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Which method or material used to record the intercuspal position yields the best accuracy of location of the maxillary and mandibular casts is unclear. The purpose of this clinical study was to determine the most reliable method of recording a patient's maximal intercuspal position by comparing 2 common methods with 2 popular registration materials. Complete arch impressions were made of both jaws with a polyvinyl siloxane impression material in a metal stock tray followed by 4 interocclusal registrations for each of the 17 participants. Two registration techniques were used. More than 1 record was obtained in the first technique, as the participant had to close through a wax sheet or a polyvinyl siloxane material. In the second technique, a polyvinyl siloxane material was injected from the buccal aspect between occluded tooth surfaces. Casts were made from Type 4 stone and vertical measurements of the casts were carried out by using digital vernier calipers, accurate to 100 μm. Hand articulation of the casts was used as the control. Consistency of measurement was assessed by the intraclass correlation coefficient, and comparisons were made by using repeated-measures regression analysis. Statistical analysis showed significant discrepancies when the participant closed through both wax and polyvinyl siloxane material (P <.001). No statistically significant differences to the control group were present when polyvinyl siloxane was injected laterally after closure. Hand articulation was the most accurate method of reproducing the maximal intercuspal position in a completely dentate individual with horizontal and vertical occlusal stability and was therefore considered the control. Recording the position after the participant had closed by using a polyvinyl siloxane material was the most accurate. [ABSTRACT FROM AUTHOR]

[Display omitted] Months after infection with severe acute respiratory syndrome coronavirus 2, at least 10% of patients still experience complaints. Long-COVID (coronavirus disease 2019) is a heterogeneous disease, and clustering efforts revealed multiple phenotypes on a clinical level. However, the molecular pathways underlying long-COVID phenotypes are still poorly understood. We sought to cluster patients according to their blood transcriptomes and uncover the pathways underlying their disease. Blood was collected from 77 patients with long-COVID from the Precision Medicine for more Oxygen (P4O2) COVID-19 study. Unsupervised hierarchical clustering was performed on the whole blood transcriptome. These clusters were analyzed for differences in clinical features, pulmonary function tests, and gene ontology term enrichment. Clustering revealed 2 distinct clusters on a transcriptome level. Compared with cluster 2 (n = 65), patients in cluster 1 (n = 12) showed a higher rate of preexisting cardiovascular disease (58% vs 22%), higher prevalence of gastrointestinal symptoms (58% vs 29%), shorter hospital duration during severe acute respiratory syndrome coronavirus 2 infection (median, 3 vs 8 days), lower FEV 1 /forced vital capacity (72% vs 81%), and lower diffusion capacity of the lung for carbon monoxide (68% vs 85% predicted). Gene ontology term enrichment analysis revealed upregulation of genes involved in the antiviral innate immune response in cluster 1, whereas genes involved with the adaptive immune response were upregulated in cluster 2. This study provides a start in uncovering the pathophysiological mechanisms underlying long-COVID. Further research is required to unravel why the immune response is different in these clusters, and to identify potential therapeutic targets to create an optimized treatment or monitoring strategy for the individual long-COVID patient. [ABSTRACT FROM AUTHOR]

The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in irritable bowel syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP powders to objectively identify triggers and evaluated the effect on symptoms, quality of life, and psychosocial comorbidities. Responders to a 6-week low FODMAP diet, defined by a drop in IBS symptom severity score (IBS-SSS) compared with baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP trigger. Patients completed daily symptom diaries and questionnaires for quality of life and psychosocial comorbidities. In 117 recruited patients with IBS, IBS-SSS improved significantly after the elimination period compared with baseline (150 ± 116 vs 301 ± 97, P <.0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5 ± 2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides, and day 3 for lactose. We confirmed the significant benefit of the low FODMAP diet in tertiary-care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP triggers. Ethical commission University hospital of Leuven reference number: s63629; Clinicaltrials.gov number: NCT04373304. We studied the impact of a blinded reintroduction using fermentable oligo-, di-, monosaccharides and polyols (FODMAP) powders to identify triggering FODMAPs. It allows the most objective identification of individual triggers and would optimize clinical practice. [ABSTRACT FROM AUTHOR]

Compared with fresh frozen plasma (FFP), Omniplasma has been attributed to an increased coagulation potential and an increased fibrinolytic potential. This study aimed to compare Omniplasma and FFP used for cardiopulmonary bypass (CPB) priming regarding the incidence of postoperative thrombotic or hemorrhagic complications and outcomes in pediatric patients undergoing cardiac surgery. A retrospective observational cohort study This single-center study was performed at the University Medical Center Groningen. All pediatric patients up to 10 kg undergoing cardiac surgery with CPB. Procedures in which FFP was used for CPB priming were compared with those in which Omniplasma was used. The primary outcome parameter was a composite endpoint consisting of the following: (1) pediatric intensive care unit (PICU) mortality, (2) thromboembolic complications, and (3) hemorrhagic complications during PICU stay. The authors included 143 procedures in the analyses, 90 (63%) in the FFP group and 53 (37%) in the Omniplasma group. The occurrence of the combined primary endpoint (FFP 20% v Omniplasma 11%, p = 0. 18) and its components did not differ between the used CPB priming agent). Omniplasma for CPB priming was associated with decreased unfractionated heparin administration per kg bodyweight (585 IU v 510 IU, p = 0. 03), higher preoperative and postoperative activated clotting times (ACT) discrepancy (90% v 94%, p = 0. 03), a lower postoperative ACT value (125 v 118 seconds, p = 0. 01), and less red blood cell transfusion per kilogram bodyweight (78 v 55 mL, p = 0. 02). However, none of the variables differed statistically significantly in the multivariate logistic regression analyses. The authors did not find an association between the plasma used for CPB priming and thromboembolic and hemorrhagic complications and death in neonates and infants undergoing cardiac surgery. Omniplasma seems to be safe to use in this population. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this longitudinal study was to assess trabecular bone scores (TBS) in institutionalized adults with refractory epilepsy and intellectual disability and to study the association of TBS and incident fractures during seven years of follow-up.Methods: In 2009 and 2016, all institutionalized adult patients of a long-stay care facility in the Netherlands (n=261) were invited to undergo a dual-energy X-ray absorptiometry (DXA) including vertebral fracture assessment (VFA) and assessment of TBS. Vertebrae T4-L4 were analyzed using quantitative morphometry. New and worsening vertebral fractures (VFs) were considered as incident VFs. Data regarding clinical fractures were extracted from the medical files. Patients were treated with anti-osteoporosis medication according to the Dutch guideline.Results: Baseline and follow-up DXA, VFA and TBS could be obtained in 136 patients (83 male) aged between 18 and 79 years old (44.7±15.5). At baseline, 36 patients (26.5%) were diagnosed with osteoporosis, 68 (50.0%) with osteopenia and 32 patients (23.5%) had a normal bone mineral density (BMD). As for TBS, 26 patients (19.1%) had a partially degraded microarchitecture and 26 patients (19.1%) a degraded microarchitecture. During seven years of follow-up, 80 patients (59%) sustained at least one fracture, of which 28 patients (35%) had one or more major osteoporotic fractures. Thirty-four patients (25.0%) had at least one new or worsening morphometric VF. Compared to baseline, TBS significantly decreased over seven years of follow-up in non-treated patients (-0.039±0.064, p<.001). In patients who were treated with bisphosphonates for more than one year during follow-up, TBS did not change significantly (p=.093). In multivariate analyses, no significant associations were found between TBS at baseline and incident fractures during follow-up.Conclusion: In this study, we found a high incidence of fractures and TBS decreased significantly over seven years of follow-up in non-treated institutionalized adult patients with refractory epilepsy and intellectual disability, but TBS was not associated with incident fractures. [ABSTRACT FROM AUTHOR]

Background: Inpatient quality indicators (IQIs) were previously developed to assess responsible antibiotic use.Aim: Practice testing of these QIs in the hospital setting.Method: This study was performed within a Dutch-Belgian border network of hospitals implementing the Infection Risk Scan (IRIS) point prevalence survey (PPS) as part of the i-4-1-Health project. Twenty out of 51 DRIVE-AB IQIs, including 13 structure and seven process IQIs, were tested. Data on structure IQIs were obtained through a web-based questionnaire sent to the hospital medical microbiologists. PPS data from October to December 2018 were used to calculate performance scores for the process QIs.Findings: Nine hospitals participated. Regarding structure IQIs: the lowest performance scores were observed for recommendations for microbiological investigations in the guidelines and the use of an approval system for restricted antibiotics. In addition, most hospitals reported that some antibiotics were out of stock due to shortages. Regarding process IQIs: 697 systemic antibiotic prescriptions were used to calculate performance scores. The lowest score was observed for documentation of an antibiotic plan in the medical file (58.8%). Performance scores for IQIs on guideline compliance varied between 74.1% and 82.3% for different aspects of the antibiotic regimen (duration, choice, route, timing).Conclusion: This multicentre practice testing of IQIs identified improvement targets for stewardship efforts for both structure and process aspects of antibiotic care (approval system for restricted antibiotics, documentation of antibiotic plan). These results can guide the design of future PPS studies and a more extensive evaluation of the clinimetric properties of the IQIs. [ABSTRACT FROM AUTHOR]

The authors aimed to study the association between postoperative atrial fibrillation (POAF) and thromboembolic stroke and to determine risk factors for thromboembolic stroke after cardiac surgery. The authors performed a secondary analysis from a randomized controlled trial (GRIP-COMPASS). The patients with thromboembolic stroke were compared with those without thromboembolic stroke, and the difference in the incidence of POAF between these groups was assessed. Odds ratios (OR) were calculated using logistic regression analyses. Brain imaging was studied for the occurrence of thromboembolic stroke during hospital admission, and POAF was monitored for seven days. To assess which characteristics were associated with occurrence of thromboembolic stroke, stepwise backward regression analysis was performed. All adult consecutive cardiac surgery patients admitted postoperatively to the intensive care unit. Academic tertiary care medical center. None. Of the 910 patients included in this study, 26 patients (2.9%) had a thromboembolic stroke during hospital admission. The incidence of POAF during the first seven days after cardiac surgery in those with thromboembolic stroke was 65%, compared with 39% in those without thromboembolic stroke: adjusted OR 3.01 (95% confidence interval, 1.13-8.00). POAF, a history of peripheral vascular disease, a higher EuroSCORE, and a longer duration of surgery were associated with thromboembolic stroke. POAF within seven days after cardiac surgery was associated with a three-fold increased risk for a thromboembolic stroke during hospital admission. Expeditious treatment of POAF may, therefore, reduce early stroke risk after cardiac surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the efficacy of vascular graft coatings used in the aortic position to prevent vascular graft infection (VGI). A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using a pre-registered protocol (CRD42020206436). Eligible studies used a vascular graft coating in the aortic position and reported on VGI. A search was performed in MEDLINE (PubMed), Embase, Web of Science, and the Cochrane Library. Primary outcome parameters were VGI, patency, and mortality. Pooled estimates of VGI were calculated using odds ratio (OR) and 95% confidence intervals (CIs) wherever possible. Quality assessment was performed with the Newcastle–Ottawa Assessment Scale and the Revised Cochrane risk of bias tool for randomised trials. In total, 6 873 papers were identified. Only eight studies were included. Six of eight studies (75%) reported on known antimicrobial coating strategies such as antibiotics (n = 3) and silver (n = 3). In the other two studies, polymer coated grafts were used. Only three of eight studies compared coated with uncoated grafts (two antibiotic and one silver). Two randomised controlled trials reported on the effect of rifampicin soaked (1 mg/mL) grafts and showed no significant effect in the early (2 months; OR 0.69, 95% CI 0.29 – 1.62) or late (2 years; OR 0.73, 95% CI 0.23 – 2.32) post-operative periods. A retrospective cohort study focusing on the effect of silver coated grafts did not reveal any advantage (OR 0.19, 95% CI 0.02 – 1.64). Two polymer coated grafts were not considered to have a potential benefit in the prevention of VGIs. Clinical studies reporting on the antibacterial effect of vascular graft coatings in the aortic position to prevent VGI are scarce. For silver and antibiotic coatings, no significant protection for VGI was observed. New types of grafts or long acting coating strategies are mandatory to prevent this complication in the future. [ABSTRACT FROM AUTHOR]

This editorial introduces a special issue with 27 short viewpoints about future research on transition studies, to commemorate the 10th anniversary of this journal. [ABSTRACT FROM AUTHOR]

• This 'farewell editorial' looks back at a ten-year period of serving as founding editor-in-chief of EIST. • It shares some personal experiences as well as thoughts about content and style. This 'farewell editorial' looks back at a ten-year period of serving as founding editor-in-chief of EIST. It shares some personal experiences as well as thoughts about content and style. [ABSTRACT FROM AUTHOR]

• We analyse 465 articles published in EIST from june 2010 until june 2021. • We identify eight topics and analyse citations to these. • Topics with largest shares of publications are "Theory of socio-technical transitions" and "Urban regimes and niches". • We assess the dynamics over time of topic shares in EIST publications. • We identify the geographical distribution of topics amongst 34 countries. We analyse 465 articles published in EIST from June 2011 until June 2021 to identify topics addressed in the journal. We find eight main topics and assess how their shares changed over time as well as how many citations they received. The topics with the largest shares in all publications are "Theory of socio-technical transitions" and "Urban regimes and niches". The two most cited topics, "Theory of socio-technical transitions" and "Geography and diffusion of eco-innovations", showed a rising share over time, while the share of topic "Finance, investment and growth" declined. We further assess the geographical coverage of topics, through affiliations of the corresponding authors. The resulting map indicates dominant topics for the 34 countries that contributed to publications in EIST. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of clinical fractures over seven years of follow-up, in adults with epilepsy and intellectual disability, residing in a long-stay care facility.Methods: In 2009, all institutionalized adult patients (n = 261) were invited to undergo a Dual-energy X-ray Absorptiometry (DXA) measurement and a Vertebral Fracture Assessment (VFA). Participants were followed over seven years or until date of discharge (in case of moving from the care facility) or date of death. The patients' medical files were screened for radiology reports and staff notes, to identify clinical fractures. Fracture incidence rates (IR) were determined and compared for subgroups, by calculating incidence rate ratios. Hazard ratios were calculated to identify factors associated with fracture risk, using Cox Proportional Hazards analyses.Results: A total of 205 patients (124 male, 60.5%) aged between 18 and 88 years (median 48, IQR 34-60) were enrolled. At baseline, 92 patients (44.9%) were diagnosed with osteopenia and 65 (31.7%) with osteoporosis. Between 2009 and 2016, 30 patients (14.6%) deceased and 3 patients (1.5%) left the care facility. During follow-up, 156 clinical fractures were reported in 82 patients (40.0%). Thirty-eight patients (18.5%) had at least one major osteoporotic fracture. Overall, the IR was 11.6 fractures per 100 person-years. Fracture risk was significantly lower in patients who were wheelchair dependent than in patients who were able to walk (p<.001).Conclusion: This study demonstrated that 40% of institutionalized adults with epilepsy and intellectual disability had at least one clinical fracture during seven years of follow-up, despite adequate anti-osteoporosis treatment. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak has put an unprecedented strain on Emergency Departments (EDs) and other critical care resources. Early detection of patients that are at high risk of clinical deterioration and require intensive monitoring, is key in ED evaluation and disposition. A rapid and easy risk-stratification tool could aid clinicians in early decision making. The Shock Index (SI: heart rate/systolic blood pressure) proved useful in detecting hemodynamic instability in sepsis and myocardial infarction patients. In this study we aim to determine whether SI is discriminative for ICU admission and in-hospital mortality in COVID-19 patients.Methods: Retrospective, observational, single-center study. All patients ≥18 years old who were hospitalized with COVID-19 (defined as: positive result on reverse transcription polymerase chain reaction (PCR) test) between March 1, 2020 and December 31, 2020 were included for analysis. Data were collected from electronic medical patient records and stored in a protected database. ED shock index was calculated and analyzed for its discriminative value on in-hospital mortality and ICU admission by a ROC curve analysis.Results: In total, 411 patients were included. Of all patients 249 (61%) were male. ICU admission was observed in 92 patients (22%). Of these, 37 patients (40%) died in the ICU. Total in-hospital mortality was 28% (114 patients). For in-hospital mortality the optimal cut-off SI ≥ 0.86 was not discriminative (AUC 0.49 (95% CI: 0.43-0.56)), with a sensitivity of 12.3% and specificity of 93.6%. For ICU admission the optimal cut-off SI ≥ 0.57 was also not discriminative (AUC 0.56 (95% CI: 0.49-0.62)), with a sensitivity of 78.3% and a specificity of 34.2%.Conclusion: In this cohort of patients hospitalized with COVID-19, SI measured at ED presentation was not discriminative for ICU admission and was not useful for early identification of patients at risk of clinical deterioration. [ABSTRACT FROM AUTHOR]

Idiopathic environmental intolerance (IEI) refers to a health condition characterized by the presence of multiple symptoms in different organ systems in response to a variety of environmental cues, such as chemical exposures, electromagnetic radiation, infrasound from windmill farms, (parts of) buildings, foods, etc. Typically, the symptoms arise in response to triggers and at dosages that do not cause symptoms in the majority of people, and no clear link with any physiological dysfunction can be found. The condition varies in a dimensional way from very mild, for which no medical help is sought, to very disabling, compromising normal life. The condition is controversial, but several indications strongly suggest that the symptoms result from nocebo mechanisms. Currently, different psychological treatments are explored, but they are generally not based on a clear understanding of the aetiopathological mechanisms and the treatment effects are not well documented. In the present paper, we describe a treatment protocol based on a comprehensive explanatory model of IEI. The goal is to contribute to standardized, mechanism-based treatments as a basis for more systematic treatment studies. • Idiopathic Environmental Intolerance (IEI) is a health problem, implying a variety of health complaints attributed to environmental triggers well below levels that are known to be harmful • Based on a comprehensive theoretical model to understand IEI, we describe a systematic treatment approach to treat these patients. • Our goal is to facilitate systematic treatment research to document efficacity of the treatment. [ABSTRACT FROM AUTHOR]

• Qualitative estimates of current and maximum emissions reduction by city policies. • Employs novel decomposition of effectiveness into reach, ability and stringency. • Complements partial and anecdotal studies with comprehensive systemwide assessment. • Formal conceptual approach to quantify estimates with numerical illustrations. • Suggest policy and political strategies to make better use of cities' competences. Optimism about the contribution of city policies worldwide to reduce greenhouse gas emissions is widespread. It is based, though, on partial and anecdotal studies rather than comprehensive system-wide estimates. Popular empirical indicators to support the importance of cities, such as consumption-based emissions within city borders, lack a policy connection. Here I undertake an initial assessment of the effectiveness of emissions reduction through urban climate policies. It employs a novel decomposition of effectiveness into reach, capability and stringency. This results in a qualitative estimation of current and maximum contributions of city climate policies – divided into four types – to global emissions reduction. I formalize the framework to numerically illustrate additional policy aspects. Based on the insights obtained, I suggest policy and political strategies to make better use of cities' competences to mitigate climate change. [ABSTRACT FROM AUTHOR]

In new guidelines published on June 5th 2020, the World Health Organization (WHO) recommends that in areas with ongoing COVID-19 community transmission, governments should encourage the general public to wear face masks in specific situations and settings as part of a comprehensive approach to suppress COVID-19 transmission. Recent online surveys in 206,729 persons residing in nine low- and middle-income countries showed that 32.7%-99.7% of respondents used face masks with significant differences across age groups and sexes. Targeted health promotion strategies and government support are required to increase mask use by the general population. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosing scaphoid fractures remains challenging. High-resolution peripheral quantitative computed tomography (HR-pQCT) might be a potential imaging technique, but no data are available on its feasibility to scan the scaphoid bone in vivo. Methodology : Patients (≥18 years) with a clinically suspected scaphoid fracture received an HR-pQCT scan of the scaphoid bone (three 10.2-mm stacks, 61-μm voxel size) with their wrist immobilized with a cast. Scan quality assessment and bone contouring were performed using methods originally developed for HR-pQCT scans of radius and tibia. The contouring algorithm was applied on coarse hand-drawn pre-contours of the scaphoid bone, and the resulting contours (AUTO) were manually corrected (sAUTO) when visually deviating from bone margins. Standard morphologic analyses were performed on the AUTO- and sAUTO-contoured bones. Results : Ninety-one patients were scanned. Two out of the first five scans were repeated due to poor scan quality (40%) based on standard quality assessment during scanning, which decreased to three out of the next 86 scans (3.5%) when using an additional thumb cast. Nevertheless, after excluding one scan with an incompletely scanned scaphoid bone, post hoc grading revealed a poor quality in 14.9% of the stacks and 32.9% of the scans in the remaining 85 patients. After excluding two scans with contouring problems due to scan quality, bone indices obtained by AUTO- and sAUTO-contouring were compared in 83 scans. All AUTO-contours were manually corrected, resulting in significant but small differences in densitometric and trabecular indices (<1.0%). Conclusions : In vivo HR-pQCT scanning of the scaphoid bone is feasible in patients with a clinically suspected scaphoid fracture when using a cast with thumb part. The proportion of poor-quality stacks is similar to radius scans, and AUTO-contouring appears appropriate in good- and poor-quality scans. Thus, HR-pQCT may be promising for diagnosis of and microarchitectural evaluations in suspected scaphoid fractures. [ABSTRACT FROM AUTHOR]

Background: Given the lack of hospital-wide ownership and shortage of nurses, the ideal model for large-scale implementation of hand hygiene (HH) behaviour change in low- and middle-income countries is unknown.Aim: The aim of the multi-modal strategy was to engender hospital accountability for HH compliance.Methods: The quasi-experimental study was conducted in 50 South African hospitals (November 2015 to July 2017) and involved five overlapping phases: executive governance and corporate behaviour change; group-wide systematic situational analysis; development of an electronic-assisted direct-observed data collection and analysis application; launch and implementation; and accountable governance. Measurement of intra- and inter-hospital variance to six HH opportunities was calculated and data compliance dashboards were e-mailed weekly to hospital leadership teams to provide feedback of recorded HH compliance and behaviour to frontline teams. Baseline comparison (July 2016) of compliance was compared versus post-implementation (July 2017).Findings: Baseline HH compliance of ≤60% was documented for 16% (8/50) of hospitals, whereas overall, 48% (24/50) of hospitals demonstrated a significant improvement (P < 0.01). Over the 13-month observation period, 523,422 observations were recorded with a mean rate of 277 ± 223 observations per 1000 patient-days. The group mean composite compliance improved by 7.8% (P < 0.01) from 77.4% ± 12.8 to 85.2% ± 8.8 between July 2016 and July 2017, respectively.Conclusion: Implementation of a multi-faceted HH model in a large, diverse group of South African hospitals translated into changes in the organizational systems and accountability, standardized HH compliance management and feedback that led to HH proprietorship. [ABSTRACT FROM AUTHOR]

Background: Recurrent hemarthrosis after knee arthroplasty is an uncommon and disabling complication of this frequently performed procedure. Selective endovascular embolization of the geniculate arteries is one of the therapeutic options to manage this complication. The purpose of this study is to analyze the effectiveness of this treatment in patients suffering from recurrent hemarthrosis after knee arthroplasty.Methods: We performed a retrospective study of 31 patients (39 embolization procedures) with recurrent hemarthrosis after knee arthroplasty. There were 17 men and 14 women with a median age of 67 years (range 48-90). All patients were referred for geniculate artery embolization between January 2007 and November 2016.Results: Twenty-seven procedures were executed on the right side and 12 on the left side. Total knee arthroplasty was performed on 29 patients, only 2 patients underwent unicompartmental knee arthroplasty. Embolization of the superior geniculate arteries was achieved in all patients. In 12 of 39 procedures (31%), at least 1 of the inferior geniculate arteries could not be catheterized, therefore embolization was achieved through collaterals. Symptomatic improvement was observed in 26 of 31 patients (84%). Discomfort or mild postprocedural pain was observed in most patients, needing only minor pain medication, mostly resolving within 24 hours. Two patients presented with a severe complication: a 48-year-old male patient developed septic arthritis and an 85-year-old hypertensive female patient treated with anticoagulants showed aseptic necrosis of the femoral condyles.Conclusion: Embolization of geniculate arteries is a safe and effective treatment in recurrent hemarthrosis post knee arthroplasty. Clinical improvement was seen in most patients. [ABSTRACT FROM AUTHOR]

Introduction : Measurement of bone mineral density (BMD) with quantitative CT (QCT) carries several advantages over other densitometric techniques, including superior assessment of the spine. As most QCT studies evaluated the lumbar spine, measurements of the thoracic spine are limited. We performed QCT analysis of the thoracic spine in a cohort of patients with primary hyperparathyroidism. Materials and methods : This study was a retrospective QCT analysis of the thoracic spine on 18F-fluorocholine PET/CT scans in patients with primary hyperparathyroidism patients between March 2018 and December 2022. Correlations between QCT-derived BMD or Hounsfield units (HU) and demographic data, laboratory parameters, results from histopathological examination after parathyroidectomy and results of DXA imaging were analyzed, when available. Results : In 189 patients, mean QCT-derived BMD at the thoracic spine was 85.6 mg/cm3. Results from recent DXA were available in 122 patients. Mean thoracic QCT-derived BMD and HU were significantly correlated with DXA-derived BMD in lumbar spine, total hip and femoral neck and with the lowest T-score at DXA imaging. Only weak correlations were found with BMI or 18F-fluorocholine uptake, while no significant correlations were found with adenoma weight, PTH or calcium levels. Conclusion : Our study confirms correlation between QCT-derived BMD in the thoracic spine with age and DXA-derived BMD measurements within a population of patients with primary hyperparathyroidism. Establishment of reference BMD values for individual thoracic vertebrae, may allow direct osteoporosis classification on thoracic CT imaging. [ABSTRACT FROM AUTHOR]

The modified early warning score (MEWS) is used to detect clinical deterioration of hospitalized patients. We aimed to investigate the predictive value of MEWS and derived quick Sequential Organ Failure Assessment (qSOFA) scores for intensive care unit admission in patients with a hematologic malignancy admitted to the ward. Retrospective, observational study in two Dutch university hospitals. Data from adult patients with a hematologic malignancy, admitted to the ward over a 2-year period, were extracted from electronic patient files. Intensive care admission. We included 395 patients with 736 hospital admissions; 2% (n = 15) of admissions resulted in admission to the intensive care unit. A higher MEWS (OR 1.5; 95 %CI 1.3–1.80) and qSOFA (OR 4.4; 95 %CI 2.1–9.3) were associated with admission. Using restricted cubic splines, a rise in the probability of admission for a MEWS ≥ 6 was observed. The AUC of MEWS for predicting admission was 0.830, the AUC of qSOFA was 0.752. MEWS was indicative for intensive care unit admission two days before admission. MEWS was a sensitive predictor of ICU admission in patients with a hematologic malignancy, superior to qSOFA. Future studies should confirm cut-off values and identify potential additional characteristics, to further enhance identification of critically ill hemato-oncology patients. The Modified Early Warning Score (MEWS) can be used as a tool for healthcare providers to monitor clinical deterioration and predict the need for intensive care unit admission in patients with a hematologic malignancy. Yet, consistent application and potential reevaluation of current thresholds is crucial. This will enable bedside nurses to more effectively identify patients needing adjunctive care, facilitating timely interventions and improved outcome. [ABSTRACT FROM AUTHOR]

Purpose: Long-term exposure to anti-epileptic drugs has been shown to decrease bone mineral density (BMD). The aim of this 7-year follow-up study was to explore changes in bone status, using quantitative ultrasound (QUS) and Dual-energy X-ray Absorptiometry (DXA) in adults with refractory epilepsy and intellectual disability (ID) residing at a long-term care facility. Both measurements can be challenging to conduct in this population.Methods: In 2009 and 2016, a total of 126 patients (18-79 years) underwent QUS of the heel and DXA of lumbar spine (LS) and hip (femoral neck (FN) and total hip (TH)). Subgroup analysis was performed for patients with (group A, n = 53) and without (group B, n = 73) bisphosphonate use during follow-up.Results: Overall, weak to moderate correlations between changes in DXA and QUS parameters were found. For group A, correlations varied from r = .31 to .59, whereas correlations did not exceed r = .40 in group B. Patients in group A showed a larger increase or a smaller decrease in BMD for all DXA regions during follow-up (p < .001 for ΔLS and ΔFN BMD, p = .001 for ΔTH BMD). For change in QUS parameters, no significant difference between groups was found.Conclusion: In this study we demonstrated the limited use of QUS in the monitoring of bone status in our study population. Although correlations between changes in QUS parameters and axial DXA are positive and mostly significant, QUS only explains little of the variability in DXA values and is inadequate for measuring treatment response in this population. [ABSTRACT FROM AUTHOR]

Primary press-fit fixation of femoral knee prostheses is obtained thanks to the inside dimensions of the implant being undersized with respect to the bone cuts created intra-operatively, dictated by a press-fit specified by the implant design. However, during prostheses press-fit implantation, high compressive and shear stresses at the implant-bone interface are generated, which causes permanent bone damage. The extent of this damage is unknown, but it may influence the implant stability and be a contributing factor to aseptic loosening, a main cause of revisions for knee arthroplasty. The aim of this ex-vivo study was to quantify, using high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging and Digital Volume Correlation (DVC), permanent bone deformation due to press-fit femoral knee implantation of a commonly used implant. Six human cadaveric distal femora were resected and imaged with HR-pQCT (60.7 μm/voxel, isotropic). Femurs were fitted with cementless femoral knee implants (Sigma PFC) and rescanned after implant removal. For each femur, permanent deformation was examined in the anterior, posterior-medial and posterior-lateral condyles for volumes of interest (VOIs) of 10 mm depth. The bone volume fraction (BV/TV) for the VOIs in pre- and post-implantation images was calculated, at increasing depth from the bone surface. DVC was applied on the VOIs pre- and post-implantation, to assess trabecular bone displacements and plastically accumulated strains. The "BV/TV post /BV/TV pre ratio vs. depth" showed, consistently among the six femurs, three consecutive points of interest at increasing bone depth, indicating: bone removal (ratio<100%), compaction (ratio>100%) and no changes (ratio = 100%). Accordingly, the trabecular bone displacement computed by DVC suggested bone compaction up to 2.6 ± 0.8 mm in depth, with peak third principal strains of −162,100 ± 55,000 με (mean absolute error: 1,000–2,000 με, SD: 200–500 με), well above the yield strain of bone (7,000–10,000 με). Combining 3D-imaging, at spatial resolutions obtainable with clinical HR-pQCT, and DVC, determines the extent of plastic deformation and accumulated compressive strains occurring within the bone due to femoral press-fit implantation. The methods and data presented can be used to compare different implants, implant surface coatings and press-fit values. These can also be used to advance and validate computational models by providing information about the bone-implant interface obtained experimentally. Future studies using these methods can assist in determining the influence of bone damage on implant stability and the subsequent osseointegration. Image 1 • Permanent bone deformation is generated due to press-fit femoral knee implantation. • HR-pQCT and DVC can quantify the generated plastic bone deformation. • "BV/TV post /BV/TV pre ratio" showed 3 points of interest at increasing bone depth: • Bone removal (ratio<100%), compaction (ratio>100%), unchanged (ratio = 100%). • DVC confirms bone compaction; peak 3rd principal strains above yield strain of bone. [ABSTRACT FROM AUTHOR]

Background and Aims: Sunlight exposure is associated with a number of health benefits including protecting us from autoimmunity, cardiovascular disease, obesity and diabetes. Animal studies have confirmed that ultraviolet (UV)-B radiation, independently of vitamin D, can limit diet-induced obesity, metabolic syndrome and atherosclerosis. The aim of this study is to investigate whether exposure to the UV radiation contained in sunlight impacts on these disease parameters.Methods and Results: We have trialled an intervention with solar UV in obese and atherosclerosis-prone mice. We have discovered that solar-simulated UV can significantly limit diet-induced obesity and reduce atheroma development in mice fed a diet high in sugar and fat. The optimal regime for this benefit was exposure once a week to solar UV equivalent to approximately 30 min of summer sun. Exposure to this optimal dose of solar UV also led to a significant increase in liver triglycerides which may protect the liver from damage.Conclusion: Our results show that the UV contained in sunlight has the potential to prevent and treat chronic disease at sites distant from irradiated skin. A major health challenge going forward will be to harness the power of the sun safely, without risking an increase in skin cancers. [ABSTRACT FROM AUTHOR]

Recently, adoption of novel drugs for systemic treatment of metastatic prostate cancer has led to a striking improvement of response rate and survival in both hormone-sensitive and castration-resistant disease. In most cases, prostate cancer essentially depends on androgen receptor signaling axis, even in castration-resistant setting, and hence may be targeted by second generation hormonal therapy. However, a subset of patients bears androgen-independent cancer biology with a short-term response to hormonal treatment, early and extensive visceral metastases, low PSA levels and poor outcomes. Identification and specific management of these rapidly fatal malignancies is of an unmet medical need since their classification and utilized therapeutic regimens vary significantly. Unfortunately, molecular pathways have not been sufficiently elucidated yet in order to provide an effective targeted treatment with a prolonged response. Lack of diagnostic and predictive biomarkers for these cancers makes successful counteractions against them even more sophisticated. In this comprehensive review, we aimed at summarizing the current body of literature reporting on causal molecular machinery as well as diagnostic and therapeutic concepts of aggressive prostate tumors and draw clinically relevant conclusions for the up-to-date sensible disease management. [ABSTRACT FROM AUTHOR]

• We study opinion dynamics in the growth-versus-environment debate. • This dynamics is relevant as it affects support for sustainability policies. • Modified replicator dynamics with multiple groups is calibrated on recent survey data. • We consider adjacent group and global interactions. • The model includes feedback of information about environmental change and policy. The evolution of opinions in the long-standing debate on growth-versus-environment may affect support for important sustainability policies, in areas such as biodiversity loss, climate change, deforestation and freshwater scarcity. In order to understand this evolution, we develop a model describing the dynamics of four distinct opinions as identified in recent surveys, namely growth-at-all-cost, green growth, agrowth and degrowth. The model is based on modifying standard replicator dynamics to match a multi-group structure. Individuals are influenced by local or global interactions with others, based on adjacent opinion groups and exposure to information about environmental change. Psychological resistance to opinion change is also accounted for. The model is calibrated with recent survey data. Numerical analysis shows which opinions survive under particular conditions. We find, among others, that under local interactions, ultimate outcomes are characterized by lack of consensus, i.e. survival of multiple opinions. In addition, equal impacts of environmental change on opinions do not always translate in joint survival of associated opinions. Under worsening environmental conditions while continuing economic growth, opinions shift from green growth to agrowth and degrowth. Fostering global interactions among individuals, causing them to be influenced by a broad spectrum of opinions, makes consensus more likely. We also consider model dynamics if feedback from opinions to policy to environmental change and back is included. This confirms robustness of the results. It should be noted that the model is not meant to predict but to explore the consequences of combinations of assumptions about social networks, psychological mechanisms, environmental dynamics, and connections between opinion distribution and environmental policy. The study represents the first analysis of opinion dynamics in the growth-vs-environment debate and suggests a number of routes for further investigation. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (CRF) is tightly linked with health and longevity and is implicated in metabolic flexibility and substrate metabolism. The high capacity runner (HCR) and low capacity runner (LCR) rat lines are a genetically heterogeneous rat model selected and bred for CRF that reflect CRF in humans by exhibiting differences in nutrient handling. This study aims to differentiate the intrinsic substrate preference of the HCR compared to LCR rats to better understand the intersection of mitochondrial respiration and intrinsic CRF. We performed bulk skeletal muscle RNA-Sequencing on male and female HCR and LCR rats and assessed the effect of rat line on mitochondrial gene expression pathways using the MitoCarta3.0 database. In a separate cohort of rats, mitochondria were isolated from skeletal and cardiac muscle and maximal oxidation rates were measured using an Oroboros O2k when provided either pyruvate or fatty acid substrates. The expression of mitochondrial genes are significantly upregulated in HCR skeletal muscle in both male and female rats. In respirometry experiments, fatty acid oxidative capacities were greater in HCR compared to LCR, and male compared to female rats, as a function of both mitochondrial quality and mitochondrial density. This effect was greater in the skeletal muscle than in the heart. Pyruvate oxidation did not differ significantly between lines. The capacity for increased fatty acid oxidation in the HCR rat is a result of selection for running capacity and is likely a key contributor to the healthy metabolic phenotype of individuals with high CRF. • Intrinsic fitness is associated with upregulated mitochondrial genes in rat muscle. • Selection for fitness shows minimal sex-specific differences in the transcriptome. • Cardiorespiratory fitness is linked with higher fatty acid oxygen consumption rates. • Higher aerobic fitness in rats is dependent on mitochondrial quality and density. [ABSTRACT FROM AUTHOR]

Humans are transforming land cover at an ever-increasing rate. Accurate geographical maps on land cover, especially rural and urban settlements are essential to planning sustainable development. Time series extracted from MODerate resolution Imaging Spectroradiometer (MODIS) land surface reflectance products have been used to differentiate land cover classes by analyzing the seasonal patterns in reflectance values. The proper fitting of a parametric model to these time series usually requires several adjustments to the regression method. To reduce the workload, a global setting of parameters is done to the regression method for a geographical area. In this work we have modified a meta-optimization approach to setting a regression method to extract the parameters on a per time series basis. The standard deviation of the model parameters and magnitude of residuals are used as scoring function. We successfully fitted a triply modulated model to the seasonal patterns of our study area using a non-linear extended Kalman filter (EKF). The approach uses temporal information which significantly reduces the processing time and storage requirements to process each time series. It also derives reliability metrics for each time series individually. The features extracted using the proposed method are classified with a support vector machine and the performance of the method is compared to the original approach on our ground truth data. [ABSTRACT FROM AUTHOR]

• Specifications that limit RAP below 40% may hinder the development of lean asphalt. • Tension levels in lean asphalt bases should be kept low to resist fatigue cracking. • LCA revealed that 40% RAP is needed in lean asphalt to outperform other base types. • LCCA showed that the sections with lean asphalt yielded the lowest economic impact. Lean asphalt is a hot mixture produced with a lower binder content than a conventional dense-graded mixture. When used as a base layer, it allows for high RAP content and increases the structural capacity of the pavement compared to an unbound base. However, its low binder content and relatively high air void content raise concerns regarding its performance. This study found that about 40% RAP content is needed to meet moisture susceptibility requirements. Additionally, lean asphalt exhibited satisfactory resistance to repeated loading in fatigue testing but very low cracking tolerance in semicircular bending and IDEAL-CT testing. Furthermore, LCA revealed that pavement sections with a lean asphalt base containing 40% RAP can yield a lower environmental impact than sections with unbound or cement-bound bases with 100% recycled aggregate. Finally, LCCA substantiated that sections with lean asphalt can have a lower economic impact than asphalt pavements with other base materials. [ABSTRACT FROM AUTHOR]

The academic debate on economic growth, the environment and prosperity has continued for many decades now. In 2015, we conducted an online survey of researchers’ views on various aspects of this debate, such as the compatibility of global GDP growth with the 2 °C climate policy target, and the timing and factors of (never-)ending growth. The 814 respondents have a wide range of backgrounds, including growth theory, general economics, environmental economics, ecological economics, environmental social sciences, and natural sciences. The two main aims are: (1) to provide an overview of agreements and disagreements across research fields, and (2) to understand why opinions differ. The survey results indicate substantial disagreement across research fields on almost every posed question. Environmental problems are most frequently mentioned as a very important factor contributing to an end of economic growth. Furthermore, we find that researchers are more skeptical about growth in the context of a concrete problem like the compatibility with the 2 °C climate target than when considering environmental problems more generally. Many respondents suggest ideology, values and worldviews as important reasons for disagreement. This is supported by the statistical analysis, showing that researchers’ political orientation is consistently correlated with views on growth. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infection (HCAI) remains a major international problem.Aim: The 'Best Care Always!' (BCA) campaign was launched in South Africa to reduce preventable HCAI, including central-line-associated bloodstream infection (CLABSI).Methods: The intervention took place in 43 Netcare Private Hospitals, increasing later to 49 with 958 intensive care units (ICUs) and 439 high-care (HC) beds and 1207 ICUs and 493 HC beds, respectively. Phase 1, April 2010 to March 2011, ICU infection prevention and control (IPC) nurse-driven change: commitment from management and doctors and training of IPC nurses. Bundle compliance and infections per 1000 central-line-days were incorporated as standard IPC measures and captured monthly. Phase 2, April 2011 to March 2012, breakthrough collaborative method: multiple regional learning sessions for nursing leaders, IPC nurses and unit managers. Phase 3, April 2012 to May 2016: sustained goal-setting, benchmarks, ongoing audits.Findings: A total of 1,119,558 central-line-days were recorded. Bundle compliance improved significantly from a mean of 73.1% [standard deviation (SD): 11.2; range: 40.6-81.7%] in Phase 1 to a mean of 90.5% (SD: 4.7; range: 76.5-97.2%) in Phase 3 (P = 0.0004). The CLABSI rate declined significantly from a mean of 3.55 (SD: 0.82; range: 2.54-5.78) per 1000 central-line-days in Phase 1 to a mean of 0.13 (SD: 0.09; range: 0-0.33) (P < 0.0001).Conclusion: This intervention, the first of its kind in South Africa, through considerable motivation and education, and through competition between hospitals resulted in significant decreases in CLABSI. [ABSTRACT FROM AUTHOR]

Addressing four persistent problems, namely human-induced environmental change, financial instability, inequality and unemployment has now become an urgent necessity. To better grasp complex interactions between technological, financial and energy systems, we propose a formal behavioral-evolutionary macroeconomic model. It describes the coevolution of four populations, namely of heterogeneous consumers, producers, power plants and banks, interacting through interconnected networks. We examine how decisions by all these economic agents affect financial stability, the direction of technological change and energy use. The approach generates non-trivial, even surprising insights, such as that brand loyalty, captured by a network externality on the demand side, can increase the likelihood of bankruptcies of banks. Cascades of such bankruptcies are found to be more likely under greater income inequalities and higher electricity prices. We employ the model to assess macroeconomic impacts of sustainability policies along three dimensions: environmental effectiveness, financial stability and socio-economic consequences. [ABSTRACT FROM AUTHOR]