data. The primary endpoint was major adverse limb events, a composite of all-cause death, major amputation, or target limb reintervention. Secondary endpoints included amputation-free survival, individual major adverse limb event components, and primary patency. Early complications were bleeding, infection, or all-cause death within 30 days. Results: A total of 639 patients were analyzed with a mean age of 68.1 ± 9.1 years and 29.0% women. Baseline characteristics were comparable between groups. At 2 years, there were no significant differences between patients who received EVT and those who received BSx regarding major adverse limb events (40.1% vs 36.4%; log-rank P = 0.447; adjusted HR [aHR]: 1.04; 95% CI: 0.80-1.36), amputation-free survival (88.1% vs 90.0%; log-rank P = 0.455; aHR for death or amputation: 1.04; 95% CI: 0.63-1.71) and the other secondary endpoints except for primary patency, which was lower in patients who received EVT vs those who received BSx (51.2% vs 61.3%; log-rank P = 0.024; aHR for loss of primary patency: 1.31; 95% CI: 1.02-1.69). EVT was associated with significantly lower rates of early complications (6.8% vs 22.6%; P < 0.001) and shorter hospital stay (3.1 ± 4.2 days vs 7.4 ± 4.9 days; P < 0.001). Conclusions: These findings further support the efficacy and safety of EVT as an alternative to BSx in patients with symptomatic femoropopliteal peripheral artery disease.

Item does not contain fulltext BACKGROUND: Immune checkpoint inhibitors and targeted therapies have dramatically improved outcomes in patients with advanced melanoma, but approximately half these patients will not have a durable benefit. Phase 1-2 trials of adoptive cell therapy with tumor-infiltrating lymphocytes (TILs) have shown promising responses, but data from phase 3 trials are lacking to determine the role of TILs in treating advanced melanoma. METHODS: In this phase 3, multicenter, open-label trial, we randomly assigned patients with unresectable stage IIIC or IV melanoma in a 1:1 ratio to receive TIL or anti-cytotoxic T-lymphocyte antigen 4 therapy (ipilimumab at 3 mg per kilogram of body weight). Infusion of at least 5×10(9) TILs was preceded by nonmyeloablative, lymphodepleting chemotherapy (cyclophosphamide plus fludarabine) and followed by high-dose interleukin-2. The primary end point was progression-free survival. RESULTS: A total of 168 patients (86% with disease refractory to anti-programmed death 1 treatment) were assigned to receive TILs (84 patients) or ipilimumab (84 patients). In the intention-to-treat population, median progression-free survival was 7.2 months (95% confidence interval [CI], 4.2 to 13.1) in the TIL group and 3.1 months (95% CI, 3.0 to 4.3) in the ipilimumab group (hazard ratio for progression or death, 0.50; 95% CI, 0.35 to 0.72; P

Most transport equity and transport-related social exclusion (TRSE) studies assume that increasing accessibility levels lead to increased activity participation and, therefore, a reduction in social exclusion. Although this assumption makes sense from a theoretical point of view, this causal relationship has not yet been validated in practice. Previous studies investigating the accessibility-participation relationship were inconclusive, indicating that increasing accessibility has a limited impact on activity participation levels, if any. Moreover, the existing empirical evidence in the literature in the Global South context is scarce, is merely correlational and fails to infer causality between both variables. The contributions of the paper are threefold. First, (a) to provide a conceptual model of the causal relationship between accessibility, activity participation and risk of transport-related social exclusion (TRSE); second, (b) to summarise the available empirical evidence about the accessibility-activity participation relationship through a systematic literature review; and third, (c) to provide evidence of the causal relationship between accessibility and activity participation levels in a Global South context. Three Poisson regression models associated with an instrumental variable identification strategy were used to assess the causal effect between accessibility and participation in total, mandatory and discretionary activities in the city of São Paulo, Brazil. The three models showed a highly significant, strong correlation between an individual's accessibility level and their actual participation in total, mandatory and discretionary activities. Models that ignore the possible endogeneity present in the relationship between accessibility and activity participation may underestimate the effect of accessibility. Based on our results, we argue that low accessibility levels may severely restrict individuals’ life chances and add evidence that accessibility has to be an important instrument to support transport policies' decision-making.

Previous research has shown the influence of smell on emotions, memories, and body image. However, most of this work has taken place in laboratory settings and little is known about the influence of smell in real-world environments. In this article, we present novel insights gained from a field study investigating the emotional effect of smell on memories and body image. Taking inspiration from the cultural design probes approach, we designed QuintEssence, a probe package that includes three scents and materials to complete three tasks over a period of four weeks. Here, we describe the design of QuintEssence and the main findings based on the outcomes of the three tasks and a final individual interview. The findings show similar results between participants based on the scent. For example, with cinnamon, participants experienced feelings of warmth, coziness, happiness, and relaxation; they recalled blurred memories of past moments about themselves and reported a general feeling of being calm and peaceful towards their bodies. Our findings open up new design spaces for multisensory experiences and inspire future qualitative explorations beyond laboratory boundaries.

Innovation is of vital importance to organizations whereby it is becoming increasingly clear that the individual innovative employee has an important role. In this article the authors describe the results of a qualitative case study based on interviews at the IT company Topicus in the Duch town of Deventer. The influence of innovation personal characteristics (creativity, psychological empowerment, optimism) and work/context factors (supportive leadership, perceived room for autonomy, external contacts and innovative teamwork) on showing innovative work behavior (IWB) was investigated. Based on this study, it is concluded that there is an interaction between the mentioned personal characteristics and work/context factors and the employee with IWB, whereby there is a converting role for the ‘innovation energy’ of employees. This is the vitality, strength and enthusiasm to generate, introduce or apply new ideas, processes, products or procedures. These results of this survey are helpful in identifying and supporting employees with IWB. The article concludes with practical recommendations for organizations in the field of organizational development, selection and coaching of employees with IWB and their managers.

The introduction of mammography as a radiographic imaging modality optimized for breast imaging revolutionized breast cancer care. Throughout the decades, conventional, screen-film-based mammography has given way to digital mammography, resulting in many benefits, including a streamlined workflow and improved performance in certain subgroups of patients. More importantly, the introduction of digital technology in mammographic imaging resulted in the development of even more advanced technologies, such as digital breast tomosynthesis. Tomosynthesis, with its ability to result in pseudo-tomographic imaging of the breast with a system that has the same footprint and workflow as mammography, has had an important impact in the breast imaging clinic. In this chapter, the basic concepts of X-ray-based breast imaging, common for both mammography and tomosynthesis, are reviewed. The major components of these imaging systems are described, and the resulting and potential clinical and screening performance of these modalities is discussed. Finally, considering their widespread use in asymptomatic women during screening, the dosimetry aspects of X-ray-based breast imaging are explained.

Purpose This paper aims to categorize users of voice assistants and analyze decision-making conflicts to predict intention to adopt voice commerce (v-commerce). Design/methodology/approach This exploratory study used expert survey-based data collection founded on data saturation. Findings This study identifies three forms of voice systems based on senses aroused (screen first, voice only and voice first) and four profiles of voice users (passive resistant, hedonistic adopter, utilitarian adopter and active resistant), each with a different appraisal of the benefits and costs of v-commerce adoption and the experiences (positive or negative) felt during the shopping experience. This study proposes a conceptual model to predict intention to adopt v-commerce depending on voice-system and -user characteristics. Practical implications Learning from this study can help improve the marketing strategies and actions put in place by voice-assistant brands and advertisers by providing insights for adapting product recommendation algorithms to meet the needs of the identified profiles. Originality/value This paper provides an answer to the limits of classical approaches based on “one-size-fits-all” strategy by showing how voice-assistant users have different profiles that span a gradient of advance in technology adoption.

Whereas interior point methods provide polynomial-time linear programming algorithms, the running time bounds depend on bit-complexity or condition measures that can be unbounded in the problem dimension. This is in contrast with the simplex method that always admits an exponential bound. We introduce a new polynomial-time path-following interior point method where the number of iterations also admits a combinatorial upper bound $O(2^{n}n^{15}\log n)$ for an n-variable linear program in standard form. This complements previous work by Allamigeon, Benchimol, Gaubert, and Joswig (SIAGA 2018) that exhibited a family of instances where any path-following method must take exponentially many iterations. The number of iterations of our algorithm is at most $O(n^{15}\log n)$ times the number of segments of any piecewise linear curve in the wide neighborhood of the central path. In particular, it matches the number of iterations of any path following interior point method up to this polynomial factor. The overall exponential upper bound derives from studying the max central path’, a piecewise-linear curve with the number of pieces bounded by the total length of 2n shadow vertex simplex paths. From the existence of a line segment in the wide neighborhood we derive strong implications on the structure of the corresponding segment of the central path. Our algorithm is able to detect this structure from the local geometry at the current iterate, and constructs a step direction that descends along this segment. The bound $O(n^{15}\log n)$ that applies for arbitrarily long line segments is derived from a combinatorial progress measure. Our algorithm falls into the family of layered least squares interior point methods introduced by Vavasis and Ye (Math. Prog. 1996). In contrast to previous layered least squares methods that partition the kernel of the constraint matrix into coordinate subspaces, our method creates layers based on a general subspace providing more flexibility. Our result also implies the same bound on the number of iterations of the trust region interior point method by Lan, Monteiro, and Tsuchiya (SIOPT 2009).

Purpose: Describes the relevance of –various classification methods for ipsilateral breast tumour recurrence (IBTR) as either true recurrence (TR) or new primary (NP) on both disease-specific survival (DSS) and distant metastasis-free survival (DMFS). Method: Two hundred and thirty-four of 4359 women undergoing breast-conserving therapy experienced IBTR. We compared the impact of four known classification methods and two newly created classification methods. Results: For three of the methods, a better DSS was observed for NP compared to TR with the hazard ratio (HR) ranging from 0.5 to 0.6. The new Twente method classification, comprising all classification criteria of three known methods, and the new Morphology method, using only morphological criteria, had the best HR and confidence interval with a HR 0.5 (95% CI 0.2–1.0) and a HR 0.5 (95% CI 0.3–1.1), respectively. For DMFS, the HR for NP compared to TR ranged from 0.6 to 0.9 for all six methods. The new Morphology method and the Twente method noted the best HR and confidence intervals with a HR 0.6 (95% CI 0.3–1.1) and a HR 0.6 (95% CI 0.4–1.2), respectively. Conclusion: IBTR classified as TR or NP has a prognostic value for both DSS and DMFS, but depends on the classification method used. Developing and validating a generally accepted form of classification are imperative for using TR and NP in clinical practice.

Pavement researchers typically adopt life cycle cost analysis (LCCA) to quantify changes in the economic performance of road pavements due to the effects of climate change. As uncertainty exists in the unit cost of materials, fuels, and machinery operation, the assessment of climate change-induced pavement costs invariably involves uncertainty. If such uncertainties remain unaddressed, the assessment of pavement costs will not be accurate. Therefore, this study develops a stochastic pavement LCCA framework to account for the effects of such uncertainties on climate change-induced pavement life cycle cost. This is achieved by integrating a sensitivity analysis methodology and Monte Carlo simulation. To demonstrate the applicability of the framework case studies are performed for standard interstate and standard primary road pavement sections in four climate zones in the United States under a high climate change Representative Concentration Pathway (RCP8.5) for four different periods between 1981 and 2100. The results show that pavement maintenance, end-of-life (EOL), and transportation costs are most affected by climate change. To assess climate change-induced pavement costs more accurately, it is important to improve the accuracy of gasoline, diesel, and hot mix asphalt (HMA) unit costs, as they are the most sensitive input to the pavement LCCA model.

The classic criteria to determine if a second-order irreversible gas–liquid reaction (AG+νBBL→νCCL) proceeds in the instantaneous regime are based on the Hatta number, HaA, and the infinite enhancement factor, EA,∞, i.e., HaA>2 and HaA≫EA,∞-1. There is no consensus, however, with respect to the latter threshold value and this work shows that it highly depends on the considered reactant concentrations and rate coefficients, in particular when the non-volatility assumption of the liquid phase component is relieved. Generalizing the original derivation yields an extended expression, which is condensed into a new dimensionless number, φA,∞, and allows to rewrite the second criterion as φA,∞>15, where [Formula presented]. Next, it is demonstrated that a breakthrough of the gas-phase reactant into the bulk-liquid is readily observed at high interface concentrations of the gas-phase reactant with respect to the bulk concentration of the liquid-phase reactant, even though the classic criteria have been met. Such a situation is quite common in the chemical industry, e.g., in case of the selective reactive removal of an impurity (BL) from a process stream containing a valuable product by a soluble gaseous component (AG). The root cause of this deviating behavior results from the position of the reaction plane and an additional criterion, φB,∞>15, is needed to resolve this. As such, the set of improved criteria are necessary and sufficient to describe the instantaneous regime for any position of the reaction plane. To conclude, a methodology is presented to apply the modified criteria to multiple parallel reactions, and the validity of these improved and generalized criteria is numerically demonstrated.

The loss of the openness and playfulness, with which children approach life, has negative effects in later life. It prevents adults from finding creative solutions to challenges, tasks, problems they may encounter in their personal lives or in work situations. Therefore, encouraging playfulness is not only good for children's motor, cognitive and social-emotional development, but also helps adults. One means of strengthening and encouraging playfulness from an early age is to make public space playable with digital technology. What we need are playable cities.

BaCe0.65Zr0.2Y0.15O3-δ – Ce0.85Gd0.15O2-δ (BCZ20Y15-GDC15) dual-phase material revealed potential for H2 production technologies due to its exceptional H2 permeation and chemical resistance. In this article, mechanical properties of BCZ20Y15-GDC15 dual-phase material were investigated to evaluate the mechanical behavior and develop strategies to warrant structural stability. Elastic modulus, hardness and fracture toughness values were studied using different indentation-based methods. The fracture experiments at different length-scales both revealed that the introduction of GDC15 makes the material tougher, facilitating the further design of robust and reliable components.

The digital transformation exposes organizations to new threats endangering their business. A way to uncover these threats is threat modeling and attack simulations. However, modeling an entire organization by hand is time consuming and error prone. Therefore, we propose to reuse Enterprise Architecture (EA) models. In this work, we propose a mapping from ArchiMate, a common EA modeling language, to coreLang, a threat modeling language, and use the resulting models to perform attack simulations to foresee possible attack paths. Then, we play back the results of the attack simulations to the EA model and complete the round-trip. To demonstrate our approach, we developed a prototype performing the transformation from ArchiMate to coreLang and applied our approach to the well-known ArchiSurance example.

Executives in family firms are often confronted with emotionally loaded issues, in part due to the need to include the interests of the owning family. Given this context, we hypothesize how high family-firm performance is affected by the emotional intelligence (EI) of a family-based CEO and top-management team (TMT), in addition to the CEO's transformational leadership (TFL) and TMT's behavioral integration. Survey measures were taken from a random sample of 72 CEOs of German family firms and 245 members of their TMTs. We found that TMT behavioral integration mediates between CEO TFL and objective firm performance while CEO EI is significantly related to both CEO TFL and TMT EI. Implications are discussed for future research thereby suggesting an extension to upper-echelon theory.

Aims To analyse the disease-free survival and overall survival in older adults with breast cancer after breast-conserving therapy, focusing on the relevance of non-breast malignancy (NBM) with respect to survival rates. Materials and methods Analyses were based on 1205 women aged 65 years and older with breast cancer treated with breast-conserving therapy between 1999 and 2015. Patients were divided into three age categories: 65–70, 71–75 and >75 years. Multivariate survival analysis was carried out using Cox regression analysis. Results The two youngest age categories showed excellent results, with a 12-year disease-free survival of 84.6 and 86.3%, respectively. We noted a 17.2% incidence of NBM, particularly for colon cancer and lung cancer. Most (72.9%) occurred after a diagnosis of breast cancer. Of those 72.9%, about 50% died as a result of NBM within 2 years of the diagnosis of NBM. The overall 12-year NBM-specific survival was 92.0%. The 12-year overall survival was 60.0% for all and for the three abovementioned age categories was 73.3, 54.4 and 28.4%, respectively. The cause of death for all was predominantly non-malignancy-related morbidity. Conclusion The impact of breast cancer on life expectancy was limited, in particularly for women aged 65–75 years. The relevance of NBM on survival was limited.

De coronacrisis heeft de taken, rollen en verhoudingen in het college van B&W flink opgeschud. Het is de vraag wat dit heeft betekend voor de rol en positie van wethouders: de relatie tussen wethouders onderling en hun relaties met de burgemeester, de gemeenteraad, het ambtelijk apparaat en de samenleving. Door middel van een digitale enquête is onderzocht of en hoe de crisismaatregelen de rol en positie van wethouders hebben veranderd. Ook is gevraagd naar beleidsmatige veranderingen als gevolg van de coronacrisis. De coronacrisis heeft een grote impact gehad op de rol en de positie van wethouders. Hun contacten met ambtenaren zijn over de gehele linie wat intensiever geworden, hun colleges zijn meer collegiaal gaan besturen en hun burgemeesters hebben een meer sturende en coördinerende rol ingenomen. De contacten met de gemeenteraden zijn als gevolg van de coronacrisis minder intensief, wat overigens niet geldt voor hun eigen fracties. De relaties met bedrijven en instellingen zijn juist aangehaald, die met inwoners zijn ongewijzigd gebleven.

Purpose: Accuracy of image-guided liver surgery is challenged by deformation of the liver during the procedure. This study aims at improving navigation accuracy by using intraoperative deep learning segmentation and nonrigid registration of hepatic vasculature from ultrasound (US) images to compensate for changes in liver position and deformation. Methods: This was a single-center prospective study of patients with liver metastases from any origin. Electromagnetic tracking was used to follow US and liver movement. A preoperative 3D model of the liver, including liver lesions, and hepatic and portal vasculature, was registered with the intraoperative organ position. Hepatic vasculature was segmented using a reduced 3D U-Net and registered to preoperative imaging after initial alignment followed by nonrigid registration. Accuracy was assessed as Euclidean distance between the tumor center imaged in the intraoperative US and the registered preoperative image. Results: Median target registration error (TRE) after initial alignment was 11.6 mm in 25 procedures and improved to 6.9 mm after nonrigid registration (p = 0.0076). The number of TREs above 10 mm halved from 16 to 8 after nonrigid registration. In 9 cases, registration was performed twice after failure of the first attempt. The first registration cycle was completed in median 11 min (8:00–18:45 min) and a second in 5 min (2:30–10:20 min). Conclusion: This novel registration workflow using automatic vascular detection and nonrigid registration allows to accurately localize liver lesions. Further automation in the workflow is required in initial alignment and classification accuracy.

Purpose: Accuracy of image-guided liver surgery is challenged by deformation of the liver during the procedure. This study aims at improving navigation accuracy by using intraoperative deep learning segmentation and nonrigid registration of hepatic vasculature from ultrasound (US) images to compensate for changes in liver position and deformation. Methods: This was a single-center prospective study of patients with liver metastases from any origin. Electromagnetic tracking was used to follow US and liver movement. A preoperative 3D model of the liver, including liver lesions, and hepatic and portal vasculature, was registered with the intraoperative organ position. Hepatic vasculature was segmented using a reduced 3D U-Net and registered to preoperative imaging after initial alignment followed by nonrigid registration. Accuracy was assessed as Euclidean distance between the tumor center imaged in the intraoperative US and the registered preoperative image. Results: Median target registration error (TRE) after initial alignment was 11.6 mm in 25 procedures and improved to 6.9 mm after nonrigid registration (p = 0.0076). The number of TREs above 10 mm halved from 16 to 8 after nonrigid registration. In 9 cases, registration was performed twice after failure of the first attempt. The first registration cycle was completed in median 11 min (8:00–18:45 min) and a second in 5 min (2:30–10:20 min). Conclusion: This novel registration workflow using automatic vascular detection and nonrigid registration allows to accurately localize liver lesions. Further automation in the workflow is required in initial alignment and classification accuracy.

Purpose: Surgical navigation techniques can guide surgeons in localizing pelvic–abdominal malignancies. For abdominal navigation, accurate patient registration is crucial and is generally performed using an intra-operative cone-beam CT (CBCT). However, this method causes 15-min surgical preparation workflow interruption and radiation exposure, and more importantly, it cannot be repeated during surgery to compensate for large patient movement. As an alternative, the accuracy and feasibility of tracked ultrasound (US) registration are assessed in this patient study. Methods: Patients scheduled for surgical navigation during laparotomy of pelvic–abdominal malignancies were prospectively included. In the operating room, two percutaneous tracked US scans of the pelvic bone were acquired: one in supine and one in Trendelenburg patient position. Postoperatively, the bone surface was semiautomatically segmented from US images and registered to the bone surface on the preoperative CT scan. The US registration accuracy was computed using the CBCT registration as a reference and acquisition times were compared. Additionally, both US measurements were compared to quantify the registration error caused by patient movement into Trendelenburg. Results: In total, 18 patients were included and analyzed. US registration resulted in a mean surface registration error of 1.2 ± 0.2 mm and a mean target registration error of 3.3 ± 1.4 mm. US acquisitions were 4 × faster than the CBCT scans (two-sample t-test P < 0.05) and could even be performed during standard patient preparation before skin incision. Patient repositioning in Trendelenburg caused a mean target registration error of 7.7 ± 3.3 mm, mainly in cranial direction. Conclusion: US registration based on the pelvic bone is accurate, fast and feasible for surgical navigation. Further optimization of the bone segmentation algorithm will allow for real-time registration in the clinical workflow. In the end, this would allow intra-operative US registration to correct for large patient movement. Trial registration: This study is registered in ClinicalTrials.gov (NCT05637359).

ASML mag nu ook niet langer oudere chipmachines naar China experteren, omdat het Westen bang is voor verregaande militaire toepassingen. Waarom moet Beijing worden gestopt? "Het hangt van de kok af, wat je ermee kunt maken"

ASML mag nu ook niet langer oudere chipmachines naar China experteren, omdat het Westen bang is voor verregaande militaire toepassingen. Waarom moet Beijing worden gestopt? "Het hangt van de kok af, wat je ermee kunt maken"

Background: We examine sex differences in relation to the nature, frequency, and burden of patient-reported adverse drug reactions (ADRs) in patients with inflammatory rheumatic diseases. Research design and methods: Rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis patients using etanercept or adalimumab from the Dutch Biologic Monitor were sent bimonthly questionnaires concerning experienced ADRs. Sex differences in the proportion and nature of reported ADRs were assessed. Additionally, 5-point Likert-type scales reported for the burden of ADRs, were compared between sexes. Results: In total 748 consecutive patients were included (59% female). From the women 55% reported ≥1 ADR, which was significantly higher than 38% of the men that reported ≥1 ADR (p

Background: Among heart failure (HF) patients, hospital readmissions are a major concern. The medication taken by a patient may provide information on comorbidities and conditions and may be used as an indicator to identify populations at an increased risk of HF readmission. Aim: This study explored the use of non-cardiovascular medication at hospital discharge from the first HF admission in search of indicators of high risk of readmission for HF. Method The study included 22,476 HF patients from the Dutch PHARMO Database Network at their first HF hospitalization. The data was divided into training and validation sets. A Cox regression model with demographics, date of first HF hospital admission and non-cardiovascular medication present at discharge, adjusted for cardiovascular medication, was developed in the training set and subsequently implemented in the validation set. Results: The study included 22,476 patients, mean age 76.7 years (range 18–104) and median follow-up time 2.5 years (range 0–15.7 years). During the study period 6,725 (29.9%) patients were readmitted for HF, with a median time-to-readmission of 7 months (range 0–14.3 years). Non-cardiovascular medication associated with a high risk of readmission for HF were identified as indicators of high risk, with no implied causal relationship. Patients prescribed antigout medications presented a 25% increased risk of readmission (HR 1.25, 95%CI 1.09–1.45, P = 0.002). Patients using insulin had an 18% higher risk of readmission versus patients not using insulin (HR 1.18, 95%CI 1.06–1.32, P = 0.002), but not versus patients treated with other blood-glucose-lowering drugs. No association between the risk of readmission and NSAIDs use was observed. Conclusion: The results suggest that diabetes is responsible for the higher HF-readmission risk observed in patients prescribed insulin. The observed risk in users of antigout medication should be further investigated. The absence of an association with the use of NSAIDs should be interpreted with caution.

Background: Drug therapy is important for controlling symptoms in Parkinson’s disease (PD). However, it often results in complex medication regimens and could easily lead to drug related problems (DRP), suboptimal adherence and reduced treatment efficacy. A structured medication review (SMR) could address these issues and optimize therapy, although little is known about clinical effects in PD patients. Objective: To analyze whether an SMR improves quality of life (QoL) in PD. Methods: In this multicenter randomized controlled trial, half of the 202 PD patients with polypharmacy received a community pharmacist-led SMR. The control group received usual care. Assessments at baseline, and after three and six months comprised six validated questionnaires. Primary outcome was PD specific QoL [(PDQ-39; range 0 (best QoL) – 100 (worst QoL)]. Secondary outcomes were disability score, non-motor symptoms, general health status, and personal care giver’s QoL. Furthermore, DRPs, proposed interventions, and implemented modifications in medication schedules were analyzed. Results: No improvement in QoL was seen six months after an SMR, with a non-significant treatment effect difference of 2.09 (–0.63;4.80) in favor of the control group. No differences were found in secondary outcomes. In total, 260 potential DRPs were identified (2.6 (±1.8) per patient), of which 62% led to drug therapy optimization. Conclusion: In the current setting, a community pharmacist-led SMR did not improve QoL in PD patients, nor improved other pre-specified outcomes.

Endovascular treatment options of aorto-iliac occlusive disease have emerged, leading to better outcomes in more complex pathology, which typically involves a reconstruction of the aortic bifurcation. The Covered Endovascular Reconstruction of Aortic Bifurcation (CERAB) configuration was introduced in 2013, in an attempt to optimize outcomes, when compared to the kissing stent configuration, which was traditionally the preferred endovascular technique for this pathology. CERAB aims to optimize geometry, and with that the arterial flow patterns that are associated with loss of patency. In CERAB, the aortic bifurcation is reconstructed using three balloon-expandable covered stents in a tight connection with each other and with an appropriate wall apposition, thereby minimizing geometrical mismatch (Fig. 1a-c). The reconstruction can be extended on both sides and could be combined with chimney, or parallel, grafts in aortic side branches that need to be preserved. In the current paper, the details of the CERAB technique are described and supported by evidence derived from pre-clinical studies that confirm the more optimal geometry and flow patterns compared to kissing stents. Also, a summary is provided of published clinical evidence, including technical and clinical outcomes of the technique. These data show promising early results, with patency rates in line with those achieved with open surgery, also in patients with extensive disease. Finally, the potential modes of failures and future developments are discussed.

INTRODUCTION: Complex pathologies involving the aortic arch can be treated using the frozen elephant trunk (FET) technique, which is versatile and continues to be improved with different innovations to further reduce, for example, circulatory arrest time and the need for hypothermia. FET may or may not be a definitive repair, however. Distal extension or completion-especially endovascular-is common but not well described in the literature. This review describes the considerations that are necessary during FET planning and preparation, how pathology specifics and sizing decisions will affect the subsequent need for treatment, and how outcomes might be better reported to improve understanding of the advantages and limitations of the technique. MATERIALS AND METHODS: This literature review was performed to identify reports of second-stage endovascular completion after FET repair, and included any literature that described such interventions after index FET, for any aortic arch pathology. RESULTS: Secondary intervention after FET is an important parameter to establish the success or failure of the index procedure. However, unplanned extensions are often reported with insufficient detail and follow up, and studies rarely differentiate between unplanned or adjunctive procedures. In addition, prediction of the need for extension is complicated by the response of the pathology to the index procedure. CONCLUSION: FET is a versatile, established surgical technique that allows for several applications in different pathologies and innovative adaptations. How, when, and why FET is extended needs to be reported in greater detail, with specific consideration given to the interaction of FET and endovascular devices in sizing, integrity, and possible complications.

Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, resulting in pain and often chronic disability and a significant burden on healthcare systems globally. Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy of knee OA has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, none of them has articular cartilage regenerating potential. Due to a better understanding of osteoarthritis, innovative new treatment options have been developed. In this narrative review, we focus on emerging OA knee treatments, relieving symptoms, and regenerating damaged articular cartilage that includes intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), metformin, lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC), exosomes, interleukin-1 blockers, gene-based therapy, and bisphosphonate.

The high cost of many new anticancer medicines significantly impedes breakthrough discoveries from reaching patients. A commonly heard refrain is that high prices are necessary to compensate for the high costs of research and development (R&D). Yet, there are promising policy proposals aimed at improving affordability without compromising innovation. In seeking new policy solutions, we argue for a shift away from entrenched opinion toward an evidence-based discourse that is grounded in experiments and real-world pilot studies. We offer a novel perspective and practical recommendations on how empirical evidence could and should be gathered to inform evidence-based policy interventions that lead to sustainable medicine prices in oncology. See related article by Franzen et al. (Cancer Res Commun 2022;2:39–47) .

While extracting buildings from high-resolution remote sensing imagery has been widely conducted in automatic surveying and mapping, challenges remain in building extraction over complex scenes, particularly for densely rotated objects with fuzzy boundaries. This study proposes a rotation-aware building instance segmentation network (RotSegNet) that integrates a refined rotated detector to extract rotation equivariant and invariant features. A boundary refinement module is added to the segmentation network to extract fine-grained boundary features. We evaluated our method using the WHU building dataset and AFCities dataset. Our RotSegNet generated a minimum of 2.5% and 0.8% mean Average Precision (mAP) on the two datasets compared with other state-of-the-art methods, which shows the superiority of our method. Results also show that the proposed method can produce regularized buildings with high geometric accuracy.

Mass-scale red blood cell genotyping of donors and transfusion recipients increases the availability of extended antigen matched red blood cell units. Therefore, a new mathematical framework is developed that can be applied for general blood groups (i.e., beyond the ABO, RhD blood groups). It determines which red blood cell units should be issued from inventory, such that requests from hospitals can be satisfied with antigen compatible red blood cell units, shortages for future requests are avoided, and outdating is prevented. The optimization model consists of two steps: a binary vector representation for general blood groups and the formulation of the inventory allocation problem as a minimum cost flow problem. The potential practical performance of the optimization model is evaluated by iterative simulations, based on historical data on supply and demand of red blood cell units in the Netherlands. When including the fourteen clinically most relevant antigens, more than 90% of all requests can be satisfied with antigen identical red blood cell units. Shortages and outdating can be kept restricted and could even be reduced to virtually zero, when only the ABO, RhD blood groups are considered.

Endorheic freshwater lakes can be vital water resources for sustaining large populations. However, their land-locked nature can lead to overexploitation and long-term sediment accumulation, reducing water storage and quality. Lake Naivasha supports a rapidly expanding population and agricultural industry. Therefore, maintaining good water storage and quality within this endorheic lake is crucial for the Kenyan economy and population. The lake has a long history of level fluctuations and the region is considered to be suffering from a chronic imbalance between water supply and demand. This study quantifies the sediment deposition rate and its impact on Lake Naivasha's water levels and volume, using inexpensive remote sensing techniques that could be easily replicated for future monitoring. Evidence of sedimentation in the northern area averaging 23 mm yr−1 was identified, which is likely annually displacing between 40.2 – 576 × 103 m³ of water. The volume displaced each year is equivalent to the water required to sustain between 40 – 1152 people. These results imply that current abstraction management, based purely upon lake level readings that govern a ‘traffic lights’ system, are detrimental to the long-term survival of the lake. The results also imply that lake health is decreasing. We recommend that future monitoring of this water resource and all endorheic lakes consider measurements of available water volume in combination with lake level data using the remote sensing methods we describe.

In this manuscript, we discuss the findings from an introductory survey conducted with more than 50 teachers in Italy. We inquired about teachers’ opinions of educational technology used in the classroom, in particular search tools. Qualitative and quantitative data inferred from collected responses provide us with a multifaceted picture of the different roles teachers perform in the classroom when interacting with technology, their preferences, skills, perceptions of the needs for training, in addition to the principles and motivations that guide them. Findings emerging from this survey serve as a foundation for an international study that would allow us to better model teachers’ needs and the barriers they face when using search tools in the classroom.

The COVID-19 outbreak and associated measures taken had an enormous impact on society as well as a disruptive, but not necessarily negative, impact on mobility. The Ministry of Infrastructure and Water Management received the most recent insights from the Dutch Mobility Panel (DMP) on a weekly basis. These insights were used to monitor the travel behaviour and to analyse changes in the behaviour of different groups and usage of modes of transport during COVID-19. The analysis shows an enormous decrease in travel at the beginning of the implementation of the so-called ‘intelligent’ lockdown and gradual increase again towards comparable levels as before this ‘intelligent lockdown, although the distribution over time, motives and used modes has changed. It becomes clear that not everyone needs to travel during peak hours and commuter travel is also not the main reason for the increase in car usage. Furthermore, cycling has shown to be an alternative option for travellers and public transport is hardly used anymore. If it is possible to sustain the lower level of car usage and integrate public transport as an important alternative for travel again, the COVID-19 impact on mobility could have a substantial remaining positive impact on mobility.

Virtual performance-based assessments (VPBAs) are environments for test takers to interact with systems, sometimes including other persons or agents, in order to provide evidence about their knowledge, skills, or other attributes. Examples include tasks based on interactive simulations, games, branching scenarios, and collaboration among students communicating through digital chats. They may be used for summative purposes, as in certification examinations, or for other purposes, as in intelligent tutoring systems and exploratory learning environments. They afford opportunities to obtain direct evidence about capabilities that inherently involve interaction, such as inquiry and collaboration. Our focus here is digital, usually with regard to the environment but always with regard to the form of data. Digital data capture makes it possible to acquire rich details about students’ actions and the evolving situations in which they occur. The challenges they pose to psychometrics lie in designing VPBAs to optimally evoke the targeted capabilities, providing students with affordances that evidence that cognition, capturing the relevant aspects of the performances, identifying meaningful patterns in performances that constitute evidence about the targeted capabilities, and providing an inferential framework for synthesizing the evidence and characterizing its properties. This chapter provides an introduction to VPBAs and psychometric considerations in VPBA design and analysis.

In the original online version of this article, Nataly Bañol Arias’s last name is incorrect. The original article was corrected.

In the original online version of this article, Nataly Bañol Arias’s last name is incorrect. The original article was corrected.

OBJECTIVETo determine whether the benefits of dapagliflozin in patients with type 2 diabetes and chronic kidney disease (CKD) in the Dapagliflozin And Prevention of Adverse Outcomes in CKD trial (DAPA-CKD) varied by background glucose-lowering therapy (GLT).RESEARCH DESIGN AND METHODSWe randomized 4,304 adults (including 2,906 with type 2 diabetes) with a baseline estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio of 200–5,000 mg/g to dapagliflozin 10 mg or placebo once daily (NCT03036150). The primary end point was a composite of ≥50% eGFR decline, end-stage kidney disease, and kidney or cardiovascular cause of death. Secondary end points included a kidney composite end point (primary composite end point without cardiovascular death), a cardiovascular composite end point (hospitalized heart failure or cardiovascular death), and all-cause mortality. In this prespecified analysis, we investigated the effects of dapagliflozin on these and other outcomes according to baseline GLT class or number of GLTs.RESULTSThe effects of dapagliflozin on the primary composite outcome were consistent across GLT classes and according to the number of GLTs (all interaction P > 0.08). Similarly, we found consistent benefit of dapagliflozin compared with placebo on the secondary end points regardless of background GLT class or number of GLTs. The same applied to the rate of decline in the eGFR rate and safety end points. Dapagliflozin reduced the initiation of insulin therapy during follow-up compared with placebo (hazard ratio 0.72; 95% CI 0.54–0.96; P = 0.025).CONCLUSIONSDapagliflozin reduced kidney and cardiovascular events in patients with type 2 diabetes and CKD across baseline GLT class or classes in combination.

Aims To study if any qualitative or quantitative optical coherence tomography (OCT) variables in combination with thin cap fibroatheroma (TCFA) patients could improve the identification of lesions at risk for future major adverse cardiac events (MACEs). Methods and results From the combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) trial database (NCT02989740), we performed a detailed assessment OCT qualitative and quantitative variables in TCFA carrying diabetes mellitus (DM) patients with vs. without MACE during follow-up. MACEs were defined as a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, and hospitalization for unstable angina. From the 390 fractional flow reserve (FFR)-negative DM patients, 98 (25.2%) had ≥1 OCT-detected TCFA, of which 13 (13.3%) had MACE and 85 (86.7%) were event-free (non-MACE). The baseline characteristics were similar between both groups; however, a smaller minimal lumen area (MLA) and lower mean FFR value were observed in MACE group (1.80 vs. 2.50 mm2, P = 0.01, and 0.85 vs. 0.89, P = 0.02, respectively). Prevalence of healed plaque (HP) was higher in the MACE group (53.85 vs. 21.18%, P = 0.01). TCFA were predominantly located proximal to the MLA. TCFA area was smaller in the MACE group, while no difference was observed regarding the lesion area. Conclusion Within TCFA carrying patients, a smaller MLA, lower FFR values, and TCFA location adjacent to a HP were associated with future MACE. Carpet-like measured lesion area surface was similar, while the TCFA area was smaller in the MACE arm, and predominantly located proximal to the MLA.

To evaluate compliance with the precaution to sleep in a supine position following total hip arthroplasty (THA) and its impact on the other precautions.Single-center, parallel-group, stratified, randomized trial. Patients were allocated to a Restricted Group or an Unrestricted Group. This study focuses on compliance with the precaution to sleep in a supine position, compliance with the remaining set of precautions and the burden of restricted sleeping. Measurements were made using a self-administered diary and questionnaires. Trial registration number: NCT02107248.During the first 2 weeks, 81% of the patients in the restricted group were compliant with sleeping in a supine position.Patients in the Unrestricted Group significantly kept sleeping fewer days per week in a supine position than patients in the Restricted Group (Compliance with restricting patients to sleep in a supine position is high. Removing this precaution has a significant decrease in burden for patients without affecting compliance with the remaining set of precautions.ClinicalTrials.gov NCT02107248 - https://clinicaltrials.gov/ct2/show/NCT02107248?term=anil+petersdraw=2rank=1IMPLICATIONS FOR REHABILITATIONSleeping precautions cause a high rate of burden to patients, whereas movement precautions do not.By removing sleeping precautions, the burden is significantly reduced without affecting the remaining set of precautions.Compliance with movement precautions is high compared to other more functional precautions.

The emergence of the Internet of Things (IoT) and the cloud/fog-edge paradigm contributes for appearance of innovative designs for smart systems. The purpose of the doctoral research outlined in this article to design a method which will discover how IoT and the cloud/fog-edge computing can be utilized for advancing the reliability, transparency, and fault detection in processes within a smart transport and logistics system. The method is designed to contribute to the integrated use of different logistics modes in order to support decision-making and transparency for enterprises. The main focus is to detect how the envisioned system can ultimately provide an enhanced quality of service and integration of logistic shipments. The doctoral plan outlines five contributions that will lead towards integration of the logistics processes in a logistics setting. The first contribution is a taxonomy of functional and non-functional requirements that can be utilized for designing a new IoT platform for transport and logistics. The second contribution examines the cloud/fog-edge computing paradigm by considering existing IoT resource management techniques. The third contribution provides a holistic view of the structure and systems required for embedding the cloud/fog-edge paradigm in a specific demonstration. This conceptual blueprint aligns organizational needs for such system by using an enterprise architecture model. The fourth contribution combines previous results in a smart transport and logistics blueprint. The fifth contribution evaluates how a ML framework can be used to improve the alert detection, and quality of shipments based on the cloud/fog-edge paradigm.

AimsThe aim of this study was to understand the impact of optical coherence tomography (OCT)-detected thin-cap fibroatheroma (TCFA) on clinical outcomes of diabetes mellitus (DM) patients with fractional flow reserve (FFR)-negative lesions.Methods and resultsCOMBINE OCT-FFR study was a prospective, double-blind, international, natural history study. After FFR assessment, and revascularization of FFR-positive lesions, patients with ≥1 FFR-negative lesions (target lesions) were classified in two groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint compared FFR-negative TCFA-positive patients with FFR-negative TCFA-negative patients for a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization or unstable angina requiring hospitalization at 18 months. Among 550 patients enrolled, 390 (81%) patients had ≥1 FFR-negative lesions. Among FFR-negative patients, 98 (25%) were TCFA positive and 292 (75%) were TCFA negative. The incidence of the primary endpoint was 13.3% and 3.1% in TCFA-positive vs. TCFA-negative groups, respectively (hazard ratio 4.65; 95% confidence interval, 1.99–10.89; P ConclusionsAmong DM patients with ≥1 FFR-negative lesions, TCFA-positive patients represented 25% of this population and were associated with a five-fold higher rate of MACE despite the absence of ischaemia. This discrepancy between the impact of vulnerable plaque and ischaemia on future adverse events may represent a paradigm shift for coronary artery disease risk stratification in DM patients.

The dynamic response of the host structure to a high-frequency actuation is usually used for the detection of tiny damage in structures in the form of breathing crack. The simulation of the microcrack’s effect on the response is essential for several damage identification targets. The conventional finite element method suffers from very small mesh size requirements to address the high-frequency problems, resulting in very large mass and stiffness matrices. In this study, the scaled boundary finite element method was applied to model different schemes of structural health monitoring of a structure with breathing cracks based on high-frequency vibration. The scaled boundary finite element method discretizes only the boundary of the model and thus substantially reduces the size of structural matrices. The node-to-node contact strategy was introduced to the scaled boundary finite element method to capture the contact problem that occurs during the vibration of the breathing crack. As breathing crack vibration results in some nonlinear effects, the simulation of three phenomena was of interest: higher harmonic generation, frequency shift, and vibro-acoustic modulation. A shooting method was used for efficient time integration and description of the frequency response function in the nonlinear regime. According to the results, the scaled boundary finite element method is of great power, efficiency, and accuracy to treat the contact problems, especially in high-frequency regimes. Moreover, the nonlinear methods provide certain advantages over the linear techniques in the early detection of incipient damage.