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Purpose Dietary factors have been suggested as drivers of the rising prevalence of adult-onset asthma, but evidence is inconclusive, possibly due to the complex interrelation with obesity. We aim to explore the relation of diet quality and food intake with incident adult-onset asthma in normal weight and overweight adults of the prospective population-based Lifelines Cohort Study. Methods Incident adult-onset asthma was defined as self-reported asthma at ± 4-year follow-up, in adults free of airway disease at baseline. Diet quality scores and food group intake were assessed at baseline. Log-binomial regression analyses were used to estimate adjusted relative risks (RR) between dietary intake (per portion) and incident adult-onset asthma, in categories of BMI (cutoff: 25 kg/m2). Results 477 incident asthma cases (75% female, 62% overweight) and 34,698 controls (60% female, 53% overweight) were identified. Diet quality—assessed by the Lifelines Diet Score and Mediterranean Diet Score—was not associated with incident adult-onset asthma in the two BMI groups. Although the dietary intake of several food groups differed between cases and controls, after adjustment for confounders only few remained associated with adult-onset asthma, including red and processed meat (RR: 0.93 per 15 g intake; 95% CI 0.86–0.99) in the normal weight group and intake of cheese (RR 1.09 per 20 g intake; 95% CI 1.00–1.17) and vegetables (RR 1.10 per 50 g intake; 95% CI 1.00–1.21) in the overweight group. Conclusion The results of this study question the role of food as a ‘simple’ predictor of adult-onset asthma and call for an integrative approach, including a range of modifiable lifestyle factors and further asthma phenotyping.

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Introduction Women with ST-elevation myocardial infarction (STEMI) present with different symptoms compared to men. This can result in delays in diagnosis and in the timely treatment of women. The aim of this study is to examine these differences, including the short- and long-term mortality in women and men. Methods This quality registry study included all patients with STEMI who received primary percutaneous coronary intervention in 2015 or 2016 in Amsterdam and the surrounding region. Results Three PCI centres and the Emergency Medical Service in Amsterdam participated. In total, 558 men (71%) and 229 women (29%) were included. Women were on average 7 years older than men (68 vs 61 years, p p = 0.002) and monovascular disease (69% vs 57%, p = 0.002). A higher percentage of men were current smokers (41% vs 49%, p = 0.043). Patient delay, system delay and overall ischaemic times were similar in both women and men (medians: 51, 94 and 157 min, respectively). Initiation of treatment was achieved within 90 min after STEMI diagnosis in 85% of patients (87% in women, 85% in men). Thirty-day and 1‑year mortality adjusted hazard ratio for women versus men was 1.60 (95% CI 0.9–3.0) and 1.24 (95% CI 0.8–2.0), respectively. Discussion Recognition of cardiac complaints remains challenging for patients. In the Amsterdam region, time delays and mortality were not significantly different between men and women presenting with STEMI. These results are in contrast to findings in similar registries. This suggests that implementation of current knowledge and national campaigns are effective in increasing awareness of the signs and symptoms suggestive of myocardial infarction.

Background The aim of this study was to determine long-term survival and clinical outcomes of the surface replacement trapeziometacarpal joint prosthesis (SR™TMC) and to evaluate implant migration using radiostereometric analysis (RSA). Methods In this clinical long-term follow-up study outcomes of ten patients who received the SR™TMC joint prosthesis were evaluated using DASH and Nelson scores, Visual Analogue Scale (VAS) of pain, and key pinch strength. RSA-radiographs were obtained direct postoperatively and 6 months, 1, 5 and 10 years postoperatively and were analyzed using model-based RSA software. Results During follow-up, two early revisions took place. Mean pre-operative DASH and Nelson scores were 54 (SD 15) and 54 (SD 17), improved significantly after 6 months (DASH 25 (SD 20), Nelson 75 (SD 18)) and remained excellent during long-term follow-up in all patients with a stable implant. At final follow-up, clinical scores deteriorated clearly in two patients with a loose implant in situ. Conclusions Long-term survival of the SR™TMC joint prosthesis is relatively poor. However, clinical outcomes improved significantly in the short-term and remained excellent in the long-term in those patients with a stable implant, but deteriorated clearly in case of loosening. The role of RSA in TMC joint arthroplasty is potentially valuable but needs to be further investigated. Several challenges of RSA in the TMC joint have been addressed by the authors and suggestions to optimize RSA-data are given. Trial registration This study was registered in the Netherlands Trial Register (NL7126).

Vascular cognitive impairment (VCI) results from cerebrovascular disease and is the second most common type of cognitive dysfunction. Sub-cortical ischemic vascular cognitive impairment (SIVCI) is the most common form of VCI. Current evidence suggests that increased or maintained cortical thickness might be one mechanism by which aerobic exercise preserves cognitive function in older adults. Whether this is also a potential pathway among older adults with SIVCI is unknown. Therefore, the aim of this secondary analysis of a 6-month proof-of-concept single-blinded randomized controlled trial of aerobic exercise was to investigate the associations between (1) aerobic-induced improvements in aerobic fitness capacity and change in cortical thickness in older adults with mild SIVCI; and (2) change in cortical thickness and changes in executive functions. This is a secondary analysis of neuroimaging data from a randomized controlled trial with 71 older adults with SIVCI who were randomly assigned to either a 6-month thrice-weekly aerobic training program or a 6-month nutrition program (i.e., control). Outcome measures were assessed at baseline and trial completion (i.e., 6 months). Aerobic fitness capacity was assessed with the 6-min walk test (6MWT). Magnetic resonance imaging data were acquired at both measurement points from 28 participants to look at changes in cortical thickness. Executive functions were assessed using (1) the Stroop test, (2) the trail making test (part A&B), and (3) the digit symbol substitution test (DSST). At trial completion, compared with the control group, participants in the aerobic training group showed significantly improved 6MWT performance (p = .037). Improved 6MWT performance was independently and significantly associated with increased change in cortical thickness, after controlling for baseline cortical thickness, baseline age, and baseline MoCA (p = .045). Specifically, change in 6MWT performance was significantly positively associated with change in the right superior temporal gyrus thickness (r = .557, p = .002). Maintenance of cortical thickness was independently and significantly associated with improved processing speed performance on the DSST over the 6-month trial, after controlling for baseline DSST performance, baseline age, and baseline MoCA (p = .014). Specifically, change in DSST performance was significantly positively associated with change in the right superior frontal thickness (r = .595, p = .002). Thus, a 6-month aerobic training program may promote cognitive outcomes in older adults with mild SIVCI by improving aerobic fitness capacity and maintaining cortical thickness.

Psychopathic individuals are characterized as “intra-species predators”—callous, impulsive, aggressive, and proficient at interpersonal manipulation. For example, despite their high risk for re-offending, psychopathic offenders often receive early release on parole. While reputed to be social chameleons, research suggests that even naive observers can accurately infer high levels of psychopathic traits in others with very brief exposures to behavior, but accuracy degrades with extended observation. We utilized a lens model approach to examine the communication styles (emotional facial expressions, body language, and verbal content) of offenders varying in levels of psychopathic traits using “thin slice” video clips of psychological assessment interviews and to reveal which cues observers use to inform their evaluations of psychopathy. Psychopathic traits were associated with more (a) Duchenne smiles, (b) negative (angry) emotional language, and (c) hand gestures (illustrators). Further, psychopathy was associated with a marked behavioral incongruence; when individuals scoring high in psychopathic traits engaged in Duchenne smiles they were also more likely to use angry language. Naive observers relied on each of these valid behavioral signals to quickly and accurately detect psychopathic traits. These findings provide insight into psychopathic communication styles, opportunities for improving the detection of psychopathic personality traits, and may provide an avenue for understanding successful psychopathic manipulation.

Wat is je werkervaring? ‘Als (long)verpleegkundige in diverse ziekenhuizen en in het Nederlands Astmacentrum Davos. Sinds 13 jaar werk ik in de huisartsenpraktijk. Nu 16 uur per week bij Huisartsenpraktijk Klaar en Vincent te Ede, waar ik me bezighoud met astma/COPD, diabetes en ouderenzorg.’

Darwin (1872) hypothesized that some facial muscle actions associated with emotion cannot be consciously inhibited, particularly when the to-be concealed emotion is strong. The present study investigated emotional “leakage” in deceptive facial expressions as a function of emotional intensity. Participants viewed low or high intensity disgusting, sad, frightening, and happy images, responding to each with a 5 s videotaped genuine or deceptive expression. Each 1/30 s frame of the 1,711 expressions (256,650 frames in total) was analyzed for the presence and duration of universal expressions. Results strongly supported the inhibition hypothesis. In general, emotional leakage lasted longer in both the upper and lower face during high-intensity masked, relative to low-intensity, masked expressions. High intensity emotion was more difficult to conceal than low intensity emotion during emotional neutralization, leading to a greater likelihood of emotional leakage in the upper face. The greatest and least amount of emotional leakage occurred during fearful and happiness expressions, respectively. Untrained observers were unable to discriminate real and false expressions above the level of chance.

Huisartsen en praktijkondersteuners hebben een belangrijke taak in het terugdringen van overmatig alcoholgebruik. Zij zien regelmatig patienten die behoren tot de risicogroep. Ook andere zorgverleners in de eerstelijns- of publieke gezondheidszorg zouden hieraan een belangrijke bijdrage kunnen leveren. Zorgverleners voelen zich echter onvoldoende bekwaam om vroegsignalering en kortdurende interventies uit te voeren. Het aanbieden van training zou kunnen bijdragen aan het overwinnen van deze drempel.

This article describes a blueprint for an online learning environment that is based on prominent instructional design and assessment theories for supporting learning in complex domains. The core of this environment consists of formative assessment tasks (i.e., assessment for learning) that center on professional situations. For each professional situation, three levels of situational complexity are defined, and within each of these three levels, tasks are offered that differ in the degree of support offered to the learner. This environment can support (beginning) professionals in complex domains in gaining insight into the available repertoire of behavior in professional situations, as well as into the quality and effectiveness of that behavior (assessment criteria), while simultaneously helping them to develop insight into the standards that their own behavior should (eventually) match.

Severe refractory asthma is a heterogeneous condition with different patterns of severity and different reasons for loss of asthma control. The three main patterns include asthma with frequent exacerbations, asthma with irreversible airway obstruction, and asthma with reduced sensitivity or resistance to corticosteroids. Each of these patterns has distinct risk factors. The assessment of patients with severe asthma requires a systematic, diagnostic and management protocol. The majority of patients will benefit from thorough analysis and treatment of aggravating factors. In some patients with severe refractory asthma, in particular those with concomitant chronic rhinosinusitis, long-term administration of systemic corticosteroids may be necessary. In these patients all efforts should be directed towards reducing the dose of corticosteroids as much as possible. Although several corticosteroid-sparing agents and immunosuppressants have been proposed in the literature, none of these has gained complete acceptance in clinical practice, either because of limited efficacy or unacceptable adverse effects. Novel potent anti-inflammatory therapies aimed at reducing the need for systemic corticosteroids in patients with severe, refractory asthma are urgently needed.

Phase behavior and microstructure formation of rod and coil molecules, which can associate to form hairy-rod polymeric supramolecules, are addressed theoretically. Association induces considerable compatibility enhancement between the rod and coil molecules and various microscopically ordered structures can appear in the compatibility region. The equilibria between microphase-separated states, the coil-rich isotropic liquid and the rod-rich nematic are discussed in detail. In the regime where hairy-rod supramolecules with a high grafting density appear as a result of the association, three phase diagram types are possible depending on the value of the association energy. In the low grafting density regime only the lamellar microstructure is proven to be stable.

The subject of this paper is inspired by microphase-separated copolymer melts in which a small-scale structure is present inside one of the phases of a large-scale structure. Such a situation can arise in a diblock copolymer melt, if one of the blocks of the diblock is in itself a multiblock copolymer or a comb copolymer. Due to the presence of the large-scale structure, the chains are stretched. The aim of this paper is to investigate the influence of this chain stretching on the formation of the small-scale structure. To gain insight we study infinite melts of infinitely long copolymer chains that are subjected to a stretching force. For melts of monodisperse multiblock copolymers we find that the stretching destabilizes the homogeneous phase. If the stretching is strong, the lamellar structure is the only stable structure. The periodicity increases with the degree of stretching. For melts of monodisperse comb copolymers the chain stretching has no influence on the stability of the homogeneous phase. If the stretching is strong, the lamellar structure and the hexagonal structure are the only stable structures. The periodicity is independent of the degree of stretching. For the multiblock copolymer we investigated the influence of block length polydispersity. For small polydispersity the period of the structure increases monotonically with the degree of stretching. For intermediate polydispersity, the period initially decreases before it starts to increase. For large polydispersity, the mean-field period at the spinodal is infinite, becoming finite once the stretching force exceeds some critical value. For very large polydispersity the mean-field period at the spinodal remains infinite for any value of the stretching force.

Hydrogenated segmented poly[butadiene-block-(styrene-block-butadiene)(n)] block copolymers, which were developed by use of a polymeric iniferter technique, were tested on their compatibilizing effectiveness for (10/90) LDPE/PS blends. They were found to be effective compatibilizers for this mixture, already giving a pronounced improvement in both tensile strength and strain of the blend at block copolymer concentrations of one percent. A concentration of five weight percent of segmented block copolymer provided a tenfold improvement in blend toughness. The effectiveness of the segmented block copolymers was found be dependent on the block copolymer composition. Block copolymer compositions of close to 50:50 EB:PS gave the best results.

Lubricant films confined in nanometric slit pores and subjected to shear flow are studied by non-equilibrium molecular dynamics in a planar Couette flow geometry. An inhomogeneous, layered density profile is developed near the confining surfaces and the shape of the velocity profile across the pore depends on the wall energetics. A nonlinear velocity profile is developed and both slippage located at the wall and inside the film (interlayer slip) are observed. The local slope of the velocity profile and the location of the slippage plane are determined by the adsorption energy of the wall. Shear-induced changes of the adsorbed chain conformations are discussed in relation with the molecular mechanism of slippage and the magnitude of the interlayer slip.

Polystyrene-block-poly(4-vinylpyridine) (PS-block-P4VP) diblock copolymer was complexed with dodecylbenzenesulfonic acid (DBSA), leading to comb-coil polymeric supramolecules PS-block-P4VP(DBSA)y (y = 1.0, 1.5, and 2.0). Complexes formed hierarchical lamellar structure with long period of ca. 1400 Å. Due to periodicity and refractive index contrast between the layers, transmission and reflectance measurements showed a relatively narrow incomplete bandgap at ca. 460 nm. The angular dependence of the bandgap was also studied using different angles (ø) relative to the surface normal. The mid-gap was blue-shifted when the incident angle was increased indicating that the lamellar structure was partly oriented by the surfaces of quartz glasses.