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• VGI and SVI integration provide promising tools for human behaviour analysis. • Several spatial quality factors' impact on running and cycling are compared. • Most natural and connectivity factors are positively correlated to running and cycling. • Blue space type and some built environment factors show inconsistent links between the two activities. • Practical design strategies and patterns are translated from the research evidence. Urban blue space offers substantial health benefits by encouraging population physical activity. Despite much evidence on the nature-health nexus, the relationship between blue space and recreational exercises remains under-studied, limiting the realisation of health benefits in blue space design. Using crowdsourced data, including volunteered geographic information and street view image data, this study investigates the associations of blue space quality with recreational running and cycling in Rotterdam, the Netherlands. Results show that recreational exercise levels on street segments vary based on the blue space type and design. Compared to inland canals and rivers, small-scale recreational waterbodies are more conducive to running but not cycling, while both activities tend to cluster around the Nieuwe Maas River. Interestingly, the Water View Index shows a general negative association with both activities after adjusting for the blue space type. Besides the waterbody characteristics, eye-level environmental factors, including higher Green View Index, lower building density, more diverse land use, greater connected street network and fewer traffic elements, are associated with more running and cycling exercises. Results for visual complexity and neighbourhood population composition are mixed depending on the exercise type. These findings are further translated into spatial design patterns for developing exercise-supportive and health-promoting blue spaces. [ABSTRACT FROM AUTHOR]

Urban agriculture is acknowledged as a multifunctional integrated concept capable of delivering various ecosystem services. Design-related empirical research which is regarded as crucial for introducing and exploring the transformation of design knowledge and practice. Despite the growing body of scientific evidence, operational guidelines for this topic are relatively scarce. The primary step in promoting practical value involves reviewing existing design knowledge and transformation status in empirical research. In conjunction with the existing design research findings, research through design is the only way to acquire and test design knowledge. Spatial design is acknowledged as a way to translate theoretical concepts into practical applications. This systematic literature review offers a comprehensive qualitative analysis of urban agriculture, ecosystem services, and design research. Additionally, it utilizes bibliometric visualization tools to clarify existing research gaps and propose reliable solutions. This paper reveals the imbalance of design research in delivering ecosystem services in urban agriculture through the review of 70 selected empirical research articles. The results suggest that the research for design approach is the most prevalent and offers abundant design knowledge. However, the relatively infrequent use of the research through design method obstructs the transition from implicit to explicit design knowledge, resulting in a shortage of available operational guidelines. Consequently, the study proposes a framework for systematic design knowledge of urban agriculture to catalyze the transformation of design knowledge. Finally, we outline the framework's composition and logic and elucidate its role in addressing research gaps. • There are identified gaps in translating knowledge on the design of ecosystem services provided by urban agriculture. • The application of research through design contributes to the transformation of the practical design knowledge. • A theoretical framework is to examine the eligibility of urban agriculture in providing a range of ecosystem services. [ABSTRACT FROM AUTHOR]

• Identification of the research gaps about conserving and developing historic garden in landscape context. • 3 Linkages between landscape approach and historic garden conservation and development. • 11 discourses of applying landscape approach in historic garden conservation and development. • Establishing a landscape framework for the conservation and development of historic garden. Although there have been numerous studies on the heritage attributes, characteristics, and values of the historic garden as a special category of cultural heritage, the question is why a comprehensive review combining mainstream historic garden conservation with ways of understanding the garden in a landscape context has not been conducted. Landscape is an integrative concept that combines physical features and the diversity of functions with social and ecological processes throughout the scales of time and space. Therefore, this landscape context means applying the landscape approach to explore the organic connection between the scale of evolution and the architectonic elements in relation to each other. To elaborate, instead of viewing the garden as an object in one specific temporal-spatial frame, such an approach focuses on the evolution of the site in order to identify persistent structures and other values. The method used in this study involved paper coding as qualitative analysis combined with bibliometric visualization software. We reviewed 162 studies to explore the interconnections between the historic garden and landscape approach. The result is that there are three correspondences between landscape approaches and different stages of the historic garden's conservation and development: studies identifying the historic garden's characteristics using landscape mapping, studies demonstrating historic gardens' conservation based on landscape planning, and studies exploring the potential of development and reuse through landscape design. Finally, we discuss the research gaps and outline an action framework for the conservation and development of heritage gardens in a landscape context. [ABSTRACT FROM AUTHOR]

Numerous studies show the benefits of wilderness to humans and the environment. Therefore, preserving and developing wilderness areas within urban settings are crucial to combat and mitigate challenges like biodiversity decline resulting from urbanization. According to previous studies, human-wilderness interactions can be contradictory, e.g., relaxing while feeling anxious and insecure. How individuals perceive and comprehend intentional urban wilderness, what dimensions contribute to their perceptions, and how these dimensions influence the visitors' perceptions remain to be investigated. Selecting Jiangyangfan Ecological Park (Hangzhou, China) as a survey case, this research investigates if and how people perceive intentionally incorporated and designed urban wilderness and how various dimensions of attributes shape their perceptions. This study identified three dimensions that may contribute to visitors' perceptions of the urban wilderness; namely, cognitive landscape attributes, perceived environmental attributes, and their visitation experience. A mixed-method approach was employed using a questionnaire, mental maps, and environmental behaviour observation as diverse data sources to assess visitors' urban wilderness perceptions and comprehension from the three dimensions. Results indicate a high propensity to visit the park as an urban wilderness. Our findings also revealed that visitors' perceptual environmental attributes, e.g., the existence of vegetation and waterbodies and encounters with wild animals, as well as their visit experiences, e.g., their satisfaction with the visit and their motivation for experiencing nature, significantly influence their perceptions. In contrast, prior knowledge and experience-based cognition of urban wilderness attributes showed no significant influence on their perceptions. Moreover, attributes like plant diversity, water visibility, and plant density emerged as critical factors shaping visitors' perceptions. These findings underscore the importance of considering visitors' on-site perception of environmental attributes and actual visit experience when assessing the value and acceptability of urban wilderness areas. Future implications of this study for urban wilderness planning and management were also discussed. • Study combines questionnaire, mental maps, and behavioural observation. • Results indicate visitors' great willingness to experience the urban wilderness. • Physical environmental attributes strongly influence urban wilderness perceptions. • Prior experience insignificantly influences urban wilderness perceptions. • Plant diversity, water bodies, and plant density critically shape perceptions. [ABSTRACT FROM AUTHOR]

What are the views of patients, close relatives and healthcare professionals on physical activity behaviour in hospital care? A meta-ethnographic synthesis of qualitative studies was conducted with a lines-of-argument analysis. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. The lines of argument were synthesised and mapped in an existing theoretical model. The confidence of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Eleven studies were included and provided data from 290 participants (145 patients, 0 close relatives and 145 healthcare professionals). We have synthesised six lines of argument that explained the (intention of) physical activity behaviour of patients during their hospital stay: patients and healthcare professionals perceive benefits and risks of physical activity for patients' health (high confidence); physical activity gives a sense of freedom, confidence in recovery and mental wellbeing (high confidence); all healthcare professionals should offer timely and tailored physical activity promotion (high confidence); patient motivation to be physically active may be contingent upon encouragement (moderate confidence); family members can influence physical activity behaviour favourably or unfavourably (low confidence); and hospital culture has a negative influence on physical activity behaviour of patients (high confidence). Physical activity behaviour of patients during their hospital stay is a complex phenomenon with multiple interactions at the level of patients, healthcare professionals and hospital culture. Considering the results of this synthesis, multifaceted implementation strategies are needed to improve physical activity intention and behaviour of patients during their hospital stay. [ABSTRACT FROM AUTHOR]

Background: Vancomycin-resistant enterococci (VRE), particularly Enterococcus faecium (VREfm), can cause serious nosocomial infections, and have been responsible for healthcare-associated outbreaks. Spreading of VREfm can occur both clonally and by the dissemination of mobile genetic elements.Aim: To report prospective analysis of whole-genome sequencing (WGS) data, including both core-genome multi-locus sequence typing (cgMLST) and transposon analysis, during a vanB VREfm outbreak.Methods: Screening for vanB-positive VREfm isolates was performed by real-time polymerase chain reaction (PCR) on an overnight enriched broth and, if positive, subculture was performed. vanB-positive VREfm isolates underwent WGS. Generated data were used for molecular typing that was performed by cgMLST using SeqSphere. For transposon characterization, sequence data were mapped against the reference sequence of transposon Tn1549 using CLC Genomics Workbench, or de-novo assemblies were used for BLASTN comparisons.Results: In total, 1358 real-time PCRs were performed. Two hundred and fifty-one specimens from 207 patients tested positive on PCR for vanB, of which 13 specimens obtained from six patients were identified as vanB VREfm positive on culture. These six patients harboured seven unique isolates belonging to four cluster types: CT118 (N=2), CT2483 (N=3), CT2500 (N=1) and CT2501 (N=1). Transposon analysis revealed the presence of an identical vanB-carrying transposon in the isolates cultured from all six patients that could be linked based on epidemiological data.Conclusion: A vanB VREfm outbreak occurred in the study hospital, including six patients with isolates belonging to four cluster types. In-depth transposon analysis revealed that dissemination of transposon Tn1549 rather than clonal spread was the cause of the outbreak. [ABSTRACT FROM AUTHOR]

Identification of factors associated with achalasia treatment outcome might help physicians select therapies based on patient characteristics. We performed a systematic review and meta-analysis to identify factors associated with treatment response. We searched MEDLINE, EMBASE, and the Cochrane Library through February 21, 2019, for randomized controlled trials and cohort, case–control, and cross-sectional studies that reported patient-specific outcomes of treatment (botulinum toxin injection, pneumatic dilation, peroral endoscopic myotomy, or laparoscopic Heller myotomy). We assessed the methodologic quality of the included studies using the quality in prognosis studies tool. We planned qualitative and quantitative analyses. We analyzed data from 75 studies (8 randomized controlled trials, 27 prospective cohort studies, and 40 retrospective studies) on a total of 34 different factors associated with outcomes (3 demographic, 17 clinical, and 14 diagnostic factors). Qualitative assessment showed age, manometric subtype, and presence of a sigmoid-shaped esophagus as factors associated with outcomes of treatment for achalasia with a strong level of evidence. The cumulative evidence for the association with chest pain, symptom severity, and lower esophageal sphincter pressure was inconclusive. A meta-analysis confirmed that older age (mean difference, 7.9 y; 95% CI, 1.5–14.3 y) and manometric subtype 3 (odds ratio, 7.1; 95% CI, 4.1–12.4) were associated with clinical response. In a systematic review and meta-analysis, we found age and manometric subtype to be associated with outcomes of treatment for achalasia. This information should be used to guide treatment decisions. [ABSTRACT FROM AUTHOR]

Patients with a primary melanoma below the knee may have lymphatic drainage to a sentinel node (SN) in the popliteal fossa. The purpose of this study was to analyze lymphatic drainage to this site and to describe clinical features and surgical management of SNs in the popliteal fossa. Patients with a primary melanoma below the knee presenting to Melanoma Institute Australia between 1992 and 2013 were analyzed. Those found to have a popliteal SN were evaluated. Data on imaging, SN biopsy, completion lymph node dissection, morbidity and follow-up were analyzed. Lymphoscintigraphy showed drainage to a popliteal SN in 176 of 3902 cases of melanoma below the knee (4.5%). In 96 of these patients (55%) a popliteal SN biopsy was attempted. The procedure failed to identify the node(s) in seventeen of them (18%). Thirteen of the 79 patients (17%) had a positive popliteal SN and in eight (10%) this was the only positive node. The tumor stage of ten patients (13%) changed as a result of the popliteal node biopsy. A positive popliteal node was associated with an increased risk of recurrence and diminished overall survival. Popliteal SN biopsy did not improve regional control or survival. Melanomas below the knee infrequently drain to lymph nodes in the popliteal fossa. Although popliteal SN biopsy can be challenging, it is worthwhile, providing improved staging and guiding subsequent management. [ABSTRACT FROM AUTHOR]

Background: Haemodialysis is a risk factor for hepatitis C virus (HCV) transmission. Two patients receiving haemodialysis in a Dutch dialysis unit in The Hague were found to seroconvert to HCV in December 2016 after the yearly routine control for blood-borne viruses. Following the presumed time of infection, three chronically infected HCV patients were identified as possible index cases.Aim: To confirm inter-patient transmission and to identify the source.Methods: Molecular investigation and review of medical records were performed.Findings: Both of the incident cases and one of the three possible index cases were demonstrated to be infected with HCV genotype 2b based on 5'UTR sequencing. Epidemiological relatedness between these viruses was further investigated by sequencing of the NS5A region. Phylogenetic analysis clearly identified the incident cases and the index case to represent a cluster distinct from unrelated controls with HCV genotype 2b. Detailed review of the medical records identified two possible incidents that might have resulted in the HCV transmission cases: contamination of the venous pressure-sensing port due to high venous pressures or incomplete compliance with infection control precautions of the unit staff during handling of two incidents, that occurred at the same time in a single haemodialysis session with the index patient as well as both incident cases present.Conclusion: This study demonstrates that detailed incident recording in combination with state-of-the-art molecular investigations such as sequencing of the NS5A region resulted in unravelling a set of two HCV transmissions that occurred at a haemodialysis unit. [ABSTRACT FROM AUTHOR]

In large parts of the northern hemisphere, multiple deer species coexist, and management actions can strongly influence wild deer communities. Such changes may also indirectly influence other species in the community, such as small mammals and birds, because deer can have strong effects on their habitats and resources. Deer, small mammals and birds play an important role in the dynamics of tick-borne zoonotic diseases. It is, however, relatively underexplored how the abundance and composition of vertebrate communities may affect the outbreak potential, maintenance and circulation of tick-borne pathogens. In this study we focus on the outbreak potential by exploring how the basic reproduction number R 0 for different tick-borne pathogens depends on host community composition. We used published data on co-varying roe deer (Capreolus capreolus) and fallow deer (Dama dama) densities following a hunting ban, and different small mammal and bird densities, to investigate how the change in host community influences the R 0 of four tick-borne pathogens: one non-zoonotic, namely Anaplasma phagocytophilum ecotype 2, and three zoonotic, namely A. phagocytophilum ecotype 1, Borrelia afzelii and Borrelia garinii. We calculated R 0 using a next generation matrix approach, and used elasticities to quantify the contributions to R 0 of the different groups of host species. The value of R 0 for A. phagocytophilum ecotype 1 was higher with high fallow deer density and low roe deer density, while it was the other way round for A. phagocytophilum ecotype 2. For B. afzelii, R 0 was mostly related to the density of small mammals and for B. garinii it was mostly determined by bird density. Our results show that the effect of species composition is substantial in the outbreak potential of tick-borne pathogens. This implies that also management actions that change this composition, can (indirectly and unintentionally) affect the outbreak potential of tick-borne diseases. [ABSTRACT FROM AUTHOR]

Historic gardens, regarded as a significant genre of cultural heritage, encapsulate the enduring essence of bygone eras while concurrently transcending temporal boundaries to resonate with the present and future. These gardens provide us vitality and inspiration, holding a collective repository of human memory and serving as a testament to our shared heritage. However, like landscapes, gardens constantly change through natural processes and human interventions. How can we preserve these gardens, though changes are unavoidable? Spatial and visual characteristics are the gardens' essential characteristics, and point-cloud (LiDAR) technologies are powerful tools to reveal and analyze gardens' spatial-visual relationships and characteristics. Therefore, this paper aims to present a point-cloud-based approach to identifying spatial-visual design principles and making them operational to protect and develop historic gardens. Additionally, several methods have been proposed in this research, including (a) a voxel-based method to transfer points into a solid model for GIS-based computation, (b) a novel method to analyze the field of view (FOV), and (c) a systemic framework to reveal historic gardens' spatial-visual characteristics based on the voxelized model. Jichang Garden, a historic garden in Wuxi, China, known for its visual design and spatial arrangement, has been selected as a case study to showcase how to apply the methods proposed by this paper. The findings include the design principles for the water body, the arrangement for a route, and the planting strategies of the garden. The conservational strategies have been formed based on the findings, and the appliable potentials and limitations of the methods have also been discussed. • Establishing spatial-visual characteristics analysis framework using point-cloud data for historic gardens. • Using Jichang Garden as an example, its spatial characteristics have been revealed. • Forming the preserving strategies for Jichang Garden. [ABSTRACT FROM AUTHOR]

• Eight practical methods are provided to describe blue spaces' accessibility and visibility. • Three space scales are proposed to classify and understand eight practical methods. • Rotterdam cases are used to show applications of blue exposure-describing methods. • Identifying the potential of blue exposure-describing methods to aid spatial design. • Offering method selection basis and integration flowchart for cross-scale practices. Water, a vital element of human existence, shapes cities and benefits human health through daily exposure. This study delves into advanced digital methods to describe blue space exposure effectively, aiming to optimise spatial accessibility and visibility of water for designing sustainable healthy urban environments. Rotterdam is utilised as a test case, demonstrating the role of these methods in evaluating the performance of blue space exposure in urban environments, specifically in terms of spatial morphology and physical characteristics. Eight distinct methods are discussed, addressing exposure type, scale levels, and design interactions, subsequently offering a novel flowchart for their integration into cross-scale spatial design and policymaking. The findings underscore the need to select appropriate methods to analyse and optimise blue exposure in spatial planning or design assignments. The selection should be based on design intentions and data availability. The biggest potential is found in combining these methods to handle the complexity of urban issues. The research reveals the importance of blue space accessibility and visibility in promoting sustainable healthy urban environments while also emphasising the need to go beyond them, factoring in the quality, function, and usage of blue spaces. [ABSTRACT FROM AUTHOR]

Abstract Introduction One-year mortality after hospital discharge is higher among older patients with colorectal cancer who underwent surgery compared to younger patients. Taking care of older adults with multi-morbidity is often fragmented with lack of coordination and information exchange between healthcare professionals. The aim of this study was to evaluate emerging health problems and quality of life after implementing a standardized shared-care model. Material and Methods 141 patients aged ≥70 years who underwent surgery for colorectal carcinoma in two hospitals were included. A standardized transmission from hospital to primary care was set up. Patients' health status and quality of life was evaluated during subsequent follow-up moments. Results A reduction in one-year mortality rate from 10.9% to 9.2% was observed after implementation of the standardized shared-care model. Almost all health status domains improved to 'good' during follow-up moments, still the general condition remained poor in 26% of patients at week fourteen. Although quality of life improved during subsequent follow-up moments, fatigue, dyspnoea and insomnia were the most prominent persisting problems at the end of follow-up. Discussion The implementation of a standardized shared-care model for older patients after surgery for colorectal cancer resulted in a reduction in the one year mortality rate. Although most aspects of both health status and quality of life improved during subsequent follow-up moments, especially the general condition remained poor for a long time after surgery. This means that, besides a good preoperative counseling of patients, future research should focus on possible interventions to improve general condition. [ABSTRACT FROM AUTHOR]

Electronic fetal heart rate (FHR) monitoring is widely used to assess fetal well-being throughout pregnancy and labor. Both antenatal and intrapartum FHR monitoring are associated with a high negative predictive value and a very poor positive predictive value. This in part reflects the physiological resilience of the healthy fetus and the remarkable effectiveness of fetal adaptations to even severe challenges. In this way, the majority of "abnormal" FHR patterns in fact reflect a fetus' appropriate adaptive responses to adverse in utero conditions. Understanding the physiology of these adaptations, how they are reflected in the FHR trace and in what conditions they can fail is therefore critical to appreciating both the potential uses and limitations of electronic FHR monitoring. [ABSTRACT FROM AUTHOR]

[Display omitted] • A scenario-based framework is proposed to rank infrastructure spatial designs. • A coupled model assesses flood performance in spatiotemporal scales. • A dynamic multi-criteria decision-making method considers temporal indicators. • Waterway connectivity and green space redundancy improve flood resilience. • Waterway storage improvement outperforms green space runoff reduction at source. Flood resilience has aroused significant interest in coastal areas dealing with a growing frequency of severe rainstorms caused by climate change and urbanisation. At the core of flood resilience is the development of a resilient green-grey-blue infrastructure system that can resist, absorb, and recover from floods in a timely manner. Current flood resilience research, however, is limited to evaluating single infrastructure systems, failing to examine the dynamic process or find ideal spatial infrastructure designs for decision-makers. This research proposes a scenario-based assessment framework for integrated green-grey-blue infrastructure systems to improve flood resilience during urban design decision-making. Rainfall-runoff, drainage networks, and river system models are interlinked to provide quantitative simulation evaluations of water quantity and urban impact in various spatial organisations of infrastructure design. A dynamic, multi-criteria decision-making process is used to reveal the importance of five temporal indicators and rank design alternatives. In Guangzhou, China, the efficiency of this architecture is demonstrated on Pazhou Island, a typical river network area. Given the limited water and green space available, the results demonstrate that submerged areas exert a greater influence during peak rainfall, and blue infrastructure storage becomes an essential factor following rainfall. Furthermore, from a spatial perspective, the looped network of green-blue infrastructure enhances flood resilience, and downstream waterway connections and green space-aligned waterways boost the water storage capacity of green-grey-blue infrastructure. This paradigm can improve flood resilience in the Greater Bay Area in the future, especially in response to heavy rainstorms and river floods. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to describe common clinical practices of manual therapists (MTs) in the Netherlands for infants with indications of upper cervical dysfunction (UCD). Methods A prospective observational cohort study was conducted to gain insight into characteristics, reasons for seeking care, and common clinical practice for infants (<27 weeks) with indications of UCD, referred to MTs. Pre- and posttreatment self-reported questionnaires were used to collect data from parents and MTs. Parents reported on infant characteristics and perceived effect of treatment. Manual therapists reported on diagnostics, therapeutic procedures, and outcomes. Results Between 2006 and 2007, data regarding 307 referred infants (mean age: 11.2 weeks) were collected by parents and 42 MTs. The most frequent reasons for seeking care were positional preference, restlessness, and/or abnormal head position. Manual therapists observed active, spontaneous, and provoked mobility and passive upper cervical mobility. Of the 307 infants, 295 were diagnosed with UCD based on positive outcomes on the flexion-rotation test and/or lateral flexion test. After treatment with mobilization techniques, positive outcomes on the flexion-rotation test decreased from 78.8% to 6.8%. For the lateral flexion test, the positive outcomes decreased from 91.5% to 6.2%. All parents perceived positive treatment effects. No serious adverse events were reported during this study. Conclusions This is the first study to describe common clinical practice for infants referred for manual therapy. Infants with UCD were treated mainly with upper cervical mobilization techniques, and the greatest perceived effect was observed after approximately 2 treatment sessions. [ABSTRACT FROM AUTHOR]

Study Design Systematic review Purpose of the Study The purpose was to review the available literature for evidence on the reliability and measurement error of protractor-based goniometry assessment of the finger joints. Methods Databases were searched for articles with key words “hand,” “goniometry,” “reliability,” and derivatives of these terms. Assessment of the methodological quality was carried out using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. Two independent reviewers performed a best evidence synthesis based on criteria proposed by Terwee et al (2007). Results Fifteen articles were included. One article was of fair methodological quality, and 14 articles were of poor methodological quality. An acceptable level for reliability (intraclass correlation coefficient > 0.70 or Pearson's correlation > 0.80) was reported in 1 study of fair methodological quality and in 8 articles of low methodological quality. Because the minimal important change was not calculated in the articles, there was an unknown level of evidence for the measurement error. Discussion Further research with adequate sample sizes should focus on reference outcomes for different patient groups. For valid therapy evaluation, it is important to know if the change in range of motion reflects a real change of the patient or if this is due to the measurement error of the goniometer. Until now, there is insufficient evidence to establish this cut-off point (the smallest detectable change). Conclusion Following the Consensus-Based Standards for the Selection of Health Measurement Instruments criteria, there was limited level of evidence for an acceptable reliability in the dorsal measurement method and unknown level of evidence for the measurement error. Level of Evidence 2a [ABSTRACT FROM AUTHOR]

This study aims to describe how the Illness Management and Recovery program enhanced recovery of persons with schizophrenia and other psychotic disorders from their own perspective. Participants valued learning how to divide huge goals into attainable steps, how to recognize and prevent a relapse by managing symptoms, practicing skills, and talking openly about illness related experience. They learned from the exchange with peers and from the information in the IMR textbook. Nurses should have continuous attention and reinforcement for progress on goals, skills practice and exchange of peer information. A peer-support specialist can contribute to keep this focus. [ABSTRACT FROM AUTHOR]

Objectives To describe data of short- and midterm results of hip arthroscopy patients based on patient-reported hip function, hip functional performance and return to sports activities. Design Observational cohort study. Setting Sports medical center. Participants 37 recreational athletes (21 men) at least six months after finishing rehabilitation for hip arthroscopy. Main outcome measures International Hip Outcome Tool 33 (IHOT-33), Pain Visual Analogue Scale (VAS), Global Perceived Effect Scale (GPE), sports questionnaires and hip functional performance tests. Results At a mean follow-up time of 2.3 years, 81% of participants reported improvement on the GPE and 84% returned to sports activities. The mean IHOT-33 score was 69.3; the mean VAS score was 35.0. Range of motion (ROM) and strength were within the 90% Limb Symmetry Index (LSI) limit, except for hip internal rotation ROM. A full recovery of hip functional performance, as measured with balance and hop tests, was established based on the 90% LSI limit. Conclusions The overall short- and midterm results of these follow-up data show good recovery of hip arthroscopy patients on patient-reported outcomes, functional performance and return to sports activities. The functional performance tests used in this study seem adequate for measuring recovery in hip arthroscopy patients. [ABSTRACT FROM AUTHOR]

Experimental studies have suggested that sleep position plays a role in the occurrence of nocturnal gastroesophageal reflux and the left lateral decubitus position is most favorable. The aim of this study was to evaluate the effect of a novel electronic sleep positional therapy wearable device on sleep position and nocturnal reflux symptoms. We performed a double-blind, randomized, sham-controlled trial in patients with nocturnal symptoms of gastroesophageal reflux. Patients were advised to sleep in the left lateral decubitus position and were assigned randomly (1:1) to an electronic sleep positional therapy wearable device, programmed to either produce a vibration when in the right lateral position (intervention) or only during the first 20 minutes (sham). The primary outcome was treatment success, defined as a 50% or more reduction in the nocturnal reflux score. Secondary outcomes included change in sleep position and reflux symptoms. One hundred patients were randomized. In the intention-to-treat analysis, the rate of treatment success was 44% in the intervention group (22 of 50) vs 24% in the sham group (12 of 50) (risk difference, 20%; 95% CI, 1.8%–38.2%; P =.03). Treatment led to a significant avoidance of sleeping in the right lateral decubitus position (intervention 2.2% vs sham 23.5%; P =.000) and increased time sleeping in the left lateral decubitus position (intervention 60.9% vs sham 38.5%; P =.000). More reflux-free nights were observed in the intervention group (intervention 9 nights [interquartile range, 6–11 nights] vs sham 6 nights [interquartile range, 3–9 nights]; P =.01). Sleep positional therapy using an electronic wearable device promotes sleeping in the left lateral decubitus position and effectively alleviates nocturnal reflux symptoms compared with sham treatment (https://www.trialregister.nl , NL8655). [Display omitted] [ABSTRACT FROM AUTHOR]

Water is a critical element of human existence and has shaped cities for centuries. In urban environments, water provides multiple ecosystem services and is an important element in the design of urban environments. Next to the many qualities and services provided by water, recent research indicates that exposure to freshwater blue space also enhances human health and wellbeing. However, health benefits are often not or implicitly taken into account in the design perspective. This research aims to provide a systematic overview of the available body of knowledge regarding the relationship between freshwater blue space, health, and design. This study first proposes a bi-directional conceptual framework connecting health evidence with design practice. And then, scientometric analysis is employed to review 1338 research articles on freshwater blue-health research. The results show that the number of articles in this area is increasing yearly, attracting more and more disciplines and stimulating interdisciplinary collaboration. Freshwater blue-health research is broadening to emphasize usage and experience, psychological advantages, and particular demographics, which provides a solid basis for future design research. At the same time, it becomes clear that there is a strong demand to develop adaptive design knowledge that integrates the available health evidence and operationalizes it in healthy freshwater blue space design. This paper could help researchers understand the current research progress and future research directions, as well as facilitate multiple applications of health evidence by practitioners. • A conceptual framework linking freshwater blue space design and health is proposed. • Using scientometric analysis reviews the articles on freshwater blue-health research. • The study pointed out three major recent research frontiers. • Three trending topics are identified and discussed relationship with design. • Action research is needed to facilitate knowledge's operability and feasibility. [ABSTRACT FROM AUTHOR]

Purpose To develop and validate a noninvasive ultrasound technique for the longitudinal analysis of functional recovery after segmental peroneal nerve reconstruction in a rabbit model. Methods Twelve male New Zealand White rabbits underwent a 1-cm peroneal nerve autograft reconstruction. Ultrasound measurements were performed before surgery and at 1, 2, 4, 8, 12, and 16 weeks postoperatively. All rabbits were managed with manual restraint for the ultrasound procedure, avoiding the risks of anesthetics. At 12 and 16 weeks, we evaluated functional recovery using compound muscle action potential, isometric tetanic force measurements, wet muscle weight, and nerve histomorphometry. Data were compared with ultrasound measurements by calculating the Pearson correlation coefficient. We determined intra-rater and inter-rater reliability of the ultrasound measurements. Results Ultrasound demonstrated good correlation with isometric tetanic force measurements and wet muscle weight, good correlation with nerve histomorphometry, and moderate correlation with compound muscle action potential. Both intra-rater and inter-rater reliability of the ultrasound technique was excellent. Conclusions Ultrasound analysis of the tibialis anterior muscle provided a reliable method for analysis of functional recovery in a rabbit peroneal nerve reconstruction model. The noninvasive nature allowed for longitudinal follow-up within the same animal and measurement of early recovery without the use of anesthesia. Clinical relevance Application of this noninvasive technique can reduce the variability and sample size necessary in peripheral nerve reconstruction studies and may provide an ideal tool for comparative studies in larger animal models. [ABSTRACT FROM AUTHOR]

Objective To investigate whether ultrasonographic measurement of the cross-sectional area (CSA) of the intrinsic hand muscles can be used to predict muscle strength in a valid and reliable manner, and to determine if this method can be used for follow-up of patients with peripheral nerve injury between the wrist and elbow. Design Repeated-measures cross-sectional study. Setting Clinical and academic hospital. Participants Healthy adults (n=31) and patients with ulnar and median nerve injuries (n=16) between the wrist and elbow who were visiting the Erasmus Medical Center or Maasstad Hospital were included in the study (N=47). Interventions Not applicable. Main Outcome Measures Correlation between measured muscle CSA and strength and assessment of inter- and intrarater reliability. Ultrasound and strength measurements of the intrinsic hand muscles were conducted bilaterally. To establish validity, the CSA of 4 muscles (abductor digiti minimi, first dorsal interosseus, abductor pollicis brevis, opponens pollicis) was compared with strength measurements of the same muscles conducted with the Rotterdam Intrinsic Hand Myometer. Repeated measures were conducted to assess inter- and intrarater reliability. Results The assessed CSA strongly correlated with strength measurements, with correlations ranging from 0.82 to 0.93 in healthy volunteers and from 0.63 to 0.94 in patients. Test-retest reliability showed excellent intrarater reliability (intraclass correlation coefficient range, 0.99–1.00) in patients and volunteers and good interrater reliability (intraclass correlation coefficient range, 0.88–0.95) in healthy volunteers. Conclusions We found that ultrasound is a valid and reliable method to assess the CSA of specific muscles in the hand. Therefore, this technique could be useful to monitor muscle reinnervation in patients suffering from peripheral nerve injury as a valuable addition to strength dynamometers. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to determine the significance of an umbilical artery pH < 7.00 in relation to neonatal morbidity and mortality.Study Design: Between 1986 and 1993 acid-base assessment of the umbilical artery was performed routinely in 10,699 deliveries. In a retrospective cohort study 84 nonanomalous neonates with an umbilical artery pH < 7.00 were individually matched with 84 neonates with an umbilical artery pH > 7.24. Matched variables included year of delivery, gender, parity, maternal age, delivery mode, fetal presentation, gestational age, and birth weight. Differences in morbidity between the two groups during the neonatal period (until 28 days after delivery) were investigated.Results: Neonates with an umbilical artery pH < 7.00 versus > 7.24 showed significant differences in the following: neonatal condition directly post partum; neurologic, respiratory, cardiovascular, and gastrointestinal complications; and neonatal intensive care unit admissions. No significance was found in renal dysfunction and mortality rate. The proportion of premature infants (< 37 weeks) was 17% in both groups. In the acidotic group a 1-minute Apgar score < or = 3 and a 5-minute Apgar score < 7 was predictive for neonatal complications.Conclusions: Severe intrapartum asphyxia, quantified by an umbilical artery pH < 7.00, poses a threat to the neonate's health. [ABSTRACT FROM AUTHOR]

Abstract: The current study examines the enzymatic decomposition of urea into carbon dioxide and ammonia as a means to increase the pH during biomimetic deposition of calcium phospate (CaP) onto implant surfaces. The kinetics of the enzymatically induced pH increase were studied by monitoring pH, calcium concentration and conductivity of the aqueous solutions as a function of time, urease concentration and initial concentrations of calcium and phosphate ions. Cryogenic transmission electron microscopy was used to study the process of homogeneous CaP precipitation in solution, whereas CaP deposition on conventional acid-etched titanium and micropatterned polystyrene (PS) surfaces was studied using scanning electron microscopy. The data presented in this study confirm that the substrate–enzyme combination urea–urease offers strong control over the rate of pH increase by varying the concentrations of precursor salts and urease. Formation of biomimetic CaP coatings was shown to proceed via formation of ionic polymeric assemblies of prenucleation complexes. The process of deposition and corresponding coating morphology was strongly dependent on the concentration of calcium, phosphate and urease. Finally, it was shown that the substrate–enzyme combination urea–urease allowed for spatial distribution of CaP crystals along the grooves of micropatterned PS surfaces at low concentrations of calcium, phosphate and urease, stressing the sensitivity of the presented method. [Copyright &y& Elsevier]

This paper describes large positive cooperative effects of two orders of magnitude in the tunneling rates across molecular junctions of mixed self-assembled monolayers (SAMs) of rectifying (ferrocenyl undecanethiol HS(CH 2) 11 Fc) and non-rectifying molecules with different terminal groups (11-undecanethiol and its derivatives, denoted as HS(CH 2) 11 X, where X = -H, -NH 2 or -NO 2). By gradually diluting the surface fraction of HS(CH 2) 11 Fc in the mixed SAM, it is found that the large positive cooperative effect is only important in the coherent tunneling regime but not in the incoherent tunneling regime. Density functional theory (DFT) shows that the measured cooperative effects in the tunneling rates in these binary systems are caused by Fc---X van der Waals interactions which increase in the order of -H< -NH 2 < -NO 2. These strong cooperative effects dramatically alter the operation of a molecular diode, further highlighting the importance of taking cooperative effects into account, in this case driven by van der Waals interactions, in the rational design of electronic devices working at tunneling regime. [Display omitted] • Cooperative effect could happen when charge passed through the molecular junctions comprising binary SAMs. • Tunneling rates could be controlled over two orders of magnitude by tuning capacitive coupling between molecules of SAMs. • Cooperative effects are solely driven by van der Waals interactions between the terminal groups of binary SAMs. [ABSTRACT FROM AUTHOR]

Abstract: Colloidal gels are a particularly attractive class of hydrogels for applications in regenerative medicine, and allow for a “bottom-up” fabrication of multi-functional biomaterials by employing micro- or nanoscale particles as building blocks to assemble into shape-specific bulk scaffolds. So far, however, the synthesis of colloidal composite gels composed of both organic and inorganic particles has hardly been investigated. The current study has focused on the development of injectable colloidal organic–inorganic composite gels using calcium phosphate (CaP) nanoparticles and gelatin (Gel) nanospheres as building blocks. These novel Gel–CaP colloidal composite gels exhibited a strongly enhanced gel elasticity, shear-thinning and self-healing behavior, and gel stability at high ionic strengths, while chemical – potentially cytotoxic – functionalizations were not necessary to introduce sufficiently strong cohesive interactions. Moreover, it was shown in vitro that osteoconductive CaP nanoparticles can be used as an additional tool to reduce the degradation rate of otherwise fast-degradable gelatin nanospheres and fine-tune the control over the release of growth factors. Finally, it was shown that these colloidal composite gels support attachment, spreading and proliferation of cultured stem cells. Based on these results, it can be concluded that proof-of-principle has been obtained for the design of novel advanced composite materials made of nanoscale particulate building blocks which exhibit great potential for use in regenerative medicine. [Copyright &y& Elsevier]

Abstract: Purpose: To study incidence of local recurrences, postoperative complications and survival, in patients with rectal carcinoma aged 75 years and older, treated with either surgery and pre-operative 5 × 5 Gy radiotherapy or surgery alone. Patients and methods: A random sample of patients aged over 75 years with pT2-T3, N0-2, M0 rectal carcinoma diagnosed between 2002 and 2004 in the Netherlands was included, treated with surgery alone (N = 296) or surgery in combination with pre-operative radiotherapy (N = 346). Information on local recurrent disease, postoperative complications, ECOG-performance score and comorbidity was gathered from the medical files. Results: Local recurrences developed less frequently in patients treated with pre-operative radiotherapy compared to surgery alone (2% vs 6%, p = 0.002). Postoperative complications developed more frequently in irradiated patients (58% vs 42%, p < 0.0001). Especially deep infections (anastomotic leakage, pelvic abscess) were significantly increased in this group (16% vs 10%, p = 0.02). 30-day mortality was equal in both groups (8%). A significant increase in postoperative complication rate and 30-day mortality was only seen in those with “severe comorbidity” compared to patients without comorbidity (respectively 58% and 10% vs 43% and 3%), COPD (59% and 12%), diabetes (60% and 11%) and cerebrovascular disease (62% and 14%). In multivariable analysis, postoperative complications predicted 5-year survival. Conclusion: Elderly patients receiving pre-operative radiotherapy show a lower local recurrence rate. However, as incidence rates of local recurrent disease are low and incidence of postoperative complications is increased in irradiated patients, omitting preoperative RT may be suitable in elderly patients with additional risks for complications or early death. [Copyright &y& Elsevier]

Summary: Background: Psychological symptoms frequently accompany severe injuries of the upper extremities and are described to influence functional outcome. As yet, little knowledge is available about the occurrence of posttraumatic psychological stress and the predictive characteristics of peripheral nerve injuries of the upper extremity for such psychological symptoms. In this prospective study, the incidence of different aspects of early posttraumatic stress in patients with peripheral nerve injury of the forearm is studied as well as the risk factors for the occurrence of early psychological stress. Methods: In a prospective study design, patients with a median, ulnar or combined median–ulnar nerve injury were monitored for posttraumatic psychological stress symptoms with the Impact of Event Scale (IES) questionnaire up to 3 months postoperatively. Results: Psychological stress within the first month after surgery occurred in 91.8% of the population (IES mean = 22.0, standard deviation (SD) = 17.3). Three months postoperatively, 83.3% (IES mean = 13.3, SD = 14.1) experienced psychological stress. One month postoperatively 24.6% and 3 months postoperatively 13.3% of the patients had IES scores indicating for the need for psychological treatment. Female gender, adult age and combined nerve injuries were related to the occurrence of psychological stress symptoms 1 month postoperatively. Conclusions: In the majority of these patients, peripheral nerve injury of the forearm is accompanied by early posttraumatic psychological stress, especially in female adults who suffered from combined nerve injuries. [Copyright &y& Elsevier]

Abstract: Objective: To synthesize patients'' views on the impact of stroke on their roles and self. Data Sources: PubMed, CINAHL, Embase, PsycINFO, and Cochrane searched from inception to September 2010, using a combination of relevant Medical Subject Headings and free-text terms. This search was supplemented by reference tracking. Study Selection: Qualitative studies reporting the views of people poststroke. The search yielded 494 records. Opinion articles, quantitative studies, or those reporting somatic functioning were excluded. Thirty-three studies were included. Data Extraction: Data extraction involved identifying all text presented as “results” or “findings” in the included studies, and importing this into software for the analysis of qualitative data. Data Synthesis: The abstracted text was coded and then subject to a thematic analysis and synthesis, which was discussed and agreed by the research team. Three overarching themes were identified: (1) managing discontinuity is a struggle; (2) regaining roles: to continue or adapt? and (3) context influences management of roles and self. Regaining valued roles and self was an ongoing struggle, and discontinuity and uncertainty were central to the adjustment process after stroke. Conclusions: The thematic synthesis provides new insights into the poststroke experience. Regaining or developing a new self and roles was problematic. Interventions targeted at self-management should be focused on the recognition of this problem and included in rehabilitation, to facilitate adjustment and continuity as far as possible in life poststroke. [Copyright &y& Elsevier]

Abstract: Background/Purpose: The objective of this study was to evaluate the long-term functional and motor development and abdominal muscle quantity in children operated on for giant omphalocele (GOC) with the Component Separation Technique (CST). Methods: Between 2004 and 2007, CST was applied in eleven consecutive infants with GOC. Eight underwent ultrasound of the abdominal wall and muscles, assessment of functional and motor development using the Movement Assessment Battery for Children, 2nd Edition (M-ABC-2), and an observational physical examination focused on possible abnormalities in stature and movements related to GOC. Findings were compared with those in age-matched controls. The parents filled in a questionnaire on the children‘s functioning in daily life. Results: The mean age at evaluation was 71 months (range, 42–141 months) with a median time of follow-up of 54 months (range, 38–84 months). Ultrasound of the abdominal wall muscles showed normal muscle thickness. In seven of the eight children, a rectus diastasis was seen without any protrusion. The MABC-2 was within the normal range, and stature and motor coordination did not differ from those in controls. Conclusions: After 4.5 years, these children show normal thickness of all abdominal wall muscles and motor function within the normal range, despite a rectus diastasis. The CST seems to be a promising closure technique for GOC. [Copyright &y& Elsevier]

Summary: Object: The gold standard for reconstructing large nerve defects, the nerve autograft, results in donor-site morbidity. This detrimental consequence drives the search for alternatives. We used a vein filled with a small piece of fresh muscle to prevent the vein from collapsing and with bone marrow stromal cells (BMSCs) to enhance regeneration. Methods: In 60 rats, a 15-mm sciatic nerve defect was bridged with a nerve autograft, a vein filled with muscle or a vein filled with muscle and BMSCs. Toe spread and pinprick were used to evaluate motor and sensory function. Compound muscle action potentials (CMAPs) and the gastrocnemius muscle index (GMI) were recorded to assess conduction properties and denervation atrophy. Extensive histology was performed to confirm presence of BMSCs and to evaluate regeneration by staining neural tissue for Schwann cells and neural growth factor. Results: After 12 weeks, all animals responded with toe spread and pinprick reaction; significant differences were found between groups. Six weeks post grafting no difference was found comparing the GMI between the groups. Group I had a significant increase in GMI at 12 weeks compared to group II and group III. The CMAP measurements showed comparable results at 6 weeks post grafting. Twelve weeks after reconstruction, group I had significantly better results compared to group II and group III. Group III showed a tendency to outperform group II at 12 weeks postoperatively. Immunofluorescence analysis showed an increased number of Schwann cells in group III compared to group II. The BMSCs were visible 6 and 12 weeks postoperatively. Conclusions: This study is a step forward in the search for an alternative to the nerve autograft because it demonstrates the beneficial effect of BMSCs to a conduit. However, our data do not demonstrate sufficient benefit to warrant clinical implementation at this stage. [Copyright &y& Elsevier]

Abstract: Fast Cycled Superconducting Magnets (FCM''s) are an option of interest for the long-term consolidation and upgrade plan of the LHC accelerator complex. The economical advantage of FCM''s in the range of 2 T bore field, continuously cycled at 0.5Hz repetition rate, depends critically on the AC loss property of strand and cable. In this paper we report the results of the AC loss measurements that we have performed both on strands and cables manufactured for the CERN FCM prototype program. [Copyright &y& Elsevier]

Abstract: Objective: to explores preferences, characteristics and motives regarding place of birth of low-risk nulliparous women in the Netherlands. Design: a prospective cohort study of low-risk nulliparous women and their partners starting their pregnancy in midwifery-led care or in obstetric-led care. Data were collected using a self-administered questionnaire, including questions on demographic, psychosocial and pregnancy factors and statements about motives with regard to place of birth. Depression, worry and self-esteem were explored using the Edinburgh Depression Scale (EDS), the Cambridge Worry Scale (CWS) and the Rosenberg Self Esteem Scale (RSE). Setting: participants were recruited in 100 independent midwifery practices and 14 hospitals from 2007 to 2011. Participants: 550 low-risk nulliparous women; 231 women preferred a home birth, 170 women a hospital birth in midwifery-led care and 149 women a birth in obstetric-led care. Findings: Significant differences in characteristics were found in the group who preferred a birth in obstetric-led care compared to the two groups who preferred midwifery-led care. Those women were older (F (2,551)=16.14, p<0.001), had a higher family income (χ 2 (6)=18.87, p=0.004), were more frequently pregnant after assisted reproduction (χ 2(2)=35.90, p<0.001) and had a higher rate of previous miscarriage (χ 2(2)=25.96, p<0.001). They also differed significantly on a few emotional aspects: more women in obstetric-led care had symptoms of a major depressive disorder (χ 2(2)=6.54, p=0.038) and were worried about health issues (F (2,410)=8.90, p<0.001). Women''s choice for a home birth is driven by a desire for greater personal autonomy, whereas women''s choice for a hospital birth is driven by a desire to feel safe and control risks. Key conclusions: the characteristics of women who prefer a hospital birth are different than the characteristics of women who prefer a home birth. It appears that for women preferring a hospital birth, the assumed safety of the hospital is more important than type of care provider. This brings up the question whether women are fully aware of the possibilities of maternity care services. Women might need concrete information about the availability and the characteristics of the services within the maternity care system and the risks and benefits associated with either setting, in order to make an informed choice where to give birth. [Copyright &y& Elsevier]

Abstract: International cooperation initiatives often focus on the development of curricula to increase the quality of education in developing countries. Through the adoption of a culturally sensitive approach, effective conditions for curriculum development can be created. Nevertheless, aid organizations and international project teams frequently lack cultural understanding to create conditions related to ownership and adequate project management. Consequently, misunderstandings and conflicts between project members and with stakeholders occur, which can lead to curriculum implementation failures and unsuccessful educational reform initiatives. This paper outlines a case study which aimed to identify how conditions supporting the development of a professional development program for polytechnic Heads of Department in Ghana, were sensitive to culture. A conceptual framework for culturally sensitive curriculum development was used to facilitate the identification of culture in conditions related to Creation of ownership and Project management. Project members from Ghana and The Netherlands participated in the data collection by means of documents, interviews, and a researcher''s logbook. Results showed that the creation of stakeholders’ involvement, partnership between project team members, and the management of project resources, budget and time were impacted by Hofstede''s cultural dimensions of High-Low Power Distance and Collectivism–Individualism and by Hall''s cultural dimensions High-Low Context and Polytime-Monotime. By developing different types of culturally sensitive strategies, the project team anticipated on culture to strengthen the conditions for curriculum development, but culture remained challenging to cope with. [Copyright &y& Elsevier]

Abstract: Goals and objectives: Necrotizing fasciitis is a serious disease entity, with only limited pathognomic features. Purpose: In necrotizing fasciitis a rapid diagnosis is necessary in order to reduce morbidity and mortality. In this study the investigation focused on specific features in the frozen section biopsy for diagnosing necrotizing fasciitis. Methods: A total of ten patients are described with final pathological examination of resected tissue. Results: A new grading system is suggested for frozen section biopsy in patients with necrotizing fasciitis. In the herein reported study it was found that granulocytes were present in both the frozen section biopsy and in the definitive paraffin coupes, in the subcutis and fascia layer. Conclusion: Frozen section biopsy could be useful in diagnosing necrotizing fasciitis. [Copyright &y& Elsevier]

Summary: Extended-spectrum beta-lactamase (ESBL) genes are distributed worldwide and their epidemiology is complex. Using the Check-ESBL assay, the distribution of class A ESBL genes in clinical isolates of aerobic Gram-negative bacilli from three laboratories in the East of The Netherlands was determined. Four patient categories were distinguished: (i) patients admitted to an intensive care unit (ICU); (ii) non-ICU inpatients; (iii) outpatients admitted less than a year before collection of the isolate, (<1); (iv) outpatients admitted more than one-year prior to isolate collection or who had never been hospitalized (>1). From February 2009 until March 2010, out of 491 putative ESBL-positive isolates detected by the Vitek2 or Phoenix automated sensitivity testing systems, ESBL genes were detected in 247 (50.3%) by the Check–ESBL assay. Of these, 116 were from hospitalized patients (35 ICU, 81 non-ICU) and 131 were from outpatients (43 <1, 88 >1). In all, 274 ESBL genes were identified in these 247 isolates: 153 CTX-M-1 group (predominantly in E. coli and K. pneumoniae, 70.4% and 51.6% respectively), 67 CTX-M-9 group (predominantly in E. cloacae, 57.9%), 32 SHV, 14 TEM and 8 CTX-M-2 group. ESBL-producing E. cloacae were significantly more common in hospitalized patients than in outpatients, 20.7% and 3.8% respectively (P =0.001). CTX-M-9 group ESBLs were significantly more prevalent in ICU patients (P =0.003), whereas SHV ESBLs were more common in hospitalized patients than in outpatients (P <0.001). There was no significant difference in distribution of ESBL genes between the two outpatient groups. [ABSTRACT FROM AUTHOR]

Purpose: It is often assumed that cold intolerance is associated with abnormalities in the skin temperature due to changes in the blood flow of the hands. In this study, we determined whether patients with and without cold intolerance after a hand fracture or healthy controls have a diminished rewarming after a cold stimulus. Methods: The severity of cold intolerance was evaluated using the Cold Intolerance Symptom Severity (CISS) questionnaire. To determine whether abnormal rewarming plays a major role in the underlying pathophysiology of cold intolerance, a cold-stress test was applied at a mean of 30 months (with a range of 11 mo) after the patients recovered from a hand fracture. A control group also underwent identical cold-stress testing for comparison. Temperature during the rewarming phase was measured using videothermography. Results: Thirteen control subjects and 18 patients participated. Control subjects did not report any symptoms of cold intolerance (CISS score, 0) and no loss of sensibility was measured. The mean CISS score of all patients was 27.8; 9 patients scored above the cut-off value for normal cold intolerance. No significant differences were found in the rewarming patterns between (1) the affected and non-affected hand of the postfracture patients, (2) the dominant and non-dominant hand of the control subjects, and (3) the patients and controls. Conclusions: The results of this study revealed no relation between the severity of cold intolerance and rewarming patterns after cold stress testing. This might suggest that temperature regulation of the hands in post-fracture patients might not be responsible for the symptoms of cold intolerance, based on cold-stress test response. Type of study/level of evidence: Prognostic II. [ABSTRACT FROM AUTHOR]

Abstract: Background: The low-grade inflammatory condition present in morbid obesity is thought to play a causative role in the pathophysiology of insulin resistance (IR). Bariatric surgery fails to improve this inflammatory condition during the first months after surgery. Considering the close relation between inflammation and IR, we conducted a study in which insulin sensitivity was measured during the first months after bariatric surgery. Different methods to measure IR shortly after bariatric surgery have given inconsistent data. For example, the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels have been reported to decrease rapidly after bariatric surgery, although clamp techniques have shown sustained insulin resistance. In the present study, we evaluated the use of steady-state plasma glucose (SSPG) levels to assess insulin sensitivity 2 months after bariatric surgery. Methods: Insulin sensitivity was measured using HOMA-IR and SSPG levels in 11 subjects before surgery and at 26% excess weight loss (approximately 2 months after restrictive bariatric surgery). Results: The SSPG levels after 26% excess weight loss did not differ from the SSPG levels before surgery (14.3 ± 5.4 versus 14.4 ± 2.7 mmol/L). In contrast, the HOMA-IR values had decreased significantly (3.59 ± 1.99 versus 2.09 ± 1.02). Conclusion: During the first months after restrictive bariatric surgery, we observed a discrepancy between the HOMA-IR and SSPG levels. In contrast to the HOMA-IR values, the SSPG levels had not improved, which could be explained by the ongoing inflammatory state after bariatric surgery. These results suggest that during the first months after restrictive bariatric surgery, HOMA-IR might not be an adequate marker of insulin sensitivity. [Copyright &y& Elsevier]

Abstract: Four Gram-negative bacterial strains, recovered from clay soils cultivated with different crops in the Netherland, were subjected to a polyphasic taxonomic study in order to clarify their taxonomic status. Comparative analysis of the 16S rRNA gene sequences revealed that they belong to the genus Lysobacter and to be highly related to the type strains of L. antibioticus DSM 2044T, L. gummosus DSM 6980T, and L. capsici DSM 19286T, displaying 99.1–99.3%, 99.2–99.6% and 99.4–100% sequence similarities, respectively, to these species. The results of DNA–DNA hybridization studies unambigiously indicated that the four strains belonged to the species L. capsici. Nevertheless, DNA fingerprinting and phenotypic characterization indicated that there was a considerable diversification and niche differentiation among the strains belonging to L. capsici. The newly identified L. capsici strains strongly inhibit Rhizoctonia solani AG2 and originate from Rhizoctonia-suppressive soils where also populations of L. antibioticus and L. gummosus were present. This is the first report of the presence of combined populations of closely related Lysobacter spp. within agricultural soils. [Copyright &y& Elsevier]

Abstract: Background: Spina bifida is a complex neuroembryological disorder resulting from incomplete closure of the posterior neural tube. Morbidity in the different fields of motor and cognitive neurodevelopment is variable in nature and severity, and often hard to predict. Aims: The current study investigates the relationship between cognitive functioning, fine motor performance and motor quality in children with spina bifida myelomeningocele (SBM) and SB-only, taking into consideration the cerebral malformations. Material and methods: Forty-one children were included (22 girls and 19 boys aged between 6 and 14 years, mean age 10;0 years) in the study. A comprehensive assessment was conducted of cognitive functioning and motor profile, including fine motor and visual-motor functioning, and motor quality. The performance outcomes were analyzed for the total group of children and separately for the nonretarded children (FSIQ≥70, N =30) to eliminate the influence of global intellectual impairment. Results: Although the children with spina bifida showed increased incidence of cognitive and fine motor impairment, and impaired motor quality, after exclusion of the overall retarded children no associations were found between cognitive functioning and motor profile. In the comparison of SBM to SB-only specific differences were found for performance IQ, visual-motor functioning and motor quality, but not fine motor functioning. Conclusion: Our findings underscore the role of cerebral malformation in spina bifida and its consequences for neuropsychological functioning. The complicated developmental interactions found strengthen the need for an individualized management of children with SB. [Copyright &y& Elsevier]

Abstract: To study the potential associations between fetal brain functions and the early essential polyunsaturated fatty acid (ePUFA) status, fetal learning and memory were assessed by repeated habituation rate measurements (HR) in fetuses of 30, 32, 34 or 36 weeks gestational age (GA). HR tests were repeated 10min later. Both measurements were replicated in a second session at GA 38. Fetal short-term memory (STM) and long-term memory (LTM) were calculated from these habituation rates and related to concentrations of ePUFAs and their status markers, measured in umbilical artery wall phospholipids. The only relevant associations observed were positive trends (0.010

Tolerance development is an important clinical outcome for infants with cow's milk allergy. This multicenter, prospective, randomized, double-blind, controlled clinical study (NTR3725) evaluated tolerance development to cow's milk (CM) and safety of an amino acid–based formula (AAF) including synbiotics (AAF-S) comprising prebiotic oligosaccharides (oligofructose, inulin) and probiotic Bifidobacterium breve M-16V in infants with confirmed IgE-mediated CM allergy. Subjects aged ≤13 months with IgE-mediated CM allergy were randomized to receive AAF-S (n = 80) or AAF (n = 89) for 12 months. Stratification was based on CM skin prick test wheal size and study site. After 12 and 24 months, CM tolerance was evaluated by double-blind, placebo-controlled food challenge. A logistic regression model used the all-subjects randomized data set. At baseline, mean ± SD age was 9.36 ± 2.53 months. At 12 and 24 months, respectively, 49% and 62% of subjects were CM tolerant (AAF-S 45% and 64%; AAF 52% and 59%), and not differ significantly between groups. During the 12-month intervention, the number of subjects reporting at least 1 adverse event did not significantly differ between groups; however, fewer subjects required hospitalization due to serious adverse events categorized as infections in the AAF-S versus AAF group (9% vs 20%; P =.036). After 12 and 24 months, CM tolerance was not different between groups and was in line with natural outgrowth. Results suggest that during the intervention, fewer subjects receiving AAF-S required hospitalization due to infections. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Sentinel lymph node biopsy (SLNB) is accepted as a standard surgical staging procedure for determining the tumour status of the regional lymph nodes. Until September 2000 we performed SLNB in general anaesthesia. Since 1999, after validation of the SLNB concept, axillary dissection was omitted in SLN-negative patients. This study presents our data after SLNB under local anaesthesia after a follow-up of at least 5 years. Materials and methods: Between September 2000 and May 2003, 356 SLNBs were performed under local anaesthesia without sedation in patients with proven breast cancer (T4-tumours and small in situ carcinomas excluded) and without clinically or ultrasound guided cytological evidence of axillary node involvement. Lymphatic mapping and SLN identification were performed through the combination of blue dye and 99m Tc-nanocolloid. All positive SLNs were followed by an axillary dissection up to level three. SLN-negative patients were followed without axillary clearance. Results: In 353/356 SLNBs at least one sentinel node was found. 254/353 SLNs were tumour free. After a median follow-up of 73 months loco-regional and distant events were encountered in 10/353 SLNBs. Four patients (SLN-negative) showed tumour localization in the residual breast or chest wall (1.1%). Three patients (SLN-negative) presented with supraclavicular metastases (0.8%). In three patients (one SLN-negative and two SLN-positive followed by ALND) an axillary recurrence was encountered (0.8%). Conclusion: This survey confirms the safety of the SLNB under local anaesthesia in selecting patients for axillary lymph node dissection in breast cancer. [Copyright &y& Elsevier]

Abstract: A primigravid woman suffered a prolonged cardiac arrest at 18 weeks of gestation. Dilated ischemic cardiomyopathy was diagnosed. After recovery, the patient received an implantable cardioverter-defibrillator. At 38 weeks of gestation she had an elective caesarean delivery. Both mother and child had a favourable outcome. The effect of pregnancy on underlying cardiac disease and the management of maternal cardiac arrest with a pre-viable fetus are discussed. The importance of a multidisciplinary approach is emphasized. Continued neurodevelopmental assessment of the newborn is necessary to detect the long-term effects of fetal hypoxia in early pregnancy. [Copyright &y& Elsevier]