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ABSTRACT The world is suffering from intractable conflicts. Societies and families are torn apart and individuals are threatened in their existence. In this article, three controverses are explored about how to deal with intractable conflicts. In taking a closer look, these intractable conflicts can be understood as “identity‐related.” It can be shown that this identity dimension of a conflict is not sufficiently addressed by argumentation and negotiation. Still, accepting that some differences in value and belief seem so fundamentally incompatible that we should give up striving for a solution need not be the conclusion. There are decades of positive reports of practical experience with various transformative methods on a microscale available that can be taken on to develop interventions to solve intractable conflicts on a societal level. Is it possible and justifiable to develop and institutionalize “transformation” as a third general approach next to argumentation and negotiation? Can interventions aiming at a transformation of self‐understanding and identity be introduced without manipulation and infringement of autonomy? [ABSTRACT FROM AUTHOR]

High‐risk HPV (hrHPV)‐based screening has led to many unnecessary colposcopy referrals, mainly because of direct referral after low‐grade cytology (ASC‐US/LSIL). DNA methylation and genotyping tests on ASC‐US/LSIL samples have the potential to significantly improve the efficiency of screening. In this study, 12 triage strategies were constructed from FAM19A4/miR124‐2 or ASCL1/LHX8 methylation, HPV16/18 or HPV16/18/31/33/45 genotyping and 1‐year repeat cytology. The performance was evaluated on 215 hrHPV‐positive ASC‐US/LSIL samples from the IMPROVE trial (NTR5078). Performance was measured by colposcopy referral rate, positive predictive value (PPV) for detecting precancer (CIN3), and negative predictive value (NPV). To evaluate efficiency, strategies were ordered by the cumulative colposcopy referral rate after 1‐year cytology and compared by the marginal PPV to detect one additional CIN3 (mPPV). The most conservative strategy (referral when HPV16/18 and FAM19A4/miR124 methylation results are positive) had a direct referral rate of 5.2%, a cumulative referral rate after 1‐year cytology of 54.1%, and mPPV of 19.3%. Replacing HPV16/18 by HPV16/18/31/33/45 increased the cumulative 1‐year referral rate to 54.6%, and yielded an mPPV of 10.0%. Similar results were obtained for strategies with ASCL1/LHX8 methylation. Of all strategies, referral after an HPV16/18/31/33/45 positive, ASCL1/LHX8 methylation‐positive, and/or 1‐year cytology‐positive result yielded the highest direct and cumulative 1‐year colposcopy referral rates of 64.4% and 79.1%, respectively. The NPVs after 1‐year cytology varied between 98.1% and 99.4%, warranting a return to routine screening. Altogether, DNA methylation‐based triage strategies are recommended as they are discriminative for CIN3 and control the number of immediate colposcopy referrals. [ABSTRACT FROM AUTHOR]

We conduct an in‐depth analysis of the reasons for changes in global value chains as a result of COVID‐19 both from a positive angle, analysing expected changes in the behaviour of firms, and from a normative angle, assessing the different arguments for policy interventions by governments. The analysis generates three main conclusions. First, the COVID‐19 pandemic could contribute to diversification of sources of supply whose extent will vary by sector depending on the costs of value chain reorganisation. The pandemic, by contrast, is not likely to contribute much to re‐shoring, the return of manufacturing activities to industrialised countries, which is more likely to be driven by pre‐existing trends such as rising factor costs in emerging countries, increasing uncertainty about trade policy, and robotization and automation of production. Second, the pandemic has led to increased attention to the provision of essential goods in situations of crisis. Third, the largest risk for the global economy in the aftermath of the pandemic is a move away from open, non‐discriminatory trade policies, which would jeopardise the large benefits of open trade regimes in the current global economy characterised by scale economies, innovation spillovers, and a global division of labour. [ABSTRACT FROM AUTHOR]

In this paper, the evolution of global trade patterns until 2050 is projected with a recursive dynamic computable general equilibrium (CGE) model. Feeding the model with exogenous projections on macroeconomic, demographic, sectoral and trade cost variables, the evolution of trade patterns emerges endogenously from the model. The approach is innovative in both modelling approach and exogenous inputs. GDP growth emerges endogenously in the model because of diffusion of ideas as a result of international trade and trade cost changes are based on estimates of technology and trade policy changes. The projections indicate that (i) because of projected reductions in trade costs, trade will grow more than GDP, generating a global trade‐to‐GDP growth rate of 1.1; (ii) because of structural change, the global share of manufacturing trade falls from 64% in 2020 to 52% by 2050, whereas the share of services trade rises substantially from 24% to 38%; and (iii) because of technological catch‐up, the share in global trade of both developing and least‐developed countries (LDCs) will rise (with developing countries overtaking developed economies around 2035), the share of intra‐developed country trade will fall, whereas the share of intra‐developing country trade and those between developing and developed countries will rise. [ABSTRACT FROM AUTHOR]

Background: A precise understanding of the neuroanatomical basis of clinical manifestation of dementia is an important step for timely diagnosis. Dementia due to proteinopathies, such as Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and Frontotemporal dementia (FTD), have different yet overlapping atrophy patterns which could account for their overlapping clinical presentations. To disentangle these relationships and facilitate timely differential diagnosis, we estimated distinct and overlapping atrophy patterns and associated them with cognitive deficits. Method: We included 1702 AD (age = 66.1±8.3), 319 FTD (age = 63.3±7.7), 213 DLB (age = 69.7±7.0), and 1330 subjective cognitive decline (SCD) (age = 59.8±9.0) participants from the Amsterdam Dementia Cohort. MRIs were processed with Freesurfer and outputs were manually checked. Scanner‐related bias in outputs was corrected using NeuroHarmony pipeline. Participants' cognition was evaluated using standardized neuropsychological tests. Z‐scores for cognitive domains of memory, executive functioning, attention, language, and visuospatial functioning were derived using SCD group as reference. We estimated distinct and overlapping atrophy patterns in each disease by computing odds ratio in each region, using SCD group as reference. Furthermore, we computed group‐wise Pearson partial correlation between the (sub‐)cortical measures and cognition while correcting for confounding effects of age, sex, and education level. Result: Atrophy in bilateral inferior temporal, and right hippocampus was more prevalent in AD and FTD patients than in DLB patients (Figures 1‐3). Temporal pole atrophy was more prevalent in FTD than in AD or DLB patients. Superior parietal and supra marginal atrophy was more prevalent in AD than in FTD or DLB patients. Bilateral hippocampus and amygdala atrophy associated with memory impairment in AD, whereas left hemisphere atrophy associated with memory impairment in FTD. Frontal atrophy associated with worse executive functioning and attention in FTD, but not in AD. Language deficit associated with left temporal lobe atrophy in both FTD and AD. Visuospatial dysfunction associated with parietal lobe atrophy in both AD and FTD. In DLB, we observed no significant correlation between atrophy and cognitive deficits. Conclusion: We identified distinct and overlapping atrophy patterns and associations of atrophy patterns with cognitive deficits in AD, FTD, and DLB. These data‐driven insights are crucial for accurate diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Background: Advanced low‐grade ovarian carcinoma (LGOC) is difficult to treat. In several studies, high estrogen receptor (ER) protein expression was observed in patients with LGOC, which suggests that antihormonal therapy (AHT) is a treatment option. However, only a subgroup of patients respond to AHT, and this response cannot be adequately predicted by currently used immunohistochemistry (IHC). A possible explanation is that IHC only takes the ligand, but not the activity, of the whole signal transduction pathway (STP) into account. Therefore, in this study, the authors assessed whether functional STP activity can be an alternative tool to predict response to AHT in LGOC. Methods: Tumor tissue samples were obtained from patients with primary or recurrent LGOC who subsequently received AHT. Histoscores of ER and progesterone receptor (PR) were determined. In addition, STP activity of the ER STP and of six other STPs known to play a role in ovarian cancer was assessed and compared with the STP activity of healthy postmenopausal fallopian tube epithelium. Results: Patients who had normal ER STP activity had a progression‐free survival (PFS) of 16.1 months. This was significantly shorter in patients who had low and very high ER STP activity, with a median PFS of 6.0 and 2.1 months, respectively (p <.001). Unlike ER histoscores, PR histoscores were strongly correlated to the ER STP activity and thus to PFS. Conclusions: Aberrant low and very high functional ER STP activity and low PR histoscores in patients with LGOC indicate decreased response to AHT. ER IHC is not representative of functional ER STP activity and is not related to PFS. Patients who have low‐grade ovarian carcinoma with a functionally low or high active estrogen receptor signaling pathway have a decreased response to antihormonal therapy. Estrogen receptor immunohistochemistry does not have predictive value for antihormonal therapy response and is not representative of functional estrogen receptor signaling. [ABSTRACT FROM AUTHOR]

Background: Automated image segmentation methods together with increasing computer power allow quantifying brain alterations in great detail in large neuroimaging datasets. The increasing size of data complicates visual quality control (QC), which is the gold standard. Increasingly often, research relies on automated QC methods. Here, we aimed to investigate the performance of automated FreeSurfer segmentation through visual QC in a large memory clinic cohort with more than ten thousand images, and to compare an automated QC measure to the visual QC. Method: 10,400 T1‐weighted MRI scans from the Amsterdam Dementia Cohort were segmented with FreeSurfer(v7.1). Quality control was performed using an adapted version of the Enigma QC protocol[https://doi.org/10.1038/ng.2250]. Twenty‐six individuals visually assessed cortical segmentations, rating each as "fail", "moderate", or "pass", identifying failure reasons and affected lobes. We investigated the error occurrence in failed or moderate quality scans, and whether segmentation failures depend on clinical diagnosis in a subset of 4990 baseline scans with most common diagnoses (i.e., SCD, MCI, AD, FTD, VaD and DLB). We compared an automated QC measure (i.e. median ± 3*IQR thresholded SurfaceHoles) with the visual QC output. Result: The majority (78.3%) of 10,400 cortical segmentations were rated as having "pass"‐quality, 16.2% were "moderate"‐quality and 5.4% segmentations were rated as "fail". Concordance between Automated QC and Visual QC was high for pass ratings(84%), but low for fail ratings(22.5%) (Table‐1). Within failed segmentations, most common reasons were processing errors(51.7%), image artifacts(14.3%) and underestimation(13.3%); for moderate ratings reasons were inclusion of meninges (47.8%) and underestimation of cortical thickness(33.2%) (Figure‐1). Stratified per diagnosis, segmentation failed in 2.3% of the SCD scans, 3% of MCI, 4.7% of DLB, 5.4% of AD, 7% of FTD and 14.5% of VaD. Further, we observed variation in affected lobes among diagnostic groups (Figure‐2b). Conclusion: The majority of scans passed visual QC, in high concordance with the automated QC. Images with moderate or failed quality, occurred more often in VaD and FTD. The most common mis‐segmentations were overestimation and underestimation of cortical thickness. This very large visually quality controlled data could be used as a benchmark to test future automated QC pipelines on. [ABSTRACT FROM AUTHOR]

Objective: Cytology performed directly on hrHPV-positive self-samples (reflex cytology) is feasible and for women with abnormal cytology, an additional cytology test at the general practitioner could be omitted. The aim of this study is to assess the added value of digital imaging (ThinPrep® Imaging System) on the clinical utility of reflex cytology by reducing screening error. Design: A secondary analysis of a prospective cohort study. Setting: One of five Dutch screening laboratories. Population: Women tested hrHPV-positive on self-samples between December 2018 and August 2019. Methods: Self-samples were used for reflex cytology with and without digital imaging. The follow-up data (cytological and histological results within 1 year of follow- up) were obtained through the Dutch Pathology Registry (PALGA). Main outcome measures: Test performance of the reflex cytology was determined by comparing it with physician-collected follow-up results. Results: The sensitivity for detecting abnormal cells by reflex cytology on self-samples increased significantly from 26.3% (42/160; 95% confidence interval [CI] 19.6–33.8) without digital imaging to 35.4% (56/158; 95% CI 28–43.4) with digital imaging (P < 0.05) without compromising specificity. Importantly, 41.7% of women with ≥CIN2 (35/84) and 45.6% with ≥CIN3 (26/57) were detected by reflex cytology with digital imaging on hrHPV-positive self-samples. Conclusion: Digital imaging is of added value to reflex cytology on hrHPV-positive self-samples with a 9% increase in sensitivity. If reflex cytology on self-samples analysed with digital imaging had been implemented in the screening programme, 35.4% of the hrHPV-positive women with abnormal cytology on additional physician-collected samples could have been referred directly for colposcopy. [ABSTRACT FROM AUTHOR]

Objectives: New temperature management concepts of moderate and mild hypothermic circulatory arrest during aortic arch surgery have gained weight over profound cooling. Comparisons of all temperature levels have rarely been performed. We performed direct and indirect comparisons of deep hypothermic circulatory arrest (DHCA) (≤20°C), moderate hypothermic circulatory arrest (MHCA) (20.1–25°C), and mild hypothermic circulatory arrest (mild HCA) (≥25.1°C) in a network meta‐analysis. Methods: The literature was systematically searched for all papers published through February 2022 reporting on clinical outcomes after aortic arch surgery utilizing DHCA, MHCA and mild HCA. The primary outcome was operative mortality. The secondary outcomes were postoperative stroke and acute kidney failure (AKI). Results: A total of 34 studies were included, with a total of 12,370 patients. DHCA was associated with significantly higher postoperative incidence of stroke when compared with MHCA (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.19–1.78) and mild HCA: (OR, 1.50, 95% CI, 1.14–1.98). Furthermore, DHCA and MHCA were associated with higher operative mortality when compared with mild HCA (OR 1.71, 95% CI, 1.23–2.39 and OR 1.50, 95% CI, 1.12–2.00, respectively). Separate analysis of randomized and propensity score matched studies showed sustained increased risk of stroke with DHCA in contrast to MHCA and mild HCA (OR, 1.61, 95% CI, 1.18–2.20, p value =.0029 and OR, 1.74, 95% CI, 1.09–2.77, p value =.019). Conclusions: In the included studies, the moderate to mild hypothermia strategies were associated with decreased operative mortality and the risk of postoperative stroke. Large‐scale prospective studies are warranted to further explore appropriate temperature management for the treatment of aortic arch pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Immunostaining with p16INK4a (p16), a tumor‐suppressor surrogate protein biomarker for high‐risk human papillomavirus (hrHPV) oncogenic activity, may complement standard hematoxylin and eosin (H&E) histology review, and provide more objective criteria to support the cervical intraepithelial neoplasia (CIN) diagnosis. With this study we assessed the impact of p16 immunohistochemistry on CIN grading in an hrHPV‐based screening setting. Material and methods: In this post‐hoc analysis, 326 histology follow‐up samples from a group of hrHPV‐positive women were stained with p16 immunohistochemistry. All H&E samples were centrally revised. The pathologists reported their level of confidence in classifying the CIN lesion. Results: Combining H&E and p16 staining resulted in a change of diagnosis in 27.3% (n = 89) of cases compared with the revised H&E samples, with a decrease of 34.5% (n = 18) in CIN1 and 22.7% (n = 15) in CIN2 classifications, and an increase of 18.3% (n = 19) in no CIN and 20.7% (n = 19) in CIN3 diagnoses. The level of confidence in CIN grading by the pathologist increased with adjunctive use of p16 immunohistochemistry to standard H&E. Conclusions: This study shows that adjunctive use of p16 immunohistochemistry to H&E morphology reduces the number of CIN1 and CIN2 classifications with a proportional increase in no CIN and CIN3 diagnoses, compared with standard H&E‐based CIN diagnosis alone. The pathologists felt more confident in classifying the material with H&E and p16 immunohistochemistry than by using H&E alone, particularly during assessment of small biopsies. Adjunctive use of p16 immunohistochemistry to standard H&E assessment of CIN would be valuable for the diagnostic accuracy, thereby optimizing CIN management and possibly decreasing overtreatment. [ABSTRACT FROM AUTHOR]

Patients tested within 1 year after finishing treatment reported significantly lower COMBI scores than patients tested >1 year after starting/finishing antibiotic treatment (32.4 vs. 51.8; I p i < .001; 95% CI (-)25.6 - (-)13.1). Baseline illustrates a GCBI-score (=0) in which no change is perceive gl Patients who ended treatment less than 1 year ago had a lower mean GCBI-score compared to patients who finished treatment more than 1 year ago ((-)12.9 vs. + 10.9; I p i = .991; 95% CI (-)52.3 to 4.6 [Figure 2]). Keywords: children; Mycobacterium abscessus; otomastoiditis; quality of life EN children Mycobacterium abscessus otomastoiditis quality of life 529 535 7 06/14/22 20220701 NES 220701 Key points I Mycobacterium abscessus i is a multidrug-resistant nontuberculous mycobacterium capable of causing otomastoiditis and its treatment is complex with frequent adverse events. [Extracted from the article]

We aim to compare endometrial cancer survival in women with or without histological proven endometriosis or adenomyosis. We identified all women with endometrial cancer between 1990 and 2015 from the Netherlands Cancer Registry (NCR). Data were linked to the Dutch pathology database (PALGA) to select all women with histological proven endometriosis/adenomyosis. Overall survival was compared between women with endometrial cancer with or without endometriosis/adenomyosis. We used multivariable Cox proportional hazard analysis to estimate hazard ratios (HRs). We included 1701 women with endometrial cancer and endometriosis/adenomyosis, of whom 1236 (72.7%) women had adenomyosis, 320 (18.8%) had endometriosis and 145 (8.5%) had both. We compared these women to 39 139 women with endometrial cancer without endometriosis/adenomyosis. Women in the combined endometriosis/adenomyosis cohort were younger at endometrial cancer diagnosis, had earlier disease stage, more often had endometrioid endometrial cancer and low grade tumors. The 5‐year survival rate in the combined endometriosis/adenomyosis cohort was 84.8% (95% CI 84.6‐88.1) and 71.6% (95% CI 71.1‐72.0) in the nonendometriosis/adenomyosis cohort. Univariable analysis resulted in a crude HR of 0.63 (95% CI 0.59‐0.69). Significant confounding factors were age, stage, cancer subtype, histological grading, surgery and chemotherapy rate. Correction for these confounders resulted in a HR of 0.98 (95% CI 0.90‐1.06). Including endometriosis/adenomyosis status as a categorical factor resulted in similar HRs. In conclusion, women with endometrial cancer and histologically proven endometriosis/adenomyosis have a better overall survival when compared to women with endometrial cancer without endometriosis/adenomyosis. This better survival was correlated to stage, grade, age and histological subtype, but not to the presence of endometriosis/adenomyosis. [ABSTRACT FROM AUTHOR]

We study the determinants of sectoral patterns of technological catch‐up of emerging economies. In particular, we test the hypotheses that technological catch‐up is slower in tacit knowledge‐intensive sectors, operationalised by measures of complex task intensity, in sectors with a high skill intensity, with a high degree of export sophistication, and higher income elasticity. Employing trade data from United Nations Comtrade and production data from the United Nations Industrial Development Organization (UNIDO) between 1960 and 2000 covering manufacturing sectors, we find that catch‐up is slower in more tacit knowledge‐intensive sectors, as well as in skill‐intensive and export sophisticated sectors. With more recent Global Trade Analysis Project (GTAP) data from 1997 to 2011, we find instead that catch‐up is faster in more tacit knowledge‐intensive manufacturing sectors, whereas catch‐up is slower in more tacit knowledge‐intensive services sectors. We discuss three potential explanations for the changing association of catch‐up with tacit knowledge intensity. [ABSTRACT FROM AUTHOR]

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Introduction: The local environment of the fallopian tube represents the optimal conditions for reproductive processes. To maintain tissue homeostasis, signal transduction pathways are thought to play a pivotal role. Enhancing our understanding of functional signal transduction pathway activity is important to be able to clarify the role of aberrant signal transduction pathway activity leading to female subfertility and other tubal diseases. Therefore, in this study we investigate the influence of the hormonal cycle on the activity of key signal transduction pathways in the fimbrial epithelium of morphologically normal fallopian tubes. Material and methods: We included healthy pre‐ (n = 17) and postmenopausal (n = 8) patients who had surgical interventions for benign gynecologic conditions. Histologic sections of the fallopian tubes were reviewed by two pathologists and, for the premenopausal patients, hormone serum levels and sections of the endometrium were examined to determine the hormonal phase (early follicular [n = 4], late follicular [n = 3], early luteal [n = 5], late luteal [n = 5]). After laser capture microdissection, total mRNA was extracted from the fimbrial epithelium and real‐time quantitative reverse transcription‐PCR was performed to determine functional signal transduction pathway activity of the androgen receptor (AR), estrogen receptor (ER), phosphoinositide‐3‐kinase (PI3K), Hedgehog (HH), transforming growth factor‐beta (TGF‐β) and canonical wingless‐type MMTV integration site (Wnt) pathways. Results: The early luteal phase demonstrated high AR and ER pathway activity in comparison with the late luteal phase (p = 0.016 and p = 0.032, respectively) and low PI3K activity compared with the late follicular phase (p = 0.036), whereas the late luteal phase showed low activity of HH and Wnt compared with the early follicular phase (both p = 0.016). Signal transduction pathway activity in fimbrial epithelium from postmenopausal patients was most similar to the early follicular and/or late luteal phase with regard to the AR, ER and PI3K pathways. Wnt pathway activity in postmenopausal patients was comparable to the late follicular and early luteal phase. We observed no differences in HH and TGF‐β pathway activity between pre‐ and postmenopausal samples. The cyclic changes in signal transduction pathway activity suggest a stage‐specific function which may affect the morphology and physiology of the human fallopian tube. Conclusions: We demonstrated cyclic changes in activity of the AR, ER, PI3K, HH and Wnt pathways throughout the hormonal cycle. [ABSTRACT FROM AUTHOR]

The WTO Global Trade Model, a quantitative trade model, is employed to project the impact on the global economy of the COVID‐19 pandemic. Because of the profound uncertainty about the duration of the pandemic and the containment measures, three scenarios are constructed, V‐shaped, U‐shaped and L‐shaped recovery, corresponding with a duration of the pandemic of 3 months, 6 months and more than a year. The pandemic and containment measures are assumed to lead to a general reduction of labour supply, a rise in trade costs, and reductions in both demand and supply in sectors most affected by the containment measures. GDP and trade are projected to fall by, respectively, 5% and 11% in the V‐shaped and L‐shaped scenarios and trade by, respectively, 8% and 20%. The response of trade to the reduction in GDP, measured by the trade‐to‐GDP elasticity, is projected to rise as the crisis lasts longer. The reason is that a longer duration will lead to a larger drop in spending on durables which are highly tradable. [ABSTRACT FROM AUTHOR]

Aim: To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT‐A) on drooling severity and its impact on daily life and care in children and adolescents with moderate‐to‐severe drooling. Method: This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8–22y, SD 2y 10mo) with cerebral palsy (58.5%) or other non‐progressive developmental disorders (41.5%) were randomized to BoNT‐A (n=26) or bilateral submandibular duct ligation (n=27). A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact of drooling on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment. Results: Both BoNT‐A and bilateral submandibular duct ligation had a positive effect on daily care, damage to electronic equipment and/or furniture, social interactions, and self‐esteem. However, bilateral submandibular duct ligation had a significant greater and longer‐lasting short‐ (8wks) and medium‐term (32wks) effect on daily care, reducing damage to electronic devices, and improving social interactions and satisfaction with life in general. Interpretation: This randomized controlled trial confirms reduced drooling by both BoNT‐A and bilateral submandibular duct ligation, but provides new evidence on improved well‐being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation, compared to BoNT‐A there was a significantly greater and longer‐lasting positive effect on most outcomes. What this paper addsBilateral botulinum neurotoxin A (BoNT‐A) and submandibular duct ligation had a positive effect on the well‐being of individuals with moderate‐to‐severe drooling.Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT‐A.Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life. What this paper adds: Bilateral botulinum neurotoxin A (BoNT‐A) and submandibular duct ligation had a positive effect on the well‐being of individuals with moderate‐to‐severe drooling.Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT‐A.Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life. [ABSTRACT FROM AUTHOR]

SMGE, submandibular gland excision. gl Recurrent LRTI - per treatment At baseline, SMGE had the highest number of patients with signs of LRTI (60%) compared to 25% (2DL) and 39% (BoNT-A). BoNT-A, botulinum neurotoxin A; 2DL, submandibular duct ligation. gl VAS - per treatment Results of the repeated measures per treatment group are shown in Table 2 and Figure 1. DISCUSSION This study revealed that even though BoNT-A, SMGE, and 2-DL relieved posterior drooling at 8 weeks and all treatments rendered a reduction in LRTI, only SMGE was significantly effective at both 8 and 32 weeks. Abbreviations 2DL Submandibular duct ligation LRTI Lower respiratory tract infection SMGE Submandibular gland excision VAS Visual analogue scale Swallowing disorders are common in children with cerebral palsy (CP) (prevalence 50.4-99%) and other neurological impairments, and consequently these children may suffer from anterior and posterior drooling.1 Up to 78% of the caregivers of children with CP report complaints of anterior drooling, with a mean prevalence of about 40%.2 The prevalence of posterior drooling is unknown, but is estimated to be 10% to 15% in the population with severe or profound intellectual disabilities. [Extracted from the article]

Objectives: To assess the association between risk factors, including socioeconomic deprivation, and mortality, recurrence and chemo‐ or radiation toxicity in cervical cancer patients. Methods: Retrospective study of cervical cancer patients diagnosed between January 2007 and July 2018. Patient characteristics and mortality data, including recurrence, were assessed, together with socioeconomic deprivation measures evaluated using the English Indices of Multiple Deprivation. Markov multi‐state models were used to model mortality and recurrence, and logistic regression models were used to model chemo‐ or radiation toxicity. Results: Included were 243 women with a median age of 49 years. A total of 57 patients died (23%), of which 41 due to cervical cancer, and 21 (9%) had recurrent disease. Hazard ratios (HR) showed no evidence of association between socioeconomic deprivation and cancer‐specific hazard of mortality from diagnosis or recurrence, hazard of mortality due to other causes or hazard of cancer recurrence. Furthermore, there was no evidence of association between socioeconomic deprivation and chemo‐ or radiation toxicity (bowel, bladder or vaginal stenosis). Conclusions: No associations were found between socioeconomic deprivation and cancer mortality or recurrence in cervical cancer patients in the population of Cornwall. In addition, no association was found between socioeconomic deprivation and chemo‐ or radiation toxicity. [ABSTRACT FROM AUTHOR]

Background: There is a clinical need for additional remote tools to improve left ventricular assist device (LVAD) patient management. The aim of this pilot concept study was to assess the safety and feasibility of optimizing patient management with add‐on remote hemodynamic monitoring using the CardioMEMS in LVAD patients during different treatment stages. Methods: Ten consecutive patients accepted and clinically ready for (semi‐) elective HeartMate 3 LVAD surgery were included. All patients received a CardioMEMS to optimize filling pressure before surgery. Patients were categorized into those with normal mean pulmonary artery pressure (mPAP) (≤25 mmHg, n = 4) or elevated mPAP (>25 mmHg, n = 6), and compared to a historical cohort (n = 20). Endpoints were CardioMEMS device safety and a combined endpoint of all‐cause mortality, acute kidney injury, renal replacement therapy and/or right ventricular failure at 1‐year follow‐up. Additionally, we investigated hospital‐free survival and improvement in quality of life (QoL) and exercise tolerance. Results: No safety issues or signal interferences were observed. The combined endpoint occurred in 60% of historical controls, 0% in normal and 83% in elevated mPAP group. Post‐discharge, the hospital‐free survival was significantly better, and the QoL improved more in the normal compared to the elevated mPAP group. Conclusion: Remote hemodynamic monitoring in LVAD patients is safe and feasible with the CardioMEMS, which could be used to identify patients at elevated risk of complications as well as optimize patient management remotely during the out‐patient phase with less frequent hospitalizations. Larger pivotal studies are warranted to test the hypothesis generated from this concept study. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of repeated onabotulinum neurotoxin A injections for the treatment of drooling in children with neurodisabilities. Method: This was a retrospective cohort study, in which the first, second, and third onabotulinum neurotoxin A injection were compared within children treated between 2000 and 2020. Primary outcomes included drooling quotient, visual analogue scale (VAS), and treatment success defined as ≥50% reduction in drooling quotient and/or VAS 8 weeks after treatment. Each outcome was obtained at baseline and 8 weeks posttreatment. Results: Seventy‐seven children were included (mean age at first injection: 8y 3mo, SD 3y 7mo, range 3–17y; 44 males, 33 females; 51.9% with cerebral palsy, 45.5% wheelchair‐bound). The objective (drooling quotient) and subjective (VAS) effect after the second injection was lower compared to the first injection. The third injection showed less objective and significantly less subjective effect compared to the first injection. An overall success rate of 74.0%, 41.6%, and 45.8% were found for the first, second, and third injection respectively. Interpretation: Although onabotulinum neurotoxin A remained effective throughout the entire treatment course, there is less effect of subsequent onabotulinum neurotoxin A injections compared to the first. Although there might be a loss of effect after repeated injections, there is continued improvement for most children. What this paper addsRepeated injections show a diminished treatment effect after the second injection.A continued improvement is seen in most patients. What this paper adds: Repeated injections show a diminished treatment effect after the second injection.A continued improvement is seen in most patients. [ABSTRACT FROM AUTHOR]

Introduction: Standard treatment for locally advanced cervical cancer is chemoradiation therapy. Treatment with chemoradiation therapy harbors a risk of local residual disease, which can be curatively treated with salvage surgery, but the risk of complications following surgical procedures in radiated tissue is not negligible. The presence of residual disease can be radiologically and/or histologically diagnosed. The objective of this study is to describe studies that report on salvage surgery for patients with locally advanced cervical cancer after primary treatment with chemoradiation therapy. Therefore, we assessed the method of determining the presence of residual disease, the risk of complications, and the survival rate after salvage surgery. Material and methods: PubMed, EMBASE, and the Cochrane database were searched from inception up to 6 March 2020. Titles and abstracts were independently assessed by two researchers. Studies were eligible for inclusion when patients had locally advanced cervical cancer with radiologically suspected or histologically confirmed residual disease after chemoradiation therapy, diagnosed with a CT, MRI, or PET‐CT scan, or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. Methodological quality of the articles was independently assessed by two researchers with the Newcastle‐Ottawa scale. Results: Of the 2963 screened articles, six studies were included, representing 220 women. A total of 175 patients were treated with salvage surgery, of whom 27%‐100% had residual disease on the surgery specimen. Of the 161 patients treated with salvage surgery based on positive biopsy results, 72%‐100% showed residual disease on the surgery specimen. Of the 44 patients treated with salvage surgery based on suspected residual disease on radiology, 27%‐48% showed residual disease on the salvage surgery specimen. A total of 105 complications were registered in 175 patients treated with salvage surgery. The overall survival rate after salvage surgery was 69% (mean follow‐up period of 24.9 months). Conclusions: It is necessary to confirm residual disease by biopsy before performing salvage surgery in patients with locally advanced cervical cancer primarily treated with chemoradiation therapy. Salvage surgery only based on radiologically suspected residual disease should be avoided to prevent unnecessary surgery and complications. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI)‐based diagnostic algorithms have achieved ambitious aims through automated image pattern recognition. For neurological disorders, this includes neurodegeneration and inflammation. Scalable imaging technology for big data in neurology is optical coherence tomography (OCT). We highlight that OCT changes observed in the retina, as a window to the brain, are small, requiring rigorous quality control pipelines. There are existing tools for this purpose. Firstly, there are human‐led validated consensus quality control criteria (OSCAR‐IB) for OCT. Secondly, these criteria are embedded into OCT reporting guidelines (APOSTEL). The use of the described annotation of failed OCT scans advances machine learning. This is illustrated through the present review of the advantages and disadvantages of AI‐based applications to OCT data. The neurological conditions reviewed here for the use of big data include Alzheimer disease, stroke, multiple sclerosis (MS), Parkinson disease, and epilepsy. It is noted that while big data is relevant for AI, ownership is complex. For this reason, we also reached out to involve representatives from patient organizations and the public domain in addition to clinical and research centers. The evidence reviewed can be grouped in a five‐point expansion of the OSCAR‐IB criteria to embrace AI (OSCAR‐AI). The review concludes by specific recommendations on how this can be achieved practically and in compliance with existing guidelines. [ABSTRACT FROM AUTHOR]

Aims: To determine the prognostic value of multilevel assessment of fibrosis in dilated cardiomyopathy (DCM) patients. Methods and results: We quantified fibrosis in 209 DCM patients at three levels: (i) non‐invasive late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR); (ii) blood biomarkers [amino‐terminal propeptide of procollagen type III (PIIINP) and carboxy‐terminal propeptide of procollagen type I (PICP)], (iii) invasive endomyocardial biopsy (EMB) (collagen volume fraction, CVF). Both LGE and elevated blood PICP levels, but neither PIIINP nor CVF predicted a worse outcome defined as death, heart transplantation, heart failure hospitalization, or life‐threatening arrhythmias, after adjusting for known clinical predictors [adjusted hazard ratios: LGE 3.54, 95% confidence interval (CI) 1.90–6.60; P < 0.001 and PICP 1.02, 95% CI 1.01–1.03; P = 0.001]. The combination of LGE and PICP provided the highest prognostic benefit in prediction (likelihood ratio test P = 0.007) and reclassification (net reclassification index: 0.28, P = 0.02; and integrated discrimination improvement index: 0.139, P = 0.01) when added to the clinical prediction model. Moreover, patients with a combination of LGE and elevated PICP (LGE+/PICP+) had the worst prognosis (log‐rank P < 0.001). RNA‐sequencing and gene enrichment analysis of EMB showed an increased expression of pro‐fibrotic and pro‐inflammatory pathways in patients with high levels of fibrosis (LGE+/PICP+) compared to patients with low levels of fibrosis (LGE‐/PICP‐). This would suggest the validity of myocardial fibrosis detection by LGE and PICP, as the subsequent generated fibrotic risk profiles are associated with distinct cardiac transcriptomic profiles. Conclusion: The combination of myocardial fibrosis at CMR and circulating PICP levels provides additive prognostic value accompanied by a pro‐fibrotic and pro‐inflammatory transcriptomic profile in DCM patients with LGE and elevated PICP. [ABSTRACT FROM AUTHOR]

Introduction: MicroRNAs (miRNAs) are noncoding RNAs that regulate gene expression and contribute to the development of cancer. They have been shown to be stable in tissue samples and may be promising diagnostic biomarkers for endometrial cancer.Material and Methods: A retrospective cohort study of women diagnosed with endometrial cancer between January 2017 and December 2017 was performed at the Royal Cornwall Hospital. Archived formalin-fixed paraffin-embedded samples were obtained from patients with endometrial cancer and healthy women. MicroRNA was isolated and quantitative real-time polymerase chain reaction was used to detect expression levels of miRNAs.Results: A total of 76 women were included: 36 endometrial cancer patients, 40 healthy controls. A distinct panel of miR-200a, miR-200b, miR-200c, miR-205, and miR-182 showed an area under the curve of 0.958, sensitivity 92%, specificity 89%, positive predictive value of 89% (95% CI 82%-94%) and negative predictive value of 91% (95% CI 85%-96%) in diagnosing endometrial cancer. High miR-182 expression levels were significantly related to high-grade endometrioid tumors compared with low-grade tumors.Conclusions: We demonstrated high diagnostic accuracy of miRNA for detecting endometrial cancer. In addition, miRNA contributed to an improvement in distinguishing between high-grade and low-grade endometrioid tumors. [ABSTRACT FROM AUTHOR]

Objective: High‐risk human papillomavirus (HrHPV)‐positive women detected by self‐sampling require an extra visit at the general practitioner for additional cytology testing, but the loss to follow up within this triage is substantial. The aim of this study was to evaluate the clinical utility of reflex cytology on hrHPV‐positive self‐samples for immediate stratification of women who need referral for colposcopy. Design: A prospective cohort study. Setting: Two Dutch cervical cancer‐screening laboratories. Population: 1014 screenees who tested hrHPV‐positive on self‐samples between 1 December 2018 and 1 August 2019. Methods: Self‐samples were directly used for cytological analysis. Cytological and histological outcomes during follow up were obtained from the Dutch Pathology Registry (PALGA). Main outcome measures: Test performance of reflex cytology on self‐samples was determined for different thresholds and compared with physician‐taken cytology and histological outcomes. Results: Reflex cytology on self‐samples for detecting abnormal cytology showed a sensitivity of 26.4% (95% CI 21.8–31.3) and specificity of 90.5% (95% CI 87.7–92.8). Of all ≥CIN2 cases, 29.4% (95% CI 22.5–37.1) were detected with reflex cytology on self‐samples. The positive predictive value for detection of ≥CIN2 was higher with cytology on self‐collected samples than on physician‐collected samples. Of women who were lost to follow up, 12.9% were found to have abnormal cytology on their self‐sampled material. Conclusion: Cytology testing is achievable on hrHPV‐positive self‐samples, could decrease the loss to follow up in screening and is easily implementable in the current clinical practice. Of all hrHPV‐positive women with abnormal cytology on additional physician‐collected samples, 26.4% could have been directly referred for colposcopy if triage with reflex cytology on self‐sampled material had been performed. Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy. Reflex cytology for triage of hrHPV+ self‐samples is of added value for direct referral of women for colposcopy. [ABSTRACT FROM AUTHOR]

Aim: This study compared the cost-effectiveness of botulinum neurotoxin A (BoNT-A) injections with two-duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle.Method: The study was part of a larger, partly single-blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32 weeks after one treatment cycle. Fifty-seven patients with cerebral palsy or other neurological, non-progressive disorders and severe drooling classified as having a drooling frequency ≥3 or a drooling severity ≥2, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT-A or two-duct ligation. An incremental cost-effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease ≥50% from baseline to 32 weeks in the subjective visual analogue scale for the severity of drooling or the objective drooling quotient.Results: Fifty-three patients were analysed (22 females, 31 males; mean age 11y, range 8-22y). Average costs for one treatment cycle, which included one BoNT-A injection, were €1929 (standard error 62) for BoNT-A and €3155 (standard error 99) for two-duct ligation. Treatment success was in favour of two-duct ligation (63% vs 27%; number needed to treat 3). The ICER was €34 per 1% gain in treatment success in favour of two-duct ligation versus BoNT-A.Interpretation: The additional cost of two-duct ligation is to some extent offset by a larger treatment success rate compared with BoNT-A.What This Paper Adds: Botulinum neurotoxin A (BoNT-A) is less expensive per percentage of success than two-duct ligation. The additional cost of two-duct ligation over BoNT-A is offset by greater treatment success. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to compare early- and late-term survival and causes of death between patients with and without a concomitant aortic valve (AoV) procedure during continuous-flow left ventricular assist device (LVAD) surgery.Methods and Results: All adult primary continuous-flow LVAD patients on the International Society of Heart and Lung Transplantation (ISHLT) Mechanically Assisted Circulatory Support (IMACS) Registry (n = 15 267) were included in this analysis and stratified into patients submitted to a concomitant AoV procedure (AoV replacement or AoV repair) and patients without an AoV procedure. The primary outcome was early (≤90 days) survival post-LVAD surgery. Secondary outcomes were late survival (survival during the entire follow-up period) and conditional survival (in patients who survived the first 90 days post-LVAD surgery), and determinants. Patients who underwent concomitant AoV replacement (n = 457) had significantly reduced late survival compared with patients with AoV repair (n = 328) or without an AoV procedure (n = 14 482) (56% vs. 61% and 62%, respectively; P = 0.001). After adjustment for other significant predictors, concomitant AoV replacement remained an independent predictor for early [hazard ratio (HR) 1.226, 95% confidence interval (CI) 1.037-1.449] and late (HR 1.477, 95% CI 1.154-1.890) mortality. However, patients undergoing AoV replacement or repair, in whom the presence of moderate-to-severe AoV regurgitation was diagnosed prior to LVAD implantation, had survival similar to patients not undergoing AoV interventions.Conclusions: Concomitant AoV surgery in patients undergoing LVAD implantation is an independent predictor of mortality. Additional research is needed to determine the best AoV surgical strategy at the time of LVAD surgery. [ABSTRACT FROM AUTHOR]

Data on the risk of aortic root thrombosis in patients with aortic valve replacement (AVR) and left ventricular assist device (LVAD) surgery are scarce. Two out of nine patients receiving AVR concomitant with LVAD surgery and two out of two patients receiving AVR on LVAD support, at our centre, developed an aortic root thrombus, all diagnosed with computed tomography (CT) angiography. These results demonstrate that patients with concomitant AVR and LVAD surgery, or AVR on LVAD support, have an increased risk of aortic root thrombosis. Therefore, early anti‐thrombotic therapy and vigilant diagnostic follow‐up, using CT scans, are warranted to prevent thromboembolic events. [ABSTRACT FROM AUTHOR]

A growing number of studies have reported a link between vascular damage and glaucoma based on optical coherence tomography angiography (OCTA) imaging. This multitude of studies focused on different regions of interest (ROIs) which offers the possibility to draw conclusions on the most discriminative locations to diagnose glaucoma. The objective of this work was to review and analyse the discriminative capacity of vascular density, retrieved from different ROIs, on differentiating healthy subjects from glaucoma patients. PubMed was used to perform a systematic review on the analysis of glaucomatous vascular damage using OCTA. All studies up to 21 April 2019 were considered. The ROIs were analysed by region (macula, optic disc and peripapillary region), layer (superficial and deep capillary plexus, avascular, whole retina, choriocapillaris and choroid) and sector (according to the Garway–Heath map). The area under receiver operator characteristic curve (AUROC) and the statistical difference (p‐value) were used to report the importance of each ROI for diagnosing glaucoma. From 96 screened studies, 43 were eligible for this review. Overall, the peripapillary region showed to be the most discriminative region with the highest mean AUROC (0.80 ± 0.09). An improvement of the AUROC from this region is observed when a sectorial analysis is performed, with the highest AUROCs obtained at the inferior and superior sectors of the superficial capillary plexus in the peripapillary region (0.86 ± 0.03 and 0.87 ± 0.10, respectively). The presented work shows that glaucomatous vascular damage can be assessed using OCTA, and its added value as a complementary feature for glaucoma diagnosis depends on the region of interest. A sectorial analysis of the superficial layer at the peripapillary region is preferable for assessing glaucomatous vascular damage. [ABSTRACT FROM AUTHOR]

Women with cervical intraepithelial neoplasia grade 3 (CIN3) have a long‐lasting increased risk for noncervical high‐risk human papillomavirus (hrHPV)‐related (pre)malignancies. The aim of our study was to estimate this risk in women with recurrent CIN3 compared to women without a history of CIN3 and women with a single episode of CIN3. Women with a CIN3 diagnosis between 1990 and 2010 were obtained from the Dutch Pathology Registry (PALGA) and matched with a control group of women without CIN3. Analysis has been conducted in a subset of women with recurrent CIN3, defined as reoccurrence minimally 2 years post‐treatment. Cases of noncervical hrHPV‐related (pre)malignancies of the anus, vulva, vagina and oropharynx were identified until 2015 and incidence rate ratios (IRRs) were estimated. Then, 1,797 women with recurrent CIN3 were included with a median age of 34 years (range 18–76) and 31,594 person‐years of follow‐up. Women with recurrent CIN3 had an increased risk of developing noncervical hrHPV‐related (pre)malignancies compared to women without CIN3 with an IRR of 25.96 (95%CI 6.32–106.58). The IRR was 2.48 (95% CI 1.87–3.30) compared to women with a single episode of CIN3. Studies on posttreatment follow‐up and prophylactic hrHPV vaccination are warranted. What's new? Most cervical and many anogenital cancer cases are high‐risk human papillomavirus (hrHPV) infection‐related. However, the risk of noncervical hrHPV‐related (pre)malignancies after recurrent cervical intraepithelial neoplasia grade 3 (CIN3) remains poorly studied. This study found that women with recurrent CIN3 had an increased risk of developing non‐cervical hrHPV‐related (pre)malignancies compared to women without CIN3, with an incidence rate ratio (IRR) of 25.96. The IRR was 2.48 compared to women with a single episode of CIN3. Besides intensified cervical screening, women with recurrent CIN3 may thus benefit from increased awareness of other hrHPV‐related (pre)malignancies and adjuvant hrHPV‐vaccination to prevent noncervical hrHPV‐related cancers. [ABSTRACT FROM AUTHOR]

Aim: To assess: (1) the effect on drooling of bilateral submandibular duct ligation as surgical therapy after the administration of submandibular botulinum neurotoxin A (BoNT-A) for excessive drooling and (2) the predictive value of treatment success with BoNT-A on treatment success after bilateral submandibular duct ligation.Method: This was a within-participant retrospective observational study in which 29 children with severe drooling (15 males, 14 females) received BoNT-A treatment at a mean age of 9 years 6 months (SD 2y 5mo), followed by bilateral submandibular duct ligation at a mean age of 10 years 11 months (SD 2y 4mo). Fifteen children were diagnosed with cerebral palsy (CP), with 12 children classified in Gross Motor Function Classification System levels IV and V. The 14 children without CP had non-progressive developmental disorders. The primary drooling severity outcomes were the Visual Analogue Scale (VAS; subjective assessment) and drooling quotient (objective assessment). Measurements were taken before each intervention and again at 8 and 32 weeks.Results: The VAS was significantly lower after bilateral submandibular duct ligation at follow-up compared to BoNT-A treatment (mean difference -33, p≤0.001; 95% confidence interval [CI]=-43.3 to -22.9). The mean drooling quotient did not significantly differ between BoNT-A treatment and bilateral submandibular duct ligation at follow-up (3.3, p=0.457; 95% CI=-4.35 to 9.62) or between 8 and 32 weeks (4.7, p=0.188; 95% CI=-2.31 to 11.65).Interpretation: BoNT-A treatment and bilateral submandibular duct ligation are both effective treatment modalities for drooling. At 32-week follow-up, subjective drooling severity after bilateral submandibular duct ligation was significantly lower compared to previous BoNT-A injections in participants. However, treatment success with BoNT-A is no precursor to achieving success with bilateral submandibular duct ligation.What This Paper Adds: Bilateral submandibular duct ligation is an effective therapy for drooling after treatment with botulinum neurotoxin A (BoNT-A). Treatment success with BoNT-A is not a predictor of successful therapy with bilateral submandibular duct ligation. [ABSTRACT FROM AUTHOR]

Introduction: Centralization has, among other aspects, been argued to have an impact on quality of care in terms of surgical morbidity. Next, monitoring quality of care is essential in identifying areas of improvement. This nationwide cohort study was conducted to determine the rate of short-term surgical complications and to evaluate its possible predictors in women with early-stage cervical cancer.Material and Methods: Women diagnosed with early-stage cervical cancer, 2009 FIGO stages IB1 and IIA1, between 2015 and 2017 who underwent radical hysterectomy with pelvic lymphadenectomy in 1 of the 9 specialized medical centers in the Netherlands, were identified from the Netherlands Cancer Registry. Women were excluded if primary treatment consisted of hysterectomy without parametrial dissection or radical trachelectomy. Women in whom radical hysterectomy was aborted during the procedure, were also excluded. Occurrence of intraoperative and postoperative complications and type of complications, developing within 30 days after surgery, were prospectively registered. Multivariable logistic regression analysis was used to identify predictors of surgical complications.Results: A total of 472 women were selected, of whom 166 (35%) developed surgical complications within 30 days after radical hysterectomy. The most frequent complications were urinary retention with catheterization in 73 women (15%) and excessive perioperative blood loss >1000 mL in 50 women (11%). Open surgery (odds ratio [OR] 3.42; 95% CI 1.73-6.76), chronic pulmonary disease (OR 3.14; 95% CI 1.45-6.79), vascular disease (OR 1.90; 95% CI 1.07-3.38), and medical center (OR 2.83; 95% CI 1.18-6.77) emerged as independent predictors of the occurrence of complications. Body mass index (OR 0.94; 95% CI 0.89-1.00) was found as a negative predictor of urinary retention. Open surgery (OR 36.65; 95% CI 7.10-189.12) and body mass index (OR 1.15; 95% CI 1.08-1.22) were found to be independent predictors of excessive perioperative blood loss.Conclusions: Short-term surgical complications developed in 35% of the women after radical hysterectomy for early-stage cervical cancer in the Netherlands, a nation with centralized surgical care. Comorbidities predict surgical complications, and open surgery is associated with excessive perioperative blood loss. [ABSTRACT FROM AUTHOR]

Public managers' decisions are affected by cognitive biases. For instance, employees' previous year's performance ratings influence new ratings irrespective of actual performance. Nevertheless, experimental knowledge of public managers' cognitive biases is limited, and debiasing techniques have rarely been studied. Using a survey experiment on 1,221 public managers and employees in the United Kingdom, this research (1) replicates two experiments on anchoring to establish empirical generalization across institutional contexts and (2) tests a consider‐the‐opposite debiasing technique. The results indicate that anchoring bias replicates in a different institutional context, although effect sizes differ. Furthermore, a low‐cost, low‐intensity consider‐the‐opposite technique mitigates anchoring bias in this survey experiment. An exploratory subgroup analysis indicates that the effect of the intervention depends on context. The next step is to test this strategy in real‐world settings. [ABSTRACT FROM AUTHOR]

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Are private donors willing to replace cuts in government funding? The authors conducted a survey experiment (n = 2,458) to examine how information about government funding affected decisions to donate money to a large charitable organization in the Netherlands. Providing information about actual budget cuts increased the number of donors. Most new donors were recruited among respondents who had processed the information correctly, underlining the importance of effective communication. The magnitude of the information effect was stronger for citizens with lower levels of empathic concern, who are less likely to donate but can be converted into donors. The authors conclude that policy information shapes not only attitudes but also civic engagement outside the political sphere. [ABSTRACT FROM AUTHOR]

A growing body of scholars, educators and policy makers has argued for reconceptualising schools as "learning organisations" in the last 25 years as. However, a lack of clarity on the concept has hindered its advance in theory and practice. This study responds to this problem by developing a schools as learning organisations scale that expands and clarifies the concept on several points. Drawing on survey data (nschool staff = 1,703) from Wales (UK), it examines the key characteristics of a school as a learning organisation through a principal component analysis and reliability analysis. The results showed that such a school is associated with eight dimensions: (a) a shared vision centred on the learning of all students, (b) partners contributing to school vision, (c) continuous learning opportunities, (d) team learning and collaboration, (e) a culture of enquiry, innovation and exploration, (f) systems for collecting and exchanging knowledge and learning, (g) learning with and from the external environment, and (h) modelling learning leadership. The resulting 65-item scale demonstrated good psychometric qualities. A reliable and valid schools as learning organisations scale can help enhance our understanding of the concept. The scale can also be used by school leaders, teachers and all others wanting to develop a thriving learning culture in their schools. [ABSTRACT FROM AUTHOR]

Background: The prevalence of valvular aortic stenosis (AS) increases as the population ages. Echocardiographic measurements of peak jet velocity (Vpeak ), mean pressure gradient (Pmean ), and aortic valve area (AVA) determine AS severity and play a pivotal role in the stratification towards valvular replacement. A multimodality imaging approach might be needed in cases of uncertainty about the actual severity of the stenosis.Purpose: To compare four-dimensional phase-contrast magnetic resonance (4D PC-MR), two-dimensional (2D) PC-MR, and transthoracic echocardiography (TTE) for quantification of AS.Study Type: Prospective.Population: Twenty patients with various degrees of AS (69.3 ± 5.0 years).Field Strength/sequences: 4D PC-MR and 2D PC-MR at 3T.Assessment: We compared Vpeak , Pmean , and AVA between TTE, 4D PC-MR, and 2D PC-MR. Flow eccentricity was quantified by means of normalized flow displacement, and its influence on the accuracy of TTE measurements was investigated.Statistical Tests: Pearson's correlation, Bland-Altman analysis, paired t-test, and intraclass correlation coefficient.Results: 4D PC-MR measured higher Vpeak (r = 0.95, mean difference + 16.4 ± 10.7%, P <0.001), and Pmean (r = 0.92, mean difference + 14.9 ± 16.0%, P = 0.013), but a less critical AVA (r = 0.80, mean difference + 19.9 ± 20.6%, P = 0.002) than TTE. In contrast, unidirectional 2D PC-MR substantially underestimated AS severity when compared with TTE. Differences in Vpeak between 4D PC-MR and TTE showed to be strongly correlated with the eccentricity of the flow jet (r = 0.89, P <0.001). Use of 4D PC-MR improved the concordance between Vpeak and AVA (from 0.68 to 0.87), and between PGmean and AVA (from 0.68 to 0.86).Data Conclusion: 4D PC-MR improves the concordance between the different AS parameters and could serve as an additional imaging technique next to TTE. Future studies should address the potential value of 4D PC-MR in patients with discordant echocardiographic parameters.Level Of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:472-480. [ABSTRACT FROM AUTHOR]

Background: Consensus on the best treatment for aortic arch pathology is unresolved due to an emerging variety of procedures. We aimed to compare the outcomes of two major techniques for open aortic arch replacement involving the supra-aortic branches and to identify the risk factors for specific adverse events.Methods: Between 1974 and 2017, 172 patients were treated with either the en bloc (island, n = 59; 34.3%) or branched graft technique (n = 113, 65.7%). Most of the patients were treated in an emergent/urgent setting (52.4%).Results: Patients who underwent the en bloc procedure had significantly shorter cardiopulmonary bypass (median: 241 vs 271 minutes, P = .041) and aortic cross clamp times (median: 124 vs 168 minutes, P = .005) than patients who underwent the separate graft technique. Overall, the hospital mortality was lower in the en bloc group, 8.5% vs 19.5%, although the difference was not significant (P = .077). No difference was found in the survival between the separate graft and en bloc groups at 1 (77.0 vs 86.3%), 5 (67.7 vs 66.3%) and 10 years (42.4 vs 51.3%), (P = .63). The postoperative stroke rate was comparable between the en bloc and separate graft cohorts (14.3 vs 19.6%, P = .52). Diabetics and those who underwent an elephant trunk procedure were at a higher risk for reintervention.Conclusions: The separate graft technique, which is more common today, showed no difference from the en bloc technique with regard to hospital mortality and morbidity. Furthermore, the late survival and reintervention rates were similar after both procedures. [ABSTRACT FROM AUTHOR]

The maternal voice appears to have a special role in infants' language processing. The current eye‐tracking study investigated whether 24‐month‐olds (n = 149) learn novel words easier while listening to their mother's voice compared to hearing unfamiliar speakers. Our results show that maternal speech facilitates the formation of new word–object mappings across two different learning settings: a live setting in which infants are taught by their own mother or the experimenter, and a prerecorded setting in which infants hear the voice of either their own or another mother through loudspeakers. Furthermore, this study explored whether infants' pointing gestures and novel word productions over the course of the word learning task serve as meaningful indexes of word learning behavior. Infants who repeated more target words also showed a larger learning effect in their looking behavior. Thus, maternal speech and infants' willingness to repeat novel words are positively linked with novel word learning. [ABSTRACT FROM AUTHOR]